Alienist and Neurologist

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Alienist and Neurologist

A JOURNAL OF

Scientific, Clinical and Forensic

NEUROLOGY AND PSYCHOLOGY,

PSYCHIATRY AND NEURIATRY.

Intended Especially to Subserve the Wants of the
General Practitioner of Medicine.

VOLUME XXXVI.

CHARLES H. HUGHES, M. D., Editor and Publisher.

West P^e St., ST. LOUIS, MO.

916

CONTRIBUTORS AND COLLABORATORS
TO VOLUME XXXVL

1916

G. FRANK LYDSTON,

Chicago, 111.

MAX A. BAHR,

Indianapolis, Ind.

MARTIN W. BARR,

Elwyn, Pa.

DAVID S. BOOTH,

St. Louis, Mo.

JOHN CURWEN,

Harrisburg, Pa.

HAGOP DAVIDIAN,

Washington, D. C.

BAYARD HOLMES,

C. H. HUGHES,

Chicago, 111.

St. Louis, Mo.

J. ALLEN JACKSON,

Philadelphia, Pa.

SMITH ELY JELLIFFE,

New York

H. C. KEHOE,

P. M. KERR,

Frankfort, Ky.

Elwyn, Pa.

JAMES G. KIERNAN,

Chicago, 111.

ETTORE MARCHIAFAVA,

Rome, Italy

ARTHUR McDonald,

Washington, D. C.

CHAS. McINTIRE,

Easton, Pa.

DENNIS J. MURPHY,

Washington, D. C.

C. B. PEARSON,

Hillsdale, Md.

FREDERICK C. POTTER,

Indianapolis, Ind.

W. C. RIVERS,

Bamsley, England

THEODORE SCHROEDER,

Cos Cob, Conn.

R. W. SHUFELDT,

Washington, D. C.

MEYER SOLOMON,

Chicago, 111.

L

ALIENIST AND NEUROLOGIST

Vol. XXXVI. St. Louis, February, 1915. No. 1.

PRINCIPLES OF CRIMINAL ANTHROPOLOGY

By Arthur MacDonald,

Washington, D. C.

Honorary President of the "3rd International Congress of
Criminal Anthropology," of Europe.

CRIMINAL anthropology is a recent line of research.
It includes the study of man mentally, morally
and physically, and necessarily depends on the results
of many sciences. It is therefore distinctively synthetic
in character. Criminal anthropology affords more op-
portunities for persons of ability to carry out the highest
ideals than any other branch of inquiry.

The following are some of the principles of criminal
anthropology, or what might be called its platform:

1. Degrees of criminality should be estimated ac-
cording to detriment to the community. From this point
of view, international crime, or war, is by far the greatest
of all crimes.

2. History is mainly history of the abnormal, es-
pecially war and one of the objects of criminal anthro-
pology is to lessen and prevent war. Montaigne says:
"It is more barbarous to kill a live man, than to roast
and eat a dead one."

3. The greatest of all studies is man, which is based
upon the individual, the unit of the social organism.

(1)

2 Arthur Mac Donald

4. If the study of civilized man is to become a
science, it must depend upon investigation of large num-
bers of individuals, and the method should be the same for
all classes, if we are to distinguish between the normal
and abnormal.

5. The best method of study for criminal anthro-
pology is that of the laboratory in connection with
sociological data.

6. The thorough investigation of ONE human being
with the means at the disposal of science, would make a
volume.

7. All facts about human beings are important
from the scientific point of view, whether those facts be
immediately available or not.

8. In studying man, names are unnecessary and
statement of facts is not criticism, for science is abso-
lutely impersonal.

9. Opinion is valuable according to knowledge, es-
pecially first-hand knowledge, and science is common
sense condensed. Yet

10. The foundation of science is the love of truth
for its own sake.

11. All that is diseased is abnormal, but hot all that
is abnormal is diseased; thus a hand with six fingers
is abnormal, but not necessarily diseased.

12. We must study the normal to comprehend the
abnormal, for

13. When the normal acts in an unsuitable way,
or at the wrong time or place, it may become abnormal.
The fundamental conception of the abnormal is EXCESS
of the normal; but

14. The difference in degree between the normal and
abnormal can be so great as to result in a difference of
kind; just as when two fluids reach a certain amount,
a precipitate is formed which is very different from the
ingredients from which it was deposited.

15. Abnormal man may be abnormal in the right
direction, as genius man, talented man or statesman;
or in the wrong direction, as criminal, pauper or defective

Principles of Criminal Anthropology 3

man. It is all MAN, and the study of these different
classes might be called the anthropology of the living
as distinguished from prehistoric anthropology.

16. The study of medicine is the study of the future.
To know the geography of the body is more important
than to know the geography of the world. Know thyself.

17. Of all forms of abnormal humanity crime is
nearest the normal; the study of criminals therefore,
is mainly the study of normal men, and knowledge
thus gained may be generally applicable to the community
as a whole. Therefore,

18. The prison and reformatory can serve as a
humanitarian laboratory for the benefit of society. As
the surroundings of the inmates are similar, conditions
for scientific research are favorable.

19. As in machinery we first repair the parts out
of order, so in society we first study the criminal, pauper,
insane, feeble-minded and other defectives, all of whom
constitute about one per cent of the community. But,

20. Why should we allow one per cent of society
to cause so much trouble and expense to the remaining
ninety-nine per cent, crime alone costing more than
one-half million dollars annually? It is mainly because
of neglecting the young, where study of man should
begin. For,

21. There is little hope of making the world better,
if we do not seek the cause of social evils at their founda-
tion.

22. No evil can be PERMANENTLY lessened
without first finding its cause. There is probably no
ONE cause of anything, but a chain of causes.

23. Drunkenness is not only one of the main causes
of crime, but one of the greatest enemies of humanity,
because it brings suffering upon so many innocent people.

24. We cannot be tempted to do wrong unless there
is something in us to be tempted; that something is a
part of ourselves as distinguished from our environment;
therefore.

4 Arthur MacDonald

25. The comprehenseve study of man requires in-
vestigation of both individual and his surroundings, for
the environment may be abnormal rather than the man.

26. Cranks or mattoids who attempt the lives of
prominent persons are very important on account of the
enormous injury they can do to society. They therefore
should be studied most thoroughly.

27. Just as the physician studies his patient in
order to treat him properly, so one should study the
criminal.

28. The exhaustive investigation of a single criminal
illustrates just how and by what steps both environment
and inward nature lead to criminal acts. Human beings
are much more alike than unlike.

29. Criminals, paupers and other defectives are
social bacilli which require as thorough scientific
investigation as the bacilli of physical disease.

30. No one should be held responsible for the first
fifteen years of life, nor is any one accountable for the
tendencies inherited from ancestors. As the die is usually
cast before adult life arrives, responsibility is most diffi-
cult to determine, and is often a minimum quantity.
Therefore,

31. In judging human beings we should emphasize
their excellencies rather than defects. As has been said,
to know all is to forgive all; yet

32. Every person dangerous to property or life,
whether insane, criminal or defective, should be confined,
but not necessarily punished.

83. The determinate sentence permits prisoners to
be released, who are morally certain to return to crime.
The indeterminate sentence affords the prisoner an op-
portunity to reform without exposing society to im-
necessary danger but,

34. Society has no right to permit prisoners to be
released who will probably return to crime; for,

35. Where it is a question between justice to the
individual or justice to the community, the community
should have the benefit of the doubt.

Principles of Criminal Anthropology 5

36. The prison should be a reformatory and the
reformatory a school; the object of both should be to
teach good mental, moral and physical habits; both should
be distinctly EDUCATIONAL. There should be a mini-
mum temptation to do wrong and a maximum encourage-
ment to do right.

37. Institutions for reforming human beings should
have the conditions as similar as possible to surroundings
outside, so that when inmates are released they may adapt
themselves more easily to society and not become misfits.

38. Every one has the right to a proper bringing up;
and,

39. The time has come when we should study a
child with as much exactness as we investigate the chemi-
cal elements in a stone or measure the mountains on the
moon.

40. One purpose of criminal anthropology is, through
knowledge gained by scientific study, to protect the weak,
especially the young IN ADVANCE, before they have
become tainted and fallen; not locking the barn door
after the horse is stolen.

41. The treatment of young criminals should be
the prototype for treatment of adults, and procedures
against them should have as little publicity as possible.

42. Publication in newspapers of criminal details
is an evil to society on account of the power of imitation.
In addition it makes the criminal proud of his record,
develops the morbid curiosity of the people, and it is
especially the weak who are affected.

43. Place confidence in the so-called bad boy,
awaken his ambition and teach him to do right for
right's sake.

45. Put the criminal upon his honor. A criminal
once said, "If they will not believe me when I tell the
truth, I. might as well tell Ues."

46. Nothing will hinder development of the young
more than the prospect of having plenty of money and
no necessity to work. Idleness often leads to crime.

6 Arthur MacDonald

47. It is more important to know what is good
than what is true; for morality is more precious than
knowledge.

48. Increase in intellectual development is not neces-
sarily connected with increase of morality, and education
which trains the mind at the expense of the will is a
questionable education.

49. The longer we live, the more we appreciate
the average honest man, as compared with the dishonest
talented man.

50. To any observer of life, the impracticability
of pessimism and the advantages of optimism are evident.
It has also been estimated that,

51. Most of our thoughts, feelings and acts are
indifferent; but of those remaining, about three-fourths
are pleasurable and one-fourth painful, indicating more
pleasure than pain in the world.

52. Act as thou wouldst act, if all the consequences
of thy act could be realized at the moment thou actest.

WHAT IS EPILESPSY?

By Dr. H. C. Kehoe,

Superintendent Kentucky Institution for Feeble Minded
Children, Frankfort, Ky.

THE world is full of epileptics, there being at least one
to every four hundred of the population, yet there
is not enough real and tangible information upon
this inportant subject to make a good essay for a county
medical society.

Yet many who have suffered with this dread disease
have risen high in the halls of fame while still carrying
the blight of this scourge.

Napoleon was an epileptoid epileptic, and if history
is authentic, but for a convulsive suspension of conscious-
ness on the morning of the battle of Waterloo, who
knows but the map of the world might have been chang-
ed.

President Roosevelt was bom a delicate child, with
a tendency toward tuberculosis, but wise parents kept
him in the far west when not in school and this rugged
life developed one of the greatest minds of modem times,
and all dyscrasia was removed by safe and sane hygiene.

Michael Montaigne, who was able to read French
novels at eight years of age and mastered the Greek
language at the age of eleven and was professor of Latin
at Oxford at the age of twelve years, and the greatest
master of language except Shakespeare, was a delicate
child and always a sufferer, dying at the age of fifty-six
from a kidney trouble — perhaps Bright's disease.

(7)

g H. C. Kehoe

Charles Darwin suffered from migraine and other
troubles and said but for these conditions, which were
ever with him, during his life, he would have accomplished
greater success as an author and scientist.

I might mention many other notable cases of sick
men who have achieved a large success in life notwithstand-
ing inherited dyscrasia, and not a few would be among
the epileptics.

I am inclined to think all inheritance of disease
is preventable and will be when medical science shall
become more af a fixed science, and more rapid progress
shall have been made along all lines affecting the vis
medicatrix naturae.

We are still stumbling, and as one of the greatest
medical thinkers of his time succinctly stated: "They
proceed to draw conclusions from these deviations re-
garding the invisible process of change going on in the
inward structure of the diseased human organism, and
shaped these conclusions into a fanciful picture which
theoretical medicine mistook for the prima causa morbi;
also for the proximate cause of disease, the inner nature
of disease and, in fact, the disease itself, forgetting the
axiom of common sense, that the cause of a thing or
event cannot be the thing or event itself."

We have had epilepsy to deal with throughout the
centuries, yet there is no well defined pathology or
etiology dependable up to the present time. In fact,
so limited is the information regarding this important
subject that every man is forced to write his own patholo-
gy and etiology on the subject of epilepsy in all its
various phases, and they are many.

Gowers says: "Forty per cent is due to heredity."
Starr says: "Heredity is the most potent predisposing cause."
Turner, in private practice, gives fifty-one per cent as
hereditary. Vorkastner says: "In the overwhelming ma-
jority of cases heredity is a constitutional, neuropathic pre-
disposition on which epilepsy develops." Church, Kraepe-
lin and others confirm the hereditary tendency.

I

What is Epilepsyf 9

Studies by Weeks, Davenport, RosanoflE and others
tend to show that epilepsy is a mendelian recessive,
closely related to feeble-mindedness because of some lack
of some factor which determines nervous stability.

I do not think heredity plays any greater part as
a causative factor in thp production of epilepsy than does
tuberculosis in the parents. In fact we do not inherit
either one, but we do inherit the dyscrasia, or morbid
state of the constitution, or a thing relating to the disease
but not the disease per se.

Epilepsy is often referred to as congenital, or from
birth. Or connate, that is, congenital or from the same
source.

We know it is cerebro-spinal, and involves the brain
and spine. There are involved forty-three pairs of nerves
— twelve cerebro-spinal and thirty-one spinal. During
a paroxysm cerebration is always marked, and the cere-
brum is affected to such an extent that reasoning power
is lost, while the cerebellum, or posterior-inferior division,
involving sensory nerve connections, becomes very
active. The brain being passive and the sympathetic
nerves coming into sudden and unexpected explosion,
the entire body through the efferent nerves comes under
control of the spinal units and all the muscular action
becomes sphincter, while volition is held in abeyance,
thus causing jactitation and irregular movement of the
body in contortion, but there is no pain or suffering be-
cause afferent nerves are inhibited. This condition
may last through one paroxysm or ninety continuous
or consecutive spasms executed without consciousness.

Now what is it that induces the convulsions? I
find from experience that nearly all epileptics are gor-
mandisers, and, reasoning by induction, it is evident that
there must be more or less of an auto-intoxication due
to bacterial origin. We know that epilepsy is a nervous
functional disease, and when an organ or organs do not
functionate nature becomes disorganized and disease
results. Yet we find nature constructive under any and
all circumstances and can never be wholly surprised

10 H. C. Kehoe

or made absolutely inadequate. By Plasmodium, or the
ultimate vital unit and the plastic or formative energy,
she immediately comes to the rescue with sufficient
vital units from the blood current to relieve the most
desperate conditions with plasomogen. When nature is
insufficient, or in extremity, death usually ends the agony.
Of course it is understood we refer to grave grandmal,
or true epilepsy, as all other forms are light or transitory.

As to how much infection is cumulative before the
convulsion and how much during the continuance of the
paroxysm is altogether problematic, but that it is the main
factor is the important conjecture I desire to make known.
In this declaration I am treading on new ground and
blazing the way for further investigation. We also
have sympathetic and spontaneous or accidental epilepsy,
where exciting causes are not included in the above
idiomatic form.

Psycho-epilepsy is sensory, or imitative, and can be
readily removed by the proper psychological treatment,
and, for this reason, epileptics should be segregated.

Petitmal, or mild cases of epilepsy, are curable
when properly studied and all causative forces removed
and symptoms eliminated.

Grandmal is the true epilepsy and the prognosis
gives but little hope of a permanent cure. I do not
report these cases till one year has elapsed from any
recurrence, which I consider a fair test looking to per-
manent relief.

The diet in these cases is most essential, as it is in
all minor cases. The most dire results come from over
feeding and improper diet.

I deprecate the use of bromides on account of the
systemic drug effect, of injudicious use which is often
more to be dreaded than the disease itself.

The moral tendencies must be looked after with the
greatest scrutiny, as onanism in a patient affected with
mitior or grandmal will most surely result in imbecility.
The exhaustion due to both conditions is so deteriorating

What is Epilepsy f 11

that the most robust constitution is soon a wreck,
both mentally and physically.

Our Institution is making some progress in the treat-
ment of these cases of epilepsy, but constant attention
is required that each case be studied separate and apart
as to its peculiarities and idiosyncrasies. There are no
specifics and each case will likely require a different
remedy according to the sjmipomatology.

What is needed most is for the various states to
have separate colonies for the care and treatment of the
epileptics.

The State Board of Control, of Kentucky, are wise
and practical men of long experience, but they have been
deterred from a progressive course because hampered
by lack of funds, but it is hoped the next Legislature
will respond generously, in a financial way, that this work-
may be given an impetus in conformity with enlightened
methods of handling this very important branch in our
state institutions.

TWO DREAMS.
By Meyer Solomon, M., D.
Chicago.

I surely need ofifer no apology for the presentation
of dream analyses. It is a subject so fascinating,
so interesting and so valuable in its results, that we find
it holding the attention of many students of psychology,
normal and abnormal, in these days of psychoanalysis.
Discussion and controversy are rife as to the fine mean-
ing and interpretation of dreams, and this is of decidedly
practical value because of the importance of dream
analyses in and the intimate relationship of dreams to
various associated or allied states of consciousness, normal
and abnormal.

I am presenting here two dreams which I have select-
ed from a fair number which I have gone over and
analyzed. These dreams were selected because of the
accuracy in detail, the clearness with which certain
basic principles in dreams are portrayed, and, further,
because of their significance in the light of the Freudian
method of dream analysis and interpretation.

The two persons whose dreams are here given are
very briefly described below, and, as will be seen, they
come within the range of mentally normal individuals.

The method employed was that described in a
previous paper. This method will not be described here
more fully than to say that it consists of ordinary con-
versation in the waking state, with introspection, concen-
tration of the attention and reflection on the part of the
patient, under the guidance of the physician or analyst.

(12)

Two Dreams 13

My object in presenting these two dreams can be stated
very briefly. The dreams seemed to me to be worthy
of presentation because they were given to me in such
detail and with such accuracy, the analyses are reliable
and fairly complete, the meaning of the dreams is easily
appreciated and is indicated with great clearness, and there
is much food for thought for those who believe in and
analyze dreams according to the Freudian theory and from
the Freudian standpoint, as well as for others interested
in the general problem of the meaning of dreams.
First Dream.

Miss R. G., a young lady of twenty-three, suffering
from no psychopathic illness, but always of a somewhat
hysterical trend, as evidenced by the fact, one among
many others, that two years ago, following a severe
emotional shock, she had an hysterical upset of four
days' duration, had the dream here detailed. It may be
added that the dreamer frequently has terrifjring, horrify-
ing dreams, that like many others, she is afraid to be
alone in the dark, and has a generally developed, exagger-
ated fear-defense reaction. I shall not here present a
characterological study of this young woman, nor shall
I here discuss the genesis and evolution of the fear-
defense reaction in her particular case, since a recital
and understanding of these is not essential for an intelli-
gent presentation of the analysis and interpretation of
the dream. I may say, in parenthesis, that I have made
a study of this patient from this standpoint, including
in this study a fair number of her dreams, but there is
nothing tangible to support the sexual significance or
basic source of origin of this fear-defense reaction. Fear
is an instinct per se. However, this study is not required
for an imderstanding of the following dream.

Dream: Miss R., her brother B., and her mother
were quietly spending an evening at home. Suddenly
somebody out in the hcdl-way was heard trying to open
the dining room door, which was the entrance to the
flat in which the family lived. They rushed to see who it
was. B. opened the door part- ways and saw at once

14 Meyer Solomon

that it was a burglar. Thereafter B. held the center
of the scene. The mother was still present but held a
position far ofl in the distance, on the outskirts, as it
were, of the scene which presented itself to the patient's
mind. Miss R. now dropped entirely out of the scene.
She had become merely a spectator, as is the case so
frequently in dreams. The burglar was making desperate
efforts to force his way into the room. B. was endeavor-
ing to do his utmost to shut the door and turn the key,
which was, as usual, projecting from the key-hole on the
dining room side of the door. B. began shouting to his
mother to bring a chisel or some instrument or other
to help fasten the door. It now seemed that the door
was coming down, that B. was bravely supporting it
and that he was shouting loudly for a chisel wherewith,
so she thought in her dream, to screw the door hinges
into their places and so keep the door from coming down.

At this point Miss G. was awakened by B.'s knocking
at the door. It was B.'s mother and not his sister G.
who came and unlocked the door. When B. came into
the room Miss G. awoke because of the noise occasioned
thereby — the knocking at the door, her mother's getting
out of bed to unlock the door, and the conversation
in a fairly loud tone which followed in the dining room.
Miss G. at once recalled the dream, told it to her brother
and mother, and then put it in writing substantially
as recited above, without extended explanations or efforts
at analysis and interpretation.

Analysis: B. could not recall just how long he had
waited outside the door before he was admitted, but,
when questioned by Miss G. immediatedly after its oc-
currence, he was certain that it was a very short wait —
perhaps one, two or three minutes. Miss G. believes
that the knocking of her brother really roused her from
her sleep and occurred at the end of her dream. But
since things take place with such lightning-like rapidity
and brevity in dreams, it may very well be that the knock-
ing first started the dream on its way and that, the subse-
quent action in the dream being very rapid, she might

Two Dreams 15

have had the whole dream before her brother was admitted
into the room, and that finally she awakened with the
increased noise. However, the fact that it was the mother
and not Miss G. who finally got up and unlocked the
doo'-, and the further fact that Miss G. did not awaken
fully until after B. had been in the room for one to three
minutes, according to the estimate of Miss G.'s mother
and brother, show that the young woman had been
sleeping fairly soundly.

Now, it so happened that B., who generally came home
at a rather late hour — about twelve o'clock midnight —
because he was employed evenings, was expected about
the time Miss G. had this dream. Another brother,
who also generally came home at a late hour, had not
yet arrived. The family generally waited for their
return, especially for the return of B. who was very
punctual, reliable and dependable, before retiring with a
feeling of safety, and with a mand free from anxiety or
expectation. On the particular evening on which Miss G.
had this dream she had fallen asleep, while dressed,
on the couch in the dining-room. Her mother had made
things safe by turning the key in the latch of the dining-
room door, which, as above stated, was the entrance to
the flat (the family had an apartment on the second
floor — one flight up.) This she did, although neither B.
nor his brother had as yet returned, in order to feel a
greater sense of security.

It would be pure, individual speculation on my part
to attempt to tell how the association of ideas, which
finally led up to the dream, was initiated, or what these
thoughts were. But it may have been that thoughts of the
expectation of her brother's return, his entrance into the
flat by the dining-room door, thoughts of the possible
entrance of burglars, etc., may account for the final initia-
tion of the dream, in which, also, the brother's knocking
at the door may play a part. The patient herself was
unable to give me any assistance here, since she could
not recall the trend of associations, if she had had any.

Then comes the dream as related above.

15 Meyer Solomon

The line of association is quite plain — so much so
that I feel that it is unnecessary to spend any time in
indicating this. The experiences detailed in the dream
are such as might occur in daily life, and the change of
scene from trying to force a door in order to keep out
burglars to that of calling for aid in fixing the door in
place is quite easily understandable — by association of
ideas and the investing of the first scene (bearing one's
weight against a door) with a significance (that of sup-
porting a fallen door) justified by the range of probabilities
as determined by more or less universal experiences or
knowledge.

But I shall say a few words in further explanation
of why this girl should have dreamed about the door,
the key and burglars. For a few days preceding the day
on which Miss G. has this dream, B. had been talking
a great deal about the key for the bath-room. This key,
it seems, had in some way disappeared and could not be
found. B. had repeatedly complained about this. He
had asked again and again where the bath-room key could
be, how it was lost, who had lost it or misplaced it,
if it was lost why was not another key gotten at once
since it was absolutely necessary to lock the bath-room
door on the inside when one was using the bath-room,
especially if visitors should come to the home.

Furthermore, two nights previous, Miss G.'s father
had been unable to find the key for the dining-room door,
and he was very much angered and upset thereat, and
had been harping upon this subject for the past two days.
Moreover, the second brother mentioned in this analysis
had, for reasons which need not be here detailed, been
coming home late at night for some time. He had no
door key. If the door to the flat was locked, as it some-
times was for safety's sake, he had to knock and pound
away at it and would thereby awaken the entire family.
If, on the other hand, the dining-room door was left
unlocked, so that he could enter the home without
having to awaken the others, the various members of the
family, particularly the daughter and mother, always

Two Dreams 17

had the vague fear that there was the possibility that a
stranger, generally conceived of as a burglar, might enter.
As a matter of fact, whenever the brother just mentioned
and B. (both of whom had been coming home late almost
nightly) entered the dining-room, if the mother or Miss
G. were awake, they would invariably call out and ask
"Who is it?" or "Who is there?" Nor did they feel
assured of safety until a satisfactory reply in the familiar
voice of one or the other of the two brothers had been
made and was recognized by them. Thus the possibility
of burglars entering the flat was always more or less
present in their minds at bedtime. So it is with many
people, except that here the reasons for an exaggeration
of this more or less normal or frequent feeling or idea
are clearly seen.

There are, of course, many other experiences in the
past life of Miss G. which were of a more or less similar
or allied nature. Many of these were unearthed, but I
feel that it is not necessary to enumerate all of these,
since it would lengthen this analysis to an extreme degree
and the most to be gained by such a recital is the dem-
onstration that there were perhaps certain factors or
experiences in the past life of this young woman which
were of a similar nature, which were centered about the
same or other instincts and which perhaps tended to
exaggerate and readily bring to the surface this reaction,
or which had some share in the determination of same.
Even though many such experiences be of very ancient
origin (early childhood or even infancy), no cause-to-
effect relationship between the early and later experiences
would thus be established. Moreover, in the cause here
reported, the recent events were quite sufficient in satis-
factorily explaining the dream. It may be added that
the past life history wotdd not show that a reaction of
the sort present in the dream is necessarily always or
most usually related to the sexual instinct. I may say
also that I have gone over the various elements of the
dream and their possible sexual association or symboliza-
tion — such as the relation between brother and sister,

Ig Meyer Solomon

the significance of the bath-room, (which is bath-room and
toilet-room combined,) the possible signification of the key,
chisel, etc'. — but I find nothing to support any particular
sexual meaning anywhere in the dream.

Interpretation: There is here a fear-reaction de-
pendent upon the motive of self-preservation. I know
very well that it may be contended that, especially in
young women, fear of the sort mentioned frequently
has certain sexual associations or sources of origin;
but, however true this may be (I believe it to be true
in most cases, even in this young woman), yet in this
particular dream in question no such significance can be
found.

It may be mentioned in passing that we do not find in
this case any tangible support of the Freudian theory of
the content or trend of most dreams.

The pleasure motive and wishfulfiUment can be
conceived of as being the motive or energic source of
origin of this dream only if we view "the fear as being the
obverse of the wish for freedom from danger of attacks or
marauding by burglars.

Associated with the satisfaction of the instinct or
motive involved (which is that of self-preservation, using
the term in a broad sense) there is a feeling of pleasure.
It may be mentioned that Putman* would classify such
associated or correlated feelings of pleasure as being of
a sexual nature, thus viewing all emotions and feelings as
sensual and sexual. With this conception, however,
as I have stated elsewhere,^ I cannot agree, since, although
all pleasurable feelings are allied to the sexual, they cannot
because of an imagined similarity or relationship, be so
classified or designated. Moreover, we are no more justi-
fied in viewing all the motives, feelings and emotions
from the sexual standpoint, than we would be, were we
to view the sexual imptdse from the standpoint of the
antecedent, ontogenetically and phylogenetically older im-

1. Dream Interpretation and the Theory of Psychoanalysis. Journal of Abnormal
Psychology, April — May, 1914.

2. Reply to Dr. J. J. Putnam's paper. See Journal of Abnormal Psychology,
June — September, 1914.

Two Dreams 19

n

pulses, yearnings, trends, instincts, motives, feelings or
what not. On the contrary, we would be more justified
in this latter viewpoint, because even according to the
Freudian psychology, that which is older in order of
appearance and in time of development and evolution,
being thus of relatively ancient, infantile or archaic
origin, should be the foundation upon which we should
build and classify. One could discuss this problem from
many standpoints — biogenetic and biologic, the origin and
nature and kinds of pleasure and others — but I shall
not digress to such an extent at this time. It is enough
for me to know that even though the fear of burglars
with its disagreeable psychophysical state is the reverse
of the wish for safety (self-preservation) with its agreeable
or pleasurable psychophysical bodily condition (and it
may be argued here, too, that it is no more logical or
rational to view things exclusively from the wish stand-
point than it would be to view them from the fear
standpoint, but that both tendencies should receive due
recognition — a statement with which Freudians should
agree, if they believe in the theory of psychical ambiva-
lence or ambitendency, as laid down so clearly by Bleuler) —
even if it be granted, I repeat, that the unpleasant fear
of danger is but the reverse of the pleasurable wish for
safety, a sexual connotation or significance cannot possibly
be established by any sound or fair methods of logic
or reasoning.

It may be added also that the fear of burglars
entering the home, may lead one to inquire concerning
why the home with all its associations should excite
such a reaction. The reason for this general fear of
burglars was discussed above, and if, to satisfy the Freud-
ians, the investigations were made absolutely thorough
and almost never-ending, I could here recite, for pages
and pages, the life experiences of this young lady, with
all possible complexes or memories, which could be evoked
by direct association or by forced symbolic thinking,
taking as starting points the mother, the brother, burglars,
key, door, latch, hole and so on ad infinitum. I

20 Meyer Solomon

have unravelled a great portion, if not most, of the
patient's life history which seems worth while, but I
find it to have no cause-to-effect or other relationship
to the persons, objects or scenes I have mentioned.
Association and analogy do not prove to me that there
is any true, valid significance from the standpoint of
the original stimulus, idea, person or scene, to be attached
to that which we later unearth (although great intimacy
and relationship may of course exist between them),
except that they are related to the same or different
instincts or motives; which is just what we should ex-
pect, inasmuch as all experiences, all habits, all complexes,
physical or mental, conscious or unconscious, are built
up about our instincts as nuclei.

I shall not carry this analysis and discussion any
further, since it wovild lead us far afield and many points
at issue would have to be discussed as we proceeded,
but I believe I have gone far enough in the analysis and
interpretation of this dream to show that the Freudian
school has made the serious mistake in many of their
analyses and interpretations of reasoning by analogy
and of proving by post hoc ergo propter hoc.

I appreciate that one could very well build up a
beautifully and imaginatively constructed interpretation,
based on sexuality, symbolism and loose reasoning, to
show the (possible) sexual significance of key, lock and
the other objects, persons or scenes, but in such a pseudo-
logia fantastica one would be living in one's own world
or conception of things, with false viewpoints, set dogma
and distortion of facts, and one would be reading certain
preconceived or fancied meanings into things which
were something entirely different, these interpretations
being the result of the investigator's individual interpre-
tation, or the result of words or ideas which the patient
has been led to say or express, having had forced upon
him, perhaps against his will, a certain way of looking
at things, a certain attitude. He has been shown how
to read into dreams the investigator's meaning, whether
or not this interpretation may seem to him logical or

Two Dreams 21

well-founded, and it may even be that he has been
convinced by the physician or he has convinced himself
by slow degrees that the standpoint of the investigator
was at first remotely possible, then quite possible, then
probable, then most probably true, next true and finally
positively true, wonderful and inspiring.

I have not attempted to point out the various mental
mechanisms which can be seen in this dream, but have
devoted most of this discussion to a consideration of the
content and motive, rather than of the mental processes
of the dream, for, in my opinion, it is the content of
dreams and of other mental states which is the main
source of disagreement between the members of the
Freudian school and their opponents.

After an impartial analysis of this dream and of
this dreamer's life history, I can find no evidences of
repressed "unconscious" tendencies or wishes, of symbo-
lism or sexuality (in the usual Freudian sense), of manifest
and latent content (these terms being used in the Freud-
ian sense of distortion by symbolism and secondary
elaboration). By no manner of interpretation can this
dream be said to be a wishfulfilling dramatization, nor
can it be said to arise on a basis of repressed, long for-
gotton, infantile, unconscious sexual desires or tendencies.
Another Dream.

Mrs. C. S. is a woman of 65, mother of six grown-up
children, three of whom are married, the other three being
of marriageable age but still single and living at home
with their parents. The patient has superficial arterio-
sclerosis and has shown symptoms of cerebral arterio-
sclerosis (attacks of headache, vertigo, of syncope and of
an apoplectiform nature.) Further development of the
present and past history will be omitted in this place.
Mentally she comes within the normal range, although
she was always a nervous woman and presents many other
characteristics of an individual nature. She presented
me with the following exquisite dream, within a few hours
after she had awakened. The woman's co-operation had
been fully gained. She is sincere, truth loving and honest.

22 Meyer Solomon

and her story is reliable and trustworthy. Allowance
should, of course, be made for possible errors in sequence
of events and the like.

Dream: She got off a train at , Germany,

her home town. She found herself in the railroad station,
which was located on a little village street. She noticed that
it was not a village station, but a large city railroad station.
Other people got off the train at the same time that she
did. She knew at once that she was in her old school
town and yet she did not know how to get to the school.
At first her appreciation of the situation in which we
find her in the dream was that she was travelling and
that she had come to see her grandmother. When she
got off the train she carried a traveling bag. She casually
lowered her eyes and looked down at her feet and noticed
that her dresses were short, like a girl's. "Ah," she
thought, "I must be a girl again." She felt for her
braid. She grasped it. To remove all doubt, she pulled
her braid over her shoulder and held it in front of her.
She looked at it. There was a pink ribbon on it. "Ah,
grandmother fixed this before I left home," said she to
herself. She felt happy again. She was a school girl.
Her grip had now changed to a school bag. Her pencil
box protruded from the bundle of books. She examined
the books, noticed that they were orderly and safely ar-
ranged and now felt that everything was as it should be.
She could now go to school, but instead of her going to
school, the following incidents next took place: She felt
once more, as in the beginning of her dream, that she
had come to her home town to visit her grandmother.
There immediately came over her a feeling of strangeness
and of sadness. Things looked different from that which
she expected. She expected to see her little country
town just as it used to be in the good old days of early
childhood, but things were so different now. The station
looked large and city-like. From the station she surveyed
the town and it looked very strange and unfamiliar to
her. She felt that she had never seen it before. With

Two Dreams 23

its large houses spread out before her eyes, it looked to
her not like a village but like a large city.

At this very moment she was transformed suddenly
from a girl to her present age. She had become a woman
again. She had a satchel in her hand. There were
plenty of people round about her. A natural water
fountain, used by the villagers as a source of supply for
drinking water for home consumption, was near the
station, just as things were in the days of long ago.
A woman of about thirty or forty years, whom Mrs. S.
did not know or recognize, but whom she took to be a
plain, honest, German housewife, was at the spring getting
a supply of water to take home with her. The spring
of her dream was just like that other one which she knew
so well in her childhood. Mrs. S. spoke in German to
this lady, asking the latter to direct her to her grand-
mother's home. In speaking to this woman, Mrs. S.
used her grandmother's real name— Lena Isaac — and
asked the lady whether her (Mrs. S.'s) grandmother
and her uncle Hertz and her aunt Henrietta and Abraham
Isaac and all the others, whom she mentioned by name,
were alive and still Hved there. Her informer told Mrs.
S. that they still lived in the same old place and that
all of them were still alive and well. She inquired of
Mrs. S. how long she had been away from home. Mrs. S.
replied that it was a long time and that in the interim
she had been staying with her uncle. This latter addition-
al piece of information was not true, but she purposely
told it to her, because she did not want to tell this woman
her private affairs. Mrs. S. now felt very poor, her clothes
were shabby and poor looking. She felt that she was in
poor financial circumstances and that she was seeking
her grandmother in order that the latter might assist
her financially and lift her out of her trouble. She felt
sad. She realized her misery. She felt that she had left
her family behind her, not in America, but somewhere
nearby in Germany, where she had been for years (so
it seemed to her in her dream). She felt that she had
left her home as a result of some misunderstanding or

24 Meyer Solomon

disagreement with the old folks, as had actually been
the case when she came to the United States fifty years
ago, and she did not feel it was right and just and proper
to come back to them now asking for aid from them.
She felt that she wanted to live with the old folks forever
from now on. The German lady directed Mrs. S. to
her grandmother's house, taking the same path by which
Mrs. S. used to go there. Mrs. S. had been away from
home for so long a time that she did not care, because
she felt ashamed, to tell her guide about her troubles
or life history since her departure from the scenes of her
childhood. However, this lady seemed to know just about
how matters were. Mrs. S. at first imagined that this
lady was the mother of an old school mate of hers, who,
contrary to her parents' advice, had a few years before
Mrs. S.'s departure left for America with a young man
whom she had married. But Mrs. S. was uncertain
whether or not she really was this girl's mother.

On their way to Mrs. S.'s grandmother's house they
walked slowly along the street. At first things looked
just as they used to be in the old days of long ago,
but as they came nearer the old cottage, things seemed
changed. The cottage was there, but it looked old and
gloomy; the garden was no longer there; she could see
only a tree or sign post (as of old with a blue and white

road sign of the flag of ), near which she had

always played garden, when a child. There were a lot
of stores in the neighborhood. She looked about for
the gate which used to lead to a meadow, on to the river,
but instead she saw a railroad track which crossed the
river, all looking black, unclean, gloomy. There, too,
were many dirty black brick and stone houses instead
of the old clean wooden ones. "Well, I must see grand-
mother now," she said to herself. All alone, she was
about to go into the cottage, but next decided that she would
not do so, because, firstly she saw nobody about ; secondly,
she did not want to shock her grandmother by appearing
suddenly after such a long absence; and thirdly, she had
an idea that this was perhaps not the right house after

Two Dreams 25

all. Furthermore, she did not want to cause excitement
by her percipitous arrival. She sat down on the store
bench as of old. Soon somebody came forth from the
house. It was Mary, her sister. Mrs. S. still did not
feel at home. Her heart was beating fast and she was
in a highly nervous state about having to meet her
grandmother face to face. Finally Mrs. S. said in German
"Mary, tell grandmother to come out." Mary took a
glancing look at Mrs. S. and silently walked on. Mrs.
S. at once recognized that this was really her own (Mrs.

S.'s) daughter. Mrs. S. then said in EngUsh, "M ,

tell grandmother to come out here," as if she and her

daughter had both always been living there. M

did not answer. She behaved distantly and strangely,
just like Mrs. S.'s sister.

A matronly looking woman of perhaps forty-five
or fifty years, apparently a stranger to Mrs. S., came
out of the house and passed Mrs. S. but said nothing.
Nor did Mrs. S. say anything to this lady, since she did
not recognize her. Mrs. S. again waited anxiously.
Another woman came out of the house. Mrs. S. recog-
nized her at once, it was her dear old grandmother.
Her grandmother did not recognize her, but walked past
the stone bench as if a stranger or passerby were sitting
there resting. The old grandmother looked as of old,
even younger and better. Then Mrs. S. said in German,
"Don't you recognize me, grandmother?" The latter
came over, looked at her and asked in German, "Are
you little Caroline?" "Yes," she replied, whereupon they
fell into each other's arms and hugged and kissed and
cried and brushed each other's tears away.

At this point our good dreamer awakened, her hands
still clasped as if she had actually been having her grand-
mother in her arms. She at once realized that she had
been dreaming and the dream thoughts came back in
quick succession. She felt very happy and much pleased
at having had the dream, although the dream visit to
her old home town and homestead had not been as
pleasant as she had anticipated that it would be, in that

26 Meyer Solomon

the village had almost become a city and as a consequence
had lost the beauty and the fascination and the memories
which it previously had held for her.

Analysis: This dream was so vivid and was given
to me so soon after awakening that I was enabled to
present it with great detail. The reason why I took
particular pains to get all the details was that I wished
to bring out clearly the trend of the association of ideas
and the changing scenes or trends of thought occasioned
by a sudden change of association in upspringing thoughts
or shifting feelings.

I do not intend to take up each portion of the dream
and indicate its possible or probable intimate significance
to the dreamer, with the various associations which may
be brought forth with respect to each such element.
Nor do I intend to point out the relationship between
the several scenes of the dream.

In truth, if I were to give a thorough analysis of
this dream, in full detail, with the history obtainable from
the patient concerning the significance of the many
persons, scenes, occurrences and other elements in this
dream, I would be compelled to give by far the greater
portion of the dreamer's life history. The analysis
would be much too lengthy for presentation in an ordinary
journal, since it would virtually be a story of this patient's
life, with a wealth of material all presented in great
detail. I shall content myself with merely taking up
some of the most important or worth while points which
appeal to me.

The Dreamer Visits Her Home Town in Germany.
This had been her great wish for many, many years.
Her old home town had for her many happy as well as
sorrowful associations. It was the emblem of her child-
hood days, of her happy hunting ground as viewed with
an old lady's fancy. Many are the unforgotten charms
of the place which Mrs. S. can enumerate; and there
are all the kind people who cared for her in her childhood.
Under this heading, tod, come the various scenes familiar
to the old town, the railroad station, the spring, a house-

Two Dreams 27

wife at the spring, the streets, the old cottage and its
familiar associations.

This old town also calls to mind the time of her
childhood when she was a school girl (into which she for
a time is transformed), her sister, her grandmother and
other persons and reminiscences referred to in the dream.

Her Grandmother. Much detail could be added
here and much of the early life history of the patient
and the history of her family might be elaborated,
all centered to a considerable extent about this grand-
mother on her mother's side. But suffice it to say that
when the patient's father left Germany and went to
New Orleans in search of adventure and fortune, the
mother went with her three children to live at her own
mother's house — the grandmother of the dream. One
year and one-half after the husband's departure, a letter,
sent to him at New Orleans one year previous by his
wife, was returned unopened, the party not having been
found. At the same time the news was brought to the
wife, through a letter from a friend, that her husband
had contracted cholera or yellow fever during an epidemic
shortly after arrival in New Orleans and had died.
The mother now became ill, her youngest child died at
one year of age from symptoms of inanition and indiges-
tion, she having been unable to nurse the child; the mother
became seriously ill and died not many months later
from what was said to be a combination of a "broken
heart" and pulmonary tuberculosis. The two surviving
children, of whom our dreamer was the older, were there-
after cared for very tenderly by the grandmother. All
the joys and sorrows of her younger years are intimately
connected with thoughts and memories of her grandmother
and her uncle, particularly of the former. These need
not be detailed. She has had many occasions since her
departure for America, spite the opposition of her guard-
ians, including her kind grandmother, for bringing back
to memory her grandmother and all that she stood for
in her life. One incident she recalls keenly: It had been
her intention to name her first daughter, now thirty-

28 Meyer Solomon

three years of age and married, after her grandmother.
There is a superstition, in which she believed, to name
a child after a relative of whom the future mother
dreams during her pregnancy; and it so happened that
during this pregnancy she had dreamed of her grandmother.
This was so much more reason why her first girl should
justly be named after her grandmother; but her husband
mentioned a name in honor of one of his relatives, before
she had expressed her own wish in the matter, and since
she was averse to permitting discussions to arise on
matters of this sort, she consented to her husband's
suggestion. This grieved her sorely. However, when,
some years later, her second girl was born, she expressed
her appreciation of her grandmother's kindness and her
reverence for the old lady by naming the second baby
Lena, which was the grandmother's first name.

Mrs. S. tells longingly of how she had frequently
yearned, as her last happiness on earth, as her greatest
joy in life, to visit the old scenes of her girlhood, the home
of her grandmother, and to see those who were still alive
and who might know her.

Her Sister Mary. Since her sister Mary came to
America at the age of fifteen, the present Mrs. S. has
never been able to get along with her. She had the
following causes of complaint against her sister. This
sister was two years younger than Mrs. S. At 15,
when this sister Mary went to America, she (Mary)
had gone to a relative who was the safe keeper of certain
money that had been left to Caroline on her mother's
death, and she (her sister) had told the lady that her
sister Caroline (the dreamer) had consented to her turn-
ing over the money to herself (Mary.) The latter had
never obtained this permission from her sister and it
was only later, after some years had passed, that the
elder sister learned of it. Nevertheless she forgave her.
Very shortly after this, Mary, who had since married,
urged Caroline, through correspondence, to come to Ameri-
ca, where, later, the now married sister took advantage
of her single sister's good nature and kindness and im-

Two Dreams 29

posed on same on frequent occasions. A second reason
why she never felt toward her sister as she should have
felt was that she had married a Gentile, although she
herself was a Jewess. Mrs. S. never had any specially
developed religious prejudice, but she did believe that
there should be no intermarriage between Jew and
Gentile and could never forgive her sister for this trans-
gression.

The third and most serious cause for dislike of her
sister was the following: Some thirty years ago, Mrs. S.,
who was the mother of several children, one of whom
was still a babe in arms and was being breast fed by
her, was suddenly taken ill and sent to the hospital,
where she was compelled to undergo a severe, major
surgical operation. As a consequence, she was unable
to care for the helpless infant, and, although her husband
had pleaded with her sister to look after the babe for
her until she was well enough to feed her by the breast,
her sister positively and unequivocally refused to do so.
The infant was of necessity sent to a public institution
and later died from inanition. Mrs. S. attributed the
baby's death to her sister's cruel determination not to
care for her and from that time on up to the present
day she has never at any time had any further dealings
with her sister, although the latter had at one time made
repeated attempts to smooth things over and forget the
past. In fact Mrs. S. has not heard from her sister
for more than fifteen years, does not know where she is
or how she is getting on. She wishes her no harm, but
she feels that her repudiation of her sister was fully
justified and at present she feels no regret for her course
of conduct in the matter.

This may perhaps account for the failure of her
sister Mary to take notice of her in the dream. As to
the reason . for the transformation of her sister Mary

to her daughter, M , no satisfactory explanation

can be ofiEered, but several points may be mentioned:
Both names begin with M, and after calling to Mary
without any return reply from her, she may have thought

30 Meyer Solomon

that she was mistaken in her original recognition of the
girl as her sister, and a name with the same letter im-
mediately came to mind as a substitute; and no girl's
name was closer to her heart and mind than that of
her own daughter, whose name also began with M.
Moreover, her sister Mary looked very much like her

daughter M , or it can be put vice versa.

Was it also not natural that, not obtaining a reply from
her sister, she desired to call upon some one from whom
she could expect to get a reply? These three factors may
have conditioned the transformation in person from her

sister Mary to her daughter M . Here too can

be noted fusion due to rapid association. Her daughter

M maintains the same strange reserve toward

Mrs. S. that had been assumed by her sister Mary, who

preceded M in the dream scene. This fusion

is due to the anticipation of one person, idea or scene
and the retardation of another, as so frequently occurs
in dreams, and it may be mentioned that the Freudian
mechanism of condensation is found to be frequently
explained in this way and not in the way in which many
Freudians attempt to apply it.

There are numerous other illustrations of fusion
portrayed in this dream. For example, we are shown
the fusion of scenes as they used to be and as Mrs. S.
feared they might now be and as she knew all growing
cities are, she having spent the past fifty years of her
life, from the moment she set foot on American soil,
in the crowded tenement house districts of New York
and Chicago, the two largest cities of the United States.
Then we see the fusion in the railroad station scene,
where we find a new, modem, up-to-date looking railroad
station in the old, small-sized country town, with all
its old associations. And again, although she finds her-
self in the town of her birth, she has forgotten the way
to her grandmother's house, which is just what she believes
is possible after such a long absence from her home and
were she to come there now as a visitor. Her transforma-
tion into a school girl (following upon a sudden thought

Two Dreams 31

of school and school days) reminds one so much of a fairy
tale. Here also is beautifully and exquisitely shown
what one may expect in a dream from association of
ideas and anticipation of elements of the dream, this
being conditioned by what one would expect in the way
of association and memories, false or true, of the past
life experience. And then again the return of the thought
that she was a visitor in her home town is succeeded
by the feeling and this in turn by her return to woman-
hood. Her conduct toward the country housewife is
quite within the range of expectation; nay, rather, it is
just what we should expect, is natural and is percisely
what we ourselves might or would do under similar
circumstances. The association of the town dweller with
someone she knew recalls to mind the mother of a girl
whose flight to America had made a deep and lasting
and memorable impression upon her young mind.

For her short-lived "feeling poor," the feeling that
she was financially oppressed and was seeking her grand-
mother for financial assistance, I cannot find a satis-
factory or convincing explanation. Whether or not a
sudden feeling of sadness led to these ideas and feelings
and whether these were then seized upon as a probable
explanation for her visit to her grandmother, (there
are many reasons which I need not detail here why this
could have been seized upon as a probable or at least a
possible explanation for her visit to her grandmother)
cannot be stated with any degree of certainty one way
or the other. It may be mentioned that a thought or
feeling, real or imagined, not necessarily dependent
upon any intimate or even most remotely intimate past
life experiences but imagined for the moment under
the circumstances of the dream, may have come to mind
and led to this series of associations. Living in the
moment, as it were, of our dreams, taking the dream
phantasy for reality, we may almost entirely forget
the past and the time, situation or experiences, so that
there results a consequent association and fusion with
otherwise incompatible scenes or situations.

32 Meyer Solomon

Mrs. S.'s conduct before the cottage and the scenes
which there ensued are such as might occur to almost
anyone in a similar situation. There one sees nicely dis-
played the swaying association and interplay of ideas,
feelings and emotions, the anticipations, fusions, probabili-
ties, etc. The reason for the transformation of Mary

to M , I attempted to explain above. Many

are the remarks which one is prompted to make when
one notes that Mrs. S., sitting on a stone bench before
her grandmother's house, under the special circumstances
hitherto mentioned, addresses her sister in German
(just as she used to in the old days) and her daughter
in English (as is her custom at present). I may say, in
this connection, that we frequently find just that sort of
apparent fusion of ideas or feelings. In reality the dream-
er is frequently pla3nng a double or triple or multiple
role, virtually a double, triple or multiple personality,
characterized by a sudden, momentary side-tracking of
the trend of the dream, due to a transient, "accidental,"
sudden stimulus or association of thought or feeling, with
a rapid, lightning-like return to the original theme, this
frequently taking place back and forth, with such rapidity
and for such a prolonged period of time that it may be
said to constitute a play on our feelings and ideas, in
varying intensity. Much as one would play on the
various stops and keys of a church organ in the endeavor
to alternately or irregularly touch the notes of two or
more different selections, which one were, as it were,
attempting to "play at the same time," so in the dream
various complexes or memories or mental trends or under-
lying personalities may be brought into play more or
less at the same time or successively, for varying intervals
and in varying degrees of admixture, until, perhaps,
at some point in the portrayal, one or the other may get
the upper hand and play the role of honor, directing
the rest of the drama from its position behind the scenes.

We see in this dream the confusion of time, place
and person.

Two Dreams 33

It is also to be noted that although the experiences
dealt with in the dream hark back to the early child-
hood of the dreamer's life, still much of the after life
is intimately interwoven with it.

Interpretation: During the recital of this dream
an actual drama was portrayed by the dreamer, and,
even in the telling of it, she found and felt herself the
heroine of it. As she proceeded in the recital of the dream
and in the analysis of it, our dreamer passed through many
emotional periods. The dream was to her an actuality.
Now she was sad and depressed. Then she was joyful
and happy. At the recollection of her reunion with
her dear old grandmother (as detailed at the very termi-
nation of the dream), with their embracing and kissing
each other, Mrs. S. cried bitterly, yet joyfully. She told
me that she had not dreamt about her grandmother
since before her first girl's birth, thirty-two years ago
(as mentioned in the analysis above). She had, however,
frequently wished to dream about the old home life,
with its heart-touching and long-remembered scenes,
and her loving grandmother. She would be unutterably
thankftil for a visit to her old home at this late period
of her life's battle (for it surely was one continuous
battle and struggle for her). For years she had longed
to see the old place. And in her dream she gives herself
this yearned for pleasure by transporting herself back
to the scenes of her childhood.

The inciting factors which led up to the dream
were not definitely obtainable.

Here then, the emotional gratification and pleasure
she desired is obtained. Her wishfulfilment is realized;
but, to be sure, although wishfulfilment is the essential
and dominant note in this wishfulfilling dramatization,
the chords of many emotions, feelings and instincts are
touched. Many of the complexes roused into activity
are unpleasant and disagreeable to her. Fear is projected
into the drama at various points.

The wishes and fears, thoughts and tendencies
played with in this dream are not repressed or un-

34 Meyer Solomon

conscious, in the sense in which these terms are used by
Freud. The dreamer knows all about them, although,
of course, she thinks of them but on occasions.

There is no special symbolism, no special latent
or dormant content with its deeply arising significance
(in the Freudian sense) found here. The meaning is
plain. It is written boldly on the surface. He who
runs may read. Surely he who investigates, who stops
and thinks and tries to read, can find it there with but
little effort at translation.

Sexuality is not at the bottom of this dream. There
is a pleasurable gratification — the emotional element.
But this element cannot, as I stated in my interpreta-
tion of the first dream, be classed as sexual. Nor can
it be related to, as being centered about, the sexual instinct
in this old lady.

The chords of several instincts or emotions have
been touched in this dream, but fundamentally we have
the fihal feeling brought to the surface. The filial feeling
is directed towards her grandmother, on her mother's
side. This grandmother took care of her as only a
mother can. She indeed was the only mother she had
known for many years.

The filial feeling, it may be mentioned, is here
dependent upon sympathy, appreciation, gratitude for
kindness to her. It is dependent upon the motive of
self-preservation, in major part at least. This love of self
and the desire for self-preservation cannot be classified
as sexual.'

Here and there through the dream one may see other
instincts and feelings coming to the fore — maternal,
fraternal and others. There also no special sexual signific-
ance can be found. Most of these feelings and emotions,
tdth their associated groups or complexes or constella-
tions of ideas can be shown to be more or less indirectly
dependent upon the self-preservation motive or instinct.

S. I have taken up the problem ol aemality in a paper entitled "A Criticism of
the Conception of Sexuality Assumed by the Freudian School," to be published in
the Medical Record, New York.

J

Two Dreams 35

Time forbids my presenting a more elaborate inter-
pretation or a discussion of the genesis and classification
of instincts, motives, feelings and emotions.

I shall not even indicate the various mental mechan-
isms in the dream or point out the relative intimacy
or significance of the different scenes, persons or other
elements of the dream. I wish only to present here
a rather typical wishfulfilling dream, which, however,
does not conform to so many of the other essentials in
the Freudian theory of dream interpretation.

I am quite well aware of the superficiality of the
records here presented, but every psychoanalyst will
pardon me for this. A paper must necessarily be of
limited length.

Conclusion

After more than three years' study of the subject
from an impartial standpoint, I find that here, as else-
where, I must reject the Freudian theory of dreams in
many of its essential theories concerning the content
and meaning of dreams. I may refer to my previous con-
clusions as presented in previous papers as embodying
present views upon this subject.*

4. "Interpretation of Dreams, Based on Various Motives," International Clinicfl,
Vol. IV, Twenty-third Series, 1913. "Analysis and Interpretation of Dreams Baaed
on Various Motives," Journal of Abnormal Psychology, June-July, 1918; "A Contri-
bution to the Analysis and Interpretation of Dreams Based on the Motive of Self-
Preservaton," American Journal of Insanity, July, 1914; and reference 2, above.

PSYCHIATRY IN THE DIETARY*

By Chas. H. Hughes, M. D.,

St. Louis, Mo.

An Editorial Overflow Contribution.

" A LL that a man hath will he give for his life." All
*» that a physician hath of reUef and treatment, ex-
perience and knowledge, should he give for the recovery
and comfort of his patient.

In whatever Hne of work, for the welfare of the
afiiicted, one may have wrought or be now ahgned,
all the resources of his great science and art (at his
command) should be searched and selected from for the
sole aim of recovery and relief. Que Prosunt Omnibus
is the right motto.

Even as the position in bed of a patient advised
by the neurologist may depend upon the neurologist's
skill and knowledge of diagnosis and prognosis beyond
the nervous system, as in pleuritic neuritis (Andrals'
decubitus) if the patient does not assume it himself, or
the bedsore attitude so often directed by the surgeon,
or he of the surgeon's knowledge in this regard, in prac-
tice— so there are matters of comfort and psychic import-
ance connected with the dietary that are often disregarded.

The treasury of medical resource to be drawn upon,
is a common one for every practitioner for the good of
his patient and has something of benefit for anyone
knowing how and when to make judicious use thereof.

•The I«it Word concluding an interesting plea by Dr. H. L. Wright of Santa
Barbara, Calif., on the function of the general practitioner in relation to the study and
prevention of nervous and mental disease is that they **may not be blinded to the great-
eat organ of aU— the mind."— Caii/. Jow. Med., Oct. 19H.

(36)

Psychiatry in the Dietary 37

The physician may benefit most thereof and therefrom
who understands most thereon concerning the mental
impression and tastes of the patient concerning his
dietary.

The ocuHst, the aurist, the laryngologist, pharyngol-
ogist, microscopist, genito-urinary man and special
surgeon, the internist, the dermatologist, the odontolo-
gist who studies the teeth in their origin and growth,
their pathology and physiology and the states and condi-
tions of the entire person and the dentist who works
upon the teeth or substitutes them by his art, can learn
and profit from this source.

Also the gynecologist, the physicist, the syphilo-
grapher and vice-versa.

The alienist and neurologist may learn from all these
sources and likewise the good general physician may
profit from all of these and from the test tube, the
microscopic lens, the x-ray and the radiograph.

"Too often in medical practice the light shineth
in the darkness and the darkness comprehendeth not,"
as in the up-to-date biological laboratory for the physician.

Psychiatry in the Feeding of the Insane

In providing the dietary of the insane who may not
require, because of special exemption of particular articles
of diet being required, such as for diabetes, diarrhoea,
typhoid, etc., their gustatory wishes and comfort should
be considered somewhat. It is a mistake to consider that
they may be given "just anything that is nourishing"
to eat and served in any way and in any condition, or that
food requiring to be cooked, be served in any way either
hot or cold if chemically indicated.

When the writer first assumed the superintendency
of a large state asylum (or hospital for the insane as it
is now called) , built to accommodate several hundred inmates
with near a hundred attendants and others (officers and
employees) with wings remote from the center building
kitchen, about two hundred feet distant and the way from
the culinary department to the patients' dining rooms
uncovered, and the food carried out in the open to these

38 C. H. Hughes

far distant dining rooms on waiters, on the heads of
servants in winter, the food reached the tables of these
dining rooms cold and unpleasant, especially at break-
fasts and luncheon hours (the mid-day luncheon being
really the dinner time.) The psychic effect, to all but
the most maniacally indifferent, being detrimental and
uninviting. (Of course to an occasionally exalted
maniac a scant cold meal might excite the delusional
impression of a princely feast, but this deluded state of
mind would not justify a cold and cheerless dietary for
them and others.) The majority of the insane are not
indifferent as to what they eat. The better the diet, as
well as environment of the patient, the more hopeful the
prognosis, either in hospitals for the insane or else-
where, in certain cases, as a rule.

Though not exactly germane I may here relate that
one of my managers (a county member) objected before
a board meeting, to my having strips of carpet beside
the beds of the non-maniacal, saying, he "did not enjoy
that luxury himself." He considered all insane as in-
different to their surroundings and unlike sane people
as to the physical comforts of existence where as many of
the insane are like sane people in this regard and some-
times they are over alert and sensitive on this subject.
This man and another of my Board of managers, equally
intelligent, ultimately joined by two more brought about
a legislative inquiry as to my extravagant management,
although five other managers sustained the propriety
of my suggestions on this and other subjects.

Among the complaints I had to face was the placing
of tramways in basement from kitchen to all the dumb-
waiters for the conveyance of supplies thereto (meals
especially) in hot vehicles. Another charge was, in
discriminating in clothing prescribed from a psychiatric
point of view, a prescription which was sustained also
by the court when the asylum treasurer was sued by a
county for refund for the cost of a black frock coat, etc.,
for an unfortunate and bankrupt college professor,
who had never worn any other than a similar garment

I

Psychiatry in the Dietary 39

and a black alpaca dress for a refined middle aged lady
music teacher who had never in all her later life worn
any other kind or quality of dress. The defense was that
both were medical prescriptions for those not used to
pauper apparel. That this apparel for both was an
essential to the patient's welfare in the direction of
recovery, considering the manner of their living before
they were mentally maimed, these garments having been
asked for, that they were in accordance with their normal
tastes as to dress when the patients were sane and were psy-
chiatrically contributary to their recovery. These clothes
were bought by the steward on my order as prescriptions.
Both patients recovered and went from the charge of
the county maintaining them, to self-maintenance in
rational life.

Neither of these unfortunates, however, survived
many years after and they "point a moral" if they
do not adorn a tale. The professor taught materia
medica in a prosperous medical college. He taught that
alcohol was the remedy par excellence for tuberculosis.
Suspecting tuberculosis he began in himself to verify
his views and became the excessive drinker that devita-
lized him and brought him to the asylum and finally,
after his brain recovery, he relapsed and died of an-
other sequent disease.

The lady, too, subsequently relapsed to the habit of
chronic meconism that caused her insanity. She died,
however, of an intercurrent disease, pneumonia, which
might not have caused her death, had she known the full
peril of frequently returning to opium taking, after different
attempts at self-recovery without medical aid and the
consequent atonic state of and failure of her unaided
resistance powers. The writer did not then comprehend, as he
does now, the deceptive and disastrous nature of this
perilous habit forming, nerve center damaging and brain
destroying drug, deceptively and insidiously impairing
the powers of the will and poisoning the brain and its
peripheral nerve relation, control.

40 C. H. Hughes

Psycho-clinical, psycho-chemical and consequent psy-
cho-therapeutic, as well as pure chemico-biologic,
laboratory considerations, should claim our attention in
prescribing what, when and how one who is ill should
eat.

There are psychic-chemic, biologic system conditions
which influence to modify that wonderful psycho-chemico
biologic work going on in every human, called by us
sometimes blindly, the metaboUsms of the organism.
This remarkable influence is too often ignored in the es-
timate of results of pure biochemical effects, as gleaned
from laboratory experiment with the microscope, test tube
and crucible and without regard to the psychology of
the higher human animals with psychic predilections,
appetites, aversions and special tastes.

Of these, the true and successful clinician will and must,
whether he be humoralist, solodist or indefinite, in his
views and modes of practice, take due note.
"The blood is the Hfe," but the neural centers, (high and
low,) the psychic neural centers especially, including the
ductless glands, especially the cerebral apophyses, suggest
the necessity of a more or less intimate knowledge of
the relations of which to lower centers and to the viscera,
entering more or less extensively and forcefully into our
conceptions of the right management of conditions which we
are called upon to rem.edy, when the marvellous machinery
of the human organism goes wrong from the normal,
in the makeup and movement of the machine — its
visceral, hepatic, gastric, renal, cardiac, pulmonary centers,
etc., when we designate it, in the group of disease.

To understand the importance of considering the
appetites, predilections or aversions of food tastes, we
have only to think of the potency of psychic shock in
physiologically bringing the blush of shame or surprise
or the pallor of fear, the paralysis of function resulting
from fear or the exuberant exalted states of delight,
the agreeable cerebro-psychic impressions of sweet smelling
aromas and the thousand and more impressions that in-
crease or lock important secretions or exalt or suspend

Psychiatry in the Dietary 41

excretions, as in the impress (salutary or non-salutary)
of the ductless glands and the emotions that exalt and
others that depress, the movements of the heart, or even
shock it into silence and suspension of movement never
to go again.

If the bowels and bladder may be moved and the
action of the skin increased, suspended and pale under fear,
the tears caused to flow, the hair to blanch or the
appetite fail under great emotion, why should we not
consider this aptitude of the human system under psycho-
cerebro-neural influence as capable of modifying results
as it is and consider the patient's feelings in this regard
and not be too rigid in dietetic autocracy of prescription,
simply because the cold chemico-hemic conclusions of the
biological laboratory suggest absolute exclusion of a cer-
tain article of diet.

We do not understand the inferior animals' food
longings or aversions as we may learn those of a human
being under treatment, nor do we know the exact harm
of total, sudden, complete contravention of a certain life
long habit formed appetite, which, even though we can
modify it in a measure by substitution, as in diabetes
melitus. But we can see the restlessness and sleep loss and
mental distress of violent withdrawal and persistent com-
plete deprivation, without substitutive support, of other
mentally satisfactory therapy and should prescribe it,
at least a slight amount of it, sufficient to appease im-
perative taste cravings. In our dietary therapeutics we
should somewhat regard the patient, his feelings and
welfare, wherever and whenever not imperatively prohib-
itable even to the allowing of a modicum of water
after an appendectomy, for cerebropsychic distress may
hinder recovery as well as a too greatly thinned blood,
which in our judgment is a surgical fallacy, notwithstand-
ing possible risk of hemorrhage.

Let us look back and estimate, if we can, the harm
and suffering caused to patients of the past by water
deprivation to them, in fevers for instance, an abstemious
observance, the breach of which brought everlasting

42 C. H. Hughes

fame to one of our craft and on his monument in Dublin
is engraved, as he requested should be placed there
"He fed fevers." Graves not only gave them to drink
but he fed them, as his kind heart and good judgment
dictated and though long dead, he yet lives in his common
sense precept and practice which the medical and lay
world now follow. But just now we are inclined to
listen too much to chemico-biological laboratory sugges-
tions as to absolute abstention from sugar forming foods
and water exclusion. Not that diabetic bread should
not be prescribed, but that pure water will not harm
the kidneys and the psycho-gastric craving should be
somewhat, if ever so slightly, appeased with a little real
sugar as well as saccharine.

And so it should be with the wise and observant
clinician all along the Hne in therapeutic dictation in disease
generally. Regard kindly and considerately the cravings
of the patient. Ease their minds a little of its food craving
distress so far as practical. It is fortunate, in this
regard, that in some diseases like diabetes, which by the
way is often psycho-cerebral in its origin — a distress
disease — that we have substitutive saccharin, etc. to our
hand.

The brain and metabolic processes are closely related
in influence and gastro and other enteric and cerebral
states are inter-related in (reciprocal) sensation. In our
dietary regulations, therefore we should well consider
the brain and mind and their systemic relations, as
well as the liver and stomach and other viscera in the
system's movements and control. Intelligent restaura-
teurs appreciate the principle of agreeable mental impres-
sions; though they may not understand the modus operandi
in the nervous system (and for that matter neither do
we entirely and always, though we have learned up to
date, much of the psycho-neural relations), and these
restaurateurs and our hotel managers (that is the wiser
ones) act accordingly in adorning their premises and in pre-
paring and setting before their guests, (or in families the good
man or woman of the house,) attractive, appetizing dishes

I

Psychiatry in the Dietary 43

in appearance, smell and taste. Likewise the better hos-
pitals pay attention to the pleasing character of the
patient's environment at table, in room, dormitory,
corridor, dining room, living room, toilet, etc.

The modem, better-class hospitals for the psychopathic
are especially illustrative of this important consideration
in many respects; in construction, location, internal ar-
rangement and decoration and in regulation of attendants,
white aproned, capped, etc., in manner to best promote the
welfare and happiness of the patients and prevent, so
far as may be, irritation and discontent and in provid-
ing rational diversion, substitutive of what may have been
had or missed in the outside world, in the patient's
rational days.

The principal point of this communication is that
to as great an extent as may be compatible with the
patient's welfare, in whatever dietary we direct, we
should not omit to consider the patient's pleasure in
appetite and taste, so far as we can, and clinically com-
promise a little where we cannot exclude them, with the
rigid suggestions of the bio-chemical laboratory. This
is simply applying the rule to dietary that most of us
do in our therapeutics. We do not give plain undeo-
dorized castor oil, as our grandmothers used to do,
nor jalap in powder only, as I have known a physician to do,
or mix a pill with saliva as I knew one doctor to do
in the patient's presence, with the remark that medicine
was not confectionery, or apply irritating applications
without associating some soothing drug where possible
with the consolingly meant, but not compensating remark,
"no smart no cure." Those days have almost passed
away, we are thankful to say, we hope, never to return,
for we are yet learning some new and better things
in our therapy and dietary almost every day.

Apropos and in conclusion, we note an interesting
and further suggestive contribution in proper extension
of this important matter of mental impression and person-
al satisfaction as to dietary, which suggestively in-
cludes agreeableness in medical dosage, is a potent con-
tribution on "Voice and Manners in Medical Practice"

44 C. H. Hughes

by Dr. T. D. Crothers, of Hartford, Conn., which ap-
peared in the Medical Record for last May 18th.

Crothers advises that "every medical student be
taught voice culture and general manners" to which
we might add voice and manners pleasing to the patient
by the physician and nurse, which is also obviously implied.

While Dr. Crothers views are not precisely germane,
they are in line with the larger subject of psychiatry
in medical practice of which psychiatry in the dietary
is a part.

The dress and manner of the physician in the sick-
room may even affect the appetite, as in the case of the patient
who could not eat or take a pill after seeing the doctor
make up the piU with his own saliva and roll it into shape
with his hand on the thigh part of his trousers leg.
To the credit of country doctors who make up their own
prescriptions, I never knew of another similar disgusting
instance, yet this man was regularly graduated and classed as
a gentleman. He was a good judge of whisky The whisky
may have been behind his pharmacy.

THE PROPOSITIONS OF THE ASSOCIATION OP
SUPERINTENDENTS OF AMERICAN HOSPI-
TALS FOR THE INSANE.

By John Curwen, M. D.,

One Time Superintendent and Physician of the Pennsylvania
State Lunatic Hospital, Harrisburg, Pa.

(Continued from last issue.)

PRELIMINARY NOTE BY THE EDITOR

Now that psychiatry is beginning to attract, from the general
profession, the practical consideration it has so long deserved and to
accomplish whidti, this magazine was founded and has so long striven
to promote, we deem it appropriate that we should bring again to the
attention of the medical men of the country these valuable suggestions
concerning the care and treatment of the insane in our psychopathic
hospitals, made more than a third of a century ago, by eminent men
in American psychiatry and ratified by that eminently practical and
clinically experienced body of physicians who, following the Esquirolian
injunction of living with the insane, to better understand them, the
superintendents of American hospitals for the insane adopted and
promulgated these propositions.

This association is now the American Medico-Psychological As-
sociation of which Dr. John Curwen, the writer and the eminent Dr.
Isaac Ray were mainly the distinguished and ever to be remembered
authors.

THE principles which underlie the arrangement and
construction of a hospital for the insane are founded
on the dictates of sound, rational common sense, and the
results of experience obtained by residence in such buil-
ings, and derived from the careful study of the require-
ments of the peculiar class of persons for which they are
to be constructed, and whose comfort and treatment are
alone to be considered in such construction. The most
important of these principles may be stated to be such a

(45)

46 John Curwen

plan as will facilitate to the greatest degree, and render
practicable at all times, the readiest and most thorough
supervision of every department by the officers, careful
selection of the best material for the construction, and the
most unwearied attention to the proper arrangement of
the different kinds of that material in the various parts of
the building, that everything may not only be of the best
quality, but put together in the best manner calculated to
secure the purpose designed; the most systemetic adapta-
tion of every part to the wants and requirements of those
who are to occupy the wards; ease and economy of
administration; and ready and prompt distribution of heat,
food and other articles constantly required, and special
care that every part of the building shall have abundance
of light and air.

While the greatest latitude may be allowed, in what
may be termed the architectural arrangements, the plan
which has been found to combine, in the greatest degree,
all the points enumerated above is the lineal plan, in which
each wing shall be opened to the full light at both
ends, and the different wings shall be continued in the
same line as that nearest the center, but falling back so
far as to leave the second open at both ends, and so on
through all the wings, in contradistinction to that plan
which would place the second wing at right angles to the
first, and so make the whole surround an included square.
This plan was first fully elaborated and explained by Dr.
Thos. S. Kirkbride, for so many years the able and ac-
complished superintendent and physician of the Pennsyl-
vania Hospital for the insane, in Philadelphia, and has
been adopted in the majority of hospitals for the insane
erected within the last thirty years. While adhering
strictly to this principle of construction many changes in
interior detail and arrangement have been made by differ-
ent persons, but these changes do not in any manner
affect the original idea.

VI. — "All such buildings should be constructed of
stone or brick, have slate or metallic roofs, and, as far as
possible, be made secure from accidents by fire."

Propositions of A. S. A. H. for Insane 47

Circumstances connected with the locality of the
building will often determine the fact of the use of stone
or brick in the construction, but when stone is used it is
always best and, in the end, most economical, to line
the outer wall with brick with an air space of about three
inches between the brick and the stone.

The brick should be well joined with or "tied into"
the stone, at short distances, so as to make the brick
secure and firm, and the space thus left between the walls
will not only render the walls more dry and prevent the
penetration of moisture, after a long continued driving
storm, as is often seen in solid stone walls, but will also
have the effect of making the building warmer in winter
and colder in summer, from the fact that neither heat nor
cold can penetrate beyond the layer of air confined
between the walls.

The same effect could also be obtained in the con-
struction of brick walls in a similar manner and thus avoid
what is so often required, the furring off or nailing strips
of wood to the walls on which the lath is nailed. Lath
and plaster partitions are always objectionable in parts of
a hospital occupied by patients, from the ease with which
they may be broken, and also from the fact that they
furnish a more ready receptacle for rats, mice and vermin
of various kinds. The wood used in furring off walls,
and lath and plaster partitions are also objectionable from
the fact that fire is easily started in them, and when so
started is extremely difficult to trace or to extinguish.
The objection to metal roofs in this climate arises from
the injurious effects caused by the alternate expansion and
contraction of heat and cold, the thermometer often fall-
ing twenty or more degrees in the course of a few hours;
and in certain metals the constant tendency to rust,
requires the frequent use of paint to preserve them from
the corroding influence of heat and moisture.

Sufficient care is not generally exercised in preparing
the sheathing of the roof on which the metal roof is to
be laid, or for the slate.

48 John Curuien

The best plan is careftilly to plane and plough and
groove the boards, and have them laid as carefully as a
floor. Slate, when properly laid on a roof, thus carefully
prepared, furnishes the best material for roofing in a
climate subject to so many changes in temperature.

The cornices of the roof should be made of the best
galvanized iron and carefully backed up with brick.

The surest plan to avoid accidents by fire will be to
have the whole interior constructed with brick partition
walls, the floors made of brick arches between iron beams,
and this arrangement carried through every part to and
including the ceiling of the upper story directly under the
roof, and the main division walls of brick carried up to
the roof.

This practically renders the building fire proof, as the
only part in any hall which could bum would be the
floor, and if that is well laid, of good and thoroughly sea-
soned lumber, there will be the smallest chance for the fire
to spread from one room to another. Every room is in
effect a brick box.

But where this cannot be done, and in institutions
already built, the best plan will be to introduce pipe con-
nected with the tanks in the attic, or from an outside
reservoir on high ground, into each ward, and have suffi-
cient hose to carry the water to every part of the ward,
and fire plugs outside with hose of large size. An ad-
ditional means of security, when the institution is heated
by steam, will be to carry pipes into the attic of the center
and different wings from the boiler, so that by opening a
few valves, the whole attic could be filled with steam,
in case a fire should break out, and it is well known that
no better fire extinguisher can be found than an abundance
of steam.

VII. — "Every hospital having provision for two hundred
or more patients should have in it, at least, eight distinct
wards for each sex, making sixteen classes in the entire
establishment."

While this proposition says "at least eight distinct
wards for each sex," it implies that a larger number would

Propositions of A. S. A. H. for Insane 49

be advisable, and, as a general rule, it could and should
be arranged so that a more thorough classification could
be obtained in a larger number of wards.

This, in many cases, is very necessary for the comfort
of patients and the greater success in treatment, so that
those patients who were annoying to others and particu-
larly to convalescent patients, may be removed from the
wards for that class, and placed among those who could
not be so much injured by their conduct or their manner
of talking. It is well known to every superintendent
that there always is a certain class, generally quiet, and
free from excitement, and who can behave themselves very
well, but who take special delight in retailing the most
outrageous stories to all who come within .their reach,
particularly to recent and convalescent patients; and, the
impression thus produced on this class of patients is often
very injurious and calculated to retard their restoration, if
it does not throw them into a state of excitement or
lead to more serious results.

The arrangements for classification should be such
that all this class should be separated entirely from con-
valescents, and placed where they could have only those
of a similar inclination with themselves to associate with,
and less incentive therefore, to exercise their mischievous
propensity. The subject is more fully stated in a propo-
sition adopted in 1866, which reads thus:

"The facilities for classification or ward separation
possessed by each institution, should equal the require-
ments of the different conditions of the several classes
received by such institutions, whether those different con-
ditions are mental or physical in their character."

VIII. — "Each ward should have in it a parlor, a corri-
dor, single lodging rooms for patients, an associated
dormitory communicating with a chamber for two atten-
dants, a clothes room, a bath room, a water-closet, a
dining room, a dumb waiter and a speaking tube, leading
to the kitchen, or other central part of the building."

The parlor shoiild be so placed as to command the
most pleasant outlook to be obtained, and shotild be of

50 John Curwen

ample size so as to afford room for a piano, library, sofa
and the other necessary furniture; and have as much
light from windows as possible; and the whole front might
easily be made to resemble a bay window by projecting
the wall so far in advance of the other walls, as to allow
a window to be placed in the connecting wall on each
side.

Everything about this parlor should be made bright

and attractive by pictures and other ornaments, so as to

induce the patients to spend as much time in it as pos-

• sible; though when bay-windows are placed in a ward,

they seem to be places of greater attraction.

The corridors should be made at least twelve feet
wide and twelve feet high in the ceiling and "no chamber
for the use of a single patient should ever be less than
eight by ten feet, nor should the ceiling of any story oc-
cupied by patients be less than twelve feet in height."

Where the wing immediately joining the center
connects with it, a space of at least ten feet should be
arranged with windows open on each side from floor to
ceiling, so as to give abundance of light and air at that
point, and these windows, like all the windows in the
wards, should be protected with some ornamental form of
guard to prevent intrusion by outsiders, and to prevent
also the escape of patients.

The omission of this open space makes that end of
the hall dark, and at that point, also, the air will be very
apt to be impure from the inability to obtain a free
circulation.

It must be very distinctly kept in mind that every
part of a hospital for the insane, occupied by patients,
should be as bright and cheerful and have as much sun-
light as it is possible to obtain by means of windows and
openings at the ends of the hall. No hall can be made
too bright and cheerful at all times; and even when the
warm rays of the sun in summer require to be excluded,
that can be done without interfering in any way with the
cheerfulness and brightness of the wards.

Propositions of A. S. A. H. for Insane 51

The advantages of this abundance of light are two-
fold: In the first place, as a matter of health, and, then,
as tending to promote greater cheerishness in all within the
range of its influence; for it is a matter of common ob-
servation, that persons obliged to be in dark rooms become
dull and depressed, while they are at the same time more
blanched and unhealthy in appearance and in fact.

It has been objected to rooms on both sides of the
hall that the effect will be to make the halls, if long,
dark and gloomy, but if they have large windows from
floor to ceiling at each end, with a large bay-window on
each side in the center, no unpleasant gloom or darkness
will be observed; and the bay-windows will give a very
pleasant sitting room which will be occupied nearly all
the time by the patients, and will be a place where flowers,
birds and other objects of interest may be kept. In the
arrangement of the rooms in a ward, great care should be
taken to have the door and window opposite, so that the
bed may be placed to one side and out of the line of
any drafts, which would be occasioned by opening the
door and window.

Every room should be provided with a flue for the
admission of warm air, and also one for the removal of
foul air, so arranged, that no unpleasant draft from the
warm air shall strike the person who may occupy the
room; and, where a system of forced ventilation is used,
this may readily be effected by having the warm air
admitted above the level of the person's head, and the
foul air removed at a lower point; but unless a strong
power is used to keep up the circulation, this arrangement
will not answer satisfactorily in practice, whatever excel-
lencies may be claimed for it in theory.

The question of the particular arrangement of the
window of the room must be left to the prevalent idea
in any particular section.

There are really three different forms of window; one
where both sashes are of iron and the upper is made to
balance the lower, and when the lower is raised about
five inches, the upper is lowered the same distance,

62 John Curwen

by an arrangement of connecting chains and pulleys;
another, where the upper sash is of cast iron and station-
ary, and the lower sash, hung with cords and weights,
raises the whole distance, and a guard of an ornamental
character protects the space opposite the lower sash so
that the patient cannot fall out or jump out; and, the
third form is where both sashes are of wood and hung by
ropes and weights so as to move up and down, and the
space outside is covered with a guard, either plain or
ornamental.

The idea has been strenuously advanced by some that
all guards to the windows and locks to the doors should
be dispensed with, which we believe to be most erroneous,
and one of those extreme measures which will cure itself
by the very state which it will induce, of remissness on
the part of those in charge of the wards and of acci-
dents and injuries to the patients. It is going from the
extreme of care to the extreme of carelessness, and avoid-
ing that which has always been found the safest, the mean
between the two extremes. If the insane be irresponsi-
ble, as will be generally admitted, the effort to give
them full liberty to go and come as they please, places
them in a position attended with risk to themselves and
to others; to themselves, because it places them in a posi-
tion to be subjected to influences and temptations which
will have a decidedly injurious influence, and to others by
the risk to life, person and property at the caprice, ill-
will or the delusions of an irresponsible party, and it is
neither right nor just to expose the innocent and unsus-
pecting members of any community to any such risks.

It has been the fashion with many to insist on large
associated dormitories, but we beheve this to be contrary
to the desire and habits of our people, who all insist on
having a room to themselves. It is true that a hospital
can be constructed more cheaply when the majority of
the patients can be placed in associated dormitories, but
there are many other things besides cheapness to be
considered in the construction of a hospital for the insane.

Propositions of A. S. A. H. for Insane 63

and chief among these are the confort and welfare of the
patients.

We have no sympathy, whatever, with that wretched
sentiment, born of parsimony and disregard of the feelings
and rights of others, which insists that the comfort, the
welfare, the happiness and the restoration of the insane,
of any class, are to be weighed in the balance with a few
hundred dollars. The State is bound, in honor and duty,
to make the very best provision for all its wards, and the
more helpless and dependent, the greater care should be
exercised in provision for them; and while proper economy
should always be exercised in the disbursement of all
money, both in public and private undertakings of any
kind, and every dollar should be strictly accounted for, no
State nor any private corporation or association can afford
to do wrong, for wrong in every form is wasteful expendi-
ture, nor are any so poor that they cannot afford to
provide for those who may be committed to their care, in
that manner which will best promote the welfare of the
insane in every way in their power. That cannot be
done when the individual is placed in a position which
injures his self-respect or is entirely at variance with all
his previous habits and education. Men and women
insist on some accommodation which will give them a
degree of privacy, which cannot be obtained by being
obliged to be in a large dormitory, and it will not do to
say that because they are insane their feelings are not to
be considered.

The effort in these days seems to be to lower the
standard of self-respect and make people feel their depen-
dency; but true humanity teaches that men, born in the
image of God, should be trained to a proper regard for
their high destiny, and that true charity consists in the
dispensation of its gifts, in such a manner as to instill
higher aims and more ennobling sentiments, and to lead
all, of every class and condition, to seek that which will
give true comfort in better and more enduring provision,
for themselves and all within the sphere of their influence.

54 John Curwen

The principle which should govern in all cases is:
"Whatsoever ye would that men should do to you, do ye
even so to them;" and regard must also be had to the
consideration which sooner or later comes home to every
one in some form, that he or his may at some time require
some such accommodation as a hospital for the insane
affords, and he must consider how the plan of such
association would suit his own case, or whether he would
like some member of his family placed in such a position
as has been indicated. Unfortunately this principle has
too limited an appHcation in governing bodies, and, partic-
ularly where the expenditure of money in public buildings
is involved, but that is no reason why it should continue
to prevail, but, on the contrary, every dictate of justice
and humanity demands that the sooner men in every
relation of life do, as they would be done by, the better
will mankind be.

There is still another consideration directly bearing on
the patients themselves, that the proper degree of sleep
at night, and that calm state which should precede and
is necessary to sound sleep, cannot be had in nervous and
restless patients in a room where a number sleep, for the
reason that among that number, particularly, if it exceed
six, there will always be one or more who are restless
and uneasy and are apt to be up and about the room, to
the annoyance of others and interference with their sleep;
and unless the room is very well ventilated, the breath
and other effluvia arising from a number of persons, soon
vitiates the air so as to render it unpleasant and unhealthy.

The argument in favor of dormitories, that those in-
clined to suicide may be placed in them with greater
safety and less probability of an attempt on their part
to effect their purpose, has only a very limited applica-
tion, and really, as a rule, does not effect the object.

The only preventive of suicide is careful and constant
watchfulness by day and by night.

Every room of the kind should have a strong wire
frame in the upper half of the door, so as to answer the

Propositions of A. S. A. H. for Insane 55

double purpose of easy inspection and more efficient
ventilation.

It is well known that associated dormitories are not
used until it becomes a matter of necessity, and the fewer
of them, and the more limited the number they can ac-
commodate, the better for the patients themselves.

Where a dormitory of large size is used, the necessity
of a chamber for two attendants communicating with
it is requisite, in order that they may better minister to
the patients in it, and prevent any disturbance, though, as
a rule, if the attendants have attended to their duties dur-
ing the day, they generally sleep so soundly, and they
should have their full sleep for the proper performance of
their daily duties, that they hear very little that may
occur during the night, unless of a very unusual charac-
ter, and the real dependence must be on the activity and
efficiency of the night watch, which in cases of special
emergency would be increased for the time.

More thought and attention should be given to the
room designed for the clothing of the patients in each
ward than has usually been the case. It should be of
ample size, well lighted and well ventilated, and placed in
close proximity to the bath room, and should be conve-
niently arranged with closets and boxes in which the
clothing can be neatly folded and arranged, with hooks
for hanging up coats and various other articles; which are
better hung up than folded and laid away. In addition
to this there should be ample arrangements for the sheets
and other bed clothing, with a convenient place in which
hats and shoes may be placed by the men, instead of
being allowed to lie promiscuously about the ward to the
annoyance of all careful people, and the inevitable loss to
those who wear them.

The bath-room should be conveniently arranged with
an ample supply of hot and cold water, and should also
be kept at a warm temperature in the coldest weather so
that the most delicate may suffer no injury before enter-
ing or after leaving a bath. In immediate connection
with the bath-room should be a wash room with station-

66 John Curwen

ary basins and an ample supply of water, to which the
patients can have ready access at all times.

The arrangements of water closets are generally on too
limited a scale, and it is best to place in every ward at
least two hoppers, so that there may not be any excuse
for careless habits on the part of the patients, by inability
to obtain the needed accommodation.

While such improvements have been made, and are
still making, in the arrangement for these conveniences, it
is not requisite that any special plan should be insisted
on further than that "all water closets should, as far as
possible, be made of indestructible material, be simple in
their arrangements and have a strong downward ventila-
tion connected with them," and, also that "the floors
should be made of material that will not absorb moisture."

The dining room should be of such size as to give
comfortable sitting room for all who may occupy the
ward, should be bright and airy,- and should have con-
nected with it, a neat china closet, where all the articles
used on the tables can be kept in neat order and in it a
sink with hot and cold water attached, in which the
plates, dishes and all articles used on the table can be
washed.

The dumb-waiter should be conveniently located in
connection with the dining room, and the apparatus for
hoisting it should be such as to involve the least labor
and trouble, and easy communication afforded with the
kitchen by means of a speaking tube, or as may now be
very satisfactorily arranged, by telephone.

IX. — "No apartment should ever be provided for the
confinement of patients, or as their lodging rooms, which
are not entirely above ground."

The requirement of this proposition would appear
superfluous, but it seems needful in these days when the
effect is made to cheapen things to the very lowest point,
and endeavor to make provision for a certain class of the
insane in a manner, which is not in strict accordance with
that proper regard for their comfort and welfare which
their position imperatively demands, and also to place, so

Propositions of A. S. A. H. for Insane 57

far as words and a protest can do it, a barrier to any
further efforts in that direction.

X. — "No class of rooms should ever be constructed
without some kind of a window in each, communicating
directly with the external atmosphere," and this, for the
reason before stated, that every patient should have the
benefit of sunlight to as great a degree as possible, and a
better opportunity can be afforded for the freest admission
of fresh air, which in many rooms is absolutely requisite
to insure cleanliness.

The eleventh proposition has been already consid-
ered in connection with the size of the rooms to be used
for patients.

XII. — "The floors of the patient's apartments should
always be of wood." It would seem scarcely necessary
to insist on this requirement, but as stone and brick floors
have been used in the past, and are exceptionally cold
and uncomfortable, particularly for that class who would
be most probably compelled to occupy such rooms; there
might be those who would consider it a good thing to do,
to return to such a state of affairs in the future, on the
ground that wooden floors would rot out by frequent
scrubbing, and it would be economy to prevent such ex-
penditure.

Wooden floors may be rendered nearly, if not quite,
impervious to all fluids by an application of boiled oil,
applied hot, so as to saturate the floor, and having this
repeated every few months. '

XIII. — "The stairways should always be of iron, stone
or other indestructible material, ample in size and number,
and easy of access to afford convenient egress in case of
accident from fire." Every ward should have, at least,
two stairways, one at each end, leading directly to the
ground, both front and rear, so that, by opening the doors
the patients could readily be taken out to the ground
around the building. The stairways must be of iron, stone
or slate, and walled into a brick wall on each side, so that
they shall be virtually fire-proof from top to bottom — all
the landings being of the same material as the stairs.

58 John Curwen

Circumstances peciiliar to the location of the hospital
will probably determine the character of the material to
be used, as in some localities one of the articles named
may be obtained at a more reasonable price than others.
Slate forms really the neatest and pleasantest stairway to
travel over, as it is less noisy when trodden on, and
experience has shown that it wears very little by constant
treading over it.

Unless care is taken to have the iron slightly rough-
ened on top of the step, it will in time become smooth
and slippery and the same may be said of certain kinds of
stone — but it does not hold good in slate. In these days
when so much is said about fire-escapes from public
buildings, it is wisest and best to construct the stairway
in such a manner as to be virtually a fire-escape from all
the wards. This can readily be done in the manner indi-
cated above, and then should a fire unfortunately take
place, the inmates can all readily be removed by the
mode of egress to which they have been accustomed.

Any fixture outside, such as is usually constructed, is
worse than useless, for very few patients would venture on
them, and they would be very likely to be used by mis-
chievious persons, for the purpose of annoying the patients.

For females such outside fixtures would be utterly
impracticable; whereas, a stairway constructed of either of
the materials named, and well built into a brick wall,
would be perfectly safe and secure, and very easily avail-
able at all times, and free from every objection which
could be urged against outside fixtures.

SELECTIONS

NEUROSYMPTOMATOLOGY

Crossed Extensor Plantar Reflex. — By Dr. L. J
Kidd (Rev. f. Neur. u. Psych., Vol. IX, No. 6). Reports
but four cases of unilateral crossed extensor response.
Four patients with disseminated sclerosis, paraplegic type.
Bilateral direct plantar response, with crossed extensor
response was present. Spasticity in all. One case more mark-
ed on one side. Here the crossed extensor response was
obtained on stimulation of the sole of the foot of the
more spastic side; all showed typical slow large toe ex-
tension. In all the crossed extension was likewise slow,
but slightly less in degree than that of the side stimulated.
The writer suggests plantar reflex dorsal decubitus and
Collier's position. — Abridged Abst. Post Grad.

NEURODIAGNOSIS

Sudden Death.— "The mystery of sudden death in
the absence of all known causal elements has often been
the subject of medical and especially of forensic discussion.
The monograph by Brouardel on "Death and Sudden
Death," published many years ago in English, was un-
doubtedly of service in calling the attention of the

(59)

60 Selections.

American public to this subject, and we continue to
hear of cases of thymus-death and other symptomatic
deaths (which upon analysis seem to involve the status
thymicolymphaticus as the chief factor.) A careful
review of the conditions which lead up to sudden death
shows a great lack of unanimity. Given there are one
or two inevitable causes the secondary factors are very
numerous. At a meeting last spring of the Niederrhein-
ische Gesellschaft fur Natur- und Heilkunde in Boim
(Deusche medizinische Wochenschrift, November 12)
Ungar related a case of sudden death preceded by hysteri-
form crises. With many phenomena of hysteria there were
no stigmata, paralyses, or contractures. The crises were
motor and accompanied by cries. The woman came out
of this state and seemed to be nearly normal. In the
midst of this new health she was seized with attacks of
pain in the head and neck, had motor crises with weeping,
etc. She emerged from this seizure but within a short
time had another epileptoid attack, with exposure of the
genitals. The whole picture was highly hysteroid. The
crises became more frequent and severe until death took
place, apparently from sudden cessation of respiration.
At autopsy pronounced lesions were found in the ventricu-
lar region of the brain. The case is valuable as showing
that clinical hysteria may end fatally; the practitioner,
confronted with these crises, must remember that a
fatal ending is by no means excluded." — Med. Rec,
12/26/14.

This is another post-mortem proof of the error of
the too frequent diagnostic conclusion that where hysteria
is existent all is hysteria.

It would have been more satisfactory if the fourth
ventricle (vagus area) autopsy had been more definite
in this record.

NEUROPHYSIOLOGY

Blood Threadlets. — Upon the introduction of dark
field illumination into medical microscopy peculiar thread-

Selections 61

like bodies were described as visible in the blood, in which
fluid they floated with a wave-like spontaneous move-
ment between the blood corpuscles. They were vari-
ously regarded as artefacts and parasites. Apparently
a constant blood find of man and warm-blooded animals
their number was much increased in certain diseases,
notably acute general infections. As the numerous data
concerning the incidence of these bodies in the blood
have never been collected and systematized and as the
subject has fallen into more or less neglect. Knack at-
tempted to revive interest therein, in a paper read before
the Biological Section of the Aerztlicher Verein of Ham-
burg last summer (Munchener medizinische Wochenschrift,
October 6.) He described a simple method of rendering
the bodies visible, but was unable to account for their
presence. The only hypothesis held at present is that
they are derived from the disintegration of red blood cells,
and represent a myelin form set free from the cell lipoids.
He pointed out that the threadlets could not be derived
from the blood fibrin. — Editorial selection. Med. Rec,
Dec. 5, 1914.

"It Should be Noted here that these teachings, in
a measure, verify the adage, 'There is nothing new under
the sun.' In the latter half of the 17th century was found-
ed the iatro-chemical sect. According to Sylvius, an in-
dustrious student of Van Helmont and Descartes, health
depends upon the relation of the fluids, acid and alkaline,
their union producing a neutral and milder substance.
Two kinds of diseases were distinguished, the result
either of acid of alkaline acridity. Among the prominent
followers of Sylvius might be mentioned WiUis, the
celebrated English anatomist; Glauber, the discoverer of
sodium sulphate (Glauber's salt), and many others, but
iatro-chemistry gradually lost repute, and was completely
overthrown early in the 18th century, principally through
the teachings of Hoffmann.

"Founded upon mere assumption and a smattering
of chemistry, with no definite conception of physiology.

62 Selections.

iatro-chemistry was foredoomed to failure. It seems
paradoxical too, because this was a period of exceptional
activity in laying the foundations of medical science.
Such names as Harvey, Steno, Vieussens, Malpighi,
Spigelius, Bartholin, Asselius, Pauli, Mentel, Wesling,
Highmore, Glisson, Wharton, Leeuwenhoeck, Ruysch,
Sydenham, Boerhaave, Stahl, Albertini, Valsalva, Bellini,
Swammerdam, Meibomius, Peyer, Duvemey, Cowper,
all belong to this period, and it is remarkable, to say
the least, that they failed to distinguish the normal
alkalinity of the building-up, from the normal acidity
incident to the breaking-down processes in both animal
and plant life.

"Running in parallel lines throughout this sketch,
we find these biologic principles brought prominently
to the fore — just as the keystone of the arch is to archi-
tecture, the flange on the wheel to commerce, so alkales-
cence (of the body fluids and tissues) is the pivot or
turning point between health and disease." — From Dr.
Aulda's "Chemic Problems in Nutrition."

Venous Blood-Pressure. — An editorial writer in
the A. M. A. gives the following:

"Until quite recently it has been generally assumed
that venous blood-pressure passively responds to changes
in the peripheral resistance within the circulation and
that it rises and falls inversely to the pressure in the
arteries. There is now a growing belief, supported in
part by experiments on both animals and man, that the
pressure in the venous system may be dominated by a
special nervous mechanism. We cannot review the entire
story of this chapter of the physiology of the circulation
which is still far from being presented in its final form.
One apparent earlier obstacle to the hypothesis of a
venomotor nervous mechanism has been in part met
by the now well-established demoiistration that the
venous system is actually supplied with motor nerves.
Only recently it has been shown that the veins may re-
spond to epinephrin with constriction, thereby furnishing

Selections. 63

one of the evidences nowadays accepted as indicative
of sympathetic innervation. As a physiologist has ex-
pressed it, although the evidence available at present
is insufficient to establish definitely the existence of a
venomotor system comparable to the vasomotor system
proper, none of the evidence is against such a hypo-
thetic nervous mechanism, and much of the data is
impossible of explanation without such an assumption.
It remains a fact, however, that no direct experimental
proof has as yet been put forth. In distinction from
the assumption that under normal conditions of life
the peripheral resistance alone controls the magnitude
of the venous pressure, Yandell Henderson has put forth
the hypothesis that there is a venopressor mechanism
which functions to maintain an optimum feeding pressure
to the heart. This forms a part of his theory respecting
the maintenance of the volume output of the heart.
The newest researches of Hooker, at the Johns Hopkins
Medical School, on the venous blood-pressure in man
are in harmony with the existence of the hypothetic
venomotor mechanism. He finds that normal venous
pressure is independent of changes in peripheral arterial
resistance. The capacity of a vein may vary without
aflecting the internal pressure. According to Hooker,
the venous pressure in man exhibits a distinct diurnal
rhythm, rising throughout the day from 10cm. to 20
cm. and falling again during the night. The normal
venous pressure varies very considerably, averaging in
the day time and under usual conditions about 15 cm.
of water; in sleep, at night, it may fall to 7 or 8 cm.
The study of venous pressure in man has been compara-
tively neglected in the past. With a renewal of interest
in its problems we may look forward to some valuable
contributions to the knowledge of the circulation."

NEUROTOXICOLOGY

A Fatal Case of Veronal Poisoning is reported
by Dr. Edward W. Lazell in the Denver Medical Times for

64 Selections.

January last, due probably to the cumulative effect of re-
peated doses, the moral of which is not to repeat this or most
other coal tar anodynes and sleep producers often in the
same day, and to administer usually but a single dose
daily and then only about the ordinary time of retiring.

Alcoholics and War. — "Russia has discontinued
the manufacture and sale of Vodka, the national alco-
holic drink. France has prohibited the sale of Absinthe.
Now, England comes forward with an appeal to all her
soldiers to refrain absolutely from alcoholic drinks.
This has been printed in the form of a poster, distributed
to all the military stations. The following reasons are
given why the soldiers should refrain from alcoholic
drinks :

(1) SLOWS the power to see signals.

(2) CONFUSES prompt judgment.

(3) SPOILS accurate shooting.

(4) HASTENS fatigue.

(5) LESSENS resistance to Disease and Exposure.

(6) INCREASES shock from wounds.

It is signed by the most distinguished physicians
in the British empire: Thomas Barlow, Frederick Treves,
C. J. H. Evatt, Victor Horsley, G. Sims Woodhead.
In addition, the statement is made that the appeal is
made on the authority and experiences of Field Marshal
Roberts and Field Marshal Wolsely. — Memphis Medical
Monthly.

Two Descriptive Cases of Chronic Poisoning by
Scopolamine Hydrobromide or Hyoscine were given by
Dr. A. W. Daniel at the last July meeting of the British
Medico-Psychological Association.

Killed by Wood Alcohol. — We are indebted to
the Medical Fortnightly for this item of wood alcohol
fatality :

"Upward of twenty Vermont farmers died recently
as the result of drinking whiskey purchased at a village
drug store. The district is under prohibition regulation
and the men of the neighborhood get their supply for

Selections, 65

the Sunday booze at the drug store. The supply at this
particular store was simply flavored wood alcohol, and
the result is many deaths and several cases of blindness."

Inherited Defects from Alcohol. — The influence
of alcohol as a detrimental factor in inheritance is one
which has not readily lent itself to convincing experimental
proof in the past. During the last four years Professor
Stockard of the Cornell University Medical School in
New York City has been engaged in a study of the effects
of alcohol in heredity. He has demonstrated conclusively
that the germ cells of males can be so injured by allow-
ing the individuals to inhale the fumes of alcohol that
they give rise to defective offspring although mated
with vigorous untreated females. The extension of these
unique investigations, in which the offspring from the
treated animals which reach maturity are usually nervous
and slightly undersized, have further shown that the effect
of the injury of the germ cells is not only exhibited by
the immediate offspring of alcoholized animals, but is
conveyed through their descendants for at least three
generations. There are many instances of matings fol-
lowed by negative results or early abortions, stillborn
young or defectives. An instructive illustration was afford-
ed in a case in which two of the four young were complete-
ly eyeless, the eyeballs, optic nerves, and chiasma being
absent. Such defects result, according to Stockard, from
the injury originally inflicted on the germ cells by the
experimental treatment. Yet this injury may have been
received by early generations only. Thus the parents
of the anophthalmic guinea-pigs just mentioned were
untreated, their four grandparents were also untreated,
but their great-grandfathers were all alcohoHzed and their
great-grandmothers were all normal animals. The de-
fective eyes of the descendants are due to impaired
development, not to the direct action of alcohol. Plainly
the spermatozoon is actually weakened, if not disabled,
by the alcohol treatment and all individuals arising from
combinations involving such a germ cell are likely to be

66 Selections.

below normal. There is food for reflection in these facts.
— Jour. A. M. A.

NEUROTHERAPY

Pituitary Therapeutics, Etc. — "The knowledge
that extracts of the anterior lobe, which is glandular in
structure, are without marked immediate effects when
injected intravenously, whereas extracts of the posterior
lobe, which is a nervous structure, produce striking im-
mediate results is very interesting when one considers that
removal of the posterior lobe, is compatible with life, while
removal of the anterior lobe terminates fatally. * * ♦

Wulzen has recently found that when young fowls
are fed with anterior lobe substance a retardation of
growth res\ilted. This effect was especially marked in
males. * * * The most striking results have come
from the administration of posterior lobe extracts. Favor-
able results have been reported by many from the use
of posterior lobe extracts in the treatment of post-partum
hemorrhage, uterine inertia and postoperative shock;
on the other hand, its use in labor is in certain cases
followed by grave results, rupture of the uterus being
reported after the repeated administration of some com-
mercial preparations.

The recent work from the Hygienic Laboratory by
Roth of the Public Health Service on the standardization
of pituitary extracts may throw some light on some of the
results obtained in therapeutics. ♦ • * jje concludes
that there is need for uniformity in the strength of
commercial pituitary preparations, and to bring this about
advocates their standardization on the isolated uterus
of the virgin guinea-pig, suggesting an arbitrary standard.
He further suggests that clinical studies should then be
made to determine the therapeutic dosage." — Abstracted
from Ed. Jour. A. M. A., Dec. 19, 1914.

Selectiom. 67

Before the British Medico-Psychological As-
sociation of Great Britain and Ireland in last July the
Intra-thecal Treatment of General Paralysis was discussed
by Drs. Mapother and Beaton.

Unsatisfactory results were obtained in the earlier
attempts at the treatment of General Paralysis by intra-
venous infusion alone of salvarsan.

Attempts were made first to introduce salvarsan and
neo-salvarsan, in aqueous solution, by intraspinous in-
jection; unfortunate sequelas led to the temporary aban-
donment of this procedure, in part, at least, referable
to the vehicle in which the drug was dissolved rather
than to the drug itself, and later attempts, with modi-
fied technique, seem to show that such accidents are not
inevitable.

The occurrence of these accidents led to the substitu-
tion for a solution of the drugs of serum of patients
treated with them.

This method, the one used by the authors, is de-
scribed, as also are several modifications, especially those
consisting in the addition of arsenical drugs to the serum
in vitro. The relative values of these methods are dis-
cussed.

A statement is given of the results obtained by the
authors and a resume of those of other observers.

Several methods of intra-cranial administration have
been practiced; these and their results are described and
their justification discussed.

The article concludes with a consideration of the
question whether anatomical inacessibility of the spirochaete
constitutes by itself a complete explanation of the re-
fractory nature of the disease.

A Dysentery "Carrier." — Drs. Gettings and Wald-
ron discovered the dysentery bacillus in the stools of a
patient with loose motions but no other symptoms.

Her history revealed that her condition has existed
since admission, four years ago, yet without giving
clinical evidence of dysentery.

68 Selections.

American Therapeutic Notes. — The Medical Coun-
cil for October last has the following of interest at this
particular time, when our therapeutic resources
from across the ocean are denied us by force of the Euro-
pean unpleasantness :

"American gelsemium takes the place of coal-tar
drugs in nerve pain.

"American cimcifuga racemosa takes the place of
coal-tar drugs in muscle pain.

"American aconite is of peculiar virtue in the treat-
ment of the early stages of fever, especially with involved
mucous membrane.

"American hellebore, or veratrum viride, is of especial
value in the treatment of sthenic fevers, being often
better than coal-tar derivatives.

"American hemp, or cannabis sativa, is a fair substi-
tute for cannabis indica, more especially as a urinary
sedative and in spasmodic conditions, or where opium
disagrees.

"American piscidia erythrina, or Jamaica dogwood,
is a useful substitute for opium, when given in full doses,
especially as a cough sedative, in spasm and neuralgia
and in pain with fever.

"American hops, or humulus lupulus, as well as
lupulin, is of great value in the treatment of insomnia.
It is a most valuable anaphrodisiac, useful in priapism
and chordee. It also stimulates the appetite.

"American valerian, while not a narcotic, is classed
as a nervine, and acts upon the spinal centers. It is
indicated in the nervousness of depression, chorea and other
spasmodic conditions, as well as in hysteria.

"American ustilago, or com ergot, is a substitute
for rye ergot, from Russia. In fact, we know its action
to be excellent in uterine inertia. Then too, we have
American pituitrin to use in cases of labor.

"American xanthoxylum, or prickly ash, is a splendid
tonic in lack of nervous tone and as a general diffusible
tonic, stimulating the capillary circulation. More es-
pecially is it of value in catarrhal gastritis.

Selections. 69

"American stramonium, or jimson weed, may be used
as a substitute for belladonna. Apocynum cannabinum
fills many of the indications of digitalis. Crataegus
oxyacantha or English hawthorn growing in America,
is another heart remedy.

"American lobelia is a splendid antispasmodic. Ameri-
can sanguinaria, or bloodroot, is a tonic and stimulant
to the bronchial membranes, much neglected because it has
been given in too large doses. Asclepias tuberosa, or
pleurisy root, acts nicely upon the respiratory tissues."

Corpora Lutea Now Therapeutically Available.
— Corpora Lutea, for prescription purposes, has now been
made available through the manufacturers, thereof, by
Parke, Davis & Co. Corpora Lutea is largely used to
control the symptoms following removal of the ovaries,
and the nervous disturbances attending upon the menopause,
amenorrhea, dysmenorrhea, chlerosis and menorrhagia.
One writer calls it "a blessing to womankind."

The Pumpkin as a Diuretic. — An interesting and
therapeutically suggestive article by A. Kakowski in the
Zeitschrift fur physikalische und diatetische Therapie,
June and July, 1914, extolling the value of the pumpkin
when administered in large quantities in the treatment
of nephritic edema, attracted the editorial mind of Dr.
Stedman of the Medical Record, the substance of which
he thus presents in his last Sept. 19th number with an
introductory reference to oatmeal as a diabetic cure, etc.

"He finds that it fulfills the following requirements
of the ideal diuretic food; it should contain considerable
water and natural salts, but should be relatively free
from sodium chloride; it should be well borne by the
alimentary tract and should act as a mild laxative; it
should have nutritive value and should be palatable;
it should not irritate the kidneys and shotdd not give rise
to harmful metabolic products; and it should be easily ob-
tainable, cheap, and easily preserved.

70 Selections.

The edible portion of the pumpkin is prepared by
Kakowski in the form of a porridge, by being cut into
small pieces, covered with water, and boiled over a slow
fire for two hours. It is administered to the patient with
butter, milk, or cream, or preferably mixed with a rice
soup. The preparation most agreeable to the patient
is one in which the pumpkin is boiled with milk or
with cream.

The pumpkin cure was employed in severe cases
of chronic nephritis in which an edema had been rebel-
lious to the entire range of medicinal diuretics. Long
standing and massive edemas disappeared within a short
time under this method of treatment. Diuresis occurred
after the use only of enormous quantities of pumpkin,
varying from three to six pounds per day, and in most
cases directly proportional to the amount of this food
that was eaten. The diuresis occurred only during the
period of administration. The number of casts rapidly
diminished, and the reaction of the urine became alka-
Hne. There was no evidence of any irritating effect
upon the kidneys nor of any otherwise harmful influence
upon the body. In one of the author's cases as much
as 252 pounds of pumpkin were administered in the course
of 80 days without giving rise to any untoward effects
apart from large fluid stools. In addition to its diuretic
action the pumpkin is said by Kakowski to have a high
nutritive value, which fact is of particular importance
in the case of chronic nephritics in whom the diet is
usually greatly restricted.

Exophthalmic Goitre. — The Dominion Medical
Monthly (a good judge in its selections,) abstracts from
the Berliner Klin. Wochen. the following from Professor
Klose :

On the increasing safety and benefit from operative
treatment in this disease since resecting the thymus along
with the thyroid has been adopted, or removing the entire
thymus. It is now considered that the danger after
thjrroidectomy is due to acute intoxication from the

Selections 71

thymus after the thyroid is removed. It is interesting
to note that at Rehn's clinic there were eight deaths
from this cause alone in 130 operative cases up to 1911.
Since that time there have been 200 operations where the
thymus has been resected along with the thyroid, with
no deaths. Local anesthesia is always used, which with
the resection of the thymus has placed the treatment
of exophthalmic goitre on a new plane.

The Harmful Constituents of Roasted Coffee.
(Coffee- toxin.) — The disturbances of the digestion which
follow excessive coffee drinking are considered by the
author, in a communication to the Societe de Therapeu-
tique, not to be due in any degree to the caffeine, but
solely to certain volatile constituents formed, and only
partly volatilised, during roasting. These are named
cafeotoxin, and may be eliminated by submitting the roast-
ed coffee to successive treatment with steam under
pressure of several atmospheres, followed by exposure
under a vacuum. The coffee thus treated is called
"atoxicafe." It retains its caffeine unaltered. It differs
from ordinary coffee only in containing less cafeotoxin.
Cafeotoxin has a marked reducing action on haemo-
globin, a hypotensive action on the circulation, a depres-
sant action on the central nervous system, occasioning
cardiac arhythmia, and on the respiratory centres, caus-
ing dyspnoea. — J. Burmann (J. Pharm. Chim.) — Pacific
Phar.

Simple Sterilization of Water. — A French scientist,
M. Dienert, has discovered that drinking-water can be
completely sterilized by being placed in a vessel containing
a small piece of zinc and stirred from time to time. He
has placed distilled water in test tubes, with a small
piece of zinc in each, and then added cultures of various
microbes. After a time the microscope shows the mi-
crobes gathered about the zinc and all dead. Zinc and
zinc oxide are practically insoluble in water, but the bac-
teria cause slight quantities of these substances to be

72 Selections.

dissolved, probably because they secrete a small amount
of some acid. The amount of zinc dissolved, however,
is so small as to be absolutely harmless when taken in
with the water.

The extended use of zinc and "galvanized" iron vessels
as receptacles for drinking-water shows that the zinc
will last a very long time. This use of zinc or zinc-
lined containers works thus automatically to sterilize
the water placed in them. — Medical Herald, St. Joseph.

The Avitaminoses and Their Treatment. — H.
Stassano defines the avitaminoses as diseases resulting
from a deficiency of vitamines in the diet. The vitamines
are complex crystalline substances belonging to a chemical
group hitherto unknown. The nitrogen is not combined
in the amine radicle and can be extracted only in part
by the Kjeldahl method. The characteristic syndromes
of the avitaminoses are classified as follows: (1) The
syndrome of degeneration of nerves with paralyses and
contractures; (2) the cardiac syndrome with dilatation
of the right heart accompanied by dyspnea, cyanosis
and oliguria; and (3) the syndrome of anasarca, hydro-
pericardium, hydrothorax, and ascites; all of these three
syndromes belong to the group of cases properly called
beriberi. (4) The classical syndrome of scorbutus.
(5) The syndrome of pellagra. In all of the above
conditions the following articles of diet which are rich
in vitamines have been found to be of curative as well
as of prophylactic value; human milk, fresh cow's milk,
butter, cheese, yolk of egg, beef juice, fresh tomatoes,
fresh legumes and soups containing them, fresh fruits
or their juices, the sauce of stewed fruits, whole com or
wheat bread, unpolished rice, slightly roasted beef,
fresh yeast, extracts and preparations of yeast, and cod-
liver oil. — La Quinzaine Therapeutique. — Med. Record.

Successful Treatment of Tetanus Neonatorum. —
The N. Y. Med Rec, 8-29-14, thus presents this subject
in its London letter—

d

Selections. 73

"The undoubted power of magnesium sulphate as
used by intraspinous injections over the convulsions
of tetanus is offset by the fact that death may still
occur from severe complications, which may well be
ascribed in part to the paralyzing action of the drug.
Attempts are naturally being made to neutralize the
overaction of the magnesium. Before the Pedriatic Sec-
tion of the Verein fur innere Medizin und Kinderheilkunde,
Berlin, which met last July (Berliner klinische Wochen-
schrift, July 27) Falk reported three cases of tetanus
neonatorum, seen within four months, in all of which
recovery ensued. The solution of magnesium sulphate
employed varied from 8 to 25 per cent. To offset the
paralyzing action chlorate of calcium was injected. In
discussion Finkelstein added that the duration of the
disease was not diminished, but the treatment certainly
prevented the violent convulsions which often terminate
life suddenly and, moreover, gave opportunity to push
nourishment while the jaws were relaxed. Falk stated,
that feeding must be done early, and that one must be
sure that the magnesium has not caused deglutition
paralysis. Late feeding might set up spasms."

THE

ALIENIST AND NEUROLOGIST

Vol. XXXVI. St Louis, February, 1915. No. 1.

Subscription $5.00 per Annum in Advance $1.26 Single Copy

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NOTICE TO NEWS AGENTS

This magazine must not be expected to print whole pages of commercially devised,
fulsoraely laudatory puffing of proprietary advertisements, prepared by non-medical
commercial agencies who know nothing of the facts of therapeutics nor of the medical
code of ethics. Some of the puffs are bo far from the truth that they are an insult
to medic^ intelligence and do more harm than good to worthy proprietaries.

Such proprietaries as we carry speak for themselves with physicians, especially
when their composition appears. Our readers are discriminating judges of what
they want.

CONCERNING RENEWALS OF SUBSCRIPTIONS

This magazine would be much indebted to its regular subsciibers and advertisers
if they would renew by direct communication with this office, especially in the United
States, and not through news agents.

CHAS. H. HUGHES, M. D., Editor and Publisher.
Editorial and Business Offices, 3858 West Pine Boul.

EDITORIAL

Freud's Method of Psychoanalytic Diagnosis
is conducted under the propulsion of preconceived im-
pression and suggestion carried to the point of hypnosis
when the patient or victim of his questioning responds
acquiescently to the answer sought.

The Freud method of interrogation would be consid-
ered leading in a court of justice and would be objected
to by counsel and the objection sustained by a just and

(74)

I

Editorial. 75

learned judge. What value shall we attach to such meth-
ods of medical diagnosis?

Candidates for Assistant Surgeon in the Public
Health Service will be examined for admission on March
8th, 1915 at Washington, Boston, New York, Chicago,
St. Louis, Louisville, New Orleans. Applicants for
invitation to appear for examination will apply to Surgeon-
General, Public Health Service, Washington, D. C.
Further details as to requirements can be found in the
medical weeklies.

Trained Men for State Institutions.— Senator
Moore's bill to take the state institutions out of the
domain of partisan politics is before the Legislature of
Missouri. On this The Republic correctly comments:

"There are branches of the public service which
can be managed by any man who is competent to manage
a store or a factory. Training in the ordinary walks of
life is training for that kind of service. There are other
branches of the public service for which no ordinary
sort of private activity will prepare any man. Into this
class falls the management of prisons, reformatories,
asylums for the insane and schools for defectives. When
positions in such institutions are filled for political reasons,
no matter how good the raw material may be, the State
is compelled to educate its servants at the expense of its
wards. About the time ♦'he education is complete the
political wheel turns and a new set of incompetents
comes in to learn again what the State has just succeeded
in teaching the old set. The folly of this proceeding
is sufficient to condemn it, but its unfairness to the in-
mates of State institutions is shocking. Senator Moore's
bill is intended to change this condition and to give the
State the services of the men whom it must train and
can rarely get in any other way than by training them."

The New Barnes Hospital, connected with the
Washington University, is conceded to be the latest and
best in all its superior appointments.

76 Editorial.

The Philadelphia Post-Graduate School of
Neurology's Faculty is composed of the following named
gentlemen: Drs. Charles K. Mills, Charles W. Burr,
William G. Spiller, James Hendrie Lloyd, Charles S. Potts,
D. J. McCarthy, T. H. Weisenburg, George E. Price.

Dr. Francis X. Dercum, 1719 Walnut St., Consulting
Neurologist, will take part in the instruction. Address
Dr. Charles K. Mills, Dean, 1909 Chestnut St., Phila-
delphia.

No further commendation of this advanced endeavor
in the line of medical education need here be named.

It Is Estimated that the number of feeble-minded
children in St. Louis is over 1000 and there is on record
in the office of the Children's Aid Society the names of
410 children who need institutional care. The State
institution at Marshall can only accommodate a small
number of those needing care.

Dr. Johnson, Superintendent of the Institution for
Feeble- Minded of Vineland, N. J., showed in a recent
lecture the immediate necessity of providing care and
training and medical treatment for these unfortunate
children.

These unfortunates need more than training. They
need treatment to put them in the best physical and sani-
tary condition for more favorable development, during the
period of growth especially. The need all the time of
their progress toward adult life, open bowels cleaned of
absorbable blood impairing ptomaines, the most digesti-
ble, easily assimible reconstructive food, ample sleep, etc.
in their growing stages to atone for and remedy defective
hereditary endowment, so far as may be practical, and
eugenic preventive management of parents to save the
yet unborn from the sequels of parental inebriety and
otherwise vicious, unsanitary, degenerating lives. To
avert race decadence is a big burden devolving upon the
present generation, involving much more than the present
day physiological enlightenment and its wise eugenic
application.

i

Editorial. 77

Caution to Surgeons as to Lumbar Puncture where
Brain Tumor Exists.

About a decade ago a warning against this practice
where brain tumor was present or expected, went out
from the Berlin Psychiatric and Neurologic Society, Ger-
hardt being the author of the warning, citing quite a large
number of fatalities up to that time, (25 or 26) to which
a considerable number have been added since.

Surgery may learn something here, as elsewhere, from
neuro-pathological observation and advance. At the
same seance eminent and cautious medical men counselled
ordinary unsurgically trained general practitioners not to
attempt the spinal puncture anyway, but American
country practitioners may become sufficiently skilful here,
as elsewhere, in sero-therapy of which spinal puncture
has become an important and essential therapeutic and
diagnostic practice.

Why Not make the present Marine Hospital
and Public Health Service into a National Department
of Health and put Surgeon General Blue in the cabinet
of the President and Surgeon-General Gorgas there also?

The Prize Dissertation. — The British Medico-
Psychological Association ofiPers a Bronze Medal and
Ten Guineas to any Assistant Medical Officer of any
Lunatic Asylum (public or private) or of any Lunatic
Hospital in the United Kingdom, for the best dissertation
on any Clinical or Pathological Subject relating to Insani-
ty.

Dr. C. B. Burr, Medical Director of the Oak Grove
Hospital for Mental and Nervous Diseases, author of
"Psychology and Mental Diseases" and noted writer
for this magazine, has an interesting and instructive
contribution on "Witchcraft in Certain Medical and
Legal Relations" in "Case and Comment," a lawyer's
magazine, for November last, which is good reading from
a right and competent source of correct clinical observa-

78 Editorial.

tion for jurists or physicians and students of the human
mind generally. We cordially commend it to the readers
of the Alienist and Neurologist.

Prince Bismarck was once pressed by a certain official
to recommend his son for a diplomatic place. "He is a
very remarkable fellow," said the proud father. "He
speaks several languages." "Indeed!" said Bismarck,
who did not hold a very high opinion of Unguistic ac-
quirements, "what a wonderful head- waiter he would
make ! ' ' — Christian Register.

Commended to doctors who maintain that physicians
should be modem linguists before being considered quali-
fied to practice medicine. An undergraduate would be
helped in his studies with at least a philological knowledge
of Greek and Latin. A post-graduate physician might
profit by the mastering of as many modem languages
as study and practice circumstances should demand.
Valuable as this knowledge is, it is not more essential
than what is necessary for waiting on a table where
different modem languages are spoken.

Detectives for Hospitals for the Insane. — There
is a good deal of human nature among attendants for
the insane in these hospitals and a few get into this
service who are sometimes as vicious and cussed as we see
outside of these worthy institutions, necessitating detectives
and police.

It is no reflection on the good attendant that this
is so, any more than it is upon society in general that
detectives and police are a necessity for the protection
of rightly governed society. But all hospitals should
have detectives for the protection of the help-
less insane, for some attendants think they know best
how to treat the patient, despite rules against violence
towards them and occasionally show their cowardly
prowess by roughly handling these tmfortunates, for
in their hearts the law of kindness unto them abideth
not, though this law is enjoined in all good hospitals.

r

Editorial. 79

Doctors. — Please send us your best views of your
patients enjoying themselves by diversion, amusement
or occupation in your institutions. The chief aim of
this magazine, aside from its scientific purpose, is to
enlighten the profession and people as to the homelike,
humane and curative features of hospitals, homes, sani-
taria and sanitoria for the mentally maimed and divest
the unfamiliar mind of the adverse prejudice yet pre-
vailing in many quarters, as to the insane, and remove
the unjust stigma that still attaches, in ill-informed
minds, toward the unfortunate victims of mental disease.

Erratum. — On page 442 of Vol. 35, in line 20, for
Boston read Salem, Mass.

The Alienist and Neurologist is a magazine of
Psychiatry, Neuriatry, Psychology, Eugenics and ad-
vanced knowledge for physicians, surgeons, attorneys,
clergymen, literati and non-aligned anthropologists, crim-
inologists and student seekers after anatomical and
psychological knowledge in relation to the nervous systems
and minds. $5.00 per year in advance.

Apropos of the Program of the combined meeting
of the New York Neurological Society and the Neurolog-
ical Section of the New York Academy of Medicine,
November 10th, 1914, shows the signs of the times in
professional appreciation of neurological progress.

Trench Caused Insanity in the Battle Area of
Europe is one of the results of the present sequences
of the unique rheumatism-engendering, opposing trench
war now raging in Europe.

The close proximity of opposing trenches, the screech-
ing murderous artillery, the overhead constant peril
and underfoot dampness in the ditches, the wet and freez-
ing, body-soaking and shivering weather, the sleep de-
stroying power of the nerve and brain racking, night and
day cannonading, are mutually destructive work beyond

80 Editorial.

all previous deadly, destroying deeds of war. The ele-
ments and armaments of this gigantic, unprecedented,
destructive world war, making the exhaustion of all
contestants only a matter of time, when the peace of
mutual destructive exhaustion shall come, with its victory
of mutual slaughter and enforced rest, as even now,
the respective combatants must come or be taken betimes
to places of rest and temporary safety from insanity,
and the other wounded and dead, calamities of the most
murderous war contest of all time, when peace will
have her sequent victory more "renowned than war"
and a rejoicing world may have seen the horrors and repair
the world harm of the present unjustifiable military madness
of army mustering Kings and Monarchs.

Taking Care of the By-Products. — During the
past year a Kansas City whiskey establishment, (notes
the St. Louis Republic early in the- year) engaged in the
"selling of mailing hsts to jag cures, which illustrates,"
it says, "the modem tendency toward the utilization
of by-products."

In this connection, may we not hope from the phlebotomy
tragedy now taking place in Europe, a peace serum may
be evolved which will give Europe relief from militarism
and starvation? Poor suffering Belgium, poor little Servia.

The Appropriation for the sanitary protection of the
five million and more of population of Illinois last year
was $30,000 less than that appropriated for the protection
of the fish and game law of the State.

The Many Hospitals and Sanitariums to which
this magazine goes, prompts us to suggest that the re-
port of the Department of Agriculture at Washington,
D. C. on the "human health and the foot and mouth
disease" be sent for and its suggestions followed.

Among the Most Prominent Deceased St. Louis
Physicians last year were Dr. Ludwig Bremer, Dr. J. K.
Bauduy, Dr. Washington E. Fischel, Dr. Ernst Saxl and

Editorial. 81

Dr. H. M. Post, the latter two being oculists, the two
former being neurologists. All were men of mark in
their several fields of work. Dr. Bremer died in Dresden,
April 12th, and the others in St. Louis. The two first
named were neurologists of merit and eminence.

W. B. Kern, M. D., recent Medical Superintendent
Ingleside State Hospital for Insane, Hastings, Neb.,
is now located at 722 Baker-Detwiler Building, 412 West
Sixth Street, Los Angeles.

When You Write for This Magazine on a matter
of practice make it known on what warrant of experience
you claim the attention of our readers. Do not be too
modest on this subject as time is valuable and life is
fleeting. Up to date the contributions to our pages
have been profitable reading and we wish to always have
them so. We have occasionally had to refuse manuscripts
because they were not adapted to our pages, making a
profitless time demand on our readers.

Drawing on the imagination and reciting therefrom
as to the curabiUty, for instance, of insanity as the non-
clinical experts sometimes do in court, is a robbery of the
readers' time.

The Dual Source op the Cerebro-Spinal Fluid
is in the choroid plexus and in the cerebral capillaries,
according to Dandy and Blackfan, Frazier, Peet and
Gushing.

Internal hydrocephalus was produced by Frazier and
Peet by blocking the Sylvian acqueduct. It may also
be a cerebral perivascular space sheath excretion. The
internal nutrient bath of the arteries and cord and the
external bath of the nerves. (For elaboration see Jour.
A. M. A., 12-19-14, p. 232.)

With the Privilege of Citizenship in a Republic
should be allied a right appreciation of meum and teum,
i. e., a fair-play regard for your neighbor's rights to

82 Editorial.

quietude, sanitation and comfortable isolation of his home
from the noise, bustle and other annoyances of city
life. He is entitled to the protected personal right
to rest and sleep, if he provides for it in a secluded home.
His front yard, if he legally possess it, and the private
street by his premises, if he provides it and not the city,
is his for enjoyment.

Yet a citizen, who ought not to be a citizen of a free
fair-play government, proposes, in a city of a free state,
to pull down the gates of a privately owned place, with-
out public necessity or legal condemnation and compensa-
tion, not especially needed for pubUc uses. Such a man
has the spirit of the autocrat rather than the democrat
and ought to seek an unlimited monarchy for his residence
where "might makes right."

"A man's house is his castle" and this includes his
grounds and the road he makes to and by it. His
comfort and his health and his family's are to be respected.
His front yard and the street he makes in front of it he
owns and considers its privacy necessary to his comfort
and health and pleasure is his to control, even in monarch-
ical England and Germany, which are freer in some re-
spects than in this "land of the free," from the tyrannically
minded members of some of our "free and equal" legis-
lators.

The constitutional guarantee of "Uberty in the
pursuit of happiness," subject only to rational restraint
against evil and harm to others, wUl always be regarded
by our highest courts.

Papine (Battle & Co.) is said by the Council on
Pharmacy A. M. A. to be a simple aqueous alcoholic
solution of morphine, containing one grain to each ounce
and exploited under the utterly unwarranted claim that
it does not nauseate, constipate, nor create a habit.

Disprove this, gentlemen proprietors, or withdraw
from the medical patronage market.

Rheumatism and Rheumatoid Insanity will be not
the least of the trench fighting sequences of the present

1

Editorial. 83

remarkable war in Europe and no specially coined German
name will alleviate the misery of this cruel infliction of
monarchical antagonism.

A Case of Hereditary Persistent Suicidal Im-
pulse is under observation and restraint in the St. Louis
City Hospital. The young man is eighteen years of age.
His morbid impulsions have recurred at frequent inter-
vals since early childhood. He is comely and intelligent
in appearance, of medium height, without cranial, facial or
other physical deformity. His father suicided five years
ago and his mother two. His name is Rajrmond Broemser.

Considerate Kindness to the Insane. — While every
hospital for the insane has printed rules against handling of
patients and so far as practicable, enforces kindness as
the rule of such institutions, the utmost viligance by
officials thereof does not always prevent a certain few
brutally-minded and often extremely ignorant and smart-
Alex attendants, from trying methods of their own
clandestinely on the unfortunately refractory patients.
An instance in proof came to light recently in a distant
state hospital, where an aged dement was strangled and
beaten to death by a trio of the brutal, smart-Alex sort
of attendants, because he did not know enough to stay
in bed and go to sleep at the command of his supposedly
sane nurses. Thus this cruel criminal trio "fixed" (as they
called it) this poor lunatic by crushing the life out of
him. Such brutality deserves the halter or electric chair.

He stayed in bed after the beating they gave him
because he could not get out and a few days thereafter
he stayed in his coffin, without even turning over. Un-
ceasing vigilance and rigid discipline against cruelty in
behalf of patients is the price of justice to the insane of
every State insane hospital. They demand a higher order
of disciplinary judgment and charitableness on the part
of medical attendants than they sometimes get, especially
where positions are the rewards of political affiliation
and service.

84 Editorial.

The Carnegie Eugenic Commission, at Cold Spring
Harbor, L. I. have decided to take up the question of
alcoholic heredity and make a scientific study of it.
A trained worker has been assigned to Walnut Lodge
Hospital, Hartford, Conn., to make exhaustive researches
under the direction of Dr. T. D. Crothers, the Superin-
tendent. This institution has been thirty-five years re-
ceiving and treating cases, and the records of these
number many thousands. The object is, to determine
something definite from these facts on the great questions
of alcohol and heredity.

Les Medicins Humanistes. — A society of this name
has been organized in Paris, with the object of uniting
physicians who are interested in literature in its re-
lations with biological sciences, to advance in every possi-
ble way the revival of the study of Greek and Latin,
and to bring about a reaction against neglect of the hu-
manities in all curricula preliminary to the study of medi-
cine. At the meeting of February 23rd, Dr. Berchon,
the secretary of the society, gave an extensive resume of
Dr. A. Rose's book, "Medical Greek," which resume will
appear in the journal of the society. In La Chronique
Medicale of April appeared an interesting review of this
book for which we regret we have not space in this issue.
But the American Practitioner, New York, May, 1914,
gives the conclusion.

Dr. Achilles Rose. — "Among men who achieve"
an idea, and persist in bringing it to our attention, is
this physician, native of the German Empire, visitor and
student among the Greeks, and, now, resident of New
York. A. Rose is interested in purifying our scientific
terminology, regarding Greek derivations, so that modem
Greek shall find our use of it correct. When we go
to Paris and read of "bif-stek" or "bouledog" we appre-
ciate in part the feeUngs of an outraged Hellenist. Dr.
Rose wishes us to remember that Greek still Uves. and is
spoken. It, to him, as to many others, offers an excellent

Editorial. 85

means of general communication. As our terms are often
coined by inexperienced men, his idea of harmony and
correctness seems to the point. We certainly ought not
to form words which would cause an Athenian to doubt
his own ears and his native tongue."

Thus T. H. E. writes in the Medical Fortnightly
of this eminent Greek scholar and enthusiast for pure
Greek in medical nomenclature wherever terms are de-
rived from this classical language.

Death of Dr. Jerome K. Bauduy. — "For many years
up to some six or eight years ago one of the most notable
figures in the St. Louis profession was that of Dr. Jerome
K. Bauduy, a man prominent professionally, intellectually,
socially and as a teacher; one of the men who made the
Old Missouri Medical College the power which it was.
Though still in practice and still teaching it was generally
recognized during the later years of his St. Louis resi-
dence that his health was not good, his disappearance
from among us caused little comment until it became
prolonged, it took considerable inquiry to discover the
fact that he had gone to a sanitarium in western New
York, in which institution he spent the remaining years
of his life. His death took place on October 16, and
his burial was from St. Francis Xavier's church in this
city on the 19th. He was 74 years of age. For a quarter
century Dr. Bauduy was physician-in-chief at St. Vincent's
Asylum and held chairs in nervous diseases and medical
jurisprudence in the Missouri Medical College, and later
at the St. Louis Medical College of Washington Universi-
ty. He served under Rosecrans in the Civil War. He
was the author of many treatises on nervous and mental
diseases and testified as an alienist in the famous Dues-
trow murder trial. He was born in Cuba and was educated
at Georgetown University, the University of Louvaine,
Belgium, and received the degree of doctor of medicine
from Jefferson Medical College, Philadelphia. The vast
body of physicians who knew Dr. Bauduy as students
under him, and those who knew him as fellows in prac-

86 Editorial

tice will be profoundly grieved that the long silence is
broken only by word of his death."

Thus records the Medical Fortnightly of our long
time friend and genial, talented and meritorious physi-
cian, whose demise so many men of medicine mourn.
His was a kindly and genial personality.

Medically Enlightening the Public — The fol-
lowing items from the same front page of a daily news-
paper show how the public is being enlightened and
incidentally shows the newspaper appreciation of the
same, especially since Osteopaths are not physicians and
whose very name is an illiterate misnomer, osteopath,
meaning, from its derivation literally, a bone disease
or a bone diseased condition or person:

NOTED OSTEOPATH TO SPEAK

"Osteopathic physicians and surgeons of St. Louis
and vicinity will observe "Osteopathy Day" next Friday.
Dr. R. Kendrick Smith will give a popular public lecture
in the evening in the blue room of Hotel Buckingham.
The lecture will be preceded by a banquet.

"Dr. Smith at noon the same day will be the speaker
at the City Club luncheon. In the afternoon he will
hold clinics at the scientific session.

"Dr. Smith is director of the department of public
health and education of the American Osteopathic Asso-
ciation and is on a lecture tour of the West. He is the
author of many magazine articles. Dr. Smith is president
of the Boston Browning Society."

FREE LECTURE ON ADENOIDS

"The fifth lecture on 'Preventive Medicine,' free
to the public, under the auspices of the Social Service
Committee of the St. Louis Children's Hospital, will
be given in the lecture hall, 600 South Kingshighway,
at 3:45 o'clock Tuesday afternoon, by Dr. Greenfield
Sluder, on 'The Ear, Nose, and Throat.' Dr. Sluder
will treat in detail the problem of tonsils."

The newspaper's preferable appreciation of the "quack"
shown here as to space allotted is suggestive.

Editorial. 87

Insane Murderers Acquitted on the ground of
insanity and set free on the ground of a jury's diagnosis
of recovery at the close of the trial, should be given the
benefit of the doubt as to permanent recovery, by a
supplemental verdict of indeterminate insane asyltun
sentence for further observation, as in the case of Harry
K. Thaw. Safety first.

There is such a brain disease as recurrent transitory
mania which true psychiatric experts with right clinical
experience recognize. As a matter of sound public policy
medical men who pose as experts and testify before courts in
such cases should only do so by warrant of ripe and right
clinical experiences with the insane and not testify from
their inner consciousness only as to what they think may
constitute insanity and recovery.

CORRESPONDENCE

The Bravest Thing I Ever Did. — My parents
now live in a town in which is located one of the State
Hospitals for the Insane. On the occasion of my first
visit to them in their new home, we went one day to
visit the Institution. I took with me my little daughter,
Marjorie, aged two and a half years.

On our arrival we were impressed with the extreme
beauty of the grounds, but a sight of the poor benighted
creatures staring vacantly at us, marred the beauty
and cast a gloom over our spirits. On entering the main
building we were taken in charge by a capable looking
matron, who piloted us off on our tour of sightseeing.
While we were still on the first floor I chanced to glance
upward, and there on an open landing two stories above
us, was a woman staring intently at some object below.
She was muttering strangely and making deep swooping
motions with her arms, like a chicken hawk swooping
for its prey. I turned to see what was attracting her
attention and discovered that it was my wee Marjorie
who had wandered apart from us. I hurried to her
and brought her back, mentally resolving not to let
go her hand while we were in that place. I related the
incident to my companions and the matron said, "Poor
Meg. She lost three children in a fire that burned out
an entire block in which her house was situated. She
has been here ever since. Children have always had
a peculiar fascination for her. We never leave her alone
with one."

When we had arrived on the third floor Marjorie
complained of weariness and refused to go on. So my
parents went on with their guide and she and I sat down

(88)

Correspondence. 89

on a settee near a window. She sat there for a few
minutes, Marjorie contentedly munching some cookies
and I became interested in watching some of the inmates
working in the garden below. After a time I became aware
that Marjorie was not beside me. A nameless fear
seized me and I started up calling, "Marjorie! Marjorie!"
A little voice answered, "Here me, mama!" I followed
in the direction from whence it came, and found myself
on the landing which I had seen from the first floor.
And there sat my baby on the lap of that insane woman!
She was eating a stick of dirty looking candy, while
the woman was fondling her face, hair and hands and
kissing her hungrily. I rushed forward with a cry of
horror and attempted to take her, but the woman evi-
dently reading the loathing in my face, hugged the child
to her breast and leered maliciously at me. Strangely
enough Marjorie clung to her and showed no desire
to come to me. Suddenly the woman arose, walked to
the railing, grasped Marjorie by each little arm and swung
her out into space, twenty feet above the first floor.
Then she turned to me and said in a voice of awful
earnestness, "Go! or I will drop your baby down, down,
DOWN!" Oh, the torture of that moment! My heart
seemed to die within me. Then a feeling of wonderful
calm possessed me. I sensed the danger of opposing this
crazed creature. With a prayer on my lips, I turned
and walked away. As I think of it now I marvel at
the strength that was given me for that act. Then it
occurred to me to sing. I seemed to remember having
heard of the power of song in subduing a lunatic. I
began to sing as clearly and evenly as my overstrung
nerves would allow. I have never been able to recall
what I sang, neither had I any consciousness of it at
the time. After what seemed an eternity to me I heard
the patter of Marjorie's little feet behind me accompanied
by the heavier tread of her captor. I walked slowly
and went steadily on with my song. Then out from a
side corridor into the main one stepped my father,
mother and the matron. I whirled, grasped Marjorie

90 Correspondence.

before the watchful woman was aware of my movement
rushed forward, thrust her into my father's arms and
then did the most womanly thing possible — fainted.

Elsie R. Campbell, Ireton, Iowa.

We give place to this to show the outside view, in
some minds, of the inside of a hospital for the insane
by a visitor novice. It is exceptional for patients like
the above, with delusions concerning children, to be ac-
cessible to little children unaccompanied. This child
might have been conducted. Though the child might
have gone with safety through half the halls of a
modem hospital for the insane unaccompanied, it was not
wise to let so little and helpless a child loose from the
hand of a guide or guardian.

The so-called horrors of the average insane hospital
as now conducted, with the insane classes separated and
classified, is not much of a place of horror. Many blankly
staring dements are not personally unhappy, but some
are in fact happy in their fatuity; others, not so grave-
ly demented are often extremely happy in their delusions,
even happier than in the days of their sanity.

Some overwrought emotion and imagination appears
in the above relation which would have been dissipated
after further familiarity with the insane. The correct
interpretation of insanity in its many manifestations
is a matter, mostly, of expert experience. We wonder
how and where this lady learned of the existence of the
Alienist and Neurologist.

The lady is right about the influence of song upon
the insane. Sweet song, like pleasing instrumental
music, hath charms to soothe the insane as it does the
savage and is one of the instrumentalities of cure in our
modern hospitals, as well as the dance for dancers.

Fatal Accidents Following the Injection of
Antimeningitis Serum. — Continuous Warm Bath for
Phymatiasis and Other Infections.

To the Editor:- Referring to Dr. Kraemer's article
under this title published in the New York Medical

Correspondence. 91

Journal, June 20, 1914, I beg to quote from my paper,
The Continuous Warm Water Bath the Rational Remedy
in Phymatiasis and Infectious Diseases in General.

"The power of the continuous bath of eliminating
products of infection can further be demonstrated by its
application in cases of cerebrospinal meningitis. The
literature concerning serum treatment in this disease has
assumed formidable dimensions, and the enthusiasm
over this new method is so great that it appears to be a
bold undertaking to speak of another remedy in place
of the antimeningitic serum, as it is called. However,
the enthusiasm may subside and the rational and safe
remedy, which we have in the continuous bath, may be
considered.

"Strange to say, this carefully prepared paper, in
which I gave the physiological explanation of the action
of the continuous bath, and which was published in
'International Clinics' II, 23, none of our American medi-
cal journals, with one exception, has noticed, while a
German translation was reviewed in German medical
periodicals. Having mailed ten thousand copies of the
original English version, I received many letters of
acknowledgment and approval from distinguished col-
leagues, but remarks of mine on the still much advertised
Flexner serum were not accepted for publication." —
A Rose, M. D.

REVIEWS, BOOK NOTICES, REPRINTS, ETC.

Mental Medicine and Nursing for use in Training
Schools for nurses and in medical classes and a ready
reference for the general practitioner, by Robert Rowland
Chase, A.M., M.D., Physician-in-chief Friends Asylum
for the Insane; late resident physician. State Hospital,
Norristown, Pa.; Member of the American Medico-
Psychological Association; Member of the Neurological
and Psychiatric Societies, Philadelphia. 78 illustrations.
Philadelphia and London, J. B. Lippincott Company.

This is one of the very best and most practical books
for the purpose designed by the author, that has come
to our editorial sanctum during ^the past year. It is
written by a psychiatric physician of adequate clinical
experience, as an introduction to the study of mental
diseases and it will not disappoint the student, the nurse
and even the general practitioner in the plain essentials
of mental and nervous conditions and their management
and treatment.

The illustrations of types of mental disease and the
anatomical showing of the principal nerve centers and
tracts are clear and fully instructive for the beginner
in neurology.

Among the illustrations is one of an insane woman
burned as a witch in Scotland in 1773, as was done in our
own Mass. at Lynn, when this sort of superstition warped
the minds of the people, also a heavily manacled man
in a bare cold cell where he had been confined for years
in happy contrast with which appears also an illustration
of our own modern and humane provision for both in-
door and non-restraint recreation and light employment.
Also a copy of the painting of Pinel liberating the chained

(92)

Reviews, Book Notices, Reprints, Etc. 93

lunatics of Salpetriere in France, twenty years after the
Scotch witch burning popular craze.

The introductory to nurses about artificial feeding
and the general care of the insane are thoroughly sound.
The price of this good book could not be mis-spent.

Radio-Activity. — By Charles R. Stevens, Broadway
Pub. Co., New York. Since the new era of radio-activity
has come this little book is of special value to all thera-
peutists. It is full of valuable fact and suggestion.

Contributions From the Physiological Labora-
tory OF THE Medico-Chirurgical COLLEGE of Philadelphia,
by Isaac Ott, A.M., M.D. Member of Amer. Physiologi-
cal Assn., Amer. Soc. for Pharm. Ex-Pres. Amer. Neurol.
Assn., Phila. Med. Club., Phila. Neurol. Soc, etc., etc.,
and John C. Scott, M. D., Lecturer on Exper. Physiol.

This is part 20 of Ott's Contributions to Physiology
for 1914 and a very interesting and instructive report
it is.

Dr. Ott is one of the foremost of American biological
investigators and discoverers. This report with that of
his able colleague. Dr. Scott, shall claim our attention
in a subsequent issue.

Besides the valuable contributions of this brochure
on the effects of animal extracts and internal secretions
on the thyroid, the corpus luteum, the spleen, pancreas,
sections of the vagus, sympathetic, etc., these contribu-
tions include portraits of Brown-Sequard, Perkinje and
addresses on both. Every reader of the Alienist and
Neurologist will read the whole with interest and profit.

Has THE Old Man the Right to Live? By J.
Martine Kershaw, M. D., St. Louis.

This author answers, he has. It is a pathetic anti-
euthanasia plea. It justly maintains that the medical
profession is with him. Euthanasia may be simply
therapeutic and not fatal. It should stop at physiological
analgesia and never go farther. All other euthanasia is
heartless murder.

94 Reviews, Book Notices, Reprints, Etc.

The Program of the Medico-Psychological As-
sociation for its late meeting at Baltimore came to us
with the handsome and benign face of its president,
Dr. Carlos F. MacDonald, gracing a frontal page.

An interesting practical program on prevalent psy-
choses follows, including the all important venereal states,
the spirochetae-pellidae in paretic brains, the equally
important relations of internal medicine to psychiatry
(and we would suggest, vice versa, for the next meeting).
A criticism of psychoanalysis, eugenics, general paralysis,
its pathology and diagnosis and a symposium thereon,
eugenics applied, insanities in children, brain finding
in manic-depressive subjects, cerebellar tumor. Abder-
haldendiclysis in psychiatry, the prevention of suicide, the
psychopathies of children. The Establishment of Train-
ing Schools for Attendants for the Insane, by W. D.
Granger, M.D., New York, Report of Com. on Psycholo-
gy in Medical Schools by E. -Stanley Abbot, M.D.,
Waverly, a Report on Five Cases of Intra-cranial In-
jection of Auto-Sero-Salvarsan and a number of other
questions for discussion came up at this instructive
meeting.

Berger's Diagnosis of Cardio-Vascular Diseases
is an instructive pocket brochure published and sent
out by the Sultan Drug Co. of St. Louis.

It is a condensed, epitomized treatise on the principal
disease included in the caption. The text, as the author
states in his preface, is simple, concise and destitute of
ambiguity. Common-sense, clinical facts and useful draw-
ings characterize the text and illustrations.

By the same author and from the same publication
sotu-ce is "An Epitome of the Diagnosis of Nervous
Diseases Including Bromide Therapy."

The text and illustrations are reliable. This little
manual is not detracted from by the commendation of Pea-
cock's Bromides, nor by the attestation of the several
analyses from reputable chemists.

Reviews, Book Notices, Reprints, Etc. 95

Journal of Psycho-Asthenics, Nos. 1, 2, 3, 4.,
Vol. XIII. — The only periodical in the English language
of general circulation devoted exclusively to the interests
of the Feeble-Minded and of Epileptics. Published
under the auspices of the American Association for the
Study of the Feeble-Minded. Officers: President, W. N,
Bullard, M.D., Boston, Mass.; Vice-President, Miss
Mattie Gundry, Falls Church, Va.; Secretary and Treas-
urer, A. C. Rogers, M.D., Faribault, Minn. Subscription
SI. 00 per annum; single copies, 30c. Address communi-
cations to the Journal of Psycho-Asthenics, or to Dr.
A. C. Rogers, Faribault, Minnesota.

These are the only numbers of this interesting magazine
we have seen. Its table of contents interested us as val-
uable and practical but the numbers disappeared from
our office mysteriously shortly after they came to our edi-
torial notice.

We should like to see more of it. We recall an es-
pecially valuable article in the number we saw on Epilep-
tic Dementia, Imbecility and Idiocy, by Wm. T. Shana-
han of Sonyea, N. Y., especially interesting to alienists.

The Journal of Experimental Medicine, edited
by Simon Flexner, M.D., Vol. XIX, No. 2, 1914, New
York, Rockefeller Inst, for Med. Research came during
our absence from the city last year and escaped ack-
nowledgment and notice. It is a well written and illus-
trated volume showing mostly the transplantability of
adult mammalian tissue in simple plasma, the behavior
of elastic tissue in post-foetal occlusion, the pathology
of epidemic poliomyelitis, intra-spinous infection in ex-
perimental poliomyelitis, epedimiology of poliomyelitis,
studies in tissue specific, etc.

This work is indispensable to the searchers after
light in medicine and justifies the grand conception
and great outlay of the great and distinguished philan-
thropic founder. Rockefeller, of the institute that bears
his worthy name.

96 Reviews, Book Notices, Reprints, Etc.

Psychology in Daily Life. — By Carl Emil Seashore,
D. Appleton & Co., New York and London, with an
introduction by Professor Jashow of the University of
Wisconsin. $1.50 net, by mail $1.62.

This volume represents the general purpose of the
conduct of mind series which is, to present the severed
aspects of mental affairs which are involved in the regu-
lation of practical interests. The volume comprises a
selection of illustrative material with their interpretation
and serves as an introduction to the study of psychology.

It deals with play, illusion, mental measurement,
mental health and mental efficiency. The illustrations
are typical of the problems of psychology and at once
suggest how completely the issues of our daily life are
conditioned by the psychological basis. The work is free
from technical terms and presents a fresh and original
arrangement of the material characteristic of modem
interest in the laws of the mind. The chapter and illus-
trations of illusion are unique. The latter from Frazer.

Implantation of the Generative Glands and its
Therapeutic Possibilities. — Successful auto-implanta-
tion of a testis from a subject dead twenty-four hours.
Other successftol implantations of testes and ovaries from
dead subjects. Experimental implantations in various
conditions, and cross implantation of testes and ovaries
taken from dead subjects. By G. Frank Lydston,
Chicago, formerly Professor of genito-urinary diseases and
syphilogy, Med. Dept. State Univ. of Ills. From the
New York Med. Jour, for Oct. 17, 24, 31, Nov., 1914.

This contribution by the distinguished author of the
"Diseases of Society" and "Degeneracy," "The Blood
of the Fathers", etc., the eminent genito-urinary surgeon
of Chicago who presents here the most practical and
probably the most epoch-making contribution to the
literature of our time on the glandular physiology and
surgical therapy of the testes is uniquely entertaining
to the student of sex gland therapy and the alienist and
neurologist.

i

Reviews, Book Notices, Reprints, Etc. 97

The early stages of locomotor ataxia, paresis, chronic
inebriety, dementia praecox, senility, etc. improved, cor-
rected or cured by sex gland transplantation as demon-
strated and maintained by the author can not fail as the
author asserts it to be of so great an advantage in thera-
peutics, as to relegate certain gland extracts to the dead
member, soon supplanted by living extracts administered
continually via the implanted gland tissue.

"The Red Man," a Carlisle Indian School illustrated
publication, whose purpose is to train Indians as teachers,
home makers, mechanics, and industrial leaders either
among their own people or in competition with whites,
comes to us often enough to keep us reminded of the
rights of these red men of the plains and reservations
and of their wrongs at the hands of a too little vigilant
government.

This school, founded in 1879 and first appropriated
for by Congress in 1883, is a meagre atonement by the
Government of the United States for its long neglect
and ill treatment permitted against the Indian by heart-
less white robbers in the past.

Fortunately, the red men are beginning to receive
better and more just treatment. The results of this school
are that its graduates are becoming leaders and teachers
among their people as Government supervisors, superin-
tendents, etc., in Government schools and good home
makers, successful in business, the professions and the
industries.

But the government should circumvent the white
rascals who rob and ruin these wards of the Nation.
The Indian makes better material than many of the
foreign devils who are coming among us of late from
abroad.

St. Louis Healthy. — From comparative mortality ta-
bles it will be seen that there is only one other city that has
as low a death rate as St. Louis, and it is hardly to be
doubted but that if the population figures of cities were

98 Reviews. Book Notices, Reprints, Etc.

accurately given, St. Louis would stand at the head of the
list with the lowest death rate (Comptroller's Rept.
city of St. Louis, 1914.)

The comptroller is certain that there is no other large
city in this country which has as fine a water system
at so small a cost as St. Louis.

He might add: the water is also aseptic as the Health
Board says. Comptroller Player also thinks the St.
Louis public schools compare favorably with any and
the school building group is equal to the best anywhere.

The Announcement of Memories of My Youth,
1844-1865, by George Haven Putnam, comes with a
handsome soldierly portrait of this then young officer
before he was brevetted major in the Civil War service.

This gentleman is described as holding the most
unique international place among book publishers. This
announcement bears a list of eleven different books by
the distinguished author and member of the great pub-
lishing house of G. P. Putnam's Sons.

This autobiography and the book on Abraham Lin-
coln ought to enlist the interest of the Loyal Legion
and soldiers of the American Civil War and the subjects
of all the entire eleven suggest popular interest and ap-
preciation. G. P. Putnam's Sons, 2-4-6 W. 45th St.,
New York, N. Y.

Surgery of the Ileocecal Valve. — A method of
repairing an incompetent ileocecal valve and a method
of constructing an artificial ileocolic valve; by J. H.
Kellogg, M.D., Battle Creek, Mich. From Surgery,
Gynecology and Obs., Chicago, 1913.

Since the interabdominal and interthoracic surgery
through Listerism have become practical intervisceral
areas have long ceased to be the terra incognito our fore-
bears regarded them. We no longer seal up penetrating
abdominal wounds and by watchful waiting leave results
to Nature. Our best surgeons go in and remedy as in
the case here considered and remedied.

Reviews, Book Notices, Reprints, Etc. 99

The Certificate in Psychological Medicine for
Great Britain's Medico-Psychological Association.

1. — Candidates must be at least twenty-one years of
age.

2. — They must produce a certificate of having resided
in an Institution for the treatment of Insanity (affording
sufficient opportunity for the study of mental disorders)
as a Clinical Clerk or Medical Officer for a least three
months, or of having attended a course of lectures on
insanity and the practice of an asylum (where there is
clinical teaching) for a like period, or they shall give such
proof of experience in lunacy as shall, in the opinion of
the President, be sufficient.

3. — They must be registered under the Medical Act
(1858) before the Certificate is bestowed.

4. — The examination is to be held once a year, at
such times as shall be most convenient, in London,
Scotland, and Ireland.

5. — The examination to be written and oral, including
the actual examination of insane patients.

6. — The fee for the examination is to be fixed at
three pounds and three shillings to be paid to the Registrar.

7. — Candidates failing in the examination to be allow-
ed to present themselves again at the next and subsequent
examinations on payment of a fee of one pound and one
shilling.

8. — The Certificate awarded to the successful candi-
dates to be entitled "Certificate in Psychological Medicine
of the Medico- Psychological Association of Great Britain
and Ireland."

9. — Candidates intending to present themselves for
Examination shall give fourteen days' notice to the
Registrar, stating in which division of the United King-
dom they propose to be examined. — From the Journal of
Mental Science.

Something of this sort should be provided for by
the American Medico-Psychological Association and
by State laws of those who would seek medical positions
in our State hospitals for the insane.

100 Reviews, Book Noticexi R<:prints, Etc.

The Nervous System and its Conservation. — By
Percy G. Stiles, Instructor in Physiology in Harvard
University; Instructor in Physiology and Personal Hy-
giene in the Massachusetts Institute of Technology.
12mo of 229 pages, illustrated. Philadelphia and London;
W. B. Saunders Company, 1914. Cloth, $1.25 net.

This is a valuable contribution to the clarifying of
much connected with the nervous system in the explana-
tion and understanding of the phenomena of health, diag-
nosis and disease by the practitioner of medicine as well
as the philosophical observer of the human frame in
action, normal or morbid. The author intelligently
presents and discusses causes of nervous impairment.

The author's views of sleep and neurasthenia are
interesting as well as on the question of fatigue, the
neurovascular system and the chapters on the cerebrum
and human development of this organ and the life of the
individual, dreams, emotion, etc., the elements of nerve
physiology, the neuro-muscular system, fatigue, etc.,
but not so materially different from current physiology,
though tersely and forcefully shown, to justify repro-
duction here.

The author introduces the plethysmography in his
study of sleep and numerous plain anatomical illustrations
of the nervous system easy of comprehension by even a
novice in anatomical science and physiology. Teacher,
physician or anyone might profit by reading this valuable
book.

A Program of Practical Measures for Mental
Hygiene Work. — An address delivered before the Mass.
Soc. for Ment. Hygiene. By Hy. R. Stedman, Brookline,
Mass. Boston Med. and Surg. Jour.

A pertinent, practical and sympathetic paper which
should have the consideration of superintendents of hos-
pitals and trustees thereof; also alienists, philanthropists
and physicians.

Archivos Brasileiros de Medicina. — Professor Ju-
liano Moreira, Director, Rio de Janeiro.

I

Reviews. Book Notices, Reprints, Etc. 101

From an Editorial on Gorgas in the Jour. A. M. A.
in the Southern Practitioner we reproduce the following:

"In the year 1912, 838,251 deaths from all causes
were reported in the registration area, which comprises
only 63.2 of the total population of the United States.
There were then approximately 1,400,000 persons who
died in our country in the year 1912. It is estimated
that at least one-third of them, or more than 450,000,
died needlessly of diseases that could and should have
been prevented. Pneumonia alone caused the death of
79,917 in the registration area and at the same ratio for
the entire United States approximately 125,000 died of
this disease, which the average person does not regard
as preventable, and which our government has done
nothing to prevent, yet on the Canal Zone among the
negro employes the death rate from pneumonia was
reduced from 18.74 per thousand in 1906 to 1.30 in 1912.
Of course, it is not possible to control the housing and
other environment of the inhabitants of the United States
as was done with the laborers working on the Panama
Canal, and we coiild not hope to reduce the death rate
from pneumonia and other diseases as low as reported by
Surgeon General Gorgas, but hundreds of thousands of
lives of good American citizens could be saved if we even
approximated the sanitary measures employed in the
Canal Zone."

The Psychological Monographs, edited by James
Rowland Angell, University of Chicago. Howard C.
Warren, Princeton University (index). John B. Watson,
Johns Hopkins University (review) and Shepherd I.
Franz, Govt. Hosp. for Insane (bulletin), comes to us
from the University of Iowa, Studies in Psychology, No. 6,
edited by Carl E. Seashore and put out by the Psycho-
logical Review Company, Princeton, N. J. and Lancaster,
Pa. Agents: G. E. Stechert & Co., 2 vStar Yard, Carey
St., W. C; Leipzig (Hospital vSt., 10); Paris (76 rue de
Rennes), are before us. They will be found of much
interest to the psychologist.

102 Reviews, Book Notices, Reprints, Etc.

Jahresbericht uber die Leistungen und Fort-

SCHRITTE AUF DEM GeBIETE DER NeUROLOGIE UND PsY-

CHiATRiE IN Verbindung MIT Dr. Adler, Berlin, Dr.
Bary, St. Petersburg, Prof. Dr. V. Bechterew, Pedrograd,
Walter Berger, Leipzig, U. F. A. Herausgegeben von
Dr. E. Flautau und Dr. L. Jacobson in Berlin Redigiert
von Prof. Dr. E. Mendel in Berlin. Verlag Von S.
Karger, Berlin.

We have not for a long time seen a copy of this won-
derful German and cosmopolitan review of the literature
of neurology and psychiatry, the most remarkable and
complete review of mental and nervous maladies and
allied sciences extant. We wonder that so valuable and
complete an annual review is not translated and published
in the English language.

The book does justice to American psychiatry,
neurological and psychiatric medical writers, especially
to collaborators and original contributors to the Alienist
and Neurologist.

We hope the war will not prevent its reappearance in
the year 1915. There is too much of value in it to be lost.

Instituto di Clinica della Malattie Nervose e
Mentale e di Antropologia Criminale della R. Uni-
versita di Catania diretto dal Prof. G. D'Abundo. Affez-
one del cono midollare in seguito a rachiostovaineiz-
zazione, pel Dott. Eugenio Aguglia, Assistente.
(V Professor Abundo is an author of merit, abundantly
able to do all that he announces his ability to do and to
verify all the asserted facts he sets forth.

Students of Italian literature in neurology (and it is
rich and meritorious from many sources) will be greatly
interested in this monograph of the distinguished author
and his conclusions. The Alienist and Neurologist is
and has been much indebted to Abundo and his confreres
in neurology for valued contributions to the literature.

This record is a case especially adapted to spinal
galvanization.

I

Reviews, Book Notices, Reprints, Etc. 103

The Continuous Warm Water Bath the Rational
Remedy in Tuberculosis (Phymatiasis) and Infection-
AL Diseases in General. — By A. Rose, M. D., New
York City. From International Clinics.

The author contends with confidence and enthusiasm
for the value of his procedure, giving illustrative cases
and interesting record at variance with correct record
of priority in the use of this simple and valuable thera-
peutic method in various diseases.

It has been found of great value in subduing maniac-
al excitement in hospitals for the insane, correcting in-
somnia, etc. We saw it in successful use in Budapest
and Vienna and think it might prove valuable in over-
coming madness in the so-called sane over there at the
present time. Even the cold bath for friend and foe
with a hose would prove salutary if the process could be
generally distributed even as far as Berlin and over the
wild armies in Belgium. Dr. Rose offers the term "phy-
matiasis" for tuberculosis.

Science for December, 1914, has a first page et seq.
article on "The Future of the National Academy of
Sciences" which all interested in the progress of science
in the U. S. should read. The paper on "National
Academies and the Progress of Research," of which this
is part third, was presented at the Baltimore convention
in 1913 and by action of the Council a copy was sent to
each member by the home secretary "for criticism and
comment."

Revue des Sciences, Psychologiques, Etc. — Par
J. Tastevin et P. L. Couchard, Paris, has not been re-
ceived since July and Sept., 1913.

We should be glad to receive all the numbers and to
exchange regularly.

Revue de Medicine, Redacteurs, Profs. L. Laud-
ouzy et R. Lepine, is not coming regularly. The last
number received was number 9, trente troi sia seme Annee.

We should be pleased to exchange regularly.

104 Reviews, Book Notices, Reprints, Etc.

ZuR Behandlung der Sexualen Neurasthenie. —
Von A. Eulenburg in Berlin (Sonderabdruck aus der
"Zeitschrift fur Sexualwissenschaft." I. Band. I. Helf.
1914.)

Whatever this distinguished, observant author writes
is worthy to be read and this abstract is no exception.
The world is his attentive audience in the fields of
psychiatry and neuriatry. In fact the magazine from
which this abstract is taken is the Internationales Cen-
tralblatt fur die Biologic, Psychologic, Pathologic und
Sociologie des Sexuallebens and is also the Offizielles
Organ der Artlichen Gesellschaft fur Sexualwissenschaft und
Eugenik in Berlin, the editors of which are Professor Dr. A.
Eulenburg and Dr. Iwan Bloch, both of BerHn and
published by A. Marcus and E. Webber's Verlag at Bonn.

Acute Poliomyelitis (Heine-Medin's Disease). —
By Dr. Ivan Wickman, Stockholm, The Nervous and
Mental Disease Monograph Series, No. 16, New York.

Among the many valuable copies of the Nervous and
Mental Disease series that have come to us is Number
16, on Acute Poliomyelitis by Ivan Wickman of Stock-
holm, which we cordially commend to the consideration
of the readers of the Alienist and Neurologist.

This is an authorized English translation and is well-
done by Drs. J. Wm. and J. A. M. Malony, F. R. S.,
Edin. The text is entertaining reading and the illustra-
tions are unique. The Jour, of Nerv. and Ment. Diseases
publishers continue to place the medical profession under
renewed obligations in publications such as this and the
publications preceding.

Psychiatry. — A new contribution to the study of
Dementia Paralytica in Brazil, by Professor Dr. Juliano
Moreira, Direct, of the Natl. Hosp. for the Insane, Rio
de Janeiro.

This is an interesting showing from the standpoint
of clinical observation in Brazil not materially different
from those of other countries.

Reviews, Book Notices, Reprints, Etc. 105

"The Story of Bethlehem Hospital," in London,
gives a history of more than six centuries, showing the
attitude of society through this whole period toward its
insane poor and the benefactions of this venerable
venture in line with the charitable impulses of civilized
humanity.

At the present time a great deal of attention is
being given with a view to remedying abuses which
tmquestionably exist.

Readers of this magazine can not fail being interest-
ed in this remarkable record of well meant effort for
the welfare and care of the unfortunate insane. The
illustrations are unique and interesting. This wonderful
book will receive further notice from us in a later issue,
suffice it to say that every alienist should have it in
his library; it is indispensable to any one who would be
posted in the history and early management or mis-
management of the insane. E. P. Button and Co.,
681 Fifth Ave., New York, are the publishers and the
price is five dollars net.

The Medical Pickwick, Vol. I, No. I is before us.
We hope to see more of it. It is the funny paper of
the medical profession. It is full of wise sayings and fun
and contains much interesting medical history and his-
torical anecdotes.

To read it is a pic(k)nic and an antidote to hypo-
chondria, melancholia and the insomnia of worry. Its
editorial staff is a guarantee of its continuance. May it
live long and prosper and like Judge PuUian's horse
"have breath to the last." — Western Med. Rev., Omaha, Neb.

The Psychoanalytic Review is not coming regu-
larly and there exists no war excuse for its delinquency.
Brothers White and Jelliffe are kindly asked to take
notice and give us a psychoanalytic explanation of their
delinquency in the premises.

This magazine is a good one and we should be pleased
to see more of it.

106 Reviews, Book Notices, Reprints, Etc.

Extradition of Insane Persons. — By Henry R.
Stedman, M. D., Boston, Mass. The author makes the
following statement from a paper read before the Psychia-
trical Society of New York:

"It has taken the notorious Thaw case to awaken
people to the necessity of interstate rendition laws pro-
viding for the return to proper custody in their own
State of insane persons who have escaped into other
communities, and if his escape from Mattewan should
by any possibility accomplish this desirable end it will be
the only redeeming feature of a case which has, as we all
know, worked much harm to the repute of the medical
and legal profession and has for years greatly offended the
moral sense of the country."

Is There an Increase Among the Dementing
Psychoses, by Charles P. Bancroft, M. D., Concord,
N. H. From the Amer. Jour, of Insanity.

The author is fully competent from ample clinical
and other experience to discuss the subject and his
contention is that the dementing psychoses are increasing.
This paper is especially interesting to alienists and
publicists.

The Phylacogen Treatment of Pneumonia. — By
Parke, Davis & Co., Detroit, Mich.

Some remarkable results are reported as having fol-
lowed the use of pneumonia phylacogen in many serious
cases that have been reported in recent months — cases
in some instances that had failed to respond to con-
ventional methods of treatment. Ample literature will
be sent on request.

X-ray Studies of the lleo-cecal Region and the
Appendix, by James T. Case, M. D., Battle Creek,
Mich. From the Amer. Quart, of Roentology.

Concerning Individual Differences in Reaction
Times. — By V. A. C. Henmon and F. Lyman Wells.
From the Psychological Review.

Reviews, Book Notices, Reprints, Etc. 107

The Systematic Observation of Personality,
in its Relation to the Hygiene of Mind; Concerning In-
dividual Differences in Reaction Times; Experimental
Psychopathology ; all by Fred'k. Lyman Wells and from
the Psychological Bulletin, are received.

These studies of Wells and his colleague, V. A. C.
Henmon, are researching analyses of peculiarities and
commonalities of character and worth of the psychol-
ogist's and psychopathologist's study.

Furor Caesareus. — This is an interesting portrayal
and brief character description by Dr. Archilles Rose,
the Greek philologist and critic of the American Medical
profession, of William the "war mad" Emperor of Ger-
many, as he, Dr. Rose, plausibly contends concerning
the present "War Lord" of the Germans. Dr. Rose
compares his German Majesty in the present war with
Napoleon, considering them "two of a kind" in world
dominion ambition, "Deutschland uber Alles."

L'Aphasie dans ses Rapports avec la Demence
ET LES Vesanies, (Etudc historique clinique et diag-
nostique considerations medico-legales.) (Avec cinq plan"
ches et quarte figures dans le texte.) — Par Dr. Maurice
Brissot, G. Steinheil, edit., Paris.

This splendid study of the subject dedicated to
Dejerine and Brieud will instruct and entertain the
neurologic reader equal to the best in any language
extant.

Archivos Brazileiros Psychiatria, Neurologia e
Medicina Legal. Edited at the Hospicio Nacional de
Alienados is a Brazillian magazine of merit devoted, as
its name implies, to the advancement of psychiatry,
neurology and medico-legal medicine.

We cordially welcome this magazine to our exchange
list. Professor A. Austregesilo and Professors Moreira
and Juliano are its scientific directors with an elaborate
corps of editorial associates.

108 Reviews, Book Notices, Reprints, Etc.

The Intimate Relation of Orthopedic Surgery
TO Neurology. — By H. W. Wright, M.D., Santa Barbara.
Reprint from the California State Journal of Medicine,
September, 1914.

The contention of this valuable paper is that "as
time goes on and neurological diagnosis becomes more
exact the communal interest of the two branches of
medicine becomes more important."

An Epitome of the Diagnosis and Treatment
OF Nervous Diseases, including Bromide Therapy.
By Henry Irving Berger, M.D. This brochure, published
by and in the interest of the Peacock Chemical Co.,
St. Louis, Mo. is a convenient little poCket remembrance
of certain nervous diseases, in which the combined five
bromides, three grains each to the drachm solution, are
indicated according to Dr. Berger.

The Effects of Goitre Operations upon Mental-
ity.— By William Seaman Bainbridge, Sc. D., M. D.,
New York City. Reprint from American Medicine.
The author claims good results where psychopathy co-
exists. He has planted thjToid grafts in little cretins
with usually distinct but only temporary improvement.
AUenists should read this paper.

The Art of Companionship in Mental Nursing,
by Henry R. Stedman, Brookline, Mass., from the Boston
Med. and Surg. Jour, contains good practical suggestions
for the welfare of mental cases, especially of the milder
forms, the so-called semi-insane, semi-fous and melan-
cholias, hyperchrondias, etc., where night companionship
is essential.

Vagabondage and Begging. — By Dr. F. DeFinkey,
Professor of law, Sarospatak, Hungary. This paper comes
with the compliments of the American Prison Association
and contains suggestions for the cure of this growing
social evil in our country.

I

Reviews, Book Notices, Reprints, Etc. 109

Claims Arising from Results of Personal In-
juries.— The relation injury bears to disease and disease
to injury. Showing how personal injuries may affect
various diseases and how certain diseases may add to
claims for accidents by protracting recovery. By W.
Edward Magruder, M. D., Medical Director National
Investigation Bureau, Inc. Formerly Associate Professor
of Clinical Medicine, College of Physicians and Surgeons;
Mercy Hospital and Bay View Asylum, Baltimore, Md.

The Case of Belgium in the light of official reports
found in the secret archives of the Belgian government
after the occupation of Brussels. With facsimiles of the
documents.

This is the German side and from this showing it looks
bad for Belgium's sincerity as to honest neutrality.

Le Traitement des Stenoses Aigues du Larynx. —
Par Le Dr. Guil. Zorraquin chef de clin de chirur a
I'hosp. de ninos de Buenos Aires, Paris, Vigot Freres,
Editeurs.

Medico-Psychological Assn. of Great Britain
and Ireland. Report of the Committee re status of
British psychiatry and medical officers with append, of
memo, notes and resolutions, 1914.

Interesting and valuable extracts to the psychiater
from this report will appear later in this magazine.

The Continuous Warm-Water Bath the Rational
Remedy in Tuberculosis (Phymatiasis) and in Infectious
Diseases Generally. — By A. Rose, M.D., New York.
From International Clinics, Vol. II, 23rd Series.

Notes Sur Quelques Maladies Nerveuses et
Mentelles Au Bresil. — Par le Prof. Docteur Juliano
Moreira, Rio de Janeiro.

Neurosis and Purpose. — By George Mitchell Parker,
M.D., New York. From Medical Record, 11-14-14.

110 Reviews, Book Notices, Reprints, Etc.

The Extradition of Insane Persons. — By H. R.
Stedman, Boston. From the Medical Record.

A very valuable contribution to the peril of lunatics
at large of the non-maniacally impressive type requiring
the attention of the guardians of the public safety and
popular welfare.

ACTES DU CONGRES PeNITENTIAIRE INTERNATIONAL

DE Washington, Octobre, 1910. — Rapports sur Les
Questions du Programme de la Section des Moyens
Preventifs, Volume V. Groningen, Bureau de la Com-
mission Penitentiaire Internationale.

Revue des Sciences Psychologiques, Psychologie,
Psychiatrie, Psych. Sociale, Methodologie. — Pub. par
J. Tastevin et P. L. Couchoud.

We hope the war will not keep this valuable maga-
zine from coming to us. It is an excellent review.

The Psychosis of Adolescense. — By J. Montgomery
Mosher, M.D., attending specialist in mental diseases,
Albany Hospital. From Albany Medical Annals.

A paper of clinical observation and illustration as
to this form of psychic degeneracy.

Present Status of Surgery of Systemic Goitre,
Illustrative Cases. — Wm. Seaman Bainbridge, A.M.,
M.D., From Jour. Mich. State Med. Soc. Also by the
same author: Question of Anaesthesia in Goitre Opera-
tions from Annals of Surgery.

The Hecht-Weinberg Reaction as a Control over
the Wasserman Reaction. A study based upon one thou-
sand parallel tests with both methods. By R. B. H.
Gradwohl, M.D., St. Louis.

Les Dysthenies Periodi&ues (Psychose Periodique
ou Maniaque-Depressive.) — Par R. Benon hospice. St.
Jacques, Nantes.

Reviews, Book Notices. Reprivits. Etc. Ill

A Criticism of Psychoanalysis. — By J. Victor
Haberman, A.B. M.D., Berlin. Instructor in Psycho-
pathology and Therapy, Col. of P. & S., Columbia
Univ., New York. From the Jour, of Abnor. Psychol.,
Boston.

The Sei-I-Kwai Medical Journal, edited and pub-
lished by the Sei-I-Kwai in Tokio, Japan, comes to us
regularly and is much appreciated for its English contents.

An Excellent Contribution in Revue de Medi-
cin. No. 9, is a clinical study on Dem^ence Epileptique
par R. Benon et A. Legal, Librairie Felix Alcan, Paris.

Instructions in the Proper Methods of Securing
and Preparing Tissues, Body Fluids, Blood, etc., for Labora-
tory Examination. — By Dr. C. L. Klenk, St. Louis.

On the Formulation in Pyschoanalysis. — Fredk.
Lyman Wells, McLean Hospital, Waverly. From Jour.
Abnormal Psychol., Boston.

Laboratory Aids to the Diagnosis of Diseases of
the Nervous System. — By David S. Booth, M.D., St.
Louis. From Medical Fortnightly.

The Way to Vaccinate. — By Isadore Dyer, Ph.B.,
M. D., Tulane Univ., New Orleans, La.

The Art of Companionship in Mental Nursing. —
By Henry R. Stedman, Brookline, Mass.

The Acid Test in Therapeutics. — By John Aulde,
M.D., Phil. From Med. Rec.

The Chemistry of Neurasthenia. — John Aulde,
M.D. From Med. Times, Phil.

Virginia State Epileptic Colony, Madison Hgts.,
Va., 1914.

The reason for

Constipation
of Infants

may often be readily traced to imperfect diges-
tion of protein or fat, to a deficiency of total
solids in the diet, to a lack of energy, or to a
diet containing starchy substances. While this
condition is not necessarily a serious one, a naturcd
elimination with soft, smooth stools of a good
character is much to be desired, and has no little
bearing on the general health of the infant.

The prompt and favorable results following
the use of Mellin's Food in constipation is com-
mon knowledge to a vast number of medical
men, but to physicians who are not familiar with
the application of Mellin's Food to correct these
errors of diet, we wall send, if desired, suggestions
which will be found very helpful.

Mellin's Food Compaivy, Boston,Mass.

ALIENIST AND NEUROLOGIST

Vol. XXXVI. St. Louis, May, 1915. No. 2.

RIGIDITY OF THE CURRICULUM AN OBSTACLE
TO THE PROGRESS OF MEDICAL EDUCATION.

By Charles McIntire, A.M., M.D.,
Easton, Penna.^

A T the meeting of the American Academy of Medicine
^^ for 1893, I presented a paper entitled: "Medical
Education in the United States; from Chaos towards
Cosmos." At that time the wildest dream of the most
imaginative would never have dared to assert that in
a score of years the requirements for licensure to practice
in more than one state would be more rigorous, academ-
ically, than the then formulated standard for admission
to this Academy. We all rejoice in the fact that when
once the professional conscience was awakened, it put
on seven-league boots in its flight from the land of Chaos.
It is not surprising, if one reviews this rapid progress, to
find imperfections and that which had been planned for
conservation becoming a stumbling-block rather than a
stepping stone. Indeed, the journey has been deflected;
it is no longer toward Cosmos but directed to crystalliza-
tion. Cosmos is the orderly array of the forces of nature
wherein unlimited flexibility is permitted to the individual
while preserving perfect harmony and precise identity to the
whole. What is formal, precise and restrictive tends
to mathematic forms — to crystals, whose only variations
are those of magnitude or of imperfections.

1 Read at the 39th annual meeting of the American Academy of Medicine, Atlantie
City, N. J., June 19, 1914.

(113)

114 Charles Mclntire

The present thesis is: "The rigid curriculum, whether
that demanded by state medical practice act, or formu-
lated by the Council on Education of the American Medi-
cal Association, or by the Association of American Medi-
cal Colleges, or any other organization, is an obstacle
to the progress of medical education."

Before attempting to defend this statement, I wish
to say that the suggestion for preparing this paper came
from two papers presented at the February Conferences
for the present year. One by President Lowell, of Har-
vard, read before the Conference of the Council on Medical
Education, entitled: "The Danger to the Maintenance of
High Standards from Excessive Formalism."* The other
by the present President of the Academy, which was
presented to the Confederation of State Medical Boards
and was entitled: "Should not the Federation of State
Medical Boards of the United States Adopt a Uniform
Minimum Curriculum for Medical Schools?"^

If unconscious cerebration causes me to make use
of the arguments from either of these papers, I hope that
this statement will be accepted as fitting acknowledg-
ment.

1. THE FACT OF A RIGID CURRICULUM.

Little time need be taken to demonstrate the exis-
tence of a rigid curriculum. Possibly most present would
accept it with the stating. Thus, the medical practice
act of North Dakota requires:

"All applicants * * * must * * * present evi-
dence * * * of having graduated from a reputable
medical college and having attended in such college or
colleges the lectures of no less than four college years of
at least eight months each, and must give evidence
* * * * of a preliminary education which would be
necessary to admit said student to the junior or third
year of the University of North Dakota or some equally
reputable American college or university."

1 Journal American Medical Association, March 14, 1914, p. 823.

2 Quarterly of the Federation of State Medical Boards, Vol. I, p. 199.

Rigidity of the Curriculum 116

The constitution of the Association of American
Medical Colleges provides :*

"The entire course of four years shall consist of at
least 4000 hours for each student and shall be grouped
in divisions and subdivisions into subjects; each division
and subject to be allotted the number of hours as shown
in the following schedule:"

The schedule that follows is particular and fixed. I
quote the first division as an illustration:

Division I, Anatomy 720 Hours (18 Per Cent.)

Lecture, Labora-

Total recitation or tory

hours. demoDBtration. work,
(a) Gross anatomy (including applied

anatomy) 610 120 390

(6) Histologic and microscopic anatomy 135 30 105

(c) Embryology 75 30 45

It should be noted that an appearance of flexibility
is given by the following provisions:

"Colleges may reduce the number of hours in any
subject not more than 20 per cent., provided that the
total number of hours in a division is not reduced. Where
the teaching conditions in a college are best subserved, the
subject may be, for teaching purposes, transferred from
one division to another. When didactic and laboratory
hours are specified in any subject laboratory hours may
be substituted for didactic hours."

While the requirements for admission are no less
fixed as reference to the Transactions for 1913 (page 67)
will show. I quote only a portion. There is required
for admission (upon the high school requirement) :

"A diploma and transcript of record from a ftilly
accredited high school, normal school or academy re-
quiring for admission evidence of a standard course in
primary and intermediate grades, and for graduation, the
completion of a standard four-year high school course,
embracing two years (2 units) of mathematics, two years
(2 units) of English, two years (two units) of one foreign
language, one year (1 unit) of American history and civics,
and seven years (7 units) of further credit in language,

3 Transactions, 1911, p. 86.

116 Charles Mclntire

literature, history or science, making the total of units
at least fourteen; and in addition, one year each of
physics, chemistry and biology of college grade of each
not less than six semester hours."

Other regulations cotild be cited but these sufiBce to
show the existence of a rigid curriculum.

II. WHAT ARE SOME OF THE CAUSES LEADING TO THE

ADOPTION OF so PARTICULARIZED A STATEMENT

FOR THE COURSE OF STUDY?

One very obvious cause is the contact with the public
school authorities and adopting their methods; another
was the laudable efifort to make men honorable by law,
and I opine that the causes are but one. Soon after the
awakening of the public conscience to the low standard
or lack of standard in medical education there was an
immediate response on the part of medical schools by
publishing in the catalogs requirements meeting every
demand. With many the only change made was that made
by the type; with most the catalog statements were
profetic rather than descriptive of actual conditions.
To correct this abuse of the imagination, rigid, undeviat-
ing requirements were formulated, which have been success-
ful to a degree but at a tremendous cost. It becomes
necessary for the medical schools to acquaint themselves
with the requirements of each state and train their
students to meet state requirements as the prime motive
for their instruction. That the efiEort has not entirely
removed the condition it was undertaken to remove is
shown by a recent article in the Journal of the American
Medical Association regarding a medical school in the
middle West. I am of the opinion that other schools
are as lenient in the interpretation of the requirements
as may be possible without actually transgressing the
letter of the law. Like all legislation of this character,
the burden is heaviest on the law abiding, while those
who made the legislation desirable find loop-holes. And
the rareness of the holes only makes the law more rigorous
for the innocent.

Rigidity of the Curriculum 117

III. HOW DOES THIS RIGIDITY HAMPER MEDICAL EDUCATION?

I. It violates the natural law of growth. In all
the higher types of life at least, there is a conformity
to type but not a uniformity of individuals. Man is no
exception to this and mental equipment varies. This
condition affects:

(a) The Faculty, so that the trend of one school,
if unhampered, would be toward research, of another,
toward sanitation and the public services; a third would
be composed of those whose desire is accomplished in
fitting men as all around family medical advisers. Such
specializing on the part of medical schools would make
medical research more extensive and advance medical
education.

It affects;

{h) The Student. By reason of mental attitude,
or of peculiar conditions, all students do not require the
same amount of time for any designated study. Thus a
lad may have been living in a family where German was
spoken and had acquired a fluent use of the language.
As now formulated this would not be accepted as an en-
trance requirement, while another having a smattering
of the language from his two units of study, is accepted.
Pardon the personal illustration. Although my degree
was obtained in the old days of Chaos, it gives the prop-
osition in a concrete form. It so happened that before
entering the University I had much more chemistry' than
would have been required even at the present. This
would avail not a bit, the hours must be given to it
when they could be used to better purpose elsewhere.
So, in the development of the medical student, a rigid
curriculum is an obstacle.

In order to prevent a misunderstanding of my con-
tention, permit me to say that I am not pleading for less
rigorous requirements, nor for courses fitting the student
only to attempt to practice a part of medicine, but for
more freedom to the professor and the pupil that the
product may be a growth and not a form cast in a
rigid mold.

118 Charles Mclntire

2. This rigidity of curriculum magnifies the scaffold-
ing to the detriment of the structure; it thinks more of
the process than of the product. While this paper was
evolving, I had a conversation with the president of
one of our more prominent smaller colleges concerning
his daughter. This young lady has the laudable ambition
of becoming a medical missionary. The father was telling
me of the difiiculty of electing her college course to
meet the requirements of her university (medical) course.
Both are so rigid that an excess of the subjects required
must be taken to the exclusion of certain studies necessary
to the education of the young lady. To quote President
X., "A . would get her degree but not an education."

While it may not be a direct obstacle to medical
education this undue stress upon the curriculum may work
hardship to many a worthy individual since it requires
the way to acquire, and disregards the actual acquirement
itself.

3. This rigidity of curriculum prevents the read-
justments made desirable by the progress of medical
science, or the broadening of medical practice. Thus,
demands are constantly making for the introduction of
new subjects for the student of medicine and the im-
portance of some of the former subjects has diminished.
Psychology and materia medica are examples of each
class. These demands would be met with comparative
ease were it not for the rigidity of the curriculum which
again becomes an obstacle to progress.

This rigid curriculum was devised to penalize the
dishonorable medical school and the results have been
meager. The advancement made, the progress in medical
education and the elevation of the standard have been
accomplished by the efforts of the honorable backed by
public opinion, and would have come apart from rigid
requirements. The suspension of so many of the weaker
schools has resulted more from the changed conditions
than the legal requirements. If it had a purpose that
purpose has been accomplished; it is no longer needed.
Since the Carnegie Foundation blazed the way and made

Rigidity of the Curriculum 119

public the conditions well known but spoken of with
bated breath, publicity can be depended upon to make
or mar a medical school. Let an independent body,
e. g., the Association of American Universities, draft a
scheme providing (I) the knowledge to be acquired before
entering upon the study of medicine, and (II) the funda-
mental knowledge necessary to seek to practice medicine.
Upon these minima let each medical school build its
course. As a prevention of fraud, let the Council of
Medical Education of the American Medical Association
continue its periodic investigation, publishing its findings
fearlessly, and the shackle to medical progress will be
broken, without abating the present educational qualifi-
cations, but rather improving them.

DISCUSSION.

Dr. N. P. Colwell, Secretary of the Council on
Medical Education, American Medical Association:

"The most encouraging point regarding Dr. Mclntire's
paper, and the paper of President Lowell, to which ref-
erence was made, is the very fact that they have been
written. If the standardization of medical education
has reached the stage where it becomes necessary to call
a halt or to urge more flexibility of standards, then in-
deed we have abundant cause for congratulation. Only a
few brief years ago the chief burden of all papers on
medical education was for better laws, higher standards
and better enforcement of those standards.

"Since in this country we are now in the active stage
where standards are being formulated, the plea of President
Lowell and of Dr. Mclntire for flexibility of standards is
very important and timely. With the stand taken by
these papers, furthermore, I am sure that those having
to do with the formulation of standards are in entire
sympathy. With the implication that the standards thus
far set forth by the Council on Medical Education have
been so inflexible as to work a hardship on high grade
medical schools or on any well qualified or deserving
student, I personally do not agree. From knowledge,

120 Charles Mclntire

I can state that from the beginning the members of the
Council on Medical Education have been avowedly op-
posed to rigid or inflexible standards. The setting forth
of minutely detailed standards has been purposely avoided,
or if such details were given, a specific statement was
made that the standard was suggestive and not intended
as a fixed requirement. Perhaps the most detailed
standard formulated by the Council was the report of the
Committee of One Hundred on Medical Curriculum, and
lest some one might take it as a rigid law a special reso-
lution was adopted that it be suggestive only. Further-
more, during the last several years, the influence of the
Council has been repeatedly, and often effectively, exerted
to prevent the adoption of excessive or over-rigid standards
by a number of state licensing boards. Instead of becom-
ing more unreasonable or over-rigid, therefore, the require-
ments by state licensing boards, even with the advances
made in preliminary standards, are more uniformly fair
than they were eight or ten years ago.

"Although flexibility of educational standards under
certain conditions is very desirable, it must be stated
that for some medical schools which have existed or still
exist, the enforcement of definite and fixed standards
has been absolutely essential. The plea for flexible stand-
ards is all very well for high grade, ethical institutions,
such as those with which President Lowell and Dr. Mc-
lntire are doubtless best acquainted. I cannot believe,
however, these gentlemen can have any real conception
of the gross commercialism which heretofore has existed
in medical education, or of the looseness, the make shifts,
the evasion of all reasonable standards and even the
out-and-out fraudulent methods employed by some so-
called medical colleges in their efforts to attract and enroll
large numbers of students. I am sure that if they had a
full knowledge of the crookedness repeatedly unearthed
in the investigations of the Council on Medical Education,
they would agree that a statement that "rigid and in-
flexible measures should be enforced" would be altogether
too mild an expression.

Rigidity of the Curriculum 121

"Until such time, therefore, when all medical schools
have developed an educational conscience and are being
conducted along conscientious lines, — until that time will
it be necessary to have a certain definite and fixed stand-
ard. This standard should represent an absolute mini-
mum. Nowhere else is a fixed standard justifiable, and
in only one place has the Council on Medical Education
adopted or advocated a fixed standard; i. e., in its mini-
mum standard on preliminary education. That standard
is a four-year course in some accredited high school, or
its actual educational equivalent, and in addition at least
one year of work including college courses in physics,
chemistry and biology. A reading knowledge of German
or French is strongly urged. For the sciences named,
after a very careful investigation, including conferences
with recognized educational experts, a schedule of minimum
hours to be required in each, was adopted. Few of the
better colleges are affected by such "inflexibility" as may
be found in that standard, however, since their require-
ments are far above that minimum. The medical college
which in its requirements gets away from and above
the minimum boundary line does not have to walk in as
"straight and narrow" a path as the one which hugs
closely to that line.

"In this discussion it must be remembered that this
side of the millenium, standards in education are as
essential as laws regulating human conduct. As Dr.
Mclntire has intimated, laws and rules are the result of
and intended to correct certain abuses, or certain in-
fringements on the rights of others. They are directed,
therefore, toward those who would prefer to do what
those laws forbid and not toward those who are doing
the right from conscientious motives. It is no more
possible, let alone desirable, for two medical colleges to
be exactly alike in all minute details than it is for two
persons to be exactly alike in all minute respects and
characteristics. As all persons have in general a similar
bodily structure, however, so all medical schools by
common consent must be generally similar, if they are to

122 Charles Mclniire

furnish their students with an all-round medical training.
Laws or rules, therefore, should relate to the matters
common to all persons, or all medical colleges, leaving
as wide a latitude as possible to the individual for the
detailed matters which are not common. Perhaps no
rule or law was ever written by human hands which was
so perfect that the intent or spirit of it could be fulfilled
by a literal interpretation. Not only should laws and
standards provide for the widest possible liberty for the
individual, but it is even more desirable that the laws
or standards be administered in a common sense manner
with the spirit in view^ so far as possible rather than the
latter.

"Standards and laws in education should be as gtiide
posts pointing the way through the amazing wilderness of
knowledge even as sign posts are placed to direct the
traveler through a forest. As certain courses in educa-
tion are pursued by large numbers of students those courses
become more marked and more generally recognized
as standards even as paths or roadways through a forest
become more distinct as larger numbers of people travel
along them. Standards, like roadways, therefore, are in-
tended to meet the needs of the larger numbers of people.
Occasionally the individual is affected by standards if he
wanders too far away from the beaten paths of education.
In such instances, however, it is not fair to blame the
standards, any more than it would be to blame a road-
way, or path through the forest, because some individual
wanders too far away from it and gets lost. It is up
to those administering standards to bring the individual
affected back to the desired educational roadway and no
one can be blamed for the accidental circumstances by
which his time may have been lost.

"It is hard to believe that there is much danger in
this country from seriously fixed or inflexible standards
in education, chiefly because the formulation of those
standards rests so much on voluntary natural organiza-
tions rather than in the national government. In indi-
vidual states where the legal power rests, occasionally.

Rigidity of the Curriculum 123

perhaps, unfair, excessive or rigid standards may be adopt-
ed but they are bound to be corrected sooner or later by
the standards adopted in the majority of other states
and by the power of publicity and public opinion. If
one looks to individual occasions in politics he is perhaps
inclined to tremble for the future of the democratic form
of government. A prolonged view of the entire field,
however, proves more than ever that this is a strong
national government and that here individual liberty
is best observed. What is true in general political condi-
tions is also true in education. In some instances educa-
tional conditions are deplorable. Again in the efforts to
correct these conditions, a few persons may be affected.
Take the country as a whole, however, and one is im-
pressed with the rapid and marked advancement both
in the standards adopted and in the fairness with which
these standards are administered. Nevertheless, as already
stated, such papers as this by Dr. Mclntire, are timely
and important as warnings to those having to do with
the formulation of standards."

Dr. H. D. Arnold, Boston:

"Dr. Col well has expressed his appreciation of the
timeliness of Dr. Mclntire's paper, from the point of
view of the standards of the Council on Education of
the American Medical Association. As a representative of
the Committee which drew up the curriculum adopted
by the Association of American Medical Colleges, also
cited by Dr. Mclntire, I wish to speak in the same spirit
of the timeliness of this paper. It is a good thing to
have criticisms of this sort from those who are not obliged
to deal with either the students or the schools that are
trying to establish standards. They look at the matter
from a little different angle.

"Both the Council and this Committee on Curricu-
lum had in mind the disadvantage of rigidity to which
Dr. Mclntire has alluded, yet at the time there was such
wide variation in the course of study in various schools
that it was unnecessary to emphasize the need of greater

124 Charles Mclntire

uniformity. It was necessary to make the curriculum
rather more rigid than the ideal which the Committee had
in mind. These things look a good deal more rigid on
paper than they do in the minds of the people establishing
them.

"There are one or two points that I would like to
emphasize on the other side, as a result of the investiga-
tion which our Committee carried on between four and
five years ago. I hope that the medical schools have
come much nearer to uniformity than was the case at
that time, but I doubt if they have attained such uni-
formity that it is not still of value to have pretty definite
standards set up.

"Our Committee asked for statistics from the 80
best medical schools as to the number of hours given to
different subjects. We received replies from something
over sixty. Two of the best medical schools were left
out of our calculations because they had so many hours
assigned for exercises that they could not fairly be taken
into account in determining the standard of education
prevailing in the better medical schools. An excessive
number of hours in the curriculum is one of the evils
to be guarded against.

"The other point is the need of balance in the curric-
ulum. Those of you who are connected with medical
schools know very well that our instruction in different
departments has grown up helter skelter; that the instruct-
or with much interest in his subject, if he has influence
with the faculty, has gotten hours assigned to his sub-
ject irrespective of what that subject deserves in a
well rounded medical education. Irregularities of this sort
are largely eliminated by gathering statistics from a large
number of schools. The average of our statistics gave
a composite picture of about sixty of the best medical
schools, and represented the consensus of opinion of
the medical educators of the country. The Committee
also discussed the question and tried to get the right
proportion for the different subjects. We tried also to

Rigidity of the Curriculum 125

get a certain amount of flexibility by allowing a difference
of 20 per cent., one-fifth of the time, in any one subject.
"I hope the condition has come about that a rigid
curriculum for the better medical schools is no longer
necessary; but I wotild emphasize also the other side:
that there has been a very wide variation in the past
and that there is danger that the medical student may
get a one-sided education instead of a well-rounded
education in the fundamentals of medicine."

Dr. Thomas D. Davis, Pittsburgh:

"This is an exceedingly important subject. The
standard should not be a matter of hours or years,
but should be what the student knows, not how long he
has been studying, nor how long it takes him to acquire
proficiency. The schools require a certain number of
hours that the student must attend, rather than giving
us a higher standard of what the student shall know.
Just as Dr. Mclntire stated, there are some minds that
will acquire knowledge very much more rapidly than
others. There are some students who have had prelimin-
ary preparation by which they can more readily acquire
knowledge, yet that is not taken into account; they must
go the full four years, even if they can complete the
curriculum in three. Those of us familiar with the
advance of medical education, for which this organization
stands, will remember the long fight that we had getting
State Boards. In Pennsylvania, not a medical college
helped us. Afterward the colleges, seeing the pecun-
iary advantages to themselves in a four years' course,
came in and seemed to force the State Medical Examining
Boards to require a definite time of study, rather than a
definite amount of knowledge. Hence, they now require
four years in a medical college, double the old time, but
as far as I can see, receive no more knowledge. It seems
to me that if examining boards are of any real value they
should tell us what the student knows and whether he
is fit to practice medicine. The standard should be
what he knows. That is the standard of other countries.

126 Charles Mclntire

The men are examined to find out how well qualified
they are and not to ascertain how many years they
have spent in becoming qualified."

Dr. Edward Jackson, Denver:

"There are certain things that make for undue
rigidity in standards. One of the most important is the
giving hours, or units in representing hours, as a standard,
instead of attainments. It is much easier to lay out a
schedule of hours than to lay out a schedule of attain-
ment in any particxilar branch. It is enormously easier
to divide four years into semesters and periods, assigning
them to one subject and to another, than to indicate the
whole field that must be covered by medical education,
and the attainment which should be recognized as proper
in each subject. But our standards will not be satis-
factory until we come to some general agreement, not
upon years or hours but upon the question of what a
medical student should know before he is allowed to
practice medicine. The examinations to test attainments
are as diffictilt to arrange as are the standards for the
work. It may require just as many years to give us
examinations that will do what we would like, and
have a right to expect they will do. Such examinations
will have to be something very different from what is
yet current among State Medical Examining Boards,
or the examinations conducted by faculties. We can not
feel that we have established proper standards for medical
education until we have our examinations worked out,
as well as the hours in the medical curriculum.

"Another matter which makes for undue rigidity is
that a certain amount of intelligence must be worked in
with the law. A good many of the States have attempted
to put too much into their laws. They have done,
what committees have also done, tried to put too much
into their schedules. It must be recognized that no law
will work itself, and that no law will work well unless
it has intelligence back of it. There must be intelligent
administrators who know what they are aiming at.

Rigidity of the Curriculum 127

recognize the proper claims of universities, and are ready
to meet them.

"Those who do not come into immediate contact
with the Council on Education of the American Medical
Association, may not know that there has been in that
Committee full recognition of the necessity of ruling on
individual cases on their merits. I suppose from some
schools questions brought up to the Council would be decided
rather strictly according to the routine standards. But
for schools in which the Council feels confidence in the
administration of their schedule, the rulings have been
on the side of liberality in individual cases, as I think
they should be. If a faculty that can be assumed to be
earnest and honest in its endeavor to have proper stand-
ards is convinced of a student's qualifications, and the
circumstances make it somewhat difficult to prove just
where he belongs in the course; or, if the faculty recog-
nizes that in spite of some apparent deficiency, he is
fully able to take up a certain year's work in medicine,
so far as I know, the ruling of the Council has been on
the side of the student, rather than to enforce the hours
laid down.

All these things must be taken into account. The
State laws must be so framed that the administration
under them will be given sufficient opportunity to change
or vary requirements. The State examiners must recog-
nize that colleges must be allowed to grow into the best
scheme, rather than have it forced upon them. This is
particularly true in the matter of hour requirements in
which two states have, within the last two years, laid
down as a minimum reqmrements seemingly unreasonably
great. Finally, it must be recognized that all along the
line there must be intelligent administration of these laws
and regulations. With this recognition, I think our stand-
ards have not gone very far in the direction of too great
rigidity."

Dr. John VanDuyn, Syracuse:

"I hardly think I should speak upon this subject
after such eloquence as we have here. I venture to say,

128 Charles Mclntire

however, that I do not quite understand what is meant
by "standards" and "knowledge" in the present discussion.
Surely, if knowledge is ability to pass an examination,
if it stands for what one knows by the authority of the
books, then medical education has made no advance
since the '60's. Many of us went before the examinations
of those times and could recite almost all of Gray's
anatomy and know our "physiology" by heart. In those
days, much as now, education consisted in the training
of the memory, and the passing up of fees. Today we are
fast coming to what we may call a physiological education.
In older days education was a matter of storing facts.
Then, too, our subjects are so much more increased in
number. In former times if we knew Dalton and Gray,
and a few things besides, we could pass any examination,
but, today, we have gone into such ji variety of things
some knowledge of which is necessary to constitute what
is called a doctor. The fellow who comes up for exami-
nation and has a good appearance, assurance and good
judgment, even though he may not know much anatomy,
etc., may be one of the best physicians of his time. I
would emphasize the fact that there can be but one stand-
ard, which is that of excellence. The knowledge of today
will not be considered knowledge, perhaps, a few years
hence in the future."

Dr. Ray Lyman Wilbur, San Francisco:
"It seems to me that a minimum fixed standard will
not interfere with the development of any good medical
school and will be of great value in the poor medical
school. I think it is a much more satisfactory guide
to know that a man has been four years in a good medical
school than to know that he has passed a set examination
as carried out in many parts of this country. Ability
to pass an examination means very little. Personally,
I would prefer to permit students who have diplomas
from recognized institutions to practice without examination
rather than see any elaboration of the examination
systeni. In such institutions as Johns Hopkins where

Rigidity of the Curriculum 129

other students are able to graduate and yet specialize
quite a little we find that they have no trouble with
State Examining Boards. Probably the standard is
sufficiently high so that the State Boards do not quibble
about number of hours and years."

Dr. James C. Wilson, Philadelphia:

"I rise with a good deal of diffidence to say a word
upon this subject upon which I have some very decided
opinions. I think it is essential that we recognize that
standards must be required, and that so far as
possible, standards of examination must be made im-
perative. The present condition is a compromise between
the requirements of the standards and the requirements
of the examinations, both relating to the graduate as
a practitioner, teacher of whatever specialty he may select.
I am quite sure that the value of the number of hours
as a standard depends, not wholly upon the student,
but also upon the teacher. Pedagogics is one of the
fine arts, and the teacher must be able to recognize the
fact that there are various degrees of capacity and be
prepared to teach the individual student. The mere
question of hours must not be allowed to take too high
a place. On the other hand, the examiner cannot feel
that he has discharged his duty without having general
information as to the amount of time or the amount
of instruction the students have had because of the great
difference in the capacity of the applicants for license.
This all goes back to the institution. The fault that I
discover in the whole matter relates to the requirements
for admission. When I say this I speak as one with ex-
perience as a teacher for forty years; first in junior capaci-
ty and general utility man in a large medical school and
afterwards for twenty years in the faculty, and I am quite
sure that I am right in saying that the institution must
determine how a student shall be prepared to receive his
degree and appear before an examining board. The aim
of the institution must be to arrange some method of
determining the fitness of a man to undertake the study

130 Charles Mclntire

of medicine other than a mere number of units from high
school, so that a man who has not the capacity, the pre-
liminary education to become a physician, shall not be
permitted to enter the classes. The institution must
see to this quite independently of any fixed regulation.
It should have a very copetent body of men to go over
the fitness of individual applicants. Some of the most
shocking things have presented themselves to my mind
as a teacher, for example: that a man should enter a
medical school, pay his fees from year to year, and be
turned down at the final examination for some grammatical
or orthografical defect in his paper. I have known that
to occur time and time again. It seems to me almost
like a scholastic crime. To state it mildly, it is a crime
on the part of an institution to allow a man with an utter
incapacity to meet the requirements to go on year after
year spending his money and his time and then be turned
down. Teachers in medical schools should see to it that
no man who lacks capacity should be graduated. More
than this, they should see that no man lacking capacity
should be admitted. Appointees should look to themselves.
No man should accept a place upon a licensing board if
not fully capable of properly examining applicants and
altogether free from bias. It is a matter of conscience
that members of an examining board shall so arrange
their basis of examination that they shall know whether
a man hesitates or makes trifling errors because he is
anxious and nervous or because he is not qualified. The
board should be able to determine whether a quick fellow
of good memory shall be able to go through on inadequate
knowledge and insufficient education. This subject is one
of the most important matters under the consideration
of the medical profession at the present time."

THE MENTAL STATUS OF ROLAND P.

Dr. p. M. Kerr,

Pennsylvania Training School for Feeble-Minded Children.

Elwyn, Pa.

VT/E are beginning to appreciate the vital importance
' ' of an early recognition of imbecility. Psychiatrists,
psychologists and pedagogues are contributing volumes;
the recently awakened interest in eugenics and sociology
is" manifested in numerous articles appearing in lay litera-
ture— even newspapers are plethoric in editorials pertain-
ing to the imbecile.

All workers in social welfare concur in the advisability
of an early and permanent sequestration of the imbecile.
But it is of paramount importance that the entire lay
world be made an advocate of the segregation of the un-
fit; the public must be taught to regard every imbecile
as a social liability. And with public thought so crystallized
it is certain that legislation for adequate funds for the
care of imbeciles will meet with better success than has
heretofore obtained; increased facilities for the care of
irresponsibles will lessen the burden of our juvenile
courts and field- workers; the tread of imbecile feet will
make a "beaten path" — not from court room to jail,
but from court room to asylum.

Experience of centuries has taught us to synonymize
irresponsibility and imbecility; we know that the average
imbecile is a potential criminal — protect him! He needs
a harbor, not a dungeon.

(131)

132 P. M. Kerr

So much for imbecility in the abstract. I shall now
offer to the reader a concrete example of an irresponsible
delinquent— a murderer at the age of nineteen, who at
the time of this writing, awaits the imposition of the court's
sentence — death.

The story of his crime follows:

On the night of November 7th, 1913, Louis P. was
brutally murdered. The victim, a young man, was em-
ployed as general manager of a dairy farm. His two
assailants were subordinates: one, whom we will designate
George M., was employed as overseer, and the second,
Roland P., was engaged as a helper or chore-boy. The
overseer, a man of forty, is said to have conceived a
hatred for Louis P. because of the latter's familiarities,
fancied or actual, with George M.'s common-law wife.
On several occasions he had remarked to Roland P.,

"Lew is to d famihar with my wife; if he don't

cut it out, I'm going to get him." On the day of the
crime he approached Roland P. and the following conversa-
tion ensued :

"Roland, wouldn't you like to have money?" To
this agreeable proposition Roland P. graciously assented.

"Roland, what does a thousand dollar bill look like?"
"Why, it would be a one with three o's."

"Is that so? Lew has one like that. One day when
I was out west I saw a farmer drive up to a bank. I
noticed when he came out and asked him for a lift. He
gave me a ride on behind and when he wasn't looking,
I hit him with a black-jack and came east with $70.
It was dead easy. Why don't you get Lew and go west?"

R. P. "What do you mean, kill him?"

G. M. "Yes."

R P. "No, I won't do that."

G. M. "I'll give you a black-jack, you hit him
first and I'll finish the job." Roland said nothing to
this.

Later in the day, George M. handed Roland a black-
jack and told him to put it in his pocket; goaded him
throughout the day and promised to "give him half."

The Mental Status of Roland P. 133

That evening he stationed himself in a position where he
could watch both Roland P. and Louis P. as they passed
to and fro in front of the barn. When Louis P. entered
the bam George M. whispered to Roland, "Now is your
chance, nail him!"

Here follows an extract from Roland P's. confession
to the District Attorney:

I went in and said, "Lew, there's a nail in the stall
next to the box stall. Go in and look at it and see if there
is any danger of it scratching the horse." Lew walked
into the stall ahead of me, up towards the manger, to
look for the nail, and I followed him in. While he was
looking for the nail, I struck him with the black-jack
in the back of the head. He turned around and said:
"Hey! What are you doing?" I did not say anything.
He grabbed for me and missed me. He made another
grab for me and caught me around the neck and shoulders.
I then took holts with him and we started to struggle.
He held on to me and I hitting at the side of his head
with the black-jack. We fought out of the stall in back
of the horses. He backing out first with his back toward
the stable door. We were tussling and he threw me down.
I then got the best of him and turned him over and struck
him in the face with my fist. He had got the black-jack
away from me. When I turned him over, he was lying
with his head — lying on his back with his head towards the
door. As soon as I got the best of him he called two
or three times for George. George was standing just
outside the stable door with both doors shut. As soon
as Lew started to call him, George came in. As soon as
George came, he asked him, "What is the matter Lew?
Did the horse kick you?" Lew says, "Yes, yes, help me."

Q. What did George say to that?

A. George didn't say anything. He leaned down
and whispered to me, "Where is the black-jack?" I
whispered back, "Lew's got it." Then George got hold
of the black-jack and tried to get it away from Lew.
I don't know whether he did get it away or not. He
must have gotten it away, because he told me afterwards

134 P. M. Kerr

that he had hit Lew in the head once or twice with it.
He said Lew had a deadly grip on it. He then kicked
at Lew's head and kicked me on the knuckles of my right
hand.

Q. What then happened?

A. I then let go of Lew, and Lew kept struggling.

Q. Did you get up?

A. Yes. I got up from Lew, and while I was getting
up George kept kicking him in the head.

Q. What did Lew say, if anything?

A. And Lew said, "George, you are no kind of a
man. Help me."

Q. Did he yell that?

A. No. I don't think he said — just the same as
if he would say it naturally.

Q. And what did George then' do?

A. George then kept kicking him in the head.

Q. And what was Lew doing?

A. Lew was struggling with his arms to keep his
kicks away from his head.

Q. And was he yelling, screaming?

A. No. I think he was halloing or moaning, sort
of kind of.

Q. Did he get up at all?

A. No, he didn't get up.

Q. And what then happened? Did George say any-
thing while he was kicking him-?

A. No, he didn't say anything.

Q. Then what happened?

A. Then after he had kicked him several times —

Q. In the head?

A. In the head, he laid still, and then George went
up to the house after a lantern.

Q. Where did you go.?

A. I went outside the stable door and waited until
he come back; shut the stable door and waited until
George come back with the lantern.

Q. When he came back with the lantern, what did
he do? Did he come in the stable?

The Mental Status of Roland P. 135

A. He went in the stable.

Q. Shut the door?

A. Shut the doors, and I followed him in, and he
felt Lew's heart; put his hand on Lew's heart, and said
he was still breathing; then he goes around to the side
of him and kicks him with his heel; stamps him with his
heel in the side.

Q. Over the heart?

A. Yes.

Q. Did Lew scream then?

A. Lew halloed. He didn't scream, I don't think,
the whole time. Kind of "Woo!"

Q. He gave one loud hallo, did he, or several of
them?

A. One loud hollo.

Q. Did George kick him in both sides or just one
side?

A. Both sides. The first time he kicked him he was
on the wrong side, he said.

Q. George said?

A. Yes.

Q. What did he say?

A. He said, "Where is his heart? Which side is
his heart?" and then he thought and went around to
the other side where his heart was, and kicked him on
that side.

Needless to say, the victim was fearfully mutilated,
the Coroner's physician testiyfng that death was due
to rupture of the heart and lungs. The murderers
carted the body several miles away from the scene of
the crime and buried it near a woods. George frequently
cautioned his accomplice: "Keep your mouth shut, don't
say a word." Contrived to keep him away from the
detectives as much as possible by sending him to husk
corn in a distant field.

The men were accused of the crime and Roland P.
confessed. George M. then led the searching party to
the grave and later pleaded "not guilty." Averred
that he had had no hand in the murder excepting that

136 P. M. Kerr

he helped to bury the deceased; feared Roland would
try to incriminate him if he refused to assist in the
disposition of the body.

The writer was asked to examine Roland P. because
the attorney could not understand the boy's attitude.
The lawyer stated that his client was "unfeeling and with-
out proper appreciation of the enormity of the crime."
I interviewed the boy in his cell in the Media jail and
must confess that I was shocked when a tall stalwart lad
of only nineteen confronted me. He shook hands and
appeared glad to welcome me; in lieu of a chair, courteous-
ly offered me a box, and pointed with evident pride at a
Bible that he had been reading. To my queries concern-
ing his history, he answered me relevantly and, I believe,
truthfully. Here is a sample of our conversation:

"How old are you?"

"About nineteen, I guess."

"Why did you leave school?"

"Wanted to work."

"Did you work?"

"Yes sir, around the house."

"Why did you leave home?"

"Had a fight with my mother."

"How old were you when you left school?"

"I don't know exactly, about fifteen, I guess."

"After you left home, how long were you away?"

(After some deliberation) "About three years."

(His sojourn from home was really eighteen months.)

"Did you like George M.?"

"Yes, he was good to me."

"Did you like Lew? Would you have cared to chum
with him?"

"Yes, Lew was a good fellow. Me and him never
had any trouble."

"Then, why in the name of all that is natural, did
you kill him?"

(Without emotion) "I don't know, I guess because
George told me to."

The Mental Status of Roland P. 137

"Roland, you studied United States History; what
were the causes of the Civil War?"

"To free the slaves."

"Who was the commander in chief of the Revolu-
tionary War?"

"I don't know that one."

"Was it Washington?"

"Oh, yes."

My diagnosis of high-grade imbecility is based on a
physical and psychological examination and a careful
consideration of the excellent data obtained from the
records of the Quaker school that he had attended.

Age 19 years; weight 165 pounds; height 5 feet, 9
inches; well proportioned and muscular; asymmetries
few and insignificant; a brunette, hair auburn and wavy;
pilosity poor, excepting head and pubes. Deep orbits;
receding forehead, 70 degrees; facial and aural angles,
68 and 20 degrees respectively. Ears somewhat asymmetric-
al, right ear having well opened helix.

Cephalic index being 81 per cent, the head is therefore
brachycephalic. There is a moderate degree of enlarge-
ment of the left lobe of the thyroid; the right lobe is
markedly enlarged. Tachycardia, pulse being 110, of
good volume, tension and rhythmn. No valve lesions in
heart. Patient tells me that he sweats easily; palms of
hands are bathed in moisture. Deep and superficial re-
flexes normal, excepting the cremasteric, it being entirely
absent. Slight dermographism.

A phychological examination reveals the following:
Powers of attention — excellent. Powers of expression —
has good vocabulary and answers questions promptly
and relevantly. Quickly grasps the general meaning of a
statement or question, if it be not too involved, but often
fails to appreciate its full significance. Prone to miss the
motive of the questioner.

Memory: poor, especially for long laspes of time.
Example, states that he left the Westtown School at
14 years of age, remained with his mother a short period
and then went to Philadelphia where he remained for

138 P. M. Kerr

three or four years. As a matter of fact his sojourn in
Philadelphia was only a year and a half. This tendency
towards temporal confusion is a common feature of im-
becility. Again — concerning the crime — he recalls with
difficulty the details which led up to the same. Has had
more than a month for reflection, but has made little
progress in this direction. A normally receptive mind
would have had each detail indelibly impressed. Since
he left his home, he has worked in numerous places, and,
with one or two exceptions, he is unable to recall the
names of his employers.

The prisoner made what was supposed to be a
full confession of the crime, the District Attorney de-
claring in court that he had cross-examined Roland for
six hours. Yet the prosecutor failed to elicit such im-
portant data as George M.'s appeal to Roland's cupidity:
the fictitious western adventure and the episode of the
thousand dollar bill. Roland told me that he had not
mentioned George's remarks prior to my visit; states
that he had nearly forgotten what George had said. It
is quite conceivable that he had forgotten them. He
failed utterly to discover sinister motives in these ad-
vances and always considered George a good friend.
Therefore, in failing to detect anything overt in the friend's
artifices, it is obvious that there could be no associative
tendencies — the conversation was relegated to that twilight
zone called 'subconscious memory.'

This obtuseness naturally implies a defective judg-
ment; and the inability to perceive motives is as common
to imbecility as is the incapacity to appreciate the subtler
forms of expression, such as irony, sarcasm, satire, metaphor
and simile. Expediency often fails to govern the actions
of the Moron; judgmental defect and a moral code
ranging perhaps from a slight obliquity to downright
turpitude, combine to constitute the viscious class of
criminals commonly called incorrigibles or recidivists.
Roland is of this class. Memory may or may not be
normal and from a medico-legal standpoint, this point
is very important. Is it not true that we tend to give

The Mental Status of Roland P. 139

memory a geocentric position in our investigations and
in the event that this process of consciousness prove in-
tact, are we not prone to underestimate the importance of
other phases of consciousness? Where the general prac-
titioner attempts to qualify as an expert, as happened in
this trial, this tendency is almost inevitable. It certainly
obtained in the case of which I write, and, I believe, milita-
ted greatly against the assumption of Roland's mental
deficiency. As compared with the tests for other processes
of consciousness, memory presents little difficulty to the
unskilled examiner.

According to the tests formulated by Binet-Simon,
Roland has a mentality of a normal boy of eleven.
Here are some extracts from the Binet tests:

I have three brothers, Paul, Ernest and myself.
Roland said, "That is all right."

If in a moment of despair I should commit suicide,
I shoidd not choose Friday, for Friday is an unlucky
day and that would bring me bad luck.

"Don't know that one."

As to definitions: "Charity is giving to the poor."
"Justice is doing good." "Goodness is being good."

Take this from the twelve year test: A person
out walking in the woods suddenly stopped, much fright-
ened, and ran to the nearest police station to report that
he had seen hanging from the limb of a tree — what?

Roland answered, "a snake."

Most of eight, nine and ten year tests, he answered
satisfactorily.

Right here, let me remark that in making my de-
ductions as to Roland's mental status, the usefulness
of these Binet-Simon tests was negligible; as a means
for presenting convincing evidence to the jury, these
tests offered little. The following remarks may explain
the difficulty.

As applied to the twelve and thirteen year child,
the Binet-Simon tests give a fair estimate of the amount
and kind of previous training; also, they may serve to
bring out certain forms of cleverness. But they fail to

140 P. M. Kerr

indicate real intelligence. The tests as applied to norms
under twelve years are of undoubted interest to the
psychologists; when applied to the field of variational
psychology, however, their value is questionable. To the
initiated they are superfluous. We tell an imbecile of
twenty that he 'tests ten years' — has the intelligence of
a normal child of ten. Logically then, we may assume
that the normal child of ten has the intelligence of a
certain imbecile of twenty. How many doting parents
will subscribe to this absurd proposition?

The chief advantage in describing a mental defective
in terms of mental age is this; it is intelligible to a lay-
man. The latter may or may not appreciate just what
low, middle and high grade imbecility means, but he
does know what is expected of a eleven year chUd. Thus,
if you tell a parent that his nineteen year old boy has
the mentality of a normal child of less than eleven, your
observation will probably be understood. During the
trial, therefore, we deemed it wise to declare to the jury:
"Roland is a high-grade imbecile or moron and his
mentality is that of a normal boy of eleven."

Roland could not retain a position if he were required
to use even ordinary judgment. At one time he worked
as a laborer during the erection of a movdng picture
theatre. He acquitted himself creditably. Because of
his prepossessing appearance, the manager promoted him
to the exalted office of ticket chopping and he was required
to exercise his judgment in separating hoodlums and
negroes from the possibly more genteel element; also, he
was enjoined to give elderly patrons the choicest seats.
He failed signally in this vocation and was discharged.

When alienists for the prosecution examined him
in his cell he answered everything to the best of his ability;
did not mention to his own attorney that he had been
examined, although he had been cautioned to answer no
questions unless his lawyer were present. The lawyer
did not hear of the inter\aew until several days had passed.
And then when he reproved Roland, the latter said,
"I forgot to tell you."

The Mental Status of Roland P. 141

Several days prior to the discovery of the body of
the murdered man, Roland suggested to a brother of
the deceased that they go to Chester to play pool.
This suggestion shows at once his lack of the ordinary
precepts of decency as well as his judgmental defect.
When asked what he would do if he were liberated from
prison, he answered, "I would go home and try to help
around the house the best I could." Would you expect
such a puerile answer from a normal youth of nearly
twenty?

Volition: Refused repeatedly to do George's bidding,
yet he accepted a black-jack three hours before he
committed the crime. Here is another extract from the
confession :

Q. What did George M. say about Lew, or doing
away with him? Do you recall?

A. No. Only that he said, "Lew's still got that pile
of money on him. Let's get it."

Q. Did he say, "Let's get it," or, "You go get it?"

A. "Let's get it." After he first spoke about doing
away with Lew he said, "You go get it and I will help
you."

Q. What did you say then?

A. I refused.

Q. What did you say?

A. I said, "No, I won't do that."

Q. "I said, 'No, I won't do that.' " Did you give
any reason?

A. First I asked him how he was going to help me.
He said, "I will help you put him away."

Q. He said, "I will help you put him away?"

A. I said, "No, I won't kill him."

Q. "No. I won't kill him."

A. Then he said to me, "Well, you start it, and
I will finish it," and he gave me the black-jack.

Q. He said, "You start it, and I will finish it?"

A. Yes.

Q. Did you hesitate at that?

142 P. M. Kerr

A. I hesitated all that day, and then he kept
coaxing me.

Q. What did he say?

A. He kept asking me all along, "Well, have you
made up your mind? Don't forget that's an easy chance.
Don't let it slip through your fingers." Or something
like that. Kept dogging at me.

Q. Up until what time?

A. Well, all that day he kept coaxing me that way.

Q. When did you make up your mind — when did
you tell him that you had made up your mind, or what
did you say to him that indicated to him that you had
made up your mind?

A. The only indication was when he handed me
the black-jack and I took it.

Q. The only indication was when he handed you
the black-jack and you took it. Hadn't you said any-
thing before that, that would indicate it?

A. No.

Q. Had he said anything to you about giving you
a black-jack to do it?

A. Yes.

Q. What had he said about that?

A. He said, "I will give you a black-jack. You
can do it with that."

Q. Where did he give you the black-jack and when?

A. In the milk-house, about three o'clock.

Q. And what did he say when he gave you the black-
jack?

A. "Here's the black-jack. Now, don't forget."

When George M. said "Now is your chance, nail
him!" Roland immediately turned to Lew with "There's
a nail in the stall; go see if there is danger of it scratch-
ing the horses." The association of the tempter's "Nail
him!" with Roland's nail pretext is evident.

During the trial of George M. and while Roland P.
was testifjdng against his former accomplice, George M.'s
attorney addressed Roland thus: "Roland, had you no
compunctions of conscience in killing Lew?" Roland,

The Mental Status of Roland P. 143

who of course, hadn't the slightest understanding of the
attorney's "compunctions of conscience" (a redundancy
by the way) hesitated, then answered "No, sir." He
was again asked if he had no compunctions of conscience,
and, realizing that his answer had been received with
disfavor, he replied in the affirmative, properly pleased
with his own penetration!

At school he had never been a leader nor was he
even popular with his companions and teachers. He is
described by one instructor as colorless and vacillating.
Temperamentally he is phlegmatic. Has no affection for
acquaintance or relative and really is too indifferent
to bear malice. He will lie when the truth would serve.
While in the employ of a physician, he disclaimed all
knowledge of cards — 'didn't approve of them anyway.'
A pack was subsequently found in his room. Said he
had no interest in the opposite sex and that very even-
ing he tried to negotiate an engagement with a serving-
girl. Once while with a crowd of hoodlums, he spoke
disrespectfully of his mother. A companion suggested
that he should like to call on Mrs. P. Roland said,
"It will be all right, go ahead." When rebuked for this
crassness, he evinced no shame whatever. Naturally a
coward, he shuns a quarrel. Says he is sorry he committed
a crime and manifests a moderate amount of self pity
because of his present predicament. Professes no remorse
for having killed a man for whom he admits he had no
dislike. He feels misused because he has not recovered
a small amount of back wages which he claims the dairy-
man owes him. When he accompanied the detectives
to the grave at the time of the discovery of the body,
he fell asleep in the wagon. He complains of the con-
finement of cell life and expresses his desire for more
exercise — a larger penitentiary. Does not appear doubt-
ful as to the leniency of his sentence. During the trial
he slouched in a chair, hardly moved a muscle and showed
no emotion when his parents were on the witness stand,
although the spectacle was most pathetic and might well

144 P. M. Kerr

have moved a Caligula or a Nero. Even the presiding
judge remarked about this unstudied stoicism.

Since the trial and conviction of his accomplice
George M., Roland has felt quite elated. Far from feeling
Judaic, he poses as a hero. Evidently assumes that the
whole blame is now resting where it belongs, serenely
ignoring his own part in the crime.

He is an inordinate cigarette smoker.

The family history is interesting. It is alleged that
the mother is of questionable character; the father is a
weakling. There is a younger sister who is said to be
backward in school work. There are also three cousins;
one is an idiot, one an imbecile; the third is a high-grade
imbecile and paraplegic. Several maternal aunts and
uncles are insane. The father told me that h left his
wife about eight years ago and in .extenuation, quotes
his wife's father as saying, "John, you can't stand all
this abuse from Lettie; why don't you get out?" States
that shortly before his boy's birth, there was a noticeable
change in his wife's temper; she became morose, faidt-
finding and extremely domineering. This history is
significant.

I was on the witness stand for an hour and a half.
The fact that the counsel for the defense had ordered an
examination of his client without first notifying the
district attorney, was considered by that official as suffi-
cient reason for striking my testimony from the Court's
records. The point was not sustained by the Judge,
however. And then begins the usual "bully ragging."
One would think that I am the culprit. The attorney
sneers at the Binet tests (his questions clearly show his
entire ignorance of their very existence) and attempts
to discredit my testimony as to Roland's neurotic family
history by presenting twelve laymen and four physicians,
all of whom swear that a cousin, distinctly imbecilic, is of
normal mind. George, the cousin in question, is a lad
of eighteen, a high-grade imbecile and paraplegic and
has a feeble-minded sister. He was committed to our

The Mental Status of Roland P. 145

institution by an uncle who feared that the boy might
involve the family in further distress.

The district attorney tries to prove that this boy
was committed to our institution merely to create sympa-
thy for his cousin Roland. Hence, to prove the normality
of our charge, twelve laymen and four physicians are
called. A whole afternoon is frivoled away in an examina-
tion of all these witnesses for evidence that is purely col-
lateral. One witness, a cobbler, states that 'George went
to church regularly and sometimes spoke.' He is, there-
fore, convinced that George is normal. A former em-
ployer of the boy testifies that George worked for him as
assistant plumber and always "minded him." Ergo,
George is normal. What could the evidence of Dr. M. W.
Barr and myself avail against such erudition?

The four medical mercenaries who offered testimony
as to George's mental condition are general practitioners,
and, with one exception, have had no experience in the
field of psychopathology. All are physicians in good
standing; they are familiar with our institution and fully
cognizant of the humane character and purpose of our
work. These pseudo-experts were retained by the District
Attorney who requested that they examine and report
George's condition — of his antecedents and history they
knew nothing. They visited our institution, were closeted
with the boy just forty-five minutes and were then
fortified in their pre-formed opinion and quite willing to
testify as to George's mental normality. Their testimony
in court must have been a revelation to the jury. They
would neither frankly concede the boy's defect nor admit
of. the boy's normality. They hemmed and hedged,
juggled and dodged — like Gratiano, they spoke an in-
finite deal of nothing. These medicos willingly abetted
their retainer, the District Attorney, whose intent was
to create the impression that a normal boy could be
incarcerated against his will — sacrificed to the interest
of his cousin Roland. Of course the whole proposition
is absurd. It proves three points: the unscrupulousness
of some physicians, the assininty of some attorneys and

146 P. M. Kerr

the patience of a certain Judge. It may be of intei'est
to our detractors to learn that George (who was present
in court and therefore heard the testimony) was much
impressed by their efforts in his behalf and has since run
away from our asylum. But let us return to Roland
and the progress of his trial.

The fact of Roland's three year retardation in school
is dismissed by the District Attorney as "showing only
inattention." Two teachers testify to the contrary and
furtherm.ore declare that the boy at fourteen was in a
class of eleven year children. For three years he had
failed to graduate from that class. The Binet tests are
pooh-poohed as absurd. Some of them are. I am
asked why I consider Roland volitionally weak, unduly
acquiescent — "when it required six hours to wring from
him a full confession of his crime.". The presiding judge
warns the prosecutor that if he enters this statement,
the whole confession will be disallowed as testimony,
stricken from the court records, his Honor holding that six
hours of grilling is equivalent to the "third degree."
Thereupon, the adroit attorney quietly withdraws his
query and offers it as a hypothetical question instead,
thus: "If it took six hours," etc. "would you consider him
of weak will?" This is allowed. I explain that H- the
confession (a lengthy statement of sixty-five typewritten
sheets) was made voluntarily- — and it undoubtedly was —
the expression "wring from him a full confession" is
clearly exaggerative and likely to misrepresent the boy's
real attitude. I also add that if six hours were required
to elicit a voluntary statement, the point in itself suggests
a low grade of intelligence. Then the attorney addresses
the following statement to the jury:

"George M. was convicted of the murder of Louis
P. almost wholly on the testimony of an imbecile — if the
testimony of the defense is to be believed. If Roland ig
free, George M. — "

At this point the attorney for the defense vigorously
objects. He contends that the prosecutor is manifestly
introducing unfair deductions. The Judge supports this

The Mental Status of Roland P. 147

objection and orders the statement ruled out. But the.
jury had heard the District Attorney's contention and it
probably left its impression.

Dr. Goddard of the Training School at Vineland,
N. J. and Dr. J. Madison Taylor, who has been connected
with our insftCution for feeble-minded for many years,
were my co-workers in behalf of the defense. These
gentlemen testified that Roland is an imbecile. Several
weeks previous to the trial, our attorney submitted a
list of propositions and requested that we consider them
carefully. We held three meetings. I introduce these
premises and my comments at this point because much
of the context was offered as testimony.

1. Roland is a high-grade imbecile or moron.
Yes. A high-grade imbecile is a person who by

reason of a faulty development of brain structure is
permanently unfitted to assume the responsibilities that
his age and previous training would warrant. Such a
person under proper training and environment may become
proficient in the arts and crafts, but because of lack of
judgment and moral control, he is almost certain to
violate the rights of his fellow-man when left unguided.
(This definition was offered on the stand and was un-
challenged.)

2. This means a mentality of about a eleven -year-
old boy.

Yes.

3. This results from a constitutional defect.
Yes.

4. His failure in school was due to this defect.
Yes.

5. The cause of this defect from a physical stand-
point is not known, if such is the case.

The defect is due to a subnormal development of
brain cell— both quantitative and qualitative.

6. It is not a thing that can be cured — it is some-
thing lacking.

Correct.

148 P- M. Kerr

■ 7. It is to be distinguished from insanity — if such
is the fact — and what is the difference.

Insanity, being a disease, is sometimes amenable
to treatment; imbecility being a condition of arrested
development in health, is incurable.

8. That such minds, and of course Roland's, cannot
project themselves beyond and see the consequences of
•their act.

Roland knew that he could be punished for his act.
This abstract knowledge of what he must do and must
not do is not engendered through any agency of conscious
process, such as judgment. It has its analogy in the
mind of all children who must first be taught right from
wrong. But if the child develops normally he will
soon perceive why certain acts are wrong. It is right at
this point that Roland manifests his moral and mental
defect. Roland is not sui generis. I personally know
hundreds of imbeciles who cannot fully appreciate wrong-
doing in the concrete.

9. That they lack all sense of proportion — would
also like to have some good illustration of this.

Only the lowest grades of imbecility show a lack of
aU sense of proportion. This sense of values is in ratio
to their mental grade.

10. That they are easily influenced by the suggestion
of a stronger mind, with illustrations.

Obstinacy is quite compatible with the imbecile
mind but I have yet to meet the imbecile who may not
be influenced by a stronger and more subtle mind.

11. That because they have no real sense of right
and wrong (notwithstanding they may phonographically
reel off a long list of them) they can be influenced to
commit crime, with illustrations.

Correct.

12. That having no opinion of their own ^s to the
right and wrong of a given suggestion, they don't recog-
nize in the concrete that which they would tell you is
wrong in the abstract.

Correct.

The Mental Status of Roland P. 149

13. That in the abstract Roland would say it was
wrong to kill a human, not because he really felt it, but
because he has been told so. (This will probably come
up in the form of the question — "Could Roland distinguish
between the right and wrong of George M.'s suggestion?"
If this cannot be answered categorically, say so. But
explain as above indicated, if that is your opinion.)

Correct, as explained in No. 8. His moral sense
is no higher than that of the young child for whom the
meaning of the Golden Rule is as yet vague.

14. That under all the circumstances of the case —
viewing the matter in the concrete — Roland did not go
forward with a fully formed conscious purpose to kill
and intention to carry out that purpose.

It is my firm conviction that the crime could not have
been consummated by a mind like Roland's. He was
without doubt dominated by a stronger personality.
The attorney's queries on page No. 63 (of Roland's con-
fession) suggest the answer that the questioner wanted —
"You did this, you expected that, you knew this and that,
didn't you?" Roland answers, "I guess so." Suggesti-
bility is an imbecile trait. It is my opinion that Roland
did realize that he might cause his victim's death. Having
no moral scruples and a weak volition, he is the typical
weakling. Such a boy almost inevitably falls victim of
the vicious.

15. That at the time he went into the stable he
was devoid of thought and proceeded under the impulse
of George M.'s suggestion.

When Roland enticed his victim into the stall with
the fictitious nail pretext, he used cunning and was there-
fore not in a state of marked mental confusion. He did
act under the impulse of George M.'s suggestion and was
practically without power to recede from this position
to which he had been carried.

16. That he was not then conscious of the right and
wrong of the suggestion.

He has no more real consciousness of right and wrong
than a child of four. To be sure, experience has taught

150 P. M. Kerr

him to avoid trouble under normal conditions. Place
him in the power of a scoundrel and he must do his bidding.

The four physicians who served the attorney so
zealously by declaring Roland's cousin of sound intelligence,
were equally obliging when the prosecutor required their
judgment as to Roland's mental status, for they forthwith
discovered that the latter is also of normal mind. This
belief they asseverated in court. Of course they could
not confute the evidence of the boy's abnormal develop-
ment in school — as already stated, two teachers testified
as to his retardation and presented school records to
corroborate their testimony. The irrationality of his
behavior, both before and after the crime, was not denied. ■
The experts admitted Roland's peculiarities but preferred
to dissociate his foibles from his intellectual attributes.
I submit that where there is a specific history of early
mental retardation, this dissociation of emotional and
volitional defect from the content of intelligence is ob-
viously unfair and unscientific. The writer claims no
profundity for the thought.

We presented our evidence of the prisoner's emotional,
volitional and intellectual inferiority or defect as simply
and concisely as is possible. The jury was composed of
farmers, artisans, and laborers. Much difficulty was
encountered in selecting these men; the talent in Chester
and Delaware Counties is essentially of Quaker extraction
and for capital punishment this sect has a very proper
aversion. It follows that many were called and few were
chosen.

The attorney for the defense pleaded for a verdict
of second degree murder. In his address to the jury
he said: "The prisoner, though physically of man's stature,
is mentally a boy in short pants." More elegantly,
perhaps: "Although the law attempts to regulate the nor-
mal mind, it does not hold to strict responsibility the
visitations of God."

The Judge charged the jury as follows:

"The first point you must consider is, 'Was this
killing done in the perpetration of, or an attempt to

The Mental Status of Roland P. 151

perpetrate a robbery and if so was the defendant afflict-
ed with a mental disease which enabled George M. to
dominate his conduct in such a manner that he could
not resist him?' If so, he was not guilty of murder in
the first -degree and you should acquit him because he
would not be responsible in law.

"If you should lind it was not done in the perpetra-
tion of, or attempt to perpetrate a robbery, then it was
murder in the second degree.

"The great battle in this case has been fought over
the question of whether or not the defendant is entirely
normal. You have heard the evidence, you have seen
him here, and it is for you to judge.

"This is probably the most important duty you will
ever be called upon to perfonn. Of course there is sympa-
thy for this young man and his mother and father,
and for the mother and father of the young man who was
killed, but that is no part of your province. Do not
let that enter into your deliberations, for if you do you
will do a greater wrong than you will ever be able to
undo."

The jury at first disagreed, a few voting the prisoner
normal and the rest expressing opposite conviction.
After m.any hours deliberation, they returned an unami-
nous verdict — guilty of raurder in the first degree.

Now in a court of common pleas, it is easily con-
ceivable why jurors disagree on doubtful points of evi-
dence and counter evidence. But in this particular case
there was presented no concrete counter evidence; twelve
men listened to the evidence of experts; they presumably
availed themselves of the ample opportunity to study
the prisoner as he sat in the court room; they listened
to counter evidence which consisted only of the inanities
of a mediocre prosecuting attorney.

We therefore felt that the jury would give Roland
the benefit of uncertainty; indeed, one might reasonably
expect that if there were even a shadow of uncertainty as
to the culprit's mental status, that doubt alone should
deter an honest man from rendering a first degree verdict.

152 P. M. Kerr

Those members of the jury who believed Roland imbecilic,
held out for what must have been a long twenty-four
hours — an ordeal well calculated to weaken their earlier
convictions. I can construe their vacillation in no other
way. Of course, these men were unschooled in matters
pertaining to imbecility and were therefore educationally
unqualified to solve the problem assigned them.

The trouble lies in this: our method of choosing
juries is ludicrous. Is there a judge in the great United
States who has not had occasion to smile at the personnel
of some of these nondescript aggregations?

It would seem that the most desirable juror is the
man who has no opinions, or, in the event of his having
ideas, lacks either the ability or the interest to express
them. Behold then, the expert, holding forth in all
sincerity and faith, and in manner deferential — expatiating
matters psychological to plow-boys and negro coachmen!
A tribunal so chosen is in no ways competent to decide
the fate of a brother in misfortune — of that am I con-
vinced.

Roland must receive the same brand of justice that
has been meted out since the days of Medievalism.

Should this boy be liberated? Certainly not. In-
herently abnormal, lacking wholly the qualities of love,
pity, altruism and remorse, constitutionally unmoral,
emotionally undeveloped, unable to adapt himself to the
disparities of our social life — such a nature constitutes
a distinct menace to the community. One would think
that his colorless temperament, mental retardation, and
all the desultory habits of his childhood, might have had
some significance to his teachers and early associates;
that some means might have been found to protect him
from vicious companionship. He was always considered
eccentric, but I am inclined to believe that no physician,
teacher, or friend had ever correctly interpreted his
actions. Had his defect been recognized early and pro-
vision made for his permanent sequestration in a suitable
institution, he would have proved tractable and adaptable.
He is not wilfully vicious. I personally know dozens

The Mental Status of Roland P. 153

of imbeciles who are not criminally inclined, and yet,
under the baneful influence of a strong or a subtle mind,
the most kindly might succumb to Roland's temptation.

Society — whose zeal in punishing these unfortunates
is only equalled by its blindness to underlying causes of
their delinquency — society adopts punitive measures where
prevention would prove humane and economical. But
the public will learn- — is learning its lesson. As physicians,
we should be teachers and propagandists — let thought
ripen into action. We have long been content with a
semblance — let us have the substance.

In this story of an irresponsible type, I have en-
deavored to emphasize the importance of an early recog-
nition of the imbecile. My efforts may serve also to
indicate the difficulties encountered when, in court, an
alienist assumes the role of protector of the liigh grade
mentally deficient. If Roland were unable to read or
write, or if he presented the drooling mouth, silly chatter,
and the marked somatic stigmata of the lower grades —
our problem would have been simple indeed. Had we
been able to show that the boy had been formerly an
inmate of an institution, that point, beyond peradventure,
would have convinced the jury of the boy's mental in-
feriority.

Roland should be punished. That little epigram
"for sparing justice feeds iniquity" is a precept to which
all criminologists must subscribe. But his punishment
should be of nature, remedial — not homocidal; his sentence
should be commuted to life imprisonment.

154

P. M. Kerr

These photographs of Roland were taken in the
yard of the jail. The prisoner has been confined since
December, 1913 and notwithstanding an uniformily good
appetite, he has lost considerable weight. Since his
conviction he has been out of his cell only once and that
brief respite was granted when I visited the jail and se-
cured these pictures. The warden states that the prisoner's
conduct is in every respect exemplary.

THE HARRISON ANTI-NARCOTIC LAW. ITS HELP

AND ITS HARM.

By C. H. Hughes, M. D.

St. Louis, Mo.

Former Superintendent Missouri State Hospital for Insane No. 1.
Editor Alienist and Neurologist and Author of the Neurological
Practice of Medicine. Member American Medico-
Psychological Assn. Honorary Member British
Medico-Psychological Ass. Etc. etc.

THIS law will arrest the present alarming growth and
peril of narcotic addiction as to novices forming
the ruinous habit of opium and cocaine taking, by those
ignorant of the pernicious sequences of habitual non
medically prescribed opium and cocaine taking, but on the
other hand, what is to become, in the present state of
public ignorance among policemen and others, of the
misery of these enthralled habitues when the drug is
suddenly taken from them by inexperienced physicians?
Dispensaries for gradual withdrawal, relief and temp-
orary substitution should have been suggested and pro-
vided for in the Harrison Bill. The author of ths
meritorious bill has overlooked this miserable feature of
the terrible narcotic drug addiction evil and
therefore failed to add suggestive caution and
possible provision fGr the miserable victims of the
too sudden deprivation. The unhappy victim of the
opium or cocaine habit, suddenly deprived of his accus-
tomed drug, suffers beyond conception, (by the clinically
unfamiliar). Only the very strong and recent addicts
can stand complete sudden withdrawal of the drug with-
out the wisest substitution and most discreet and dis-
criminating management.

(155)

156 C. H. Hughes

When the daily dosage (enormous doses) to which
many of the pitiable victims become accustomed, is
suddenly out of their reach, they suffer tortures incon-
ceivable. They are sick and distorted in mind. They
become restless, vague, erratic, untruthful and often
criminal, perverse and in many other ways display
astonishing mental abnormalities, that are incomprehensi-
ble except on the assumed basis of fiendish criminality,
as the ignorant regard them, or as diseased, as all truly
clinically experienced know them to be. The ignorant
cruelly or inconsiderately call them "fiends," "dope
fiends," (a most uncharitable, cruel and ignorant mis-
nomer.)

Their actions and speech deceive courts, jurors,
police officers and other public_ officials and sometimes
the best and most intimate friends misjudge them.

Pity them, succor them. They need medical con-
cern and care and public consideration perhaps more so
than the helpless confirmed alcohol poisoned inebriate.

In the list of exemptions Camphorated Tincture of
Opium U. S. P. (paregoric) erroneously appears and a
number of mildly opiated cough mixtures, while opiated
lozenges are not exempted. The opium habit may be
formed from these. The writer knows of one instance
where a physician's direction to take moderate medical
doses of paregoric developed the habit, through copy
and refilling at different drug stores and finally through
getting the same on personal verbal order. This party
acquired the habit of taking a drachm of sulphate of
morphia at a dose and finally died in consequence of
sudden deprivation and heart paralysis.

The police are often as ignorant of their real morbid
states as they too often are of the normal citizen's person-
al rights. One of them having recently in St. Louis
slapped a pharmacist for refusing him access to the
prescription counter, in search, without warrant and on
his own notion, for a woman he suspected . was there.

The danger of getting the opium habit and the
cocaine habit likewise is in the voluntary repetition at

The Harrison Anti-Narcotic Law 167

different pharmacies and through different doctors' pre-
scription for the same, painful condition as the patient
represented himself ,to have and as he does have under
deprivation, if the quantity of opium taken is great and
withheld.

Any prescription for internal use that has opium or
coca or their derivatives should only be obtainable on
a reputable registered physician's prescription, except
apomorphia and this nausea producing alkaloid is (singu-
larly) prohibited in this bill.

But this law, though onerous to the physician,
is aiming in the right direction for popular safety from
narcotic drug addiction and community damage and de-
generation and will be perfected in time for completer
public safety, in regard to this deplorable harmful evil
of self medication; all too common for the people's wel-
fare as to personal stamina and citizenship qualification
of that high standard needed for the stability and per-
petuity of our great Republic.

This law will prove especially valuable as a safeguard
to neuralgia subjects, to surgical "after care" cases and in
victims of cancer and other painful diseases, to diabetics
also, where opium and its derivatives, morphia, codia,
etc., are considered essential to successful treatment.

(By the way 'and in parentheses we would here re-
mark that some authors do not advise with sufficient
caution in view of possible danger of the formation of
this pernicious habit, in regard to the use of opium,
in diabetes, Struempell for instance.)

He says, of internal remedies, opium should be named
first. A patient can take four to eight grains of opium
(0.25 to 0.50 grm.) or even more, in twenty four hours,
without bad effect. (Vickery and Knapp — Translation,
Shattuck, Editor.) Dr. Shattuck thinks Struempell does
not do justice to codia, etc. and, though not germane
to our subject, we in passing, concur, especially as to
codia, since codia appears less likely to create the opium
habit craving and, as a thirst quencher, for which Struempell

158 C. H. Hughss

advises opium (and sugar excretion arrest also), opiates
are rather provocatives than assuagers.

Following is the Physicians' Federal Opium and fcoc%..
Law^. For this epitome we are indebted to D. 0. Haynes
& Co., Publishers of the Era, New York, N. Y. who put
on the market a physicians' register for record of these
narcotics, as the law requires-

RELATING J'O THE PRODUCTION, IMPORTATION, MANF-
FACTURI"!MG, COMPOUNDING, SALE, DISPENSING OR
GIVING AWAY OF OPIUM OR COCA LEAVES,
THEIR SALTS, DERIVATIVES OR PREPARATIONS.
By Act of Congress Approved December 17, 1914
Each Physician, Dentist and Veterinary Surgeon who prescribes or
dispenses any of the drugs which come under the provisions of this
law is required:

1. To register with the Internal Revenue Collector of his District,
on or before March 1, 1915; to pay a tax of $1.00 a year (34c to June
30, 1915) and obtain his Registry Number, also a supply of special
Order Blanks.

2. To prepare on March 1, 1915 and kaep on file an Inventory
of all such drugs and preparations he has on hand at that date, which
must be verified by oath not later than March 5, 1915.

3. To use the special Order Blanks for all such goods as he orders
and to keep a duplicate of each order on file for at least two (2) years,
accessible to official inspectors.

4. To sign all prescriptions that he writes for these drugs with
his full name and his registry number, together with the date as issued
and the location of his office, also the name and address of the person
for whom such prescription is written.

5. To keep a Record Book of all such drugs dispensed or dis-
tributed by him (at his office) showing: (a) the date when dispensed
or distributed, (b) the kind of drug and quantity and (c) the name
and residence of the patient.

The medical profession, with its accustomed philan-
thropy, and over looking for the time being its defects,
will hail this Harrison Bill with pleasure, knowing the
Iliad of woes it will avert from humanity in preventing
the often innocent formation, by unmedically prescribing
repetition of certain narcotic and anodyne dosages after
the need of them shall have ceased. But it wiU not over-
look its defects in including in its restrictions so many non-
habit-forming agents as it has, whereas opium, cocaine and
chloral and certain of the coal tar derivatives are the
chiefly perilous therapeutic agents and accepting minimum
doses of opium and its derivatives, such as morphia, in

1. — Harrison Law.

The Harrison Anti-Narcotic Law 159

cough lozenges and mixtures, whereas the peril is in the
minute doses too often repeated without medical advice
and prescription or contrary thereto.

The penalty of this bill for those who are innocent
of the harm and horrors of the opium is too severe, and
hardly severe enough for the inhuman creatures who,
knowing the life wrecking potency of the habit, would
foster it for purposes of personal profit.

The bill should have contained a warning of the
misery of non-medically prescribed doses duplicated,
quadruplicated, even quintuplicated for their fatally
pleasurable effect and suggested remedial measures for
the wrecked creatures of sudden complete deprivation
(clandestine Chinese opium smoking dens should be put
out of existence) under lawful surveillance.

It has been a generation of decades* since the present
author wrote his first warning paper on the subject of
the opium habit, even before cocaine came into its present
fatal habit use and the rapid growth of the habit since
that warning was written is now terrible to contemplate.
But since then, the knowledge of the fatal final happiness
and health destroying power of both drugs has grown
in medical circles, with its evil among the innocent popu-
lace and it is gratifying to know that through the very
sources that at first made the evil a possibility, by in*
judicious prescribing and dispensing, exists a remedy
and rescue through the provisions of this timely warning
and saving law.

We notice with pain and surprise that men so in-
telligent as the average city news writer, especially of
St. Louis, should continue to characterize these unfortu-
nate victims of a seriously damaged mind and nervous
system destroying drug disease who are innocent, ig-
norant victims mostly, not of their own choosing, of a
habit usually began for relief of some real or imaginary med-
ical need, should characterize them as fiends. A long time
has elapsed since the unfortunate but gifted DeQuincey,

♦The Opium Psycho-Neuroais-Chronic Meconiam or PapavBrism. Alienist and Neurolo-
gist, Vol. 5. p. 122 et aeq. Revised for author's book, The Neurological Practice of
Medicine, bot not publiahed. It will appear in the next issue ot this Magasine.

160 C. H. Hughes

with whom every Hterary man is supposed to be familiar,
wrote his "Confession" detailing the "Horrors of opium
abstention" as he realized them in his own person when
his daily dose was out of him and likewise Coleridge's
self recorded experience.

The chief peril of the abrupt withdrawal of opium,
especially from any but the young, very vigorous and
non-chronic habitues is the tendency to complete collapse,
heart failure, delirium, insanity and death under sudden
complete deprivation of the accustomed dosage, such as
is sometimes enforced by impecuniosity, etc. The quanti-
ty of drug taken should be ascertained, if possible, and
quinine substituted (two grains for one of each grain
of morphine withdrawn). More than half the morphine
habitually taken daily should never be withdrawn from
the opium victim at once.

To suddenly shut off from a chronic opium eater
all his drug at once is a murderous crime in certain
extreme cases, especially without narcotic substitutes.
Cocaine may be helpfully substituted temporarily for
opium and vice versa — chloral hydrate of nights and
ammonium bromide, hypophosphites and malted and
peptomized nutrients, belladonna, hyoscyamus, etc.

But the imharmful treatment of the opium habitue calls
for expert and experienced management to avert bad sequen-
ces to the unfortnate victim of this pernicious and peril-
ous habit. Egotistical conception of what ought to be
done in these cases is not a substitute for clinical ex-
perience. The right and safe management of these cases
is a phase of cUnical psychiatry, the proper experience
of which is not possessed by any physician whose practi-
cal understanding of it is not special.

The proper place and persons are the institutions
and physicians especially familiar with these cases, par-
ticularly in the safe conduct to recovery of the long
time addicted slaves to the destructive habit. The danger
is in the abrupt withdrawal rather than in the continued
gradually reduced allowance, till nature's powers to resist
withdrawal are gradually restored.

The Harrison Anti-Narcotic Law 161

Copy of Safety Prescription Blank

DR. C. H. HUGHES,

3858 W. Pine Boul., St. Louis, Mo.

Hours: 9:30 to 10:30 a.m., Sundays, by Special

Appointment Only.

Bell Phone.

Pharmacist will please retain this Prescription, neither

copy nor repeat without instructions from me.

This memorandum of instructions to the pharmacist
we have used for over forty years at the head of our
prescription blanks, based on what we have known of
the peril and harm of injudicious renewals of certain
medicines, thus conserving the prescriber's real purpose
of so much and such a quantity for the case and time.

Final Note — More than forty years ago the writer
of this paper was interested in a St. Louis Hospital for
the treatment of the opium habit in association with
another medical gentleman, and was regarded by at least
one otherwise intelligent medical practitioner, as in error
because he considered the opium habit as a drug poison
disease instead of a more vicious habit which could be
easily abandoned at will.

The vigilance, close attention and steady burden of
rightly managing these often trying cases, compelled the
abandonment of this work, as other demands of practice
increased and good establishments, such as now exist,
became plentifully estabUshed to meet the increasing
demand for the care and treatment of these drug damaged
unfortunates.

CYST OF THE LATERAL VENTRICLE.
By G. Frank Lydston, M. D.,
Chicago.

CYSTS of the brain in general are frequently met with.
They vary widely in origin, structure and contents,
so widely indeed, that the nomenclature covers conditions
so widely different that, in some instances, it really is
stretching a point to use the term "cyst."

Any tumor of the brain which consists of a more or
less definite "enclosing" tissue forming a cavity of greater
or less extent containing fluid or semisoUd material, is
classified as a "cyst."

Obviously, the etiology and morbid anatomy of brain
cysts necessarily must be quite comprehensive; thus
they may be due to: 1. (a) External trauma, producing
a blood clot which is imperfectly absorbed or organized,
forming a soft grumous mass of greater or less consistency
and varying quantity, (b) Internal trauma, as by sponta-
neous rupture of diseased blood vessels, or rupture from
violence to the cranium; 2. Parasitic invasion, e.g., by the
echinococcus ; 3. Cystic degeneration of malignant neoplasm
— sarcoma or carcinoma; 4. Cystic degeneration — soften-
ing of guma; 5. Simple arachnoidean cysts. Some of
these latter probably are traumatic and due to slight
hemorrhages, others to simple occlusion.

The symptomatology and treatment of brain cysts
will not be touched upon here, as it is my intention
merely to record a most interesting case which obviously
would not have been amenable to surgical intervention,
even though a diagnosis had been made before death.

(162)

Cyst of the Lateral Ventricle

163

CYST OF LEFT LATERAL VENTRICLE. ENLARGED ONE-THIRD.

Case : Man aged twenty-one. Occupation clerk. Had
suffered from periodic, severe headaches and perturbation
of vision for five years. Nothing else could be elicited
in regard to the history, nor could any information be
obtained as to the treatment he received.

The subject was seized with one of his severe head-
aches and speedily lapsed into coma. Dr. Thos. J.
Sullivan was called to see the case, which by this time
was in an apparently hopeless condition. Death occurred
one hour later, the subject not reacting from coma.

Dr. Sullivan very wisely refused to sign a death
certificate and the case was referred to the coroner.
It is therefore, primarily due to Dr. Sullivan that I had
the opportunity of securing the specimen. Through the
courtesy of Dr. Jos. Springer, I assisted at the autopsy.

The subject was normal throughout save as to the
brain. There was a large amount of sub-arachnoid

164 G. Frank Lydston

effusion with enormous distention of the ventricles.
There were no hemorrhages or other evidence of disease.
On the floor of the left ventricle in the anterior comu,
close beside the septum was found the cyst herewith
depicted. It fortunately was not ruptured in removal.
The cyst apparently was simple, its walls being perfectly
translucent and its contents clear fluid of a slightly
yellowish tinge. It apparently was a retention cyst and
originated in the ependyma. Its analogy to simple
arachnoid cyst at once suggests itself. No microscopic
study of the cyst was made, merely because its character
seemed clear and I did not wish to destroy so beautiful
a specimen. In a fairly extensive search through the
literature I have not found a similar case.

32 N. State St.

IS GENIUS A SPORT, A NEUROSIS, OR A CHILD
POTENTIALITY DEVELOPED?*

By James G. Kiernan,
Chicago, 111.

Formerly Assistant Physician Manhattan State Hospital

(1874-8) and Superintendent Chicago State Hospital

(1884-9)

Fellow Chicago Academy of Medicine, Foreign Associate Member French
Medico-Psychological Association ; Honorary Member Chicago Neuro-
logic Society, Honorary President Section of Nervous and Mental
Diseases Pan-American Congress 1893, Chairman Section on
Nervous and Mental Diseases American Medical Asso-
ciation 1894; Professor Neurology Chicago Post-
Graduate School 1903 ; Professorof Nervousand
Mental Diseases Milwaukee Medical Col-
lege 1894-5; Professor of Nervousand
Mental Diseases Medical Depart-
ment Loyola University 1905;
Professor of Forensic Psychi-
atry Kent -Chicago
College of Law.

ONE unrecognized obstacle to eugenics is the popular
belief in the healthy significance of childhood and
adolescent lipomatosis. Metabolic researches have taught
the populace that adult obesity is often but a morbid
sub-oxidation. That the reverse tendency obtains among
eugenists toward childhood and adolescent lipomatosis
is shown by their marriage health certificates. Lipoma-
tosis, as Fere^ shows, occurs at periods of stress from the
end of the first dentition until the climacteric. As was
pointed out years ago^ Byron and his mother had this
lipomatosis. Byron did not become immediately obese
until he stopped growing at twenty: such obesity, first
described by Cruveilthier, is an expression of nutritive
stress in descendants of defectives and instabilities.

* Continued from The Alienist and Neurologist, August, 1914.

(165)

166 Is Genius a Sport?

There is great liability to disease and tendency to
systemic weakness when under morbid influence. These
children are particularly liable to rheumatism, gout,
scurvy, etc., and great haemorrhage from slight causes.
Youthful obesity is sometimes associated with precocious
maturity and resultant early senescence. Often it co-
exists with narcolepsy and extended infantilism, as in the
case of Dickens' "fat boy."

Owing to the struggle for existence which occurs at
puberty between the old type of the chondrocranium and
its new type as supplemented by the dermal bones, the
nervous system may take a distorted ply which arrests
bodily, nervous and mental development at certain points.
In infantilism the arrest is of the future promise of the
child, so that body and face remain at the childish point,
or body and nervous system are checked, or finally the
nervous system or certain organs alone are checked while
the body goes on to full development. Not infrequently
the face is arrested at any period from birth to puberty.
Hence many persons retain a youthful appearance through
life. Often these are vain and egotistic. The mental
stamina is weak. They are frequently unreliable. The
females are often sexually anesthetic prostitutes, prurient
prudes, hysteric reformers, or gossip-mongers.

E. S. Talbot,* examining 267 corpulent school child-
dren and adtdts, found that nearly all had marked stig-
mata of degeneracy. Ninety-two per cent, had markedly
deformed ears. Sixty-six per cent, had arrested facial
development, as compared with their age, while twelve
per cent, presented excessive development. Thirty-four
were too young to determine the form and size of the jaw.
In thirty-three and a half per cent, of the thirty-four
the molars, incisors, cuspids and bicuspids were present.
Ninety-six per cent, of these had small teeth. Eighty-
seven per cent, (of the 233) had arrested development
of the upper jaw. Twenty-two per cent, arrest of
lower jaw. Sixty-four per cent, had V-shaped or saddle
shaped arches or their modification and protruding teeth.
Seventeen per cent, had hypertrophy of the alveolar

James G. Kiernan 167

process. Eighty-three per cent, had small teeth. Twenty-
seven per cent, had extra tubercles upon the molars.
Eighty-two per cent, had stenosis of the nasal cavity
more or less marked. Thirty-six per cent, had deflection
of the nasal septum to the left and twenty-nine per cent.
to the right. Twenty-one per cent, wore glasses for eye
defect. In fifty-eight per cent, there was chyroid en-
largement and in seven per cent, arrested development
of it.

In 296 cases of puberty lipomatosis (180 males and
116 females) coming under observation, ten were cryptor-
chids, six hypospadiacs and three cases of pseudo-
hermaphroditism. Three females had infantile bifid uteri.
Four had enlarged clitorides; in one of these the urethra
perforated the clitoris as in the female shrew (sorex.)
Of forty girls who had reached the age of eighteen but
three menstruated normally. The others were amenorrhoeic
or dysmenorrhoeic, or had neurotic storms during the
period. There were 160 hebephreniacs among the num-
ber; of these 120 masturbated excessively. Ten had been
nymphomaniac or satyriasic, the sexual appetite became
completely extinct at eighteen. Fifty of the non-hebe-
phreniacs never showed any signs of sexual appetite.
Three of the hebephreniacs were sexual inverts, while
eighty practiced various perversities. Of the non-hebe-
phreniacs ten were cyclothymiacs, thirty had had acute
forms of insanity, ten were epileptic and fifteen hysteric.
Thirteen had had chorea. Ninety-seven had difficulty
in learning to speak and thirty always stuttered.

The mental relations of obesity are much more ex-
tended than is usually supposed. Some years ago
Theophile Gautier^ remarked that Victor Hugo, who as
the sovereign prince of French romantic poetry, should
be (v/ere ordinary opinion as to poets correct) angular,
with Ught or dark hair and pink complexion. The world
and an overcoat could hardly contain the glory of Victor
Hugo's belly. He burst his button band every day
and as for buttons in front they were snapped off con-
tinually. Victor Hugo's embonpoint was most richly

168 Is Genius a Sporif

deserved for his plate was a mixtum compositum of veal
cutlets, lima beans and oil, roast beef and tomato sauce,
omelettes, milk and vinegar, mustard and cheese, which
he swallowed rapidly and in immense amounts while
drinking coffee. Rossini had not been able to see his
feet over his abdomen for six years ere his death. He
was a hippopotamus in trousers. Jules Janin would break
down any eighteenth century sofa on which he might
happen to sit. The Africanism of Alexander Dumas'
passions did not prevent the author of "The Three Guards-
men" from being very plump. He ate three beefsteaks
where any other fat man ate one. Saint Beuve saw his
abdomen bulge under his goatee. The most fertile of all
French romancers, Balzac, looked more like a hogshead
than a man.

Eugene Sue, of the "Mysteries of Paris," was greatly
grieved when he could no longer see over his stomach.
Theophile Gautier merited a place among obese literary
gods; Renan, Maupassant, Flaubert and Sarcey were
to be there classed. Most of these victims of obesity
(which as a rule came early) had neurotic taint. In
Balzac, according to Nisbet,^ there was a converging
heredity of nerve disorder. His maternal grandfather died
of apoplexy and his mother was a woman of great viva-
city of m.ind, untiring activity and extraordinary firm-
ness. In many respects she displayed the egotism of
the born neuropath. On the father's side there was a
pronounced strain of insanity. The father was a lawyer
at Tours. Although perfectly well in body, he took
it into his head one day to lie in bed and this he did
continuously for twenty years thereafter, receiving his
friends meanwhile and even taking part in public affairs.
To everybody's surprise he got up one morning at half
past four, dressed and went about his business as if
nothing had happened. He had an extraordinary m.emory.
Balzac exhibited between the thirteenth and fifteenth
year a tendency to obesity. He had, while at school,
an epileptoid seizure which so alarmed his teachers that
they urged his parents to take him home. Balzac,

James G. Kiernan 169

an omnivorous reader, cut a poor figure at school. His
epileptoid attack never returned.

Victor Hugo's brother, who died at thirty-seven in
an insane hospital, was a quick, precocious child. He
had poetical tastes and achieved some distinction at school.
He broke down at puberty and passed into hebephreniac
dementia. General Hugo, the poet's father, was an
irritable, obstinate, peculiar man, who fell into disgrace
with his military superiors, separated from his wife and
passed his declining years in profuse scribbling. Biography,
fiction and drama were poured forth in showers. Victor
Hugo's mother was an energetic, sensitive woman of
literary tastes, who broke down early into a neuropath
and died suddenly.

The environmental influence of her husband must be
taken into account.

Factors entering into fetal environment influence
progress. Maternal strength hence plays an important
part. Much alleged heredity, charged to paternal defects,
arises from the influence of these on maternal nutrition.
Albeit paternal deficiencies are present at marriage, the
influence of these is very often not obvious until one
or more children have been born. The influence of
paternal defects in producing maternal neurasthenia must
therefore be taken into account.

Most hereditary defects are expressions of weakness
along lines of least resistance and not due to direct in-
heritance. Epilepsy is often an expression of inability
to pass periods of stress without motor explosions. It
therefore expresses an arrest of development at certain
phases in childhood. Through ignorance of this fact
convulsive disorders of childhood often pass into epilepsy.
Through that law of the nervous system whereby nerve
action, once occurring, has a tendency to recur, habits
are established.

Heredity obeys no absolute law in details, but is
governed by a struggle between contending forces. Initial
hereditary velocity is an important factor, but so likewise
is intra- and extra-uterine environment, especially as

170 Is Genius a Sportf

constituted by maternal strength during intra-uterine
periods, during periods of nutrition by the mother, and
during periods when the child is under maternal training.
Heredity is a prophecy of what may be, not a destiny
which must be.

Rossini had imbeciles among his maternal relatives.
He suffered from irregularly periodical melancholia.

Flaubert had a nervous strain which evinced itself
in epilepsy during puberty stress. Previous to his parox-
ysms he was accustomed to see a flame, first in one eye
then in the other, and then everything appeared to him
under a yellow hue. A year or two before the onset of
the epilepsy Flaubert's intelligence and intellectual power
were observed to develop enormously. Afterwards Flau-
bert's memory became fitful. He lapsed into a dreamy,
indolent state and at times was so petulant and irritable
as to be upset by a trifle. He would" run about the room
uttering cries because his pen knife was out of its ordinary
place. His mother was a neuropath and a sister died
insane. His nephew, de Maupassant, died from paretic
dementia which took on the rapid type, not the pro-
tracted one usual in hereditary taint and from this Gautier
also died.

Flaubert sprang from a family of physicians. His
maternal grandfather was eminent in the profession and
so were his father and brother. His maternal grand-
mother was a playmate of Charlotte Corday who was a
republican before 1789. His father had a bourgois
contempt for art and literature whence came estrange-
ment between father and son. The mother was congenial.
In "Madame Bovary"* Eleanor Marx Aveling finds "the
great physician's infinite patience in observation, his
quick power of diagnosis, his inexhorable calm and de-
termination, his kindly yet somewhat contemptious pity
for every form of human weakness. Nothing escapes
him; not the most secret thoughts or the most carefully
hidden human infirmities."

Flaubert was taught to read with difficulty and only
did so perfectly at nine. His great passion in childhood.

James G. Kiernan 171

according to de Maupassant, was to have stories told
him. Then he remained for hours dreaming. His mind
was at work for he had already composed pieces which
he could not write but acted by himself, improvising
long dialogues. He was regarded as an adolescent cupid
from his beauty then.

While Shakespere'' gives plotter Cassius "a lean and
hungry look" yet his typical trickster* Falstaff is as
"fat as butter larding the lean earth as he walks along."
Wilkie Collins® depicts an extremely obese zoaphiliac
moral imbecile. Count Fosco, as replete with shallow
sentiment of which Carlisle^" says "beautiful sentiment,
thou art better than nothing and also worse." Flaubert
portrays a shallow egocentric philoneistic (lover of the
new) sentiment in Madame Bovary as a phase of hysteria.
She has the nervous cough^^, etc., of hysteria. As
depicted, it resembles allied states in criminals who remarks
Havelock Ellis^^, "craves for some powerful stimulant
excitement, uproar to lift him out of his habitual inertia."

Egocentric, like the desire for new sensations in the
hysteric, this differs totally in kind from an intellectual
yearning for newer truths. This same forced analogy
between Bovarism and yearning for intellectual truth
was drawn by Kuehne Beveridge,^^ who in an interview
on her statue's success at Berlin, claimed it represented
human bouyancy and exaltation through deep sense of
sex. She regards active algolagnia like that of "Jack the
Ripper" as a like expression. This view is so especially com-
mon among certain artists, literati and critics that it tends
to foster the egocentric spirit whether an expression of
precocity or of imperfectly evolved adolescence. It is
undeniably true, as Ellice Hopkins^^ remarks, that many
girls get into mischief merely because they have in them
an element of the black kitten which must frolic and
play but has no desire to get into danger. "Do not you
think it a little hard," she remarks, "that men should
have dug by the side of her foolish dancing feet a bottom-
less pit and that she cannot have her jump and fun in
safety and put on her fine feathers like the silly bird

172 7s Genius a Sportf

witted thing that she is, without a single false step
dashing her over the brink and leaving her with the
very womanhood dashed out of her."

The difference in type between one who consciously
has her fun at others' expense and one deeply considerate
of others is not recognized in these forced analogies.
The true nature of intellectual yearning for truth appears
vividly in Emerson's "Sphinx."

"The fiend that man harries

Is love of the best.
Yawns the pit of the Dragon,

Lit by rays of the blest.
The lethe of Nature

Can't trance him again.
Whose soul sees the perfect

His eyes seek in vain."

This, as Harriet Alexander points out, is but a
paraphrase of Malthus^^ who says that "the impressions
and excitements of this world are but the instruments
by which the Supreme Being forms matter into mind."

The philoneistic morbidity of Madame Bovary
(albeit he does not recognize its hysteric egocentricity)
is designated by Jules Gaultier^^ 'Bovarism.' This is a
desire to be other than what one is. It implies therefore
a reaching after ideals. This may be an expression of
involution as well as of evolution dependent upon whether
it result from the primary or secondary ego, the mere
aspiration for an ideal does settle its origin.

Development of a complex mental state tends to
control a simple explosive prosperity in accordance with
the law that evolution proceeds from the simple indefinite
homogeneous to the complex definite heterogeneous, with
a loss of explosive force. The forebrain. which increases
in size wifh evolution, is a checking apparatus against the
lower, more destructive natural impulses. The higher
its development, the greater is the tendency to subordinate
the particular to the general. Even in the lower animals
a high state of social growths occur, as in the bee and ant
communities. The same is the case in the development
of man; in the infant a being entirely wrapped up in
its instincts of self-preservation, the primary ego is pre-

James G. Kiernan 173

dominant and the child is an egotistic parasite. As
evolution proceeds this standpoint is passed, conscience
assumes its priority, the forebrain acts as a check on
purely vegetative functions and the secondary ego takes
precedence over the primary. This is the usual order of
civilization in its advance.^*

The hysteric smashing valuable porcelain from the
sadistic sense of pain given others is lower in type than
the paranoiac^^ who, asked why he smashed his chair,
replied: "Philosophy must conquer aesthetics." His sym-
bolism had a higher ethical intellectualism than her
sadism. Gaul tier like most "psychologists" ignores the
essential elements of the psychologic moment, the general
mental state of the subject; the mental state at the time
the excitant was applied and the nature and influence
of the excitant. Havelock Ellis^* accepting Bovarism
from Gaultier as a title for a patent biological force,
ignores these relations hkewise when he remarks: "It
often impresses me with wonder that in Nature or in
Art exquisite beauty is apt to appear other than it is." Jules
de Gaultier seeks to apply to human life a principle of
Bovarism by which we always naturally seek to appear
other than we are, as "Madame Bovary sought as sought
all Flaubert's personalities, and indeed, less consciously
on their creator's part, as claims the great figures in all
fiction. But sometimes I ask myself whether there is
not in Nature herself a touch of Madame Bovary."

"There is, however, this difference in the Bovarism
of Nature's exquisite movements; they seem other than
they are, not by seeming more than but by seeming
less." This seeming differs in kind from that of "Madame
Bovary," as Mayne Reid^^ years ago remarked "every
truth is overshadowed by a sophism more like truth than
truth itself, a sophism constituted by that tyranny of
the obvious against which Dryden thus protested:

"Errors like straws upon the surface float
Who'd seek for truth and pearls must dive below."

Madame Bovary has been for decades to cultured
physicians the type hysteric of fiction. To place her upon

174 Is Genius a Sportf

the pedestal of "Bovarism" is to defy explosive force
and decry those calm workings of Nature of which
Goethe^" sang.

"Nature, the living current of her powers,
Was never bound to day and night and hours,
She makes each form by rules that never fail,
And it is not Force even on a mighty scale.
Hysteria, unHke what ElHs calls "Bovarism" in Nature,
always seems immensely more than it is. Flaubert's
epilepsy never betrayed him into occultism or affinity
for Charlatanism. His great charlatan Honeass; the
prescribing druggist is exquisitely painted from a medical
standpoint in all his sophomoric intriguing meanness.

Balzac, albeit not behind his period, has the news-
paper sympathy with charlatanism, occultism and
spiritualism^^. Like Besant^^ Garland, Hichens^*, Howells^^
Henry James ^*, who, though to a lesser degree, exhibits
such a peculiar religiosity in a novel which the late
G. F. Shrady of the Medical Record called a hair raiser,
as to picture a woman under the "control" of a dead boy
sexual perversity. The charlatan sympathy of Balzac
appears prominent in "Miss Bernard"^*, who becoming
pregnant for a second time after her marriage, displays
"such singular symptoms that the physicians were all
puzzled. The child was stillborn; literally strangled
by internal convulsions. Then came on a general de-
bility during which she was liable to the most extra-
ordinary attacks of catalepsy and would lie with her
eyes open and staring, sometimes in the attitude in which
the fit seized her. She had even attacks of tetanus,
and sometimes well defined characteristic attacks of
hydrophobia. Not only may the sight or sound of
water or a glass or a cup rouse her to frenzy, but she
barks like a dog, a melancholy bark, or howls as dogs
do at the sound of an organ. Her feet feel as if they
were made of cotton. This weakness became paralysis.
Her feet could be bent under her, twisted around, and
she felt nothing. The limbs were there, but they seemed
to have no blood, no flesh, no bones. This condition,

James G. Kiernan 175

which is unlike any recognized disease, attacked her
arms and hands. It was supposed to be connected
with her spine. She cannot move without dislocating
her hips, shoulders, or wrists. The catalepsy suggested
the application of mesmerism. Then her mind became
subject to every marvel of somnambulism, as her body
was to every form of disease. Even in her mesmeric
sleep she has never been able to reveal the cause of her
sufferings. She could not see it, and the methods of treat-
ment suggested by her under these conditions, though care-
fully followed, have had no good results. For instance, she
said she must be wrapped in a freshly killed pig; then she
was to have points of highly magnetized red-hot iron ap-
plied to her legs; to have melted sealing-wax on her spine.
Her teeth fell out, she became deaf and then dumb, and
suddenly after six months of perfect deafness and silence
she recovered her hearing and speech. She occasionally re-
covers the use of her hands as unexpectedly as she loses it,
but for seven years has never caught the use of her feet."
The physicians of the "Comedie Humaine," Bianchon
and the rest, are unable to diagnose the case. Her father
has recourse to a Polish charlatan, whom Balzac thus
describes: "Halpersohn, who for five or six years was
regarded as a charlatan, with his powders and mixtures,
had the innate instinct of a great healer. Not only
was he learned; he had observed with great care and had
traveled all over Germany, Russia and Turkey, where he
picked up much traditional lore. As he was learned in
chemistry, he became a living encyclopedia of the secrets
preserved by the 'good women,' as they were called,
the midwives and the 'wise women' of every country
where he had followed his father, a wandering trader.
He has a little bag which he soaks in water till it is faintly
colored, and certain fevers yield to this infusion taken
by the patient. The virtues residing in plants are in-
finitely various according to htm, and the most terrible
maladies admit of cure. Halpersohn admires homeopathy
less for its system than for its therapeutics. He keeps
his hand dark, though it was full of discoveries; he would

176 h Genius a Sportf

have no pupils."

The retrocessive theories of this charlatan are similar
to those of the rural charlatan who said he could not
cure the patient, but could throw him into fits, and he
was death on fits. According to Halpersohn, Miss Bernard
has "a vicious humor, a national disorder in her blood,
and it must be brought out. For seventeen years she
has been suffering from the disease known as plica polonica,
which can produce all these torments." Halpersohn has
seen the most dreadful cases, and "is the only man living
to bring out the plica in such a form as to be cruable,
for not every one gets over it."

"Cure of the retrocession" (obviously a phase of
medicine whence Hahnemann derived his "psoric"doctrine)
has results like "cures" from Eddyism, Spirituahsm, Lourdes,
Relics, "New Thought," Perkemanism, Chiropractice, Oste-
opathy, Spondylotherapy, etc. Autointoxication like other
phases of nutritive strain at periods of stress has played
many parts in literature. One celebrated case is that of the
Nicolae-Goethe controversy imbedded in the Walpurgus-
nacht of Faust^*. Faust's friend, Jerusalem the proto-
type of Werther^**, was a victim of adolescent melancholia
attended with religious and morbid consciousness of
adolescence. The acme of his despair was reached when
he fell in love with Frau Herdt, the wife of the Elector
Palatine's ambassador. He borrowed a pair of pistols
on pretense of a journey and shot himself.

Jerusalem's "Philosophical Essays" were thought to
be of great value by Lessing who had them published.
Jerusalem's suicide lead to the widely criticised and praised
"Sorrows of Young Werther." This is said to have in-
creased romantic suicides in Germany, although it is far
more probable it simply caused explanations of, not the
stiicides themselves. Such suicides are an old story, only
new because of fresh explanations. Christoph Frederick
Nicolai*^, a German author and pubHsher, had been the
victim of hallucinations from which he recovered under
venesection supplemented by climeination, exercise and
diet. He "was a leading representative of the 18th

James G. Kiernan 177

century rationalism" but Paul Cams and Carlyle claim
"was narrow in his views, his prosaic nature had no
tolerance for religious mysticism or poetic enthusiasm."
He didn't even understand the psychic aspect of Wer-
ther's sentimentalism and charged Werther's state to
autoxaemia. He therefore parodied "the Sorrows" in
the "Joys of Young Werther" which lead to Thackeray's
parody. Goethe wrote "At Werther's Grave" as an
answer to "the Joys." Hern, a visitor to the grave,
declares Werther would still be alive had he enjoyed a
good digestion. Nicolai, however, through his own trying
experience was more nearly in the right than Goethe and
his modern upholders. Jerusalem was clearly suffering from
adolescent stress; on this dietetics and elimination
have a good effect. Byron's'^ results from epsom salts,
diet and exercise show this.

The state to which he thus brought himself was
attended with the pleasurable sensation of intoxication
and indeed differed from vinous exhilaration in being
followed by no serious depression. "A dose of salts,"
Byron remarks in one of his journals, "has the effect
of a temporary inebriation like light champagne upon
me." Wine made him gloomy and savage as soon as
the momentary exhilaration had passed; the irritation
of the medicine affected his brain as alcohol affects
men whose nerves suffer no painful consequence from it.
And to the last, starvation and medicine operated in the
same way on his mental forces. "By starving his body,"
says Trelawney, speaking from his observation of the poet
in his closing years, "Byron kept his brain clear; no
man had brighter eyes or a clearer voice."

The sacrifices which Byron thus made for the quick-
ness of brain and freedom from bodily grossness were
too heavy and grievous to be made daily throughout
successive years, without reluctance and with no occasional
relaxation of the stern discipline. But as soon as he wavered
in his ascetic course so far as to eat and drink like other
men he began to fatten and, in his early manhood, wax
dull; and it was only by returning to the severe regimen

178 Is Genius a Sportf

that he could recover his vigor and intellectual brightness.
What it cost him in discomfort and effort thus to "clap
the muzzle on his jaws" (to use his own words,) and like
the hibernating animals consume his own fat, he alone
knew. He spent the greater part of his manly time
under the pangs of keen hunger, living for days together
on a biscuit and soda water till, overcome by gnawing
famine he would swallow a huge mess of potatoes, rice
and fish drenched with vinegar and after recovering from
the indigestion occasioned by such fare, would go in for
another term of qualified starvation. This eliminated
diet and exercise struck at auto-intoxication and sub-
oxidation. It acted on Byron during adolescence pre-
cisely as it acts in early life. In early life, as Havelock
Ellis remarks,^^ the emotions caused by forced repression
of the excretions are frequently massive and acute in the
highest degree and the joy of relief is correspondingly
great. But in adult life, on most occasions, these desires
can be largely pushed into the background of consciousness,
partly by training, partly by the fact that involuntary
muscular activity is less imperative in adult life so that
the ideal element in connection with the ordinary ex-
cretions is almost a negligible quantity. Many attacks
of brief melancholia and apathy may be removed by a
saline purgative. The mental relief being so intense as
to seem like a mental stimulation. Byron undoubtedly
carried this regimen to its utmost limit since he based
it rather on pugilistic notions of training than on medical
notions of hygiene. In all probability even with this
excess, it arrested what might have proven the complete
breakdown, mentally, of hebephrenia. In removing obesity
it undoubtedly improved Byron's suspicional tendencies
and favorably affected the morbid introspection which
is such a poison, mentally speaking, to adolescence. The
pugilistic exercise also greatly aided the effects of the
regimen.

For the sacrifices which he made for the attainment
of his object, Byron was repaid nobly. He submitted to
starvation and physic, in order to escape loathsome un-

i

James G. Kiernan 179

sightliness; and besides relieving him of the repulsive
aspect, the regimen to his astonishment and delight —
endowed him with the beauty of loveliness — beauty that
became proverbial. No longer big and puffy, his eyelids
and cheeks became fine and firm and delicate with
curves as clear in outline as the curves of sculpture.
Ceasing to be thick and heavj', his lips and chin assumed
the peculiar sweetness and softness that made him in the
lower part of his countenance a bewitchingly charming
woman rather than a handsome man. The nose, even
in his comeliest period sometimes too broad and having
(as Leigh Hunt spitefully remarked) the appearance of
having been put on the face instead of coming out from
it, was relieved of its clumsiness and refined into harmony
with the rest of a profile singularly suggestive of high
breeding. At the same time the blue-gray eyes, fringed
with dark (almost black) lashes, acquired a brightness
and subtlety of expression that had never before distinguish-
ed them. His complexion was purified to transparency
and his auburn hair, playing over his brow in short
feathery curls, became richly lustrous.

But for his marriage with the daughter of a hysteric
squirearch the errors and miseries of Byron's later life
would not have happened.

Byron, according to a prevalent opinion accepted by
Haydon^^ had a morbid aversion to see women eat,
which aversion, as Noel^^ points out, has a simple
explanation: At the time of marriage (a fact well
known to Lady Byron) Byron was dieting. Necessarily
irritated by seeing enjoyment of the pleasures of the
table while his appetite must be resisted, it was difficult
to assume to like what he disliked. Byron could not
pretend to enjoy dinner and chat with his wife while
longing for the meal's end. After the honeymoon Lady
Byron generally breakfasted, lunched and dined alone,
or had the solitude of her meals briefly broken by her
husband. Another source of Byron's irritability toward
his wife arose from his not unnatural dislike to be in-
terrupted when writing. Lady Byron practiced interrupt-

180 Is Genius a Sport?

ing him because she thought his dislike to interruption
a mere whim. A business man would be extremely
irritated by unnecessary interruption during correspondence,
furthermore, such frivolous interruptions were obviously
fatal to good literary work.

Lady Byron was the daughter of a hysteric intriguing
mother of the county family village gossip type. Re-
garding her daughter as a paragon she spoilt her. The
daughter was of that auto-erotic type which puts meretri-
cious constructions on the most innocent actions of friends,
which makes self-indulgence an art, is indolent, elfish, and
"religious." She was attractive looking, ostentatiously
philanthropic, clever, stiff, prim, formal, very priggish
and pruriently prudish. Naturally therefore she was much
influenced by her toady governess, Mrs. Clermont. The
latter having been a successful governess in those snobo-
crat days was a skilled toady. Miss Milbanke during
Byron's courtship had been so jealous of Lady Caroline
Lamb as to satirize her in verse. Once she kindly told
Lady Caroline that her affectation of a woebegone Byronic
visage marred the effect of her "fair seeming foolishness."
She thus so played the arts of the Minervan "coquette"
as to outdo the impulsive Lady Caroline in Byron's
esteem. The most skilled matrimonial intriguant could
not better have posed at another woman's expense
than did this "unsophisticated virgin" of the Beecher-
Stowc*^ myth. During the early months of marriage
Lady Byron nagged Byron eternally, stimulated by her
mother (whose conduct showed there were justifications
for the pre-historic taboo'" which kept the mother-in-law
out of the son-in-law's way on pain of death'^) and the
mischief making Mrs. Clermont. Even on a healthy man
such nagging might have the disastrous effects which
Shakespeare paints in the "Comedy of Errors."

Adr. "It was the copy of our conference:
In bed he slept, not for my urging it:
At board he fed, not for my urging it;
Alone it was the subject of my theme;

I

James G. Kiernan 181

In company I often glanced it;

Still did I tell him it was vile and bad.

Abb. And therefore came it that the man was mad:
The venom clamours of a jealous woman
Poison more deadly that a mad dog's tooth.
It seems his sleep were hindered by thy railing
And therefore comes it that his head is light,
Thou say'st his meat was sauced with thy upbraidings :
Unquiet meals make ill digestions;
Thereof the raging fire of fever bred;
And what's a fever but a fit of madness.
Thou say'st his sports were hinder'd by thy brawls:
Sweet recreation barr'd, what doth ensue
But moody and dull melancholy,
Kinsman to grim and comfortless despair
And at her heels a huge infectious troop
Of pure distemperatures and foes to life?
In food, in sport and life-preserving rest
To be disturb'd would mad, or man or beast
The consequence is then by jealous fits
Have scared thy husband from the use of wits.
There was therefore good reasons for the depression
seemingly amounting to melancholia but due to adequate
external causes which even Byron's sister noticed in him
at that time. Urged on by the prying curiosity of Lady
Milbanke, Mrs. Clermont did not hesitate to pick locks
and search private memoranda in order to pander to
Lady Byron's worst qualities who like most frigid hysterics
had an ability of assuming "confidential relations with
inviolable secrecy" to secure power and adherents. By
the flattery implied in such confidential relationships,
hysterics captivate self-admirers, especially those who,
drenched with philistinism conceive themselves thereby
endowed with opinions which must be "common sense."
Lady Byron for years thus captivated poseurs of the "social
purity" pervert type, of the "superior" woman type, of the
type which canted then about the inherent depravity of
American institutions as it now cants about inherent
depravity of nonalcoholophobia. No ostentatious charity

182 Is Genius a Sport?

or pseudo-reform failed of blatant support by Lady
Byron as thereby were sycophants secured at slight cost.
From her sedulous patronage of that modern notoriety
dodge the "Charity" Ball, came Byron's bitter lined:
"What matter the pangs of a husband and father,
If his sorrows in exile be great or be small,
So the Pharisee's glories around her she gather,
And the saint patronizes her charity ball.
What matters — a heart, which, though, faulty, has

feeling.
Be driven to excesses which once could appall
That the sinner should suffer is only fair dealing
As the saint keeps her charity back for the ball."

(To Be Continued.)

1. La Famine Nervopathique. ^

2. Alienist and Neurologiat, 1899. ''

3. Developmental Pathology.

4. Journal de Med. de Paris, 1893.

5. Insanity of Genius, page 135.

6. Introduction to Madame Bovary, (American Trans.)

7. Julius Caesar.

8. Henry IV and V.

9. Woman in White.

10. French Revolution.

11. American Translation, Chap. 9; Ft. I;

12. The Criminal.

13. Alienist and Neurologist, Nov., 1910.

14. Cited by Havelock Ellis, Sex and Society.

15. Alienist and Neurologist, 1901.

16. Essay on Population.

17. Greisinger, Mental Pathology.

18. Impressions and Comments, 1914.

19. Young Jagers.

20. Faust.

21. The Wild Asa" Skin.

22. Louis Lambert.

23. St. Katherine's by the Tower.

24. Flames.

25. Questionable Shapes.

26. Two Magics.

27. Turn of the Screw.

28. Seamy Side of History.

29. Bayard Taylor's Translation.

30. Open Court, June, 1912.

31. Forbes Winslow, Sr. Obscure Brain Disease.

32. Jeafferson — ^The Real Lord Byron.

33. Psychology of Sex, Vol. IH.

34. Life, Letters and Table Talk.

35. Life of Byron: Great Writer's Series.

36. Atlantic Monthly, 1870.
31. Evolution of Marriage

i

SELECTIONS

CLINICAL NEUROLOGY

The Pituitary Body. — "The discovery by Marie
that an intimate relationship exists between the pituitary
body and acromegaly created a new interest in a body
which previously had been of interest purely on accouut
of its anatomic relations and its histologic structure.
About a decade later Oliver and Schafer found that ex-
tracts made from the entire pituitary body produced a
rise in blood-pressure when given intravenously. By
working with extracts made from its various parts,
Howell concluded that the pressor effect was produced
only by posterior lobe extracts. Later it was found by
others that posterior lobe extracts caused diuresis, dilata-
tion of the pupil, and increase in the secretion of milk
and the contraction of unstriped muscle, especially that
of the arteries, uterus, intestines and bladder.

"The evidence that the pituitary body is essential
to life is now convincing. Paulesco and Cushing, using
an improved technic, showed that fatal results are to
be expected from removal of the anterior lobe. Partial
removal of the anterior lobe led to striking changes in
metabolism. — ^Editorial Jour. A. M. A.

CLINICALf^PSYCHIATRY

Insanity in Relation to Sex and Age. — The Vir-
ginia Medical Semi-monthly notes from the report on the

(183)

184 Selections

insane in the United States prepared by Dr. Joseph
A. Hill and issued by Director of the Census that there
is more insanity among men than women, as based upon
data received from hospitals and asylums for the insane
for 1910. In 1880, the two sexes had nearly an equal
representation in these institutions, but on January 1,
1910, there were 98,695 males, as compared with 80,096
females in institutions for the insane. Nearly 25 per
cent, of the males in the hospitals in 1910 were admitted
for alcoholic psychosis or general paralysis, resulting
from vice and dissipation. These causes being eliminated,
the disparity in numbers of admissions between the sexes
practically disappears. While the largest percentage of
admissions is between the ages of 25 and 50 years, in
proportion to the number of people in the same period
of life, the number of admissions is larger in old age
than in middle life and in middle life than in youth.

NEUROTOXICOLOGY

"The Telephone in Medical Practice."— From
The Hospital, London, 2/13/15 we extract the following:
"A medical practitioner ordered the preparation of a solu-
tion of eserine sulphate, and sent the directions by tele-
phone. The dispenser, mistaking the figures, made the
solution much stronger than the doctor had intended,
with the result that the administration of the medicine
to the patient was followed promptly by a fatal result.
In this individual instance there was some mitigation
of the position in the fact that the patient was the sub-
ject of a malignant growth, and was therefore beyond
the reach of hope. * * * The brief fact is that a
poisonous dose of medicine was administered because the
directions for the compounding of the medicine were
conveyed through the telephone. The moral is obvious.
* * * The only safe rule, and it ought to be enforced in

Selections 185

all hospitals and nursing institutions, is that the prescrib-
ing should be by written directions, and that for such
purposes the telephone should be forbidden."

Many pertinent and valuable editorial suggestions
follow for which we have not space. The entire edi-
torial of one and a quarter pages is well worth reading
by every physician. The editor knows what he is talking
about from the standpoint of medical experience. The
telephone has its perils in medical practice as well as its
benefits and annoyances.

NEUROPATHOLOGY

The Cause and Control of Cancer. — The 1914
report of the Missouri State Board of Health gives us
the following: "In one sense we do not know the 'cause
of cancer, since we have not learned what induces the
changes in the character and behavior of the beginning
of its rebellious and destructive career. But in another
sense, we have much empirical knowledge as to the
'causes' of cancer, that is we know from long recorded
observation in many countries many of the conditions
under which the disease develops. Foremost in this
department of our knowledge is the fact that continued
irritation in a given spot is frequently followed by the
disease. The examples are familiar to all who have read
even the simplest accounts of the disease. Chimney
sweeps develop cancer of the skin from irritation by the
soot. Workers in tar distilleries, in the manufacture of
grease or briquettes also seem specially subject to skin
cancer. Something in tar and pitch under such continued
exposure develops warts which break down and become
cancers. Men employed in dye works have been ob-
served to suffer from cancer of the bladder. Cancer of
the tongue from irritation by the pipe or cigar is common-
ly reported. Even long continued irritation is not always

186 Selections

necessary and cases are recorded where cancer seems
clearly to have developed after a single blow or wound
or fracture of some bone.

The Control of Cancer.
While these interesting and often curious observations
have not yet led us appreciably nearer to that absolute
understanding of the disease which is here, as always, the
aim of science, yet they furnish us with valuable practical
guidance in the recognition of cancer in its early stages
and give the chief hope at present of its better control.
For we see in all these recorded cases, the prime fact that
cancer is at first a local disease. If it cannot be cured
it can be removed. Competent surgery in the early
stages means a large percentage of cures, and the earlier
the better. Hope lies chiefly in the first operation.
Delay means not simply danger but, as a rule, inevitable
death. Many surgeons believe that all cancers develop
from some "precancerous lesion," such as a wart or mole
or scratch that does not heal. If others dispute these
statements as too sweeping, there is nevertheless absolute
agreement as to the necessity of early recognition of the
disease and prompt treatment if the death rate is to be
reduced. But what are the facts and the knowledge
and habits of people in this respect as we find them?

NEUROTHERAPY

Concerning Gastro-Intestinal Antisepsis. — Intes-
tinal antiseptics, it is believed, say Parke, Davis & Co.,
do not cleanse the digestive tract of objectional bacteria
and poisonous substances resulting from their growth,
nor is purgative medication effective. But the bacillus
bulgaricus, administered in the form of tablets, is said,
on the other hand, to be notably efficacious in such condi-
tions. It is asserted that these lactic-acid-producing
bacilli, thus administered, survive for a long time in the

Selections 187

intestine, multiplying and producing quantities of lactic
acid, obstructing the growth of harmful micro-organisms
and preventing disease. And they are offering to the
profession tablets of bacillus bulgaricus, claiming that
they give good results in the vomiting and diarrheas of
infants, in diseases due to intestinal autointoxication,
and in glycosuria and diabetes.

The Vitamine Dietary of Stassano. — The following
articles of diet which are rich in vitamines, have been
found to be of curative as well as of prophylactic value:
human milk, fresh cow's milk, butter, cheese, yolk of
egg, beef juice, fresh tomatoes, fresh legumes and soups
containing them, fresh fruits or their juices, the sauce of
stewed fruits, whole corn or wheat bread, unpolished rice,
slightly roasted beef, fresh yeast, extracts and preparations
of yeast, and codliver oil.

The Fatigue Toxin and Immunity. — New York
Med. Record. — Ranke was the first to show that the
aqueous extract of a fatigued frog's muscle when made to
perfuse the muscle of another frog evokes in this muscle
all the phenomena of fatigue. Weichardt isolated the
co-called fatigue-toxin, ponogen, or kinotoxin, and reported
later the production of a fatigue antitoxin capable of
neutralizing the physical evidences of fatigue. Many
investigators have studied the relation between fatigue
and disease. In 1909 Scalfati reported that the fatigued
organism provides a favorable culture medium for the
typhoid bacillus, and one year later De Sandro demonstra-
ed in fatigued animals a diminution in the phagocytic
and chemotactic powers of the blood-cells. Vincenzo
Palmulli (Riforma Medica, October 31, 1914) details the
important results of his experiments showing the role
played by the fatigue toxin in the process of immunity.
He found that in dogs the intravenous injection of this
substance causes a reduction in the immune power of
their blood serum. The reduction consists in lowering
in the agglutinating, bacteriolytic, phagocytic, and opsonic
powers of the blood. It would appear, therefore, as if

188 Selections

during fatigue there is an inhibition in the production
of agglutinins, opsonins, bacteriolysins, etc. This fact
fits in closely with the observations made by Marfan,
Jaccaud and others, that physical fatigue predisposes
to bacterial infection.

Looking Backward on Scopolamine Anaesthesia. —
In a paper in 1905 read before the Medical Society of
the State of Pennsylvania Dr. John V. Shoemaker (since
deceased) calls attention to the danger attending its
use in large doses. The drug is said to be identical
with hyoscine, and the commercial article contains an
admixture of "atropine" which is isometric with hyoscine
or scopolamine. This latter fact may explain variations
in the action of the commercial scopolamine hydrobromide,
depending upon the quantity of atropine present.

"As a mydriatic scopolamine resembles atropine, but
upon the circulatory and nervous systems its effects are
quite different. 'Scopolamine does not affect the respira-
tion, except in large doses, which produce the Cheyne-
Stokes type. Small doses slightly increase the blood
pressure, but large doses decrease it. The heart's action
is made slower, owing to a sedative action upon the cardio-
motor apparatus. Cerebral activity is diminished and
the electrical excitability of the brain is reduced. Narcosis
and coma are produced by full doses. Motor reflex
paralysis indicates a marked depression of the spinal
cord, and there is consequent profound relaxation of the
voluntary muscular system.' Two drops of a 1%

sol. instilled for mydriasis into the eyes of an adult pro-
duced complete muscular relaxation and loss of conscious-
ness which lasted for four hours. This was followed by
delirium lasting two hours, and then sleep for an hour and
a half. There were no subsequent ill effects. It is
contraindicated in the young and the old, — in nephritis,
scarlatina and diphtheria, and heart disease. The anti-
dotes are 'the diffusible stimulants, as nitrogylcerine,
strychnine and caffeine, artificial respiration, the adminis-
tration of oxygen by inhalation, hot external applications,

Selections 189

friction of the skin, and electricity.' Morphine is syner-
gistic. Karff recommends giving scopolamine gr. 1-640
and morphine gr. 2/5 in three doses, the first to be given
2y2 hours, the second l}4 hours, and the third K hour
before the operation. When used preliminary to chloro-
form or ether it reduces the excitement accompanying
the administration of these drugs, and lessens the tendency
to vomit. Dr. Shoemaker justly remarks that there
is no such thing as a perfectly safe anaesthetic, and
warns against the large doses used in this country, where
surgeons give scopolamine gr. 1/64 with morphine gr.
1/6 at intervals of an hour. In view of the uncertain
composition of the commercial drug, and personal idiosyn-
crasy, such doses may be very dangerous."

It is a wise precaution to be cautious with these
drugs in the light of even later revelations. The Medical
World concludes an editorial on the subject as follows:

"In the 1,500 cases of anesthesia reported there have
been fourteen deaths. Since the only claim which scopol-
amine has upon the attention of the medical profession
is the purpose of avoiding the known dangers of general
anesthesia by the old methods, its claim must be consider-
ed as far from being proven. Fourteen deaths are suffi-
cient warning that scopolamine is either not yet suffi-
ciently understood, or that it should not be used if any
other anesthetic is available. The problem has incited
enough interest and experimentation to admit of the
promise of a speedy elucidation. As soon as there is suffi-
cient data to admit of definite conclusions, we will note
the fact in our columns; meanwhile, we advise that the
general practitioner let scopolamine anesthesia severely
alone."

Nutritional Therapy. — From this point of view
the New York Medical excerpts from the Berlin Clinical
Wochn. for February the following valuable matter under
the following caption:

"The Potato as a Universal Aliment. — Richter
states that a universal food substance is one which is

190 Selections

necessary to the life of a community, is within the reach
of the smallest purse and is palatable either per se or
through various forms of cookery. The great monotony
of the menu in the poorest strata of society undoubtedly
leads to the use of alcohol. A universal foodstuff must
of course be one which is readily obtainable, and there-
fore one which can be readily stored in sufficient quan-
tities. It must be grown on home soil and in quantities
so large that im.ports become unnecessary. Does the
potato fill all these requirements? This tuber originated
in South America and about 1560 it was introduced by
way of Spain to Italy and Burgundy, reaching England
in 1584, encountering strong opposition. It was first
grown in Austria in 1686 and in Saxony 1705, and strong
prejudices had to be overcome before it became an
article of diet; and perhaps only famine was responsi-
ble for its free consumption. In France it was unknown
before the Revolution. The prejudice was due in part
to confusion of the tuber with the fruit, the latter being
unfit for consumption. At present the GeiTnan acreage
exceeds that of every other country, 12.6 per cent,
of arable land being given up to the potato or over
five times the acreage of England. The tonnage of the
potato crop has increased enormously in late years. An
acre of potatoes contains more nutriment than an acre
of vegetables or cereals. In addition to an enormous
human consumption potatoes are used very largely for
fodder, and for making spirits. The per capita con-
sumption of potatoes of human beings is about 400 lbs.
per annum, but the amount used for fodder exceeds con-
siderably that used for human food, v/hile half as much
is used for distilling as for feeding the people. By cut-
ting down the fodder or spirit production, or both, the
public can benefit by large reserves of food. The po-
tato is far from being an ideal food in itself, for it is
almost fat free, and its protein content is sm.all, al-
though quite utilizable. The tuber loses nearly a fourth
of its nutriment by peeling. To depend upon the potato
for all the protein requirement an Irish day-laborer

Selections 191

finds it necessary to eat about 13 pounds a day, and
the same ration obtains among the peasants in parts of
Silesia and Bavaria. However, under the more recent
teachings concerning the sufficiency of low-protein diet
such amounts may be far too large. In other words,
from half to two-thirds tha amount of potatoes men-
tioned above may furnish the protein requirement of
subjects engaged in moderate activities, while at rest a
much less amount will sustain life and even give a sur-
plus of stored N. This laboratory find does not quite
agree with clinical experience, however, for a potato
diet is used to some extent successfully for the reduc-
tion of weight. When eaten as usual with butter loss
of weight does not occur. Those who have used the po-
tato diet in practice further state that if more than five
pounds daily are consumed beyond an interval of sev-
eral weeks, symptoms of intestinal insufficiency devel-
op. Those who are forced to eat these large amounts
as sole aliment develop the well-known "potato belly" of
the very poor man. From all that has been said, there-
fore, the potato will serve admirably as a leading con-
stituent of diet. The theoretically advised eating of the
skins is met by the objection that the latter cover up
decayed regions and that only after peeling can these
be detected and removed. Potato porridge, mashed po-
tato, etc., form the best utilizable methods of prepara-
tion. Dried potatoes have never made good as a food
product."

THE

ALIENIST AND NEUROLOGIST

Vol. XXXVI. St. Louis, May, 1915. No. 2.

Subscription $6.00 per Anninn in Advance 11.26 Single Copy

Tliis Journal is published between Uie first and fifteenth of February, May, August
and November. Subsciibers failing to receive the Journal by the 20th
of the month of issue will please notify us piomptly.
Entered at tiie Post-office in St. Louis as second-class mail matter.
All remittances should be made to Chas. H. Hughes.

The Alienist and NEuaoLOGiST is always glad to receive articles or photograpfaa
from Hubacriljers or friends and material acceptable for publication. Address manu-
scripts and photographs to The Alienist and Neurologist. For return of non-
accepted manuscript send addressed envelope and sulTicient postage.

Any comment, favorable or unfavorable, specifically act forth, is always wel-
come from friend or enemy or "mouths of wisest censure."

NOTICE TO NEWS AQENTS

This magazine must not be expected to print whole pages of commercially devised,
fulsomely laudatory puffing of proprietary advertisements, prepared by non-medical
commercial agencies who know nothing of the facta of therapeutics nor of the medical
code of ethics. Some of the puffs are so far from the truth that they are an insult
to medical intelligence and do more harm than good to worthy proprietaries.

Such proprietaries as wo carry speali for themselves with physicians, especially
when their composition appears. Our readers are discriminating judges of what
they want.

CONCERNING RENEWALS OF SUBSCRIPTIONS

This magazine would be much indebted to its regular subsciibers and advertisers
if they would renew by direct communication with this office, especially in the United
States, and not through news agents.

CHAS. H. HUGHES, M. D., Editor and Publtaher.

If. L. HUGHES, Manager. • '

Editorial and Business Offices, 3858 West Pine Boul.

EDITORIAL

A Military School Sold to Osteopaths.— The
Blees Institute property at Macon, Mo., valued at $75,000
has been purchased by the Still Brothers and other
citizens of Macon to become the Osteopathic Sanitarium
Company and the Osteopathic School interests will be
located there, of which the elder Still was the founder.

The multiplication of irregular medical short term
teaching schools suggests the wisdom of not too greatly
lengthening the term and conditions of acquiring the
essentials of a regular scientific medical education.

Ambitious young men or women of limited means
and with the necessity upon them of beginning early in
life to get a livelihood through medical practice, can not,

(192)

Editorial 193

as a rule, well wait five or six years after their preliminary
education before being ready to practice.

Conditions would seem to suggest the blending of
literary and scientific medical education in one institution
of instruction. Latin and Greek philology by natural
methods and the essentials of chemistry should be taught
as well as microscopy, serum therapy and pathology
should be imparted in a medical university giving a blend-
ed degree of B.S., B.L. and M.D., etc.

This suggestion is merely thrown out to the Council
on Medical Education. At this time of great medical
advance and great multitude of matter to be im.parted
to medical students it is essential to eflEiciency in practice
that a wise medical pedagogy should be sought by the
medical profession.

The Next (Seventy-First) Annual Meeting of the
American Medico-Psychological Association will be May
II th to 14th, 1915, at The Hotel Chamberlin, Fortress
Monroe, Va.

An Alienist and Neurologist Subscriber Elected
Governor. — W. N. Ferris of the Ferris Institute of Big
Rapids, Michigan, a subscriber to the Alienist and Neurol-
ogist has been elected Governor of the State of Michigan.
Note what becomes of our subscribers.

We should not be surprised to hear next of others
elected to the Governorships of other States and maybe
President, in case his excellency. President Wilson does
not get matters straightened out in Mexico.

To be a reader of the Alienist and Neurologist is no
disparagement to any gubernatorial or presidential as-
pirant.

Subscribe for the Alienist and Neurologist, aim for
the Presidency even if you only fall into the national
cabinet or become a lieutenant governor.

The National Committee for Mental Hygiene is
a salutary and hopeful movement for the welfare of our

194 Editorial

race arid country. Though its inception is tardy it is
gratifying to see the movement so vigorously started and
under such promising auspices as was shown at last
February meeting.

Mrs. William K. Vanderbilt has contributed 844,500
and Mrs. Elizabeth Milbank Anderson $40,000, to be
used in the extension of its work. Dr. Thomas W. Sal-
mon, New York, of the Rockefeller Foundation. State
societies for mental hygiene throughout the country are
to be organized. A quarterly magazine for the prevention
of insanity and the care and treatment of the insane,
the feeble-minded and alcohol and drug victims, will
be published. The officers for the ensuing year are:
President, Dr. Lewellys F. Barker; Baltimore; Vice-
Presidents, Dr. Charles W. Eliot, Boston, and Dr. William
H. Welch, Baltimore; Treasurer, Otto T. Bannard;
Medical Director, Dr. Thomas W. Salmon, New York;
and Secretary, Clifford W. Beers.

The Pan-American Medical Congress under the
Presidency of Dr. Charles A. L. Reed, which meets at
San Francisco, Calif., June 17th, promises to be an instruc-
tive and pleasant reunion of the physicians of all of the
Americas. It should be well attended from our United
States. It will be good for the brethren of the profession
to get together there.

State Psychologist for Illinois. — Dr. George
Ordahl, of the Minnesota State School for Feeble-Minded,
has been selected State Psychologist of Illinois and has
commenced his work at the Lincoln State School and
Colony of whose staff he will be a member.

Dr. Ordahl comes to Illinois with the best of recom-
mendations from men high in the study and work among
the feeble-minded. Dr. A. C. Rogers, the progressive
superintendent of the Faribault school, gave him unquali-
fied praise.

Mrs. Ordahl, who has worked with her husband in
many studies, will continue her work in this State.

Editorial 195

Eight years ago when it was proposed to add a
psychologist to the staff of the Lincoln State School,
the idea was not received enthusiastically. The position
was looked upon as one of the modern fads. It required
several years of agitation before the authorities finally
concluded to give the idea a trial.

The Object of the Visiting Nurse Association
of St. Louis, (Central Office, Vanol Building, Vandeventer
and Olive Street, Lindell 1340, Delmar 1102) is to provide
graduate, registered nurses to visit those otherwise unable
to secure skilled assistance in time of illness, to teach
cleanliness and the proper care of the sick, and to prevent
the spread of disease.

The aim of this commendable organization is chiefly
to assist indigent people and those in moderate circum-
stances. Others will be expected to pay $1.00 an hour.
Mrs. John B. Shapleigh, President, 4950 Berlin Avenue;
Margaret M. McClure, R. N. Superintendent of Nurses.

Professor Johnson's Tuberculo-Phobic Suspender
Investment. — Professor John B. Johnson, eminent in
his day as lecturer on physical diagnosis and diseases of
the thoracic cavity in St. Louis Medical College, now a
department of the Washington University, St. Louis, who
in his enthusiastic student days was a pupil of the re-
nowned Henry I. Bowditch of Boston, became so hypo-
chondrically convinced that he had incipient tuberculosis
that on purchasing a pair of suspenders, he selected
the cheapest fifty cent pair placed before him, out of a
lot running up to dollars in price, because he was im-
pressed that he would not live to wear out a costlier
pair. Prof. Johnson related this story of himself to the
class when Dr. C. H. Hughes was a medical student in
1S59. Prof. Johnson lived to old age and grew extremely
stout notwithstanding.

Earnest students are prone to this sort of lecture
hypochondria. Dr. Johnson's (like Dr. Bowditch's) lectures
were very impressive on physical diagnosis.

196 Editorial

The editor of this ma;^azine confesses to having had
a similar phthisophobia in his student days, though he
has survived the fear a great many years.

The American Academy of Medicine has specialized
in medical sociology for the last eight years. The work
done has been of the greatest importance. The publica-
tions of the Academy have won a high place and are in
constant demand. The revised Constitution and By-
Laws niake it possible to so extend its membership as to
include as Fellows all physicians who are interested in
this phase of medicine, and, in Associate membership,
all workers in the field of sociology who recognize that
scientific n.edicine is fundam.ental to all inquiries and in-
vestigations of abnormal social conditions, and that the co-
operation of the physician is essential for the successful
administration of measures for the correction of conditions
which interfere with human efficiency.

We agree with this society that the field of sociologic
medicine is so large that it can only be satisfactorily
covered by a national society of the broadest scope such
as this organization is, and with the widest conception
of the nature of the work before it. We believe that
the American Academy of Medicine is the legitim.ate
one to expand into such an organization.

The good work up to date justifies the scope of its
work for the present and coming years as announced,
viz.:

"The child and its relationship to society. The
medical aspects of education. The social inefficient.
Legislation and medicine. Medicine in its relationships
to industry, trade and com.merce. Civilization in its
effects on morbidity and mortality."

Medical Opficer.s of Hospitals for the Insane
should make their visiting rounds of the halls at different
hours of different days and at different entrances, so that
they may know from personal observation how their
patients are being treated.

Editorial 197

All of these hospitals should have inspecting head
attendants of undoubted integrity, fidelity and kindness
of heart toward the patients, to detect any possible
mistreatment of the helpless patients.

As a rule kind treatment prevails in these institutions
but every now and then some brutal conceited inhuman
"smart Alex," who thinks he knows better how the insane
ought to be managed than the humane rules and regula-
tions enjoin, gets into the hospital as a nurse or attendant
and shows his vicious, cruel, conceited, inhuman, domineer-
ing nature, by clandestinely punishing a patient (even
unto death sometimes) for the patient's delusional attempt
at violence or stupid insane resistance of the nurse's
orders. Such violent-minded nurses ought to be subjected
to the severest punishment, even to the penitentiary
or electrocution, where death results from the attendant's
violence. An insane hospital is no place for the display
of vicious passion or prowess toward the so-called unruly
insane.

It is the part of the profession of nursing the insane
to be imperturbable under insane insult or violence
and summon other nursing aid to quietly handle excited
patients. But ignorant and vicious attendants prefer to
handle excited patients alone and unaided and sometimes
the death of the patient results. Continual surveillance
brings safety.

The Psychiatry of Flowers in the Sick Room. —
The observant editor of the Indianapolis Medical Journal
notes the salutary "influence of flowers in lightening
suiTering and their employment in cases of sickness" and
contributes an interestingly therapeutic editorial thereon,
all of which he who ministers to minds diseased and knows
the power of psychic pleasure to exalt organic resistive
power in combat against disease, every psychiatrist ap-
proves, from his special experience. Alienists in charge
of the hospital for the insane know well the value of
agreeable, pleasing appeals to the senses of sight and
smell of flowers and similar impressions of the other

198 Editorial

senses, as of music, pictures, palatable diet and agreeable
environments of every sort. Flowers have charms as
well as music, etc. for the insane, . and general hospitals
might therapeutically and profitably adorn their walls
as the walls of the insane hospitals are. Surgeons should
pleasingly decorate their reception and operating rooms.

Dr. G. W. Morrow has been appointed first assistant
superintendent of the Anna State Hospital, Ills, to succeed
Dr. W. W. Mercer, resigned.

The Dual Source of the Cerebrospinal Fluid
is in the choroid plexus and the cerebral capillaries,
according to Dandy and Blackfan, Frazier, Peet and
Gushing.

Internal Hydrocephalus was produced by Frazier
and Peet by blocking the Sylvius aqueduct. For elabora-
tion see Journal American Medical Association, Dec.
1914, p. 2232. It may also be a cerebral perivascular
space sheath excretion — the internal nutrient both of the
arteries and cord and the external bath of the nerves.

The Suspension of Gazetta Medica Italiana
is noted at the office of this magazine with regret.

The Eminent Alienist, Maragliano, is to be justly
memorialized by a suitable tablet to his honored memory
in the Asylum over which he so worthily presided in Italy.

Roland B. Molineux is Violently Insane. — Baby-
lon, N. Y., Sept. 7 — Roland B. MoHneux, twice tried
for the murder of Mrs. Katherine L. Adams in 1902
and acquitted on the second trial, was adjudged insane
today by two physicians sitting as a board in lunacy,
and formally committed, as a violent patient, to the
King's Park Asylum.

Prosperous Grinnell College, Iowa. — This flourish-

Editorial 199

ing College has something to say concerning its interests
in this issue:

"The foundations are in and one story about com-
pleted for a women's dormitory to cost about $200,000,
and to house some 300 young women. A dining room
to seat 400, with a kitchen of modern hotel equipment,
is part of the new dormitory.

"The alumni have plans under way to do something
for the College in the way of a fine new building towards
which they are arranging to contribute $100,000.

"A tract of eighty acres lying north of the college
grounds, and connecting with them, has been priced and
will undoubtedly be added to the campus.-j;|The College
is prospering." , vp "'".•

Harvey iij; Ingham in The EveningV^.Tribune, Des
Moines, Iowa, November 24, 1914, speaksisome mighty
good words for this pioneer educational institution of
the great State of Iowa, from whom we have taken a part
of this notice. This college is fast developing into the
Yale and Harvard of the Central West.

Doctor Charles McIntIre's Contribution on the
Rigidity of the Medical Curriculum as an obstacle
to the progress of medical education should be read,
and the comments thereon of other eminent members
of the Academy, by all well wishers of the profession and
the people. Medicine needs the best minds in quality,
essential acquisition and capacity possible to bring into
its ranks.

It needs powerful, intelligent executive soldiers of
science to battle with disease. It needs enlightened
armamenture for fighting disease, real weapons of utility
rather than literary embellishment and the best and most
ready means of acquiring practical proficiency. It needs
clinical skill based on knowledge of all of the allied
sciences. It needs proficiency taught as briefly and
completely as possible and adopted to the average student's
limited time and means for study. Instruction should
be condensed. Modern languages might be relegated

200 Editorial

to the post-graduate period or to the interim of the
college curriculum.

The Harrison Opium Coca Bill will contribute
to prevent the indefinite blind prescribing of certain
proprietaries, the ingredients and exact proportions of
which are not definitely made known to the profession
and which no accurate prescriber should write, to the
business detriment of square dealing proprietary pharma-
cists who offer the medical profession good meritorious
and true and useful productions, because the law and the
physicians must correctly know the goods he is handling.

Many Insane Hospital Reports come to us. We
are glad to receive them and would be pleased to have
their interesting medical features marked or better epito-
mized for medical notice. Physicians outside of these
worthy institutions (public and private) should know
more about their work and claims on professional and
public philanthropic consideration. While it is true we
have not space for noticing all in detail, we like to inform
our readers what these worthy hospitals and sanitariums
are doing and to make occasional note to promote their
welfare and of their meritorious physicians and managers.
If the inside of our insane hospitals were better known
on the outside there would be a better appreciation of
them than now exists in some not well informed quarters.

The First Case of Opium Abstention Suicide
under the Harrison Anti-Narcotic Law, occurred in St.
Louis in April. Sudden deaths as well as suicides and
insanity are frequent sequences of sudden deprivation
of opium in the opium addict of long standing. The
unfortunates are to be sympathized with, pitied, nurtured
back to normal and not censoriously and brutally con-
demned as "drug fiends," for most of them have become
unconsciously and not intentionally the pitiable, helpless
habit victims they are. They are not "dope fiends" but
victims of an opiated or cocainized patent medicine or

Editorial 201

doctor's prescription, too often and without medical
judgment, repeated and too long continued.

The British Medico-Psychological Association at
its last May meeting had under "Consideration of a letter
from the Board of Control which asked for suggestions
as to the use of Government Grant toward scientific
research in Psychiatry."

A very timely and pertinent question which we hope
was answered in the interest of this important matter. At
the same meeting "Some Observations on Early Nervous
and Mental Cases, with sugestions as to possible improve-
ment in our methods of dealing with them" was read by
A. Helen Boyle, M.D.,L.R.C.P.

Married School Teachers Should Be Retained
IN Service. — The Medical Times for last March had a
commendable editorial on teacher mothers advocating
their retention in school service.

We go further. Female teachers should be encouraged
to marry and become mothers and rewarded when they do.

Women who marry and have children or have married
and had children, and their affections cultivated toward
children and their understanding concerning them, educat-
ed and interest in them increased and trained and im-
proved, should be preferably sought after by school
boards and more highly prized because of their wider
life experience and consequently better qualified to "teach
the young idea how to shoot."

They should even be pensioned or what is the same,
their pay allowed to them, when out of school during
certain weeks of unavoidable absence. There is good
psychological reason for this in the better quality of
child understanding and management which would accrue
to pedagogy from the liberal treatment of mother teachers.
Besides it would be only fair to the married female
element of the teaching profession.

The Seventh Pan-American Congress will meet in
San Francisco, June 17th-21st inclusive. It assembles

202 Editorial

pursuant to invitation of the President of the United
States issued in accordance with an act of Congress, ap-
proved March 3, 1915.

The countries and colonies embraced in the Congress
are the Argentine Republic, Bolivia, Brazil, Canada,
Colombia, Cuba, Chile, Costa Rica, El Salvador, Ecuador,
Guatamala, Honduras, Haiti, Hawaii, Mexico, Martinique,
Nicaragua, Panama, Paraquay, Peru, Santo Domingo,
United States, Uruguay, Venezuela, British Guiana, Dutch
Guiana, French Guiana, Jamaica, Barbadoes, St. Thomas
and St. Vincent. The organization of the Congress is
perfected in these countries and the majority of them
have signified their intention to be represented by duly
accredited delegates.

The Palace Hotel will be headquarters.

The First Pan-American Medical Congress was most
successfully held in the United States in 1893. Five
intervening Congresses have been held in Latin American
countries.

"The Practical Side of Masonic Work in Servia
is well shown by the fact that the bodies there have
established an orphanage with a capital of more than
500,000 francs, where they are caring for 2,600 orphans
and training them so that they will be able to take up
life's duties. They have also raised over 1,000,000 francs to
estabhsh schools and aid needy students; manual training
is furnished for deaf mute children, and another enter-
prise provides meals for poor scholars." — The New Age.

Why has not the American public and medical press
solicited aid for poor little Servia as it has for unfortunate
and devastated Belgium? Why does Belgium get all
foreign sympathy- This Magazine will receive, receipt
for and transmit to the proper authorities contributions
to either country. The sun of charitable giving should
shine on all — Greek and Roman Catholic alike. "If
mindless of home or creed over the suffering form hath
bent, he who gives hath not lived in vain."

Editorial 203

The Council on Medical Education of the
A. M. A. has done much to advance medical education
in the United States. We think, however, it has done and
is doing something against the native born American medi-
cal student in demanding the knowledge of two modern
languages besides the knowledge of mother tongue, as
prerequisite to graduation in the medical schools of this
polyglot country.

The German, French, Italian, Russian born student,
etc., thus has the advantage over the native American
in usually having already acquired at least one of the re-
quired foreign languages and gets credit over the native
born student and has more time (in all too limited) for
the exacting course of medical application required by
our colleges and which can not be dispensed with except
the foreign languages.

Modern languages as a preliminary essential to
graduation, though valuable, should not be exacted of
medical students. A knowledge of philogic Greek and
Latin might be briefly and incidentally learned to ad-
vantage by the medical student in vacation or very briefly
taught in the college course. But the doctor should
have all of his student years for pure medical study
unless he should be required to study more than four
years and more than four years taken for medical study
before permitting final examination for the M.D. degree
would be a wrong to the rightly inclined student and tend
to foster and promote the multiplication of the pseudo-
scientific sects — the osteopaths, chiropractics, etc., now
multiplying over the land.

OBITUARY
The Nestor of Kentucky Medicine, Doctor
James Morrison Bodine, for many years Professor of
Anatomy and Dean of the Medical Department of the
University of Louisville, Ky., died January 25th, 1915,
at the age of eighty-four years.

REVIEWS, BOOK NOTICES, REPRINTS, ETC.

Nervous and Mental Diseases. — By Archibald
Church, M.D., Professor of Nervous and Mental Diseases
in Northwestern University Medical School, Chicago;
and Frederick Peterson, M.D., formerly Professor of
Psychiatry, Columbia University. Eighth edition, revised.
Octavo volume of 940 pages, with 350 illustrations.
Philadelphia and London; W. B. Saunders Company,
1914. Cloth, $5.00 net; Half morocco, $6.50 net.

The new edition of this meritorious book which we
have hitherto unstintedly commended needs no further
word from us except to say that it fully sustains the
high reputation it has won as an up-to-date text book
of the subjects of which it treats. The authors write
by warrant of experience.

The Theory of Psychoanalysis. — By Dr. C. G.
Jung of Zurich, Journal of Nervous and Mental Disease,
Series No. 19, New York. The Journal of Nervous and
Mental Disease Publishing Company, 1915. In these
lectures the author attempts to reconcile his practical
experiences in psychoanalysis with the approaches to
existing theories. His attitude towards those principles
which his honored teacher, Sigmund Freud, has evolved
from the experience of many decades. Since he has
long been closely connected with psychoanalysis he thinks
it will perhaps be asked with astonishment how it is
that he is now for the first time defining his theoretical
position. When, some ten years ago, it came home to
him what a vast distance Freud had already travelled
beyond the bounds of contemporary knowledge of psycho-
pathological phenomena, especially the psychology of
the complex mental process, he no longer felt himself
in a position to exercise any real criticism. He did not

(204)

Reviews, Book Notices, Reprints, Etc. 205

possess the sorry mandarin-courage of those people
who — upon a basis of ignorance and incapacity — consider
themselves justified in "critical" rejections. He thought
one must first work modestly for years in such a field
before he might dare to criticize. The evil results of
premature and superficial criticism have certainly not
been lacking. A preponderating number of critics have
attacked with as much anger as ignorance. Psychoanalysis
has flourished undisturbed and has not troubled itself
one jot or title about the unscientific chatter that has
buzzed around it.

With these views of the distinguished author we
submit this up-to-date treatise on a subject just now
enlisting much interest and some criticism in the ranks
of clinical psychiatry. The subject is well and briefly
handled covering only one hundred and thirty-three pages.
Libido, the sexual theory and all the other aspects of this
new and interesting theme of neural and psychoneural
diagnosis are intelligently and critically discussed, together
with their relations to certain classical psychoses and in
such manner and with such candor as will not fail to
interest and enlighten the thoughtful and truth-seeking
alienist. We commend this valuable addition to present
day psychiatric literature to our readers.

Trattato di Psichiatria ad uso dei medici e
degli studenti del Prof. Leonardo Bianchi, Direttore della
Clinica della Malattic Ncrvoce e Mentali della R. Universita
di Napoli.

Napoli Casa Editrice Cav. Dott. V. Pasquale. S.
Andrea della Dame 17 p. p. Press of the Universal
Clinic.

This is the second edition of this meritorious work
embellished with numerous plates relating to the text.

From the borderland of war comes this illuminating
treatise of psychiatry for the use of physicians and the
instruction of students by the eminent corypheus in
Italian psychiatry, Professor Leonardo Bianchi, Director
of the Clinic of Nervous and Mental Diseases of the

206 Reviews, Book Notices, Reprints, Etc.

University of Naples.

The text is admirable, the illustrations numerous and
superb. One of the most novel of illustrations in clinical
psychiatry is the posa catatonica di dementi precpci.
This and the illustrations of the entire first chapter,
particularly figure 2, showing the author's conception
of the insula and operculo-fronto-parietal relations are
especially entertaining.

The record and the history and photo of Carlo 1st
should have a place in every hospital library. The author's
chapters are all of supreme interest from the Italian
view point and chapter XXXV on Nevropatie e psico-
nevrosi traumaische, will excite new interest in this
debatable subject and turn the reader's mind to Charcot,
Dupuy, Oppenheim, Erichsen, Page, Obersteiner and
Beard.

The toxic insanities of cocaine, -chloral, phycosi
leutica, coreica, nevrastenica, acute and tardy paranoia,
frenosi, maniaco-depressiva mania, dementia paralj'tica,
dementia senilis, have separate chapters and are well
presented, especially the tremor and manuscript showing
of paralytic dementia.

The pages of this magazine have borne testimony
to the merits of may eminent Italian authorities in
neurology and psychiatry and carried many valuable
contributions from such eminent men of the author's
nativity as Golgi, Maragliono, Tamburini, Sepille and
others, but none has higher claim in psychiatry to the
esteem of our readers, than Bianchi, the distinguished
author of this meritorious book.

The Laws of Heredity — Their Definite Meaning
AND Interpretation. — The second of a series of mono-
graphs on the Improvement of the Human Plant. Henry
Smith Williams, M.D., LL.D., Editor. Issued by the
Luther Burbank Society, Santa Rosa, California.

An interesting study for the eugenist, the alienist
and the neurologist. The author in his foreword truly
says:

Reviews, Book Notices, Reprints, Etc. 207

"Heredity is more of a factor in human life than in
plant life — more of a menace — more of a hope.

"And nothing in the world of living things responds
so quickly to new environments as the human mind —
child and adult.

"The great value of Luther Burbank's work lies
in blazing the path of the application of the forces of
heredity and environment to the improvement of the
human plant — to the production of better races, better
nations, better communities, better families, better in-
dividuals.

"Having completed the classification of Mr. Burbank's
Records as applied to plant life. The Luther Burbank
Society now proceeds to the larger task of interpreting
the forces of heredity and environment toward the better-
ment of the human plant through a series of monographs
now appearing."

Eugenics, Euthenics and Love — How they Go
Hand in Hand. — This is the fourth of a series of Mono-
graphs on the Improvement of the Human Plant, by
Henry Smith Williams, M.D., LL. D., editor. Issued by
The Luther Burbank Society, Santa Rosa, California.
The author states in his foreword that:

"Heredity is more of a factor in human life than in
plant life — more of a menace — more of a hope.

"And nothing in the world of living things responds
so quickly to new environments as the human mind —
child and adult.

"The great value of Luther Burbank's work lies
in blazing the path of the application of the forces of
heredity and environment to the improvement of the
human plant — to the production of better races, better
nations, better communities, better families, better in-
dividuals.

"Having completed the classification of Mr. Burbank's
Records as applied to plant life. The Luther Burbank
Society now proceeds to the larger task of interpreting
the forces of heredity and environment toward the better-

208 Reviews, Book Notices, Reprints, Etc.

ment of the human plant through a series of monographs,
of which this is one."

This brochure gives good reasons from the study of
plant life for restricting the fecundity of the unfit. Its
reading will well repay the eugenic philanthropist and
American patriot.

Christian Science Sentinel.— To those who may
be brought to feel that the "Everlasting Arms are under
them" Christian faith in Him that healeth the wounded
in spirit and the broken-hearted becomes a helper to
the "Good Physician" as the Great Physician called his
follower Luke.

Psychiatry suggests to the physician not to ignore
the psychiatry of faith and hope, nor the efficacy of the
Pool of Siloam nor physical means the Divine Master
commended and employed. Poor blind Bartimeus on
the road to Jericho received his sight by means of the
anointm.ent of clay and spittle for instance. Let us have
no quarrel with them who hear the Master's voice more
clearly than we and closer follow Him nor harshly
judge them.

The Pro! aganda for Reform of the A. M. A. in
proprietary medicine, although never submitted to us for
review, represents the work of the Council on Pharmacy
and this has been very serviceable to the medical profession,
especially in its laboratory reports.

It reminds us, in these financially hard times, of the
banknote detectors which used to be on every mercantile
counter to tell the good from the bad money in circula-
tion. It has been called the "Medical Rogues Gallery"
like its companion the Dictionary of Quackery.

We acknowledge our indebtedness to the Council
on Pharmacy for valuable and prompt laboratory in-
formation which has helped us to clear our pages of some
false representation which we peni:itted to appear in
them.

Proprietaries must be meritorious and ethical to be

Reviews, Book Notices, Reprints, Etc. 209

carried in the Alienist and Neurologist.

Clinical Symptomatology. — A unique little bro-
chure (24 pages) has already been distributed to the medi-
cal profession by the Purdue Frederick Company of
Gray's Glycerine Tonic fame. It consists of tables or
charts giving the "symptom-complex" (of each of sixty
different diseases,) of exceptional value for reference
purposes. A copy can be obtained free by addressing
this Company, 135 Christopher Street, New York City,

Contrary to the custom of some others among otir
proprietary caterers and friends, this little brochure is not
submitted with any idea of instructing those who are to
receive it. The author fully realizes how presumptious
on their part any such purpose or thought would be.
This is a specially useful symptom remembrance for the
country practitioner whose visits often take him many
miles from his home and library.

International Clinic Week at the N. Y. Poly-
clinic Medical School and Hospital during the International
Surgical Congress, April, 1914. By Alfred C. Jordan, M.D.,
Eugene Hertoghe, M.D., Benj. Merrill Ricketts, M.D.,
John A. Wyeth, M.D., John A. Bodine, M.D., Alexander
Lylr, M. D., William Seaman Bainbridge, M. D., New
York.

An excellent clinical showing, well illustrated, of
thyroid deficiency, myxedema, etc., before and after treat-
ment and is worth any phj'sician's consideration. This
excellent brochure comes with the compliments of Dr.
John A. Wyeth, Prest. of Faculty, which adequately
commends it.

Carnegie Endowment for International Peace. —
2 Jackson Place, Washington, D. C. This circular comes
with countenance and support of many of the philanthropic
minds of our peace loving country. Among them Elihu
Root, Oscar Strauss, Nicholas Murray Butler and our
own Robert S. Brookings, the list being headed by

210 Reviews, Book Notices, Reprints, Etc.

Joseph H. Choate and should be read by all peace loving
patriots and philanthropists who believe that "Peace
hath her victories no less renowned than war" and even
more commendable and fruitful for the welfare of man-
kind.

Address in Medicine before the Iowa State Medical
Society, May 14, 1914. Remarks on Some Ordinary
Headaches, Hugh T. Patrick, M.D., Chicago, 111. Re-
printed from Journal of Iowa State Medical Society,
November, 1914.

Dr. Patrick is nothing if not interesting. A view of
striking humor as well as of solid science embellishes all he
writes. You will read this, gentle reader, and try cannabis
indica probably, as the doctor commends, but will probably
resort to the bromides finally, aided by pepsin and liver
laxatives and your patient will be .relieved and finally
recovered if he or she lives long enough for the happy
sequel of senile tranquility.

BuRGERSDijK & NiERMANS, Leiden, Nieuwsteeg No. 1.
(Templum Salomonis)— Telefoon Interc. No. 1067. Boek-
handel — Antiquariaat — Boekverkoopingen.

Notwithstanding the inconvenience to men engaged
in literary pursuits caused by the present war in Europe
we are glad to see the way is still open to this well-
known cosmopolitan book store and we take pleasure in
acknowledging receipt of this well-known firm's extensive
catalogue of old and new books, including so many
American authors' productions.

The Diseases of Personality: the Diseases op
THE Will and the Psychology of Attention. — By
Theo. Ribot, translated and published by the Open Court
Publishing Co., of Chicago, should have a place in
every psychologist's and in every alienist's and neurologist's
library. Reflectively read they will enlighten the veteran
and amateur in psychological and pathological mental
science. The price of each volume, cloth bound, is only
seventy-five cents. Full set, cloth, SI. 75.

Reviews, Book Notices, Reprints, Etc. 211

The Smith Indian Cataract Operation in the
Light of Scientific Investigation. — A. S. Green, M.D.,
Chief of Ophthalmology, San Francisco Polyclinic and
Post-Graduate School of Medicine and L. D. Green,
M.D., Visiting Assistant Ophthalmologist, San Francisco
City and County Hospital, Stanford University Medical
Department. Reprinted from Ophthalmology, January,
1915.

Dynamics Psychological by F. L. Wells, McLean
Hospital, Waverly, Mass. From the Psychological Bulle-
tin, November 15th, 1914.

"Common Factors in Mental Health and Diseases,"
reprinted from Science Monthly.

"Note on Retention of Acquired Faculties." All
by same author.

La Personalita del Giudicabile. — Nel Nuovo
Codice di Procedura Penale, Estratto dall' Archivio di
Antropologia Criminale, Psichiatria e Medicina Legale
(1914, Vol. XXXV, Fasc. 3.) Prof. Leonardo Bianchi,
Ordinario di Clinica delle malattie mentali e nervose nella
R. Universita di Napoli, Deputato al Parlamento. Torino,
Fratelli Bocca, Editori, Milano, Roma, Firenze.

One Hundred and First Annual Report of
Trustees Massachusetts General Hospital. — Includ-
ing the General Hospital in Boston and McLean Hospital
and the Convalescent Hospital in Waverley, 1914; Section
A, Cambridge, The University Press. George T. Tuttle,
M. D., Medical Superintendent.

Human Plumbing — Amelioration and Cure of
Chronic Intestinal Stasis. — Illustrated. By William
Seaman Bainbridge, M. D., New York City. Reprint
from The Charlotte Medical Journal, October, 1914.,
Charlotte, N. C.

212 Reviews, Book Notices, Reprints, Etc.

A Unique Case of Syphilis of the Cranium and
Spine — With Remarks on Syphilitic Bone Dystrophy. —
By G. Frank Lydston, M.D., Chicago. Formerly Professor
of Genitourinary Surgery and Syphilology, State University
of Illinois. Reprinted from the Medical Record, January
9, 1915.

Experiments With Emulsions of Organs Taken
From Dead Human Body and Sex-Glands of the
Lower Animals. — By the same author. From American
Medicine, New Series.

Annali di Nevrologia. — Diretti dal Prof. L. Bianchi.
Estratto dal Fasc. Ill dell' anno 1914. L'Afasia Amnesica
per il Prof. Leonardo Bianchi, Napoli.

Treatment of Drug Addiction and Alcoholism. —
By William K. McLaughlin, M.D., Chicago, Ills. From
the Chicago Medical Recorder, issue of January, 1915.

A Note on the Retention of Acquired Capaci-
ties.— By F. L. Wells, McLean Hospital, Waverley, Mass.
Reprinted from the American Journal of Psychology.

A Case of Pure Psychic Epilepsy. — By E. Stanley
Abbot, M.D. Reprinted from The Journal of Nervous
and Mental Disease.

Report of the Director of Sanitation of Porto
Rico. — From the Report of the Governor of Porto Rico,
1914. Bureau of Insular Affairs, War Dept., Washington.

La Forme Asthenique de la Paralysie Generale.
— Par R. Benon et H. Cier. Extrait Revue de Medecine.
Librairie Felix Alcan, Paris.

Dental Electro-Therapeutics. — By Ernest Stur-
ridge, L.D.S. Eng., D.D.S. Fellow of the Royal Society
of Medicine, Member of the British Dental Association.

Reviews, Book Notices, Reprints, Etc. 213

Bulletin of St. Louis University. — April, 1915,
Volume Eleven. Containing the Announcement of the
Summer School of Medicine.

Mellins Food

was the first preparation of maltose
and dextrin presented to physicians
in serviceable fi)rm, and it stands
today as a true representation of
Liebig's principles which are now
so generally applied to scientific
infant feeding.

There is a distinct advantage to
the physician in the employment
of Mellin's Food where

A

Maltose and Dextrin
Product

is desired, and we cannot emphasize too
strongly the importance of using a product
scientifically prepared from carefully selected
material and by clean methods if successful
results are to be obtained.

Samples and literature upon request.

Mellin's Food Company, Boston, Mass.

ALIENIST AND NEUROLOGIST

Vol. XXXVI. St. Louis, August, 1915. No. 3.

A CONTRIBUTION TO THE STUDY OF PROGRESS-
IVE MUSCULAR ATROPHY AND A REPORT
OF FOUR CASES WITH MENTAL
DISORDERS.

By Dennis J. Murphy, M. D.
Government Hospital for the Insane.
Washington, D. C.

"PROGRESSIVE Muscular Atrophy is a term used to
•'• designate certain conditions which present as their
most important feature a progressive wasting of the
muscles. It is used rather loosely and in a general way
to designate any condition presenting this feature but is
also used more specifically to denote certain more or less well
defined clinical entities. It is in this more specific desig-
nation that we have more or less confusion. Some writers
consider Chronic Anterior Poliomyelitis, Amyotrophic
Lateral Sclerosis and Spinal Progressive Muscular Atrophy
under the single heading of Spinal Progressive Muscular
Atrophy. Others consider all three separate and distinct
clinical entities. Dana can see no reason for changing
the name of a disease from Spinal Progressive Muscular
Atrophy to that of Amyotrophic Lateral Sclerosis just
because a certain amount of spasticity happens to occur
in the course of what was thought to be the former
disease syndrome and indeed it seems rather unnecessary

(215)

216 Contribution on Progressive Muscular Atrophy

and only adds to the confusion already existing in regard
to this disease. The symptoms of both conditions are
practically identical with each other except for the addi-
tion of a spastic condition in the latter. The pathological
anatomy is much the same in both disorders. In the
first the destruction is more or less confined to the an-
terior horn cells but frequently the pyramidal and antero-
lateral tracts are involved, while in the second condition
the pyramidal tracts are involved first and later the anter-
ior horn cells. It would seem that the two conditions
are simply the manifestation of one and the same under-
lying disease process.

There are many conditions which produce muscular
atrophies. Many of the muscular wastings have their
origin in the muscles themselves as seen in what is known
as Progressive Muscular Dystrophy. Others begin in
the peripheral nerves as in the neural form of Spinal
Progressive Muscular Atrophy and we also have those
conditions which develop because of destruction of certain
cells in the spinal cord. Aside from its blood supply a
muscle depends on the lower motor neurone, the axis
cylinder and the end processes for its integrity. We may
have peripheral or reflex atrophies due to irritating
joint processes. We may get muscular atrophy in Hysteria
and this is explained as being due to a diminution in tone
of the anterior horn cells. Muscular atrophy may occur
following certain infectious diseases as Typhoid Fever,
Diphtheria, Scarlet Fever, Syphilis, etc.; or it may follow
certain toxic conditions as lead or arsenic poisoning.
Oppenheim has repeatedly seen the rapid development
of atrophy after operations on the motor cortex of the
brain. Monakow is of the opinion that deficiency of
the sensory, motor and vasomotor impulses may be the
cause of the muscular atrophy. In the opinion of Wilson
progressive muscular atrophy is the manifestation of
a degeneration of the lower motor neurones and many
cases give positive findings in regard to Syphilis. Four-
nier places a special form of muscular atrophy in liis
classification of the parasyphilitic diseases.

Dennis J. Murphy 217

The cases which I have to present were selected
because of the association of mental symptoms with the
progressive muscular atrophy and it was thought that
they might prove of interest for this reason. No well
defined mental syndrome has been put forward as being
due to this disease but certain mental aberrations have
been noted in some of these conditions.

By some, a certain degree of mental reduction has
been observed in that form of progressive muscular atrophy
which presents bulbar symptoms and by them it is con-
sidered part of the symptom complex. Marie states that
in aniyotrophic lateral sclerosis with bulbar symptoms
the mentality is more or less affected, intelligence is
enfeebled, emotionality is increased and the tendency to
laugh or weep is pronounced. Sometimes a demented
condition exists. The patient is moody and intellectually
and morally approaches the attitude of a child.

The literature concerning the occurrence of mental
disorders in cases of progressive muscular atrophy is
very scant and of course it would be impossible to come
to any definite conclusion on the few cases which I have
seen but it was thought worth while to add this small
contribution to the subject. The first two cases of this
series have for their most prominent mental symptom the
occurrence of marked paranoid ideas and present a rela-
tively small amount of mental reduction. The third case
was rapid in its course and the only mental symptom
noted was a slight lowering of the general intellect.
The fourth case was one of General Paralysis of the
Insane and presented the mental symptoms usually found
in the advanced stages of this disease.

Before going on with a description of the cases it
will probably be well to give a brief description of the
disease progressive muscular atrophy and that form known
as spinal progressive muscular atrophy and which probably
includes both chronic anterior poliomyelitis and amyo-
trophic lateral sclerosis will be given. The same description
applies in all essentials to all three. In chronic poliomyeli-
tis the paralysis is supposed to occur first and the atrophy

218 Contribution on Progressive Muscular Atrophy

later while in amyotrophic lateral sclerosis we simply ad 3 to
the description, a condition of spasticity. In some cases
the disease is clinically one of Spinal Progressive Muscular
Atrophy but on pathological section we find sclerosis of
the pyramidal tract.

In this disease we have a progressive wasting of the
muscles dependent upon some diseased condition of the
spinal cord, usually to a degeneration of the cells in the
anterior horns of the spinal cord and frequently de-
generation of the pyramidal columns. The condition
begins as a rule in the small muscles of the hand but
may begin in the shoulder girdle or the peroneal muscles.

The disease is not considered to be due to hereditary
influences but in what is called the infantile form or the
Werdnig-Hoffmann type there seems to be a distinct
hereditary tendency. The etiology is obscure; but trauma,
over use and exposure are put forth as causes. Many
cases are undoubtedly caused by Syphilis and Wilson
believes that if the question of antecedent Syphilis were
carefully investigated in every case or if every case were
subjected to the Wassermann test that this disease, like
Paresis and Tabes, would take its place as a parasyphilitic
disease. Dana maintains the importance of Syphilis in
bringing about the typical form of the disease. The
symptoms of the disease usually begin about middle life
except in the infantile form when they are manifested
early in infantile life. In this latter form the disease
terminates after a varying period of time in death while
in the other form the patients may live for years and then
die of some intercurrent disorder.

The disease manifests itself usually between the third
and fourth decades and the first symptoms noted are
an awkwardness in the use of one or both hands, usually
one more than the other. The thenar and hypothenar
muscles then atrophy and the atrophy gradually extends
to the flexors of the forearm and then to the extensors;
it may even reach the deltoid. The trunk and neck
muscles waste and the ribs become prominent. The
lower limbs likewise may become atrophied and a number of

Dennis J. Murphy 219

cases are on record in which the atrophy began in the
lower limbs, especially in the peroneal distribution. Fib-
rillary twitching in the affected muscles and a diminu-
tion and subsequent loss of the deep reflexes are usually
present. The fibrillary twitching is absent when the
atrophy has reached to an extensive degree. In amyo-
trophic lateral sclerosis the reflexes are usually increased
but this is not invariable. The electrical reactions are
diminished or altered and the reaction of degeneration
may even be present. There is usually little or no pain,
that present being due to over use of the atrophying
muscles. Pupillary changes have been observed, even
stiff unequal pupils. These cases may be of luetic origin.

Case I. — L. M. Admitted to the hospital in August,
1900, age sixty years. Family history as given by the
patient was negative. He knew of no other members of
his family similarly affected. Birth and childhood were
normal. He claims to have always been well and never
had any serious illness. He states that he had Syphilis
in 1865. He was married but his wife died shortly after
bearing him a baby boy. The patient earned his living
by peddling and for some time before entrance to this
hospital he solicited alms by exhibiting his deformity.

The patient states that his arms began to atrophy
about forty years ago. The first thing that he noted
was that his right hand grasp became weak, later this
extended to the left and following this the muscles began
to waste away. The small muscles of the hand were
first affected, then the condition involved the muscles
of the shoulders and from here extended down to the wrist.
About twenty years ago his left leg became weak and the
muscles began to waste and this condition slowly pro-
gressed so that for the past five or six years he has been
unable to walk.

On admission to this hospital in 1900 he could walk
fairly erect but there was some uncertainty in his gait
due to a weakness of his left leg. Coordination was im-
paired and Romberg's sign was present. The pupils
were small, did not react to light but did to accommodation.

220 Cmttribution on Progressive Muscular Atrophy

Temperature sense was normal. Fibrillary tremors were
noted in the affected muscles. There was paralysis of all
the muscles of the right arm including the right pectorals,
subscapular and trapezius, all of the left except the triceps
and part of the deltoid. The muscles of the hands, arms,
shoulders and left leg were atrophied and the muscles
small and lacked tone and strength. There were no
contractures. No scars of lues were noted.

Since the patient has been in the hospital the condi-
tion has progressed very slowly. On admission he was
able to use the left arm slightly but at the present time
he cannot move either arm except by swinging his whole
body. The muscles of both hands are almost completely
atrophied. He is unable to flex or extend the fingers
and the hands flop loosely about, presenting a typical
monkey hand. The muscles of the forearm are almost
entirely gone but there is a slight amount of use in the
pronators of the right hand. He is unable to flex or
extend the forearm on the arm. The muscles of the upper
arm are completel}' wasted, there being practically nothing
but skin and subcutaneous tissue over these areas. The
head of the humerus is prominent. The deltoid and tri-
ceps seem to be entirely gone. The pectoral muscles are
almost completely atrophied on both sides. The trapez-
ius is partially preserved and the patient can raise and
lower the shoulders. The muscles of the scapular are
wasted and practically obliterated. The leg and thigh
muscles of both lower extremities are atrophied but the
wasting seems to be concentric. The calves are equal in
size, each measiuing 23 cmm. The left thigh is somewhat
smaller than the right, the former measuring 30 cmm.
and the latter 33cmm. The strength in both extremities
was about equal. The patient is able to flex and extend
the legs on the thighs and the thighs on the abdomen
and also to adduct and abduct the legs against considerable
resistance. None of the usual reflexes could be elicited.
The patella reflex is absent and there is no ankle clonus
or Babinski. The pupils are pin point in size and did not
react to light or accommodation. No fibrillary tremors

Dennis J. Murphy 221

were elicited and none have been observed for the last
four or five years. Sensation appears normal. Wasser-
mann reaction with the blood serum negative. Luetin
test negative.

During his entire residence in the hospital there has
been no essential change in his mental condition. He is
quite delusional and has marked persecutory ideas. He
says that an English Lord is at the bottom of all his
troubles and that he was kidnapped and sent over here.
He thinks that people are trying to poison him and at
times for this reason he has refused to eat. He is usually
cross and irritable and frequently indulges in profane
and vulgar language. At times auditory hallucinations
have been in evidence. The patient is quite euphoric
and thinks that he is a great man. He calls himself
"Captain Kidd, the public pirate and highway robber."
Memory in unimpaired and general information is good.
Ideation is rather poor. He has no insight whatever
into his condition and thinks that he could leave the hospi-
tal and go out and make his own living.

Here we have a rather typical case of progressive
muscular atrophy but associated with it are symptoms of
mental disease. This mental condition is characterized
by delusions of grandeur and persecution and to a slight
extent by auditory hallucinations. Thep sychosis became
manifest at the age of sixty. The patient has arrived
at that age when the individual finds it hard to adjust
himself to conditions. He is rendered helpless by reason
of his physical condition and develops a defense mechanism
which manifests itself in delusions of persecution and gran-
deur. He projects his difficulties on the outside world
as ideas of persecution and compensates by developing
ideas of grandeur.

The patient gives a history of having been infected
with syphilis in 1865. Ten years later, in 1875, he noticed
the beginning of his physical disorder. He presents no
other signs of syphilis except for the Argyll-Robertson
pupil and Romberg's sign. As against syphilis we have
a negative Wassermann reaction with the blood serum

222 Contribution on Progressive Muscular Atrophy

and a negative reaction to the luetin test. This would
seem to ride out syphilis but we have a fairly definite
history of syphilis and the presence of the Argyll-Robert-
son pupil to consider. Spiller has reported a number of
cases of progressive muscidar atrophy in which both the
history and the Wassermann reaction were negative
for syphilis but post mortem examination showed the
presence of this disease in the spinal cord. I feel, there-
fore that we cannot absolutely rule out this condition
and we must consider the mental disorder in this case
as being possibly due to it. In certain cases of tertiary
syphilis we occasionally find paranoid conditions present
which are quite similar to that we have in this patient.

Disease of the cerebral arteries must be considered.
The age of the patient renders this condition probable.
The mental syndrome is such as we frequently find as-
sociated with cerebral arteriosclerosis. The superficial
arteries ar^ not sclerotic and while this cannot be consider-
ed as an indicator of the condition of the cerebral arteries,
if they were sclerotic we would expect such a condition
in the cerebral vessels. No focal symptoms have been
noted in the patient. The course of the disease has not
been such as we would expect in arteriosclerosis. There
has been no essential increase in the intensity of the ment-
al condition and if it were due to disease of the arteries
of the brain, which is a progressive condition, we would
expect greater degree of mental reduction after fifteen
years.

Dementia Precox of course must be thought of but
it is hardly likely that it would remain latent until the
age of sixty or if the condition had been present in a
mild form for years we would probably get a history of
eccentric characteristics being present for some time.

Case II.— M. M. Admitted to the hospital in 1900.
aged forty-five. Family history entirely negative. Birth
and childhood uneventful. No serious illness. He was
a clown in a circus for a while, later worked as a tele-
grapher and finally became a bugler. He had gonorrhoea
in 1887. He denied syphilis but stated that he had an

Dennis J. Murphy ; 223

eruption on his face and chest and his hair came out.
The first symptoms of his present disorder were noted
in 1887 and came on gradually with slight pains in his
right shoulder and hands. When playing the bugle
he found it difficult to hold the instrument up because
his right shoulder was weak. He could not manipulate
the keys with his left hand as well as formerly, as they
would cramp up and he would have to use the right to
straighten them out. There was some pain in his arms
and a great increase in perspiration of the upper extremi-
ties.

He first received treatment for his condition in 1891
and at that time there was decided atrophy of the upper
extremities, motion was almost completely abolished, sensa-
tion not impaired. The reflexes were absent in the affected
muscles but were slightly increased in the lower ex-
tremities. The pupils reacted normally. Fibrillary tremors
were brought out by tapping or extending the muscles.

During the patient's residence in the hospital this
condition remained practically stationary. He was unable
to use his arms at all and they hung limply at his side.
The muscles of the hands markedly atrophied and pre-
sented the typical monkey hand. The muscles of the
forearms, arms and shoulders were almost completely
gone. The trapezius seemed to be in fair condition and
he was able to raise and lower his shoulders. The scapu-
lar muscles were markedly atrophied. There was no loss
in the tactile or temperature sense over the regions
atrophied. No fibrillary tremors were noted at this
time. The Wassermann with the blood serum was
negative.

The most prominent mental manifestation that this
patient showed throughout his residence in this hospital
were the marked paranoid ideas. He thought that people
talked about him and called him vile names. Whenever
he would see two people talking together he would think
that they were talking about him. These voices threatened
to kill him and at times he was afraid that his food was
poisoned. He was continually complaining that he was

224 Contribution on Progressive Mtiscular Atrophy

not treated as well as the other patients and had many
fancied grievances tov/ard the attendants. On several
occasions he thought that the doctors were going to
practice vivisection on him. His persecutory ideas were
constantly changing. At times he evidently had visual
hallucinations. He thought that ghosts and spirits were
continually following him about and that they warned
him of approaching danger. These spirits rapped on the
walls of his room at night. He was accurately oriented
in all respects. He had no insight whatever into his con-
dition. His memory and general intelligence were some-
what reduced. He had a fair knowledge of current
events.

The mental symptoms in this patient are almost
identical with those in the first patient. Paranoid and
grandiose ideas were present. The paranoid ideas were
most prominent in this case. Auditory hallucinations
were much more prominent in this case than in the
preceding one. This man's psychosis became manifest
after he became practically helpless by reason of his
physical condition and the possibility of the psychosis
being in the nature of a defense reaction must be thought
of in this case.

In this patient we also have a fairly definite history
of syphilis. The pupils were irregular but reacted nor-
mally to the usual tests. The Wassermann reaction was
negative with the blood serum. We have less in this case
than in the previous one to base a diagnosis of syphilis
but with such a definite history of infection and the fact
that the Wassermann reaction particularly in tertiary
syphilis is frequently negative it must be considered.

The age of this patient, forty-five, is rather early for the
development of arteriosclerosis but not by any means
too early. As in the previous case, however, there were
no clinical signs of arteriosclerosis and the course of the
disease was not at all characteristic.

In this patient the possibility of paranoid precox
must receive a good deal of consideration. The mental
pictiire is quite suggestive of this condition. One would

Dennis J. Murphy 225

expect, though, after fifteen years that there would be
considerably more deterioration than manifested by this
patient.

Case III.— J. C. Admitted February, 1912, aged
35 years. Family history negative. Common school
education and enjoyed good health. Typhoid fever at
the age of ten and rheumatism between the ages of twenty
and twenty-three. Had hard and soft chancre at the
age of eighteen which came on nine days after exposure.
Denied secondaries. Gonorrhoea about ten times. In
1911 the patient noticed that the muscles of his right arm
were becoming weak. Began, according to his brother,
in 1910 and first noted by a marked change in his hand-
writing. This was particularly noticeable when he was
required to wash windows when he found that he could
not reach up as high as he had been accustomed to do.
Shortly after this his throat began to bother him, he
became hoarse and was continually annoyed by m.ucous
phlegm rising in his throat. He noticed difficulty in
articulation. The muscles of the left side of the neck
then became affected and there was some pain in the
muscles, especially on arising in the morning. This pain
lasted for three months and was then distributed to both
sides of the neck. This was followed by muscular weak-
ness. Five months before admission his speech was so
affected that at times he could not talk at all. He had
difficulty in swallowing liquids which would at times return
through his nose and other times run into his trachea.
About one month previous to admission his left arm
became affected. He denied any convulsions, vertigo
or headaches. He never had any pain except in the
muscles in the back of his neck and this pain was dull
in character and noticeable when he turned his head.
He received two doses of salvarsan in 1911.

On admission he was unable to raise his amis to a
right angle with his body or place them above his head.
The muscles of both sides of the neck, shoulders, scapular
region and arms showed marked wasting and almost
complete paralysis. Breathing was diaphragmatic entirely,

226 Contribution on Progressive Muscular Atrophy

The intercostal and accessory muscles of respiration were
paralyzed. In the right arm the triceps was weak but still
retained some power. The biceps was also weak. The
flexors of the hands were somewhat stronger than the
extensors. The opponens, pollices and abductors were
normal as were also the lumbricales. The right supra
and infraspinatus reflex was absent. The right trapezius
and splenius capitis were wasted and very weak. The
sterno-cleido mastoid on both sides was wasted, more
especially on the right side. The left arm was slightly
more powerful than the right but presented a similar
condition. The hand grasp was much diminished on the
right side. The pronators were weak but more powerful
than the supinators. There was practically no power
in the biceps. The triceps was not so markedly afl'ected.
The right side of the pillars of the pharynx were partly
paralyzed. The lower part of the face was aff^ected. The
3rd, 4th, and 6th nerves functioned normally. There was
tremor of the tongue but little wasting. The plantar,
tendo-Achilles and abdominal reflexes were present.
All the reflexes in both arms were diminished or absent.
Sensation was normal. The pupils were irregular and
moderately dilated but reacted promptly to all the tests.
Fibrillary tremors were present and quite marked. The
Wassermann reaction with blood serum was negative to
double the quantity. Lumbar puncture and examination
of the spinal fluid showed the Wassermann to be negative,
appearance of the fluid clear, protein content not increased
and cells per cmm. one-half.

Following admission to the hospital the paralysis of
the neck muscles became more marked so that his head
would fall to either side and could not be held erect
without support. Bulbar symptoms became marked and
the patient died four months after admission of bulbar
paralysis. At autopsy the brain showed nothing patholog-
ical. The cerebro-spinal fluid was slightly increased,
the spinal cord small and hard. On section the anterior
horns of the cervical cord were reddish in color. There

Dennis J. Murphy 227

were many bony plates on the posterior aspect of the
spinal pia.

During his short residence in this hospital the only
psychotic symptoms manifested were those of a beginning
dementia. There was a slight lowering of the general
intelligence. He acted in a rather childish way to his
environment. No delusions or hallucinations were present.
His mental reduction was noted more particularly previous
to admission here by his associates in the army who
observed a marked reduction in his ability to understand
and carry out orders. When given an order he would
almost immediately forget it and fail to carry it out.

The disease in this patient ran a rapid course re-
sulting in death from bulbar paralysis after a few months.
It is in such cases as this that Marie finds mental dis-
orders as part of the symptom complex. We have a
simple deterioration present in this case. Whether this
is due to organic changes in the brain it is impossible
to say. No gross lesions were found in the brain and
unfortunately a microscopical examination was not done.
It is quite possible that in these cases where we have
bulbar involvement the degenerative process has extended
into the brain. A number of observers have found the
degenerative process extending even as far as the cortex.

This patient also gave a marked venereal history.
He denied ever having secondaries but it is quite possible
that they might have been overlooked and the very marked
venereal history forces us to consider syphilis. This
disease was considered so probable that while in the army,
he was given two doses of salvarsan intravenously. When
he arrived at the hospital approximately four months
later the Wassermann reaction was negative with both
the blood serum and spinal fluid, the other characteristics
of the fluid being normal. Whether treatment modified
this is hard to say but I feel sure that two doses of sal-
varsan would ordinarily render the blood serum negative
to the Wassermann test and possibly modify the findings
in the spinal fluid but I doubt very much if it would
render a positive Wassermann negative or reduce an

228 Contribution on Progressive Muscular Atrophy

increased protein content. The mental symptoms in this
case were suggestive of those due to an organic condition
of the brain.

Case IV. — E. C. L. 58 years old on admission in
1913. Family history negative. Birth and early history
uneventftd. Used alcohol freely. Education good. Em-
ployed as bookkeeper until about the age of forty-eight,
when he had to quit work because of weakness of his
hands. About 190-3 the muscles of his left hand began to
atrophy. A short time later the muscles of his right
hand began to atrophy also. This condition slov/ly
progressed up the forearm. In 1911 his speech became
affected. Six months previous to admission to this hos-
pital he began to act in an eccentric manner. His memory
showed marked defect.

Physical examination showed the small muscles of
both hands and forearms markedly atrophied. There
was also partial atrophy of biceps and triceps muscles
on both sides, more particularly on the left side. There
was present a marked speech defect and also considerable
difficulty in swallowing. The tongue showed no atrophy
but lips were markedly tremulous. The biceps, triceps,
and patella reflexes present. Ankle clonus on both sides.
Pupils round and contracted and did not respond to light.
No fibrillary tremors noted.

The patient's mental condition was one of advanced
dementia. He was entirely disoriented and led merely
a vegetative existence. He vras extremely untidy in
hal)its. Wassermann reaction complete positive with
both blood scrum and spinal fiuid. The appearance of
the fluid was clear, protein content increased and cell
count tC'.'-a per cmm.

This patient presented a rather typical ]>icture of
general paresis. The mental symptoms were those of an
advanced case. The serological findings were absolutely
conclusive of this disease. The only point of interest
here is as to the connection existing between the muscular
atrophy and general paresis. Are these conditions inde-
pendent of each other or dependent on the same etiologi-

1

Dennis J. Murphy 229

cal factor? The patient was too demented to give any
history of infection with syphilis but we know that this
disease is a necessary antecedent for the production of
general paresis. The interval between the initial lesion
and appearance of symptoms of paresis is anywhere
from ten, fifteen or twenty years. The muscular atrophy
in this case began twelve years before symptoms of paresis
became manifest, therefore, we may assume that syphilitic
infection antedated the development of the muscular
atrophy. On the other hand the patient was at that age
when progressive muscular atrophy is supposed to develop
anyhow. Therefore it is hard to claim absolutely that
syphilis was the etiological factor.

In conclusion I wish to say that it is not the m-
tention of the writer to try and claim that progressive
muscular atrophy is associated with any well defined
psychosis. Very little is said in regard to mental symp-
toms in this disease and it was thought that these fev/
cases with their attendant psychotic manifestations might
be of value as a contribution to the subject.

In the first two patients the mental syndrome is
practically identical and rather closely associated with the
physical disorder. The physical condition in both had
existed for years without manifesting any evidence of
a psychosis but the condition is a progressive one and
evidently the etiological factor continued to be active.
Therefore it is quite possible that the degenerative process
may have extended so far as to invade the brain or else
produce some toxic substance which finally attained
sufficient virulence to cause a disturbance in the function-
ing powers of the brain. It would be difficult to make
any diagnosis other than that of a paranoid state unless
we should desire to be more specific and say associated
with progressive muscular atrophy.

The mental and physical symptoms seem to be more
closely connected with each other in the third case. It
is in such cases as these that Marie finds the presence
of psychotic symptoms and he considers them part of
the symptoms complex. There seems to be a definite

230 Contribution on Progressive Muscular Atrophy

relation between the physical and mental condition here
and I would not hesitate to diagnose the mental condi-
tion as a psychosis associated with progressive muscular
atrophy.

The mental symptoms in the fourth case are frankly
those of an advanced case of general paresis and really
call for no further comment.

The cases were interesting to me from the viewpoint
of the psychiatrist and it is to be hoped that they may
prove of interest to others from a similar viewpoint.

i

A REPORT OF THE CLINICAL AND PATHOLOG-
ICAL FINDINGS IN A CASE OF HYSTERO-EPI-
LEPSIA AND HYSTERO-EPILEPTOID.

By J. Allen Jackson, M. D.,

Chief Resident Physician of Philadelphia Hospital for the

Insane.

/^HiEF Complaint. — H. L., white, aged 43. Was ad-
^^ mitted to the Philadelphia General Hospital, May
21, 1908, with a chief complaint of hysteria and convul-
sions, at the request of a police surgeon for the reasons
stated: that he had tried to commit suicide and had had
two epileptic attacks.

Family History. — The family history at that time
shows that the father died of apoplexy at the age of 63;
the mother of Bright's disease at the age of 43; the patient
had three brothers who were living and well.

Past Medical History. — Patient was somewhat back-
ward all his life; had convulsions in his fifth year, and
measles when a child. At the age of seven years he fell
out of a swing, injuring his head. The ward notes made
at the time of admission state that the patient had been
seen by two physicians about three months before, and
that they had informed him he had some mental trouble.
He had had two strokes that morning and one in the eve-
ning; the first stroke involved the whole left side and the
second stroke involved the same side. He was paralyzed
for eight weeks and recovered, but he could not use his
left side as well as he did formerly. He was in the Park
and fell over, and they said he tried to commit suicide.
The Park patrol took him to the 23rd district and then
he was brought to the hospital. He said he had been

(231)

232 A Case of Hystero-Epilepsia

worried about the loss of money, and that he had been
treated in several hospitals.

Examination showed the left arm flexed and rigid,
fingers rigid and semi-cone shaped. Left leg rigid, with
the left foot held in the position of foot drop; could be
relaxed upon repeated commands and active manipula-
tion. Reflexes were equal and slightly exaggerated.
Hemianesthesia of the left side; anesthesia of tongue.
Impaired vision of the left eye; tubular vision of the
left side, restricted vision of the right side, pupils blue,
normal re action to light and accommodation. Apex
beat, fifth interspace midclavicular line; first impulse strong,
soft systolic murmer at the apex, first sound good, second
sound accentuated, pulmonic accentuated. Pulsu, fairly
good volume and tension.

On June 2, patient was discharged as improved.
Three days later he was readmitted with a repetition
of his former symptoms. Twelve days later he requested
his discharge as his condition had cleared up. Shortly
thereafter, however, the patient became boisterous, unruly,
choked his nurse — and was immediately sent to the
psychopathic ward from where, four days later, he was
committed to the Hospital for the Insane suffering from
what was on admission diagnosticated as hysterical
insanity.

On admission he gave exhibition of having fits, at
which time he was careful not to injure himself. He was
grandiose, silly, and had vague delusions.

Five months after his admission he was discharged,
and was again readmitted less than three months later
with the same mental and physical symptoms.

This process of discharges and readmissions continued
until his final admission in 1911, when true epileptic-
like seizures were noted, as the patient in falling severely
injured himself. Mentally, his condition was one of
argumentation, alternating with quietude and subsequently
mild dementia. There was no return of his anesthesia,
or tubular vision; his eye-grounds were normal, blood
negative, Wassermann negative, urine and feces negative.

J. Allen Jackson 233

On July 9, 1913, he was seized with convulsions.
Examination showed he was dull, speech slurring, pupils
unequal, reacting to light and accommodation. Tongue
protruded to the left, left side of face was smooth, unable
to lift corner of mouth, unable to wrinkle forehead on
left side, complained of headache, left arm slightly ele-
vated, moved left leg fairly well, faint suggestion of
Babinski on the left, sensation normal. On April 15,
his muscular strength returned but his speech defect
was present.

On July 2, 1914, he suddenly died.

During the patient's period of treatment, extending
over several years, he manifested an unusual array of
clinical symptom.s indicative of hysteria with all its
stigmata, as well as symptoms of true epilepsy and organic
hemiplegia. The pathological findings which follow are
of an equal interest.

Pathological Report

Chronic mitral endocarditis with stenosis and dila-
tation of left auricle. Recent mitral vegetation with clos-
ure of mitral valve. Hypertrophy of right ventricle.
Chronic aortic endocarditis.

Bilateral hydrothorax.

Edema and congestion of lungs.

Healed tuberculosis in left peri-bronchial lymph nodes.

Old infarcts of spleen.

Chronic interstitial nephritis.

Congestion of liver. Solitary gall stone.

Edema of brain.

Hkart. — Both auricles contain small quantity of
lar;.;c!y fluid blood, of which there is a small quantity
in right ventricle. Left auricle dilated. On opening left
auricle it presents at lower portion a mass 2 c.c. in diame-
ter that alm.ost entirely blocks the mitral opening. The
mass is quite firm, mostly dark red with a greyish band
over the surface, and is attached to the anterior leaflet
of mitral valve. Viewed from ventricular side the mitral
leaflets are greatly thickened and narrowed, including
the tendinous cords. The valves present a funnel-shaped

234 A Case of Hystero-Epilepsia

opening which barely admits the tip of the little finger.
The thrombus described in connection with the auricle
can be seen through this buttonhole opening. The aortic
leaflets are thickened, especially at the margins, and in-
verted. They are also shortened. The endocardium is
slightly grey. The muscle is dark, almost brownish red
in color. Left ventricle 1.4 cm. thick. Right ventricle
0.7 cm. thick.

Brain. — Fairly firm. Moderately edematous. Vessels
at base not sclerotic. Small vessels moderately prominent.
No gross evidences of disease. Falx -contains near the an-
terior portion a spicule of bone 4 cm. long; 1 cm. broad;
and 0.5 cm. in greatest thickness.

Spinal Cord. — Shows no gross lesions.

A Study of the Brain by Dr. Spiller shows that
an area of old softening is found in the region of the right
external capsule, extending from low in the cerebral hemi-
sphere to the level of the upper part of the lenticidar
nucleus. This area in its upper part indicates fibres
passing to the internal capsule, and seems to be the
cause of the degeneration of the pyramidal tract. Under
the microscope this area shows overgrowth of neuroglia
tissue and destruction of nerve fibres with much lympho-
cytic infiltration. The right anterior pyramid is much
degenerated, as is also the left crossed pyramidal tract.
There was, therefore, an anatomical cause for the left
hemiplegia. Distinct lymphocytic infiltration is found
about the vessels in the cord of the cervical region, but
lymphocytic infiltration is not distinct in the midthoracic
or lumbar region or in the medulla oblongata. The nerve
cells of the anterior horns of the spinal cord are in good
condition. There is some proliferation of the intima in
the vessels of the pia over the medulla oblongata. The
pia is greatly thickened over the left paracentral lobule,
and moderately thickened over the right paracentral
lobule. Moderate but distinct lymphocytic infiltration is
found in the pia of each paracentral lobule. There is slight
lymphocytic infiltration around the vessels in the cortex

J. Allen Jackson 235

of these lobules. The Betz cells are well stained. The
optic nerves are not degenerated.

The Findings suggest a moderate degree of syphilis
of the brain and cord.

34th and Pine Streets.

IS GENIUS A SPORT, A NEUROSIS, OR A CHILD
POTENTIALITY DEVELOPED?*

By Jambs G. Kibrnan,
Chicago, 111.

Formerly Assistant Physician Manhattan State Hospital

(1874-8) and Superintendent Chicago State Hospital

(1884-9)

Fellow Chicago Academy of Medicine, Foreign Associate Member French
Medico-Psychological Association; Honorary Member Chicago Ncu'-o
logic Society, Honorary President Section of Nervous and Mental
Diseases Pan-American Congress 1893, Chairman Section on
Nervous and Mental Diseases American Medical Asso-
ciation 1894; Professor Neurology Chicago Post-
Graduate School 1903; Professorof Nervous and
Mental Diseases Milwaukee Medical Col-
lege 1S94-5; Professor of Nervousand
Mental Diseases Medical Depart-
ment Loyola University 1905;
Professorof Forensic Psychi-
atry Kent -Chicago
College of Law.

A most quaint expression of the doctrine of disease
producing genius is that of C. B. Reed' who thus shows
the usual error of ignoring morbid irritability while
fostering attention on genius and it products.

"Among the non-febrile affections that are under
suspicion as stimulants to intellectual activity may be
mentioned asthma, which is represented in literature
by Macaulay and in statesmanship by William III.
In confirmation, however, we can present no data except
the numerous cases that might be quoted.

"In this category also is gout, which takes its origin
not from micro-organisms, but from disturbances of the

•Continued from The Alienist and Neurologist, May, 1915.

(236)

James G. Kiernan 237

bodily metabolism, and is characterized by fever only
at the crises. It is fallacious, but interesting, to find that,
while this disease formed barely 1 per cent, of the chronic
medical disorders of the past, over 5 per cent, of its
victims were literary workers. The effect observed is
similar, as we shall see, to that found in bacterial diseases,
but the method of operation is quite different. In place
of the optimism and feverish intensity, there is a massive,
patient energy; without haste, to be sure, but also without
rest.

"One writer goes so far as to compare these classes
with presumptively normal individuals and asserts that
those afflicted with gout, judged by their books, are
superior in imagination, style, and intellectual power to
any equal number of healthy workers who can be chosen.
Without attempting to substantiate this predication,
the evidence shows that Gibbon was urged onward by
a stately but irrepressible momentum for which his
literary occupation afforded only a partial outlet.

"Bulwer Lytton's irritability and melancholy were
widely known, and so, too, was his desperate devotion
to work and tobacco. Gibbon and Lytton were great
sufferers from gout, and thoroughly exemplify the class
which included Landor, Campbell, Milton, Steele, Sydney
Smith, Dryden, Fielding, Defoe, and many others in
literature; Rubens and Claude Lorraine among the
painters; actors like Charles Kean, and statesmen like
the Pitts.

"These unhappy owners of creative brains were the
victims of their organizations. They were compelled to
work by the toxins they elaborated, and it is not too
much to say that the periods of active production proba-
bly stood in close relation to the ebb and flow of the toxic
tide "

William Ill's asthma was probably bronchiaectatic
causing the irritability which marred his tact and
led to his difficulties with the English. But for this
he would have been, great as he is, a far greater statesman,
since many difficulties would not have occurred. History

238 Is Genius a Sport?

of the greatest of the Pitts destroys Reid's position.
As I pointed out^ over three decades ago, the dangers
of George Ill's lucid moral imbecility^ was more
demonstrable than those of his irregularly periodic in-
sanity, especially at the outset of the War of Independence
when the gouty mental eclipse of a great statesman flung
all power into his hands.* George the third was a back-
ward child, religious, priggish, egocentric, selfish and un-
grateful. His shrewd grandfather, George the second, pro-
nounced him "good for nothing but to read the Bible to
his mother." He, probably the most imbecile mentally
and morally of English Kings, was intellectually and
ethically akin to the English plutocrats who urged on
his war upon English, Scottish, Irish, American, and
French freedom. From avarice he evaded his children's
claim on his civil list thus producing that attempt at
taxing Americans without representation which formed
the United States. His political creed for Englishmen
(absurd in one who owed his throne to the 1688 Revolu-
tion and a resultant parliamentary statute not "divine"
right) was: "Fear God and Honor the King." Strong
as Byron* puts the case against him:
From out the past
Of ages, since mankind have known the rule
Of monarchs — from the bloody rolls amass'd,
Of sin and slaughter — from the Caesar school,
Take the worst pupil, and produce a reign
More drenched with gore, more cumber'd with the slain.

He ever warr'd with freedom and the free:

Nations as men, home subjects, foreign foes,

So they that uttered the word "Liberty"

Found George the Third their first opponent. Whose

History was ever stain'd as his will be

With national and individual woes.

Yet this censure is mild compared with the sober
judgment of Green,* Macaulay,^ and Greville,* and the
caustic invective of Junius' and Patrick Henry.'" To-
ward women he was as guilty'^ secretly of base betrayals

James G. Kiernan 239

as Geovge IV was blatantly. His avarice, his worship
of the sacred strong box, his cant, his "law and order"
and "farmer" dodges, his deference to the "respectable
business man" still so sway the British philistine that
Thackeray^^ and Besant'^ have written mawkishly
fulsome biographies of him. His aid to the "law and or-
der" dodge (whereby plutocrats defraud workmen of
wages by threats of imprisonment) was prompted by
more despicable meanness than cant. He and "snuffy"
Queen Charlotte not only shared^^ in jobs but eternally
tried to extend the field of the laws forfeiting a felon's
goods to the king. For this purpose more offenses were
made capital during the reign of George III alone, than
during the reigns of all the Plantagenets, Tudors, and
Stuarts, put together. The most venial ciime was severely
punished. The result, as the satirist sung, was that:

"Scarce can our fields, such crowds at Tyburn die,
With hemp the gallows and the fleet supply."
These executions did not reduce crime. Forgery was
seldom if ever pardoned, yet, as James Payne^^ points
out, forgeries increased from fifteen prosecutions in Jan-
uary, 1798, to two hundred and forty-two in January,
1819. For the worst Judicial murders, George III and
the shop-keeping, manufacturing, and merchant classes,
were directly responsible. A husband was pressed for a
seaman. Left to starve with two children, one at the
breast, the wife stole a bolt of cloth and escaped. Her
conscience troubled her, she returned, replaced the cloth
and was captured. She was found guilty and sentenced
to death. An appeal in her favor to George III was
rejected because the "law and order" wool merchants
demanded an example. The child was taken from her
breast just ere she was hanged. It must be admitted
that George III, as Dunscombe^® shov/s, was more a
Hanoverian junker than an EngHsh constitutional king.
The younger children, noticeably the Duke of Kent
(father of Queen Victoria) were put in charge of
German combinations of pedant, spy, boodler and rascal.
Of the $5000 annuity granted the Duke, all but $416 was

240 Is Genius a Sportf

pocketed by the German governor. A similarly brutal
boodler is depicted by Burney." Altogether, as Green**
shows, the state of the English and Irish Church during
the reigns of George III and George IV was as low as
that of the Church during the reign of Charles II and
his immediate successors. The subordinate clergy were
usually appointed by dissolute squires and nobles to
whom they had previously played the part of panders
and sycophants. Such men naturally became enthusiastic
supporters of "church and king" and headed the mob,
the chemist from Birmingham because of his republi-
can opinions. The Tory reaction consequent on the
downfall of the French monarchy enabled the Church
of England to denounce liberals for mild lapses while
condoning gross violations of decency in the Tories.

WiUiam Paley,'^ the author of the "Evidences of
Christianity" was refused ecclesiastic preferment because
he had written: "Among men you see the ninety and
nine toiling and scraping together a heap of superfluities
for the one and this too sometimes the feeblest and worst
of the whole set."

George the Third was brought up in the junker
absolutist school. This, like Munsterberg^" today, thus
reverted to the primitive doctrine — the absolute. If the
things which we proclaim true and beautiful, moral and
religious, were preferred by us "simply because they gave
to you or to me or to the greatest possible number the
most intense possible individual pleasure," then we would
still remain in a world where nothing has an absolute
value, and where "what we call ugly or inharmonious,
untrue or immoral, has just the same right to be called
valuable if somewhere people chance to have so curious a
liking. Yet such is the prevailing attitude of modem
science, which accepts our ideals of beauty, of religion,
of morality, as merely products of social development,
and at best provisional." Even among present-day philoso-
phers, he adds, it is the fashion to take the whole life
of reason as a practical scheme without absolute dignity.
Science itself must fall asunder if we disbelieve in ab-

James G. Kiernan 241

solute ideals; and fhat esthetic, moral, and religious
values belong forever to our real world, which without
them would be, not a world, but a chaos; not real, but
a dream. The universe is a melody in which those first
tones have the right to demand that last one. Every one
of us lives in a chaos of experience. . . . But by a
fundamental act of our over-individual personalities, we
transcend the chaos; we become intelligent subjects by
creating the idea of a world which is common to us.
To make a world out of our experience means — and can
not mean anything else — to ap perceive every bit of the
chaos as something which must will to be itself. Thus
self-fulfilment becomes the highest good when the will
of the individual is in harmony with the will of the
universe. But the will to be itself must lead to different
demands, and each of these demands thus introduces a
special group of values into the world, eternally given with
its deepest ultimate structure. To be itself may mean,
firstly, that our bit of experience is to be pi-eserved,
is to last through ever new experiences, and is to be
found again and again. The satisfaction of this demand
gives us the values of truth. But to be itself may mean,
further, that our bit of life experience is to stand for
itself, complete in itself, independent of everything be-
yond it. The satisfaction of this desire gives to the
world the eternal values of harmony and beauty. Thirdly,
to be itself may also mean that our bit of experience de-
mands a completion which it has not yet reached, and
which it aims thus to secure. The satisfaction of this
demand gives to the world the values of progress and
law and morality. And, finally, to be itself means to
be ultimately without inner contradiction, to be a unity.
If those various desires interfere with one another, if the
order of knowledge and the beauty of happiness and the
duty of morality can not dwell together, then we have
not a world which remains really unified in all eternity.
Thus arises the ultimate demand that all the values be-
come one, that the world remain absolutely itself; and the
satisfaction of this demand brings us the values of re-

242 Is Genius a Sportf

ligion and philosophy. Wherever this realization is
completed in the connections of truth, in the self-fulfil-
ment of art, in the loyalty of duty, in the beliefs of re-
ligion, and in the convictions of metaphysics, there a
personal satisfaction is reached which must be absolute
and eternal, as it is determined by no individual need
but only by the acknowledgment of the world as such.
Our need to understand the world as a whole, he continues,
can be fulfilled only by "the system of our convictions," of
which the immediate form is religion.

"If we transcend the outer world by our convictions,
we come to God; if we transcend the social world, we
come to immortality; if we transcend our inner sphere
and link it with religious convictions, we come to the
belief in providential leading. If every one of these
conceptions of the world of things and of men and of duties
developed into a system in which the logical, esthetical,
and ethical demands are unified, in which the causal
events of the universe and the moral duties and the
desire for happiness are no longer in conflict. Religion,
too, can speak a hundred languages, as the logical, esthetic
and ethical demands which must be harmonized may vary
from man to man, from time to time. But the value of
the conviction that the reality in which we live, if we
knew it completely, would be perfectly harmonious in
the totality of its demands is eternal and absolute. But
just as science and art and civilization develop system-
atically the naive apperception of the immediate values
of the world, so . . . philosophy completes the function
of religion. Philosophy harmonizes, too, the conflict of
demands, but not by building up a superstructure of re-
ligious convictions, but by laj'ing down a substructure,
on which this whole world of appearances can rest, a
substructure out of which the apparent conflicts can be
understood as apparant only, and thus as not really con-
flicting in the ultimate being of the world. The critical
philosopher turns indeed to the outer world, not to seek
God beyond it, but the transcendental consciousness
underlying the idea of the world itself; and he turns to

James G. Kiernan 243

the world of men, not to make men live in time after
death, but to reach the transcendental act of reason, by
which alone the life of mankind can attain all the value
of reality. And to the inner world he finally turns, not .
to seek its religious ties with the absolute beyond, but to
understand its transcendental selfhood as itself the abso-
lute condition of the whole theoretical and practical
reality."

This is a decided reversion to the anthropocentric
days of the scholastic philosophers who reverenced the
idols of the cave, den, etc., whom Bacon destroyed.

The truer, more benign, non-egocentric philosophy
is that paraphrased by the German student song:
"Nothing is and nothing's not
But everything becoming."

The body in gout, remarks Sydenham, ^^ is not the
only sufferer and the dependent condition of the patient
is not his worst misfortune. The mind suffers with the
body and which suffers most it is hard to say. So
much do mind and reason lose energy as energy is lost
by the body, so susceptible and vacillating is the temper,
such a trouble is the patient to others as well as himself,
that a fit of gout is a fit of bad temper. To fear, anxiety
and other passions, the gouty patient is a continual
victim; whilst as the disease departs, the mind regains
tranquillity.

Of the mental state from gout Watson^^ draws the
same picture. The mental phenomena manifested under
gout by the great Earl of Chatham soon after the repeal
of the "Stamp Act" had no little influence on the future
of the Anglo-Celtic race. He, the idol of the Americans
whom he had protected against the French and Indians
and whose views as to taxation he had supported, became
insane at a very critical period of his own career and of
the relations of Great Britain to America. The Stamp
Act had been repealed, Pitt's policy had triumphed and
his policy was the correctness of the view adopted by
the Americans anent the unconstitutionality of the Stamp
Act. ■ He formed a ministry and then became insane,

244 75 Genius a Sportf

in a manner described by Macaulay^ in his inimitably
pellucid style. Pitt's insanity led him to fall into the
snares of that cunning paranoiac, George III. Pitt at
this time was as eloquent as ever, and no one suspected
him of mental disorder, but his habits became more
and more eccentric. A horror of loud sounds grew upon
him. Though the most affectionate of fathers, he could
not bear to hear the voices of his children and laid out
great sums buying up houses adjacent to his own at
Hayes, merely that he might have no neighbors to dis-
turb him with their noise. He then sold Hayes and took
a villa at Hampstead where he again began to purchase
houses right and left. At Burton Pynsent he ordered
a large extent of ground to be planted with cedars which
had to be collected all over England and were, by his
orders, planted by torchlight. No man was notoriously
so abstemious as Pitt, yet at this time the profusion of
his kitchen was the marvel of epicures. Dinners were
always dressing, as he had a capricious and fanciful
appetite and when he felt inclined to eat, everything must
be on the tabic. As Macaulay remarks, in the true spirit
of an alienist, setting an example which could be followed
to advantage, by both lawyers and physicians, other
circumstances could be detailed, which, separately and
singly, were of little moment, but, combined and con-
trasted with surrottnding circumstances, and with Pitt's
previous and after character, justified a diagnosis of in-
sanity. While in this fit of planting, Pitt was summoned
to form an administration, and his notes to his colleagues
in posse were so arrogant that even the despot, Louis
XIV, would have deemed them unfit to use in correspond-
ence with a French nobleman.

The ministry then formed by Pitt displayed anything
but sagacity. In it irreconcilably bitter personal and
party enemies were so mingled that they could not but
conflict with each other. Pitt with an equal abandonment
of his sagacity and in somewhat of a contrast with the
course of the old English families from which he sprang,
accepted an earldom, thus ruining for the time being

James G. Kiernan 245

his popularity in England and his influence on the con-
tinent. Up to the time of the appearance of the mental
phenomena already detailed, Pitt had been tormented
with hereditary gout. The disease had been suppressed
by remedies whereupon the psychical symptoms described
suddenly appeared. He became melancholy, irritable and
fanciful. The state of public affairs was embarrassing;
his colleagues were in constant dispute; his opponents
were clamoring against him, yet he, the clear-headed
statesman, the man of whom Frederick the Great said,
"England has been long in labor, but she has brought
forth a man," whined that he could be saved from all
these misfortunes only by repurchasing the house he had
so capriciously and hastily sold. This fancy accomplished,
he was somewhat easier, but when business was mentioned
Pitt, the energetic ally of Frederick the Great, the dictator
of Europe, trembled and bixrst into tears. He passed
twenty-one months in gloomy seclusion, while his col-
leagues carried out the measures proposed by that morally
imbecile paranoiac, George III, under, as it were, Pitt's
sanction but in total contradiction to his policy and
wishes. During this time American colonies were taxed,
in defiance of Pitt's stirring denunciation of even the
theory of such practices, but even this could not call
him from his morbid seclusion. He at length resigned
his office. Nine months thereafter the j;o'^t reappeared
and with it Pitt's intellect. He was once more buoyant,
hopeful and self confident but his attack of insanity had,
as Macaulay says, enabled the government formed by
him to violate every principle of foreign, domestic and
colonial policy dear to his heart. But for this attack
of insanity the relations of the United States would never
have been severed. Obviously here, as often elsewhere,
gout decidedly marred the genius of its victim.

This history shows the error of assuming coincidence
as a cause. Gout, arthritism and the calculous diathesis
when they influence genius at all, influence for evil.
The iatriohobia and the unphilospliic attitude to science
of Michel Montagne were, as C. G. Cumstone^'* shows,

246 75 Genius a Sportf

due to the gout which was a famiha disorder. It at
times caused anxiety states which gave birth to his rather
inconsistent predilection for sorcerers or rather for the
fetichism of early Egyptian science. Like Munsterberg,
he wants a permanent conventionalizing ideal in science.

(To BE Continued.)

REFERENCES

1. Forum, June, 1912.

2. Jour. Nerv. and Ment. Dis., 1883.

3. Jesse, Life of George 3rd.

4. Ray Mental Pathology.

5. Vision of Judgment.

6. History of the English People.

7. Essays. Earl of Chatham.

8. Memoires.

9. Letters.

10. Life and Speeches.

11. Banvard: Court and Times of George IV.

12. The Four Georges.

13. A Fountain Sealed.

14. Caricature History of the Georges.

15. Gleanings of Dark Annals.

16. Life of Thomas Slingsby Duncombe, Vol. I.

17. Diary: Macaulay. Essay on Fannie Bumey.

18. History of English People.

19. Moral and Political Philosophy.

20. Science and Idealism.

21. Works.

22. Practice of Medicine.

23. Albany Medical Annals, 1907.

24. Albany Medical .\nnals, 1907.

ALCOHOLISM
By Prof. Ettore Marchiafava
of Rome, Italy.

(Selected with Editorial comment).

AT the International Congress on Alcoholism held in
the fall of 1913, Professor Ettore Marchiafava,
Physician to Pope Pius X, the following epitome of the
most essential paragraphs in the Professor's interesting
address, as translated from the author's manuscript by
Mr. Arthur Bennington of the Press was given publicity
through the medium of one of the most cosmopolitan
of St. Louis' great city daily papers, the St. Louis Post-
Dispatch, Dec. 14th, 1913.— Ed.

We deem it of such value as to merit a place
before our many interested and discriminating readers.

When our American dailies take up themes like this
and present them to the public so fully we need not
fear the pathological decadence of the American people.
Scientific "truth is mighty and will prevail" for the ulti-
mate salvation of the social and political welfare of the
people. The nations of the past, that have perished,
did not have the enlightening and warning public free
press as we have today.

Now, if His HoHness, the present Pope, would, by
an encyclical to the faithful, imitate the temporal niling
powers of Europe and our own country, the brain and
mind and body destroying vice which this paper so ably
discusses would be placed very soon in process of ex-
tinction.

(247)

248 Ettore Marchiafava

"Alcohol is a substance that receives a special treat-
ment from the stomach, for, while water must pass out
from it to be absorbed, alcohol is quickly absorbed by
the blood vessels and lymphatics of the stomach and
passes rapidly into the blood.

"It is interesting to note- That alcohol circulates
unaltered in the blood for several hours after its inges-
tion; that after five or six hours the alcohol decreases
and vanishes, the time varying with the kind of animal
and with the quality of the alcohol; that the alcohol is
found not only in the blood but in many organs — liver,
kidneys, brain, etc. — and in the several excretions —
lymph, saliva, milk, etc.; that from 90 to 95 per cent
or even more of the alcohol is burnt.

"As alcoholic drinks are introduced first into the
digestive tract, it is in this that the first functional
and organic changes are observed, changes that are the
more grave if the alcohol be drunk upon an empty
stomach. Seneca, who must have been familiar with
the debauches and orgies at the court of his degenerate
pupil, condemned this habit of some of the drinkers of
his day. In one of his letters to LucuUus he wrote:

" 'Does it not seem to thee that they who drink
wine when fasting, when their veins are empty, and go to
eat already drunk, are acting contrary to nature?'

"An alcoholic inflammation of the stomach, the true
alcoholic gastritis, has been described as hyper-acid from
excess of wine and beer. The liver, that organ of which
the functions are so important to the bodily economy, is
most largely damaged by alcohol, some of which has to
pass through it in order to enter the major circulation.

"Pathologists dispute over many questions in con-
nection with that common malady, cirrhosis of the liver,
but almost all physicians are agreed that alcoholic drinks
are its principal cause. This disease diminishes the
volume of the liver, increases its consistency and compress-
es the blood vessels.

Alcoholism 249

"The, by no means rare, alcoholic cirrhosis in children
and youths accustomed to drink much wine, rouses a feeling
of sadness and indignation.

"In addition to the true cirrhosis of Laennec, which
atrophies the liver, alcohol may also produce a hyper-
trophic cirrhosis without dropsy, which, as I have noticed
several times, may be cured by giving up the abuse
and even the use of alcohol.

"The alcohol, having penetrated the major circulation,
circulates with the blood into the various territories of the
system.

"While exact researches on the alternations brought
about in the blood by chronic alcoholic poisoning are
lacking, several investigations would seem to show that
there is a diminution in the vigor of the corpuscles and
in the bactericidal power.

It is no rare thing for us doctors to be consulted by
middle-aged men, even intelligent and industrious men,
who attribute the symptoms of hardening of the arteries
to weakness of their nervous systems and continue to
drink wine and spirits in generous quantities, ignorant of
the fact that they are aggravating the arterial disease,
which, with sobriety, might permit them to live long
and be moderately active and useful in private and public
life.

"Alcohol is an enemy of the arteries through its
insidiously poisonous action upon the nutrition of their
coats and through a mechanical action that produces
sudden and abnormal variations in the arterial pressure.

"All physicians admit that diseases of the heart
arise from abuse of alcohol. Alcohol alters chiefly the
heart muscle and the arteries that supply this with blood.

"It is well known that in Germany, especially in
Bavaria, enlargement of the heart through the enormous
abuse of beer, has been observed. The pathologist, Bolt-
inger, called this "beerheart." Its origin is to be sought
in an over supply of alcohol.

"When the heart, the most perfect motor that the
world knows, because of its instant adaptability to every

250 . Ettore Marchiafava

need of the body, becomes enlarged, the ominous signs of
weakness in that marvelous function are revealed sooner
or later in the form of insufl&ciency. In drinkers this
may appear even without hypertrophy and be the cause
of death, which, according to Fahr, is to be explained
by lesion of the ganglia and nerves of the heart.

"The baleful influence of chronic alcoholism and
even of intoxication upon progeny is demonstrated by
observations upon the fate of the children of drunkards,
by the still births, and by all the malformations, deform-
ities, mental degenerations and psychoses which are
manifest in these children, and also by the now numerous
experiments upon animals that have been made in Italy
and elsewhere.

"The drunken mother poisons the unborn child at
the very outset of its development, for the alcohol passes
freely from the maternal blood to that of the embryo.
The drunken mother poisons the nursing baby, for the
alcohol passes into her milk. Some ignorant mothers
give alcohol to babies, even to nurshngs, and continue
to give to children and youths. That drinkers are often
the children of drinkers is a well-known fact. And for
precocious criminality I recall the statistics of Garnier:
80 per cent of youthful criminals are children of drunkards.

"Alcohol is an enemy of the nervous system, especially
of the brain, or at least of many brains; an enemy under
the gmse of a friend who brings joy, a sense of well-being,
the illusion of warmth, oblivion or weariness, of need for
food, of the worries of the mind.

"Whatever opinions one may hold about the use
of alcoholic beverages, all should agree that for most
men, mental labor, work that demands steady attention
and critical sense, work that calls for assiduous precision
of judgment and of action, work which involves re-
sponsibility for the lives of others and of oneself, should be
performed in abstinence from any alcoholic drinks, since
these make the mind less lucid, the attention less viligant,
the perceptions less keen, confusing the judgment, diilHng
the critical faculty, obscuring the feeling of responsibility

Alcoholism 251

and duty, until they fail to notice these little things, the
neglect of which even for a moment, may be the cause
of irreparable damage.

"In the course of chronic alcoholism systematic
deliriums, like that of jealousy, are by no means rare.
In its later stages the drunkard may fall into a condition
of dementia with symptoms of paralysis, with epileptic
attacks, and so-called alcoholic pseudo-paralysis, that are
to be distinguished from progressive paralysis due to
nervousness.

"To the psychic symptoms are to be added the
nervous, such as the well-known tremor, ataxia, palsy,
perturbations of vision even to total blindness, epilepsy,
of which there is a purely alcoholic form. etc.

"Prof. Marchiafava speaks of tremors and softenings
of the corpus callosum as producing results upon the
mind similar to those produced by alcohol. He also
speaks of degenerative changes in the frontal lobes and
the cerebellum, which augment the bountiful effects of
alcohol on the brain.

"Thus far the abuse of alcohol has been considered
as a direct cause of disease. Now we must add that this
abuse may so affect the body as to render it more apt
to contract diseases of other origin. Among these is
progressive paralysis. The fact that peoples who do not
use alcohol do not have progressive paralysis, and that
this makes its appearance as soon as alcohol is introduced
among them, as happened with the negroes and with
the North American Indians, is very eloquent.

"Among the infectious diseases upon which the abuse
of alcohol has the greatest influence is tuberculosis, that
other great scourge of society. I remember a time in
which it was believed that alcohol was antagonistic to
tuberculosis, whence the generous use of alcoholic bev-
erages by those predisposed to it, and the alcoholic
'cures' for consumption. But the facts did not agree;
on the contrary, they proved that alcoholism is favorable
to the pathogenic action of the specific bacillus of which,
in the words of Landouzy, it is like the bed.

252 Ettore Marchiafava

"The drunkard, in his life of misery, abjection and
suffering, his defensive mechanism enfeebled, dyspeptic,
with his blood and his tissues perpetually saturated with
alcohol, is an easy prey to tubercular infection, as is the
diabetic, whose blood is poisoned by too much sugar.
And as in the diabetic so in the inebriate pulmonary
tuberculosis is often distinguished by a rapid diffusion,
a greater tendency to ulceration, hence the course of
galloping consumption. This is confirmed by experience
in the Umberto Hospital for Tuberculosis in Rome,
where, from 1907 to 1912, out of 1780. cases of tuberculosis
32 per cent were heavy drinkers.

"The principal or, better, the most evident fact in
sections of the brain is an alteration of great 'bridges,'
that is, the corpus callosum and the anterior commissure.
The corpus callosum runs like a principal bridge from
one hemisphere to the other; it is the greatest connecting
system of the human brain, linking with its fibers almost
the entire cortical surface of the two hemispheres. Ac-
cording to recent studies, expecially those of Ramon y
Cajal, this bridge must not be looked upon as merely a
connecting link, but rather as a route of association be-
tween the two hemispheres, for the simultaneous func-
tions of the different zones of the cerebral cortex of each.
The parts of the cerebral cortex that are left independent
by the corpus callosum are joined together by the an-
terior commissure, which may be termed the minor
bridge.

"If the abuse of alcohol were to cease upon the earth,
as is the fervent hope of all of us, with it would vanish
no small part of the misery and wickedness that bar
the way to that speedy perfection which is the destiny
of a sober, good and industrious humanity."

A NEW THEORY OF KISSING, CUNNILINGUS,
AND FELLATIO.*

By W. C. Rivers, M.R.C.S., D.P.H.,
Bamsley, England.

'T'HE writer first considered the idea of saliva as a
■'- lubricant in sexual acts after reading the following:

"Notwithstanding all these facts, coitus may still be
the chief factor in the production of genital tuberculosis.
The fact was accidentally brought to my notice that many
individuals — not only the Venus vulgivaga but even those
in higher circles — were accustoined to smear the penial
member or the vulva with saliva, in case the genitals were
not well lubricated and coitus produced pain. If then the
person (man or woman) contributing the saliva be affect-
ed with pulmonary consumption, infection of the virile
organ or the vulva may easily be brought about by parti-
cles of the sputa which happen to be in the mouth."

And again . . .

"Von Guttceit, who has apparently enjoyed a wide
experience in this class of cases (manustupration among
females) especially emphasizes the fact that in these
onanistic practices the saliva is very frequently
made use of by either sex to lubricate the finger or other
implement employed."^

This, when one considered the similar conduct (in
coitus, that is) of the lower mammals, seemed probable
enough. Accordingly the ingenious generalisation of Dr.
Waller,^ to be next cited, came as a most interesting
piece of confirmation, especially since medical textbooks
had apparently no explanation of the association he
mentions anything like so good as his.

* Paper invited for Erster Internationaler Kongress fur Sexual-Forschung, Berlin
Nov., 1914. (A meeting prevented by the European War.)

(253)

254 W. C. Rivers

"The connection between the testes and the parotid
gland is shown by 'metastatic orchitis' occurring in mumps,
and 'metastatic parotitis' occurring in orchitis. (The latter
is not described by authorities. W.C.R.— ) A reference
to the animal kingdom will make these associations less
strange than appears at first sight. Animals, such as
the dog, rely on the sense of smell to find the female in
season, and the nose must, therefore, be reckoned as a
sexual organ. When a dog finds the urine of a bitch
on heat, he invariably licks it up, the process being
speedily followed by profuse salivation; and the same thing
occurs at the mating time, when the dog makes a very
free use of his tongue. Hence, the parotid gland which
secretes the watery saliva is in some measure a sexual
gland."

"In animals such as the dog, under the influence of
sexual excitement profuse salivation occurs. Having been
a breeder of dogs I can vouch for this fact. I believe
the same thing occurs in cats, in the female of which
I have seen the head and neck dripping wet with the
saliva of the male after mating."

Dr. Waller's evidence is all the stronger, it will be
noticed, from the absence of any teleological elaboration
of it. He simply records associated acti\'ity of two widely
distant glands, and advances this observed physiological
association as an explanation of their known pathological
association; but without speculating as to the ultimate
basis of the affinity.

About this time the present writer began to read
contemporary sexuological text-books, coming to them to
begin with in a roundabout way in the course of investi-
gating the order of birth of consumptives, and later
on in consequence of suspicions raised by perusal of some
parts of Walt Whitman's "Leaves of Grass." It was a
surprise, to find neither in Moll nor Ellis nor Raffalo\nch
nor Hirschfeld anything of a discussion of the probable
rationale of two of the three sexual phenomena in which
the tongue is concerned, namely cunnilingus and fellatio.
Let us see what these authorities have to say on the

i

A New Theory of Kissing 255

subject. MoU,^ as also Ellis,* opines that the impulse
to active cunnilingus sometimes comes from a predilection
for the odours of the female genitals. Raffalovich^
mentions the same act as one of the expedients of the
impotent male, and passive fellatio as a gratification, not
readily procurable from women, held out as an inducement
by inverts trying to 'seduce' an hetero-sexual male, or
given as a proof of their abased devotion to him. In
Hirschfeld's chief work (Die Homosexualitat) no ex-
planation is found, nor is any advanced by previous
writers.

Rosenbaum,^ who has given some space to the subject,
treats of cunnilingus and fellatio as merely Unzucht.
No doubt in ancient (and modern) times they frequently
were (and are) venal, practiced by uncleanly and disease-
tainted persons, or, with utter and anomalous lack of
reference to conjugation, by sexual inverts. The allusions
in the classical satirists, like Martial and Aristophanes,
are generally to such practice. A later writer, Ausonius,
mentions however (Epigrams 127, 128) matrimonial
cunnilingus; but his tone is the same. Nevertheless, as
will appear later, and as Dr. Havelock Ellis has said in a
private letter, cunnilingus and fellatio, within due limits,
cannot be looked upon as perversions, as being abnormal.
It is remarkable, indeed, seeing that the Greek word for the
former act is derived from the word for a dog, in which
animal it is so commonly seen, that Aristotle has not touched
upon it either in De Generatione or in De Pariibus
Animalium. This point, the well-nigh universal practice
in mammals, will be referred to below. Meanwhile, the
theory here advanced to explain the three lingual sexual
acts, namely intra-buccal kissing, cunnilingus, and fellatio,
might be stated at once. In main origin they are directly
and manifestly ultilitarian, the purpose served, besides
the obvious one of excitation, being that of lubricating
the genitals. Kissing probably begins as part of the Kantrek-
tatioHstrieb. Among the sexually inexperienced it stops at
contact with the skin of the lips. This truncated form
of kiss has also been preserved as an expression of affec-

256 W. C. Rivers

tion, as a greeting, a rite, and so forth. The fully develop-
ed variety is the intra-buccal, in which the tongue of the
male (or, in human inverts, of the more virile) is thrust in-
to the mouth of the female (or, of the less virile) ; and
occasionally vice-versa also. One great effect of this
procedure, on both parties, but more perhaps on the
male, is sialogogue, the repeated introduction of a foreign
body into the mouth of course exciting the flow of saliva.
Soon thereafter the ' mouth of the male, now well sup-
plied with moisture, is applied to the vulva, coming to
it either directly, or indirectly by way of intervening
parts of the female's body. By means of the tongue the
vulva is wetted within and without with saliva mixed
with vaginal mucus, and the immediately circumjacent
hair, pubic or other, is thus 'laid'; in any case conditions
are made more favourable for penile intromission. There
is also some tendency for the male to present the penis
to the mouth of the female, when fellatio (but exceot-
ionally) may occur. Coitus generally follows very soon
however after the cunnilingus. As orgasm approaches,
the male, even in species that do not hold the female
with their jaws, may lick the part of the female which
is nearest its head.

The above schema of the lingual preliminaries to
coitus in mammals is, of course, not uniforml}' followed:
different species make default in respect of different items
of procedure, just as, in other spheres of animal conduct,
not quite explicable variations are seen. Mention of these
omissions, and the general and particular arguments
for the above theory, will be most conveniently set forth
by means of small disquisitions upon the acts under
notice. To begin, then, with

Kissing.

The strongest evidence in favour of the sheer sexual
origin of kissing is the fact that the sexual kiss has a
wider distribution than the non-sexual one. So far as
is known, nearly all races of mankind kiss when engaged

A New Theory of Kissing 257

in coitus,* while to a considerable number of them non-
sexual lip contact is unknown, being replaced in various
ways. In the words of Nyrop^:

"Kissing is unknown in a great part of Polynesia,
in Madagascar, and among many tribes in Africa, more
particularly amongst those who mutilate their lips. . . .
Kissing is likewise unknown amongst the Esquimaux
and the people of Tierra del Fuego."

The same is true of the Malays, of the Japanese and
of certain Finnish tribes. And the presumption is certainly
against these peoples being ignorant, not only of kissing
as a salutation, but also of sexual kissing. Lafcadio
Hearn^ says in effect that in Japan the kiss has remained
sexual, although (a point Freudians should note, for
it is told of other non-mouth-saluting peoples) "mothers
lip their little ones." He opines that the original primi-
tive significance of lip-contact, or even lip-cheek contact,
is "physiologically traceable to the love which is too often
called I'amour, but which has little to do with the higher
sense of affection." Bayard Taylor^ narrates of the Finns
above mentioned that although the sexes freely mingle
naked in the bath, and the women scrub their husbands,
brothers and male friends, and while the conventional
salutation is an embrace with the right arm, a kiss is
considered grossly immodest and improper. Several other
and similar contemporary examples of this point will be
found in Havelock Ellis' already cited essay. A senti-
ment of the kind must have existed formerly, for Cato
degraded a senator for kissing the latter's wife in daylight
and in a daughter's presence. Plutarch's comment upon
this affair was that in any case it is disgusting to kiss
when third parties are present. Now the Romans freely
practiced the mouth kiss of greeting,* even between
males; hence the above personages thought a matrimonial
kiss must necessarily be sexual. Clement of Alexandria
exhorted married couples to refrain from kissing one anoth-
er before their servants.

Another fact showing the sexual origin of the lip-
contact salute is that the latter has been known to take

258 W. C. Rivers

on distinct sexual significance. Thus the ceremonial
kiss exchanged by members of the early Christian church
became a scandal, and had to be confined to those of the
same sex, men kissing only men, and women only women. ^"

That subsidiary sexual behaviour may, to borrow a
Freudian term, be 'sublimated' into a symbol of friendship
is illustrated (among primates, too) by a ludicrous habit
of captive monkeys. The bright red fleshy callosities
on monkeys' buttocks are a secondary sexual character,
their display constituting a sexual attractiou. But the
monkey when domesticated or in captivity may use them
non-sexually too, frequently turning and presenting them
to the view of his keeper and other human beings with
whom he is friendly. ^^

Amongst animals, the intra-buccal kiss is well seen
in stallions (the highly fed specimens of the domesticated
race, at least) and also it appears, in elephants. The
naturalist of authority just quoted relates (loc. cit. p. 71):

" as with all animals, pairing is impossible

without the consent of the female, and this is never
accorded until she is desirous that it should take place.
As a preliminary to this, an amorous dalliance is perhaps
the invariable rule among animals, and this takes many
and often strange forms. The elephant afTords a case
in point. For the late A. H. Neumann once came upon
a pair which were evidently as he says, 'love making.'
Creeping upon them noiselessly, he found the male fond-
ling his mate with his trunk, and then, standing side by
side, they crossed their trunks, and put the tips thereof in-
to each others' mouths, the elephantine form of kissing."

The 'billing' of some birds may have to do with smel-
ling, a factor to be presently mentioned. The dove's
habit, which has an appearance of love, but not of passion,
of inserting the bill between another's mandibles, is prob-
ably, although poets have compared it with human
intra-buccal kissing, connected rather with the way this
species has of feeding its young. Neither practice is
closely related in time with conjugation or attempts at
conjugation, as is intra-buccal kissing.

A New Theory of Kissing 259

But little of what has been said above will apply to
the intra-buccal kissing of human inverts, whether male
or female, for there the transposition of the sexual ob-
ject must entail futility of any lubricatory function.
The desire for the act persists all the same, much as the
developmental impulse in an ectopic pregnancy persists —
and as uselessly.

The Nose-Salutation.

Among the non-mouth saluting peoples, the com-
monest form of equivalent is either nose rubbing, or,
chiefly among Mongolians, a complicated kind of smelling,
unaccompanied by nose to nose contact. The former
Darwin has described in Malays, and it is also found
among some tribes of Madagascar, and indeed in many
other races. The names, which nearly all mean 'to smell,'
given to this custom by the various Polynesian sub-
peoples have much interested ethnologists.^^ I have
seen the practice in the North Island of New Zealand:
two oldish Maori women met in the street, and with
grave earnest faces steadily pressed their noses together,
keeping them in contact for five seconds or so. A local
acquaintance congratulated me on having witnessed this,
as the custom was becoming rare. Indeed it is generally
described as tending everywhere to disappear in presence
of European culture, becoming replaced by 'ordinary'
kissing or by handshaking. Nevertheless originally man-
kind was — still is to a large extent — divided in respect
of facial salutation into two classes, the lip saluters and
the nose saluters. Between these two forms there are
the following analogies, which do not seem to have been
previously pointed out. First, when practised between
those of unequal station, the nose or lip, as the case
may be, of the inferior is applied, not to the corresponding
part of the superior, but to some other region, generally
the hand. Proofs of this as regards European kissing
hardly need giving. Kissing the hand of sovereigns,
the feet of popes; the Spanish formula of politeness

260 W. C. Rivers

"I kiss your hands;" the classic Greek custom of kissing
the hand, breast or knee of a superior^^; these and many
other illustrations are familiar. Now, coming to the nose-
salute, Williams^' told that on one occasion a South Sea
Island chief only rubbed his nose on his (Williams') hand,
because he esteemed the missionary greater than himself.
The same writer speaks of penitent Samoans 'kissing"
their chief's feet. Again, according to Roth, to smell a
person's hand, "making rather a noise about it." is in Fiji
a very courteous and respectful method of salutation and
farewell. The second point of analogy between lip
saluting and nose saluting has to -do with a fact noted
by Ellis (loc. cit.) and afore mentioned here, namely that
in races with whom mouth kissing is otherwise solely
sexual, mothers will practise it with their children. It
is thus worth noting that Grandidier" states than in
Annam the nose salutation is only performed with child-
ren. Lastly, an analogue may be found to the practice
of kissing one's hand to someone as a greeting. Accord-
ing to Grandidier, the salutation of a certain Polynesian
tribe consists merely in each party touching the end of his
nose with his own finger.

Can a probability of sexual origin be shown for the
nose salute as for the lip salute? Affirmatively, the Mon-
golian olfactory kiss has certainly sexual associations,
d'Enjoy^^ going so far as to compare it with the sniffing
of dogs which precedes coitus. It is 'strictly voluptuous,'
exchanged only by married people or lovers. Then there
is the statement mentioned above, namely that the
Tamils rub noses during congress. If the nose rubbing
in Annam is only publicly practiced with children, that
too speaks for its sexual significance. But what the
nature of the sexual significance may be is difficult to see.
The odour of the face and breath can hardly differ
according to sex, even to the acute olfactory sense of
Asiatic and uncivilised persons. There can be no specific
excitant effect, as in animals, where the smelling is directed
to the genitals. Likewise there can be no lubricant action.

A New Theory of Kissing 261

The sexual ingredient in sniffiing the face seems of a very
attenuated character.

On the other hand both face sniffing and nose rubbing
are reminiscent of friendly expressions on the part of
lower animals. Quite commonly the first act of dogs
on meeting is to sniff each other's muzzle with every
sign of amity. It is true, however, that this sniffing
a priori is frequently followed by the same a posteriori.
Professor Nyrop quotes (loc. cit.) a French writer who adds
to a description of human nose rubbing the observation
that cats which are fond of one another greet in this
way; and that a cat belonging to him always tried to
squeeze its nose against his as a mark of affection.
The actual contact may well have been developed from
sniffing nose to nose, a mutual position resulting from
simple reciprocity, for the sense of smell is the test to
which lower animals and many savages put every newly
encountered object, animate or inanimate, and particularly
every organic object; while the rubbing may be explained
by the fact that gentle friction of the skin of the head
and neck is often pleasurable. In human subjects it
has been used to procure sleep; and horses may be seen
to rub each other's manes with the teeth for long periods.

Seemingly, then, the nose salutation derives, if at
all, from sexual procedure, then much less directly
than does the mouth salutation.

CUNNILINGUS AND FELLATIO.

As most mammals are handless, coitus must be
much facilitated by good lubrication of the area around
the vulva, so that the penis, which can but rarely
be accurately opposed to the rima, may glide readily on
from an initial faulty position into the vulval orifice. Again,
in mammals the penis approaches the dimensions of its
recipient aperture more nearly than in birds, which are
of course monotreme. In these the penis is perhaps
relatively smaller, since it has not to serve for the passage
of urine, and certainly the vent of the female is rela-

262 W. C. Rivers

tively larger, comprising anus and vulva in one. Ac-
cordingly copulation must present more intrinsic diffi-
culty to mammals than it does to birds. Such diffi-
culty would be partially obviated by lubrication, in other
words by cunnilingus and fellatio, practices totally absent
in birds. The former must be the more effective of
the two acts, because it 'lays' circumjacent hair and
prevents this adhering to the glans. Penile lubrication
alone would help less. Quite in accordance (in accor-
dance too, of course, with the less active role of the
female in sexual intercourse) is the much greater fre-
quency of cunnilingus than of fellatio. The latter act
in lower animals hardly goes beyond a slight attempt.
The case Moll (1. c. s. 369) cites, where a bitch would
break off coitus in order to practice it, must certainly
be reckoned as he reckons it, namely as a pure per-
version, since fellatio after this fashion is hysteroti pro-
teron, preventing instead of favouring fecundation. That
also in the human race, at all events among Occiden-
tals, cunnilingus is much the commoner act, independ-
ently of its practice by female inverts, all evidence goes
to show. Thus, according to Dessoir,^* the superior
Berlin prostitutes find that about a quarter of their
clients desire to exercise cunnilingus, while in France
and Italy the proportion is higher; Ellis adding that the
number of women who find the cunnilingus agreeable is
doubtless much greater. In a case history communicated to
the last named author^^ the statement is made regard-
ing fellatio — "This is the only case I have known of a
woman wishing to do it for the love of it." Pathological
data show the same thing. Foumier',^^ the noted syphi-
lologist, taught that buccal and lingual chancres resulting
from contact of these parts with infected genitals were
greatly commoner in men than in women. Contagion in
this way "n'est que trap reele et formelletnent demontree par
un grand nombre d' observations ou les aveux ont ete
enregistres." It should just be remembered, however,
that fellatio is doubtless a practice which in Europe
is more affected by female prostitutes than by other

A New Theory of Kissing 263

women, and that prostitutes are likely to have had
syphiUs, contracted in the ordinary manner, quite early
in their career, and so to be protected against a second
attack. The sex incidence of buccal gonorrhoea the
authorities (Finger, Luys) do not seem to state; and since
gonorrhoea does not confer immunity, figures bearing on
this detail would be interesting. A valuable indication
of the closer physiological connexion, in men than in
women, that exists between the salivary and the re-
productive glands, is however furnished by the theory
(which deserves text-book recognition) outlined, as above
cited, by Waller. The indication lies in this point, that
whereas the sexes are about equally liable to mumps,
orchitis or epididymo-orchitis complicates that disease
very much more often than does the analogous genital
involvement in the female, namely mastitis (occasionally
seen, by the way, as supporters of the bisexual theory
might remind us, in boys with mumps) vulvitis, vaginitis
or ovaritis. There can be little doubt that the frequency
of orchitis in mumps does speak for a physiological sialo-
gcnital association, or at least a parotido-genital one.
For although in mumps secondary inflammations of parts
other than the genitals occur (but much less frequently)
and although the probable micro-organism of epidemic
parotitis is said to be demonstrable in the testicle when
orchitis is present, as also in the blood, yet the fact is
well established that an unaccountable parotitis supervenes
noticeably often upon lesions of the generative system.
Paget^^ found that of 101 cases of parotitis after injury
or disease of the abdomen or pelvis, ten followed injury
01 disease of the urinary tract, eighteen the same of the
alimentary canal, twenty-three of the abdominal wall,
peritoneum and pelvic cellular tissue; and fifty trauma,
disease or operations affecting the generative organs,
twenty-seven of these being operations on the ovary.
Now in view of the close relationship (lately shown by
Pawlow's^" work, for instance) between the salivary
glands and the rest of the digestive apparatus, one
could understand the possibility of disturbances of the

264 W. C. Rivers

alimentary canal and its coverings being followed by
sympathetic derangement of the parotid. Yet the above
figures show that in the case of the generative system
the sympathy is even closer. In passing one must note
that ovarian operations are much commoner than opera-
tions on the testicle. Eustace Smith^^ says, too, that
septic parotitis in surgical practice complicates all septic
operations, but especially abdominal and pelvic genito-
urinary operations, puerperal infection and pyaemia. We
must remember further that salivation is one of the
signs of pregnancy; and in Kelly's well-known work is
mentioned a case where one parotid enlarged in six suc-
cessive pregnancies, and at no other time.

Again, while mumps is generally a childish ailment,
the most vulnerable age being from four to fourteen years,
nevertheless the orchitis in question is 'excessively rare
before puberty'^ since it is likewise 'almost unknown in old
age,'^^ in the male, at any rate, the connection
between salivary and reproductive gland holds good
only during the functional period of the latter; at the
period then when the saliva would be required to help
in the reproductive act. Another point of kinship be-
tween the salivary and the procreative organs is the fine
sensibility of both to psychic excitation. The psychic
excitation of the salivary glands, says, Pawlow, comes
about through intermediation of other end organs, such
as the nose, eyes and ears, which are receptors for many
influences originating reflexes from a distance. Compare
with this Dr. Waller's observation that sexual excitement
in the dog acts as a sialogogue. The odour of the bitch's
genitals, when in oestrus, certainly excites the male
sexually, and this may furnish him with copious saliva
for the subsequent so frequent cunniHngus, which is
again followed by mounting. Thus animals of keen scent,
like the dog or pig, would have no need of intra-buccal
kissing as a salivary excitant, and as a fact this last
phenomenon is seen in neither. In the renowned work
of the Russian physiologist there is almost a suggestion
of the genital function of the saliva, when he writes

A New Theory of Kissing 266

(loc. cit. p. 68) "the great multiplicity of excitants of
salivary secretion, has, without doubt, some connection
with the comprehensive physiological functions of the
saliva." In any repetition of his salivary experiments
on dogs, it would be of interest to try on the male,
both by buccal contact and also indirectly, the stimulus
of the oestral vulval secretions of bitches.

It may be objected that the particular salivary
gland which shows this sympathy with the reproductive
system is the parotid, which secretes the watery element
of the saliva; whereas lubrication would be best effected
by mucus, the contribution not of the parotid but of the
sublingual and the submaxillary, However, in mumps
these latter are also sometimes involved, and in rare in-
stances exclusively so.^"* Moreover, the parotid is the
chief salivary gland,* weighing more than twice as much
as the other two together. Again, a watery fluid would
act well in 'laying' the hair surrounding the female ex-
ternal genitals, as previously noted; while mucus is ready
provided by the muciparous glands of vagina and vulva.
A mixture of watery and mucoid fluids is doubtless better
for lubrication than either separately, or else it is hard
to see why dogs, and other animals whose spittle contains
no digestive ferment, are provided with a parotid, for
Starling^* opines that in such the sole object of the saliva
is to render the mass of food in the mouth slippery.

The overt estimation in which civilized man holds
fellatio and cunnilingus, and to a less degree intrabuccal
kissing, is that these acts are disgusting, uncleanly,
immoral and unaesthetic. This view is merely an ac-
centuation of his professed and inculcated outlook upon all
manifestations of sexuality, and therefore probably derives
from the same causes. It is here only necessary to say that
in this particular case the influence of the ascetic ideal
fostered by Christianity seems less operative than usual.
The sculptures in the Cuttack temples, representing
fellatio, are described by Hindu authors as the work of
unchaste women and low persons such as eunuchs and
slaves; although they adnit such acts are done privately

266 W. C. Rivers

by many.^* The tone taken by other non-Christian
writers, e.g. the classical satirists, has been already noticed.
It was no doubt moral repugnance that made Martial
lay so many strange ailments (like paralysis of the tongue,
chronic pallor, foul breath) to the score of these practices,
while better authorities, such as the ancient physicians,
made no mention of them. It has been stated^' that
buccal gonorrhoea causes foul breath, but Luys^* was
unable to confirm the digestive disturbances described
as occurring in prostitutes as the result of mutual cunni-
lingus, while he cites a case of habitual fellatio with no
ill-effect. Obviously these actswillafford extra opportunities
for the spread of tubercle and of venereal disease; but
when both parties are healthy, their moderate, hetero-
sexual, and physiological use, as in animals or savages,
can hardly damage health.

But while in his conventional moral judgment the
modern European views the three lingual preliminaries
to coitus even more severely, even more distrustfully,
than he does general sexual passion, in the matter of
physical appetite there is a plain distinction. Alone
of the mammals, civilized man finds, as a rule and at
first sight, the genital odour of its female, and bucco-
genital contact with her, not gratifying but most re-
pulsive. Obviously a great many factors are ungeneric
to both civilized man and the lower animals, and of this
multitude many again may be invoked to explain the
difference in taste under notice. One might just suggest
in passing two— the wearing of clothing, with its masking
effect upon bodily odours; and the early separation of
the sexes. Yet matrimonial, physiological cunnilingus,
and even fellatio, have probably always occurred; before
the foundation of Nola, before the Phoenicians; although
modern occidental influences are probably checking their
vogue. Kokkokam, a Tamil work on love, mentions the
vulva as one of the eight parts of the female body suitable
for kissing, and describes six methods of practising
fellatio.^®. That modern northern Europeans of education
still perform them is likely, if from nothing else, from the

A New Theory of Kissing 267

behaviour of a London theatre audience once observed.
On the stage a wife was persuading her husband to some
course of action; and in her eagerness (he being seated
on a sofa, leaning forward pondering, with elbows on
parted knees) she suddenly sat down on the floor just in
front of him. It was an 'innocent' enough movement
on the actress's part, but immediately she took up that
posture a sudden and noticeable stillness came over the
audience, the result no doubt of the close attention a
suggestion of sexuality now and here arouses; especially
in an assembly — affected as that is by the raised emotional
tone described by students of crowd psychology. From
the relative positions of the pair, and the passivity of
the man, fellatio or some approach thereto, must have
been the particular form of sexuality thought of.

In conclusion, the genito-Iubricatory function of the
saliva is not advanced as wholly accounting for intra-
buccal kissing, cunnilingus, and fellatio; but it would
seem a factor indispensable to their explanation, and
similarly to the explanation of the orchitis of mumps.

And thus, indeed, in the narrow sector of medical
knowledge proper (outside which the advice is superfluous)
we may profitably remember what Semon said in 1887
of his subject, then likewise a nascent specialty:

"Die nachste Aufgabe. . . . besteht darin, dem weiteren
Kreise unserer Fachgenossen immer neue Beweise von
dem Koennen und der Bedeutung der Laryngologie in
Verbindung mit medicinischen Fragen von weiterem
Interesse zu geben."

1. Cornet: Tuberculosis. Nothnagel's Encyclopaedia of Practical Medicine.
English edn., Philadelphia, 1904. P. 205 et seq.

2. Waller: The Helationship of the Thyroid Gland to other Internal Secretions
of Sexual Origin. The Practitioner, Aug., 1912.

Idem: Internal Secretions in the Chain of Dental Caries. British Dental Journal
July 15, 1913.

3. Moll: Untersuchungen ueber die Libido Sexualia. Berlin, 1898. Bd. 1, s. 134,

4. Ellis: Sexual Selection in Man. Philadelphia, 1911. p. 75.

5. RafTalovich: Uranisme et Unisexualite. Lyons, 1896, pp. 8, 123.
Idem: Archives d'Anthropologie Criminelle. Sept. 1907, p. 622.

268 W. C. Rivers

6. Rosenbaum: Geschichte der Lustaeuche im Altertume. Zwtr. Abdk. Halle.
1845. The passage from Galen (De simplic. medicamentorum tern., etc., Lib. X, C. 1.)
which this writer and MoU cite in connection with cunnilingtis, surely refers almost
wholly to coprophagia, and the nearly eaually repulsive coprotherapy of early times. The
very short reference however to the Phoenician origin of cunnilingus (a conclusion
given also by Rosenbaum, writing in pre-sexuological days) is interesting as showing
yet again the habit of one nation to credit another with missionary work in respect
to some detail of sexual conduct; indeed two peoples may mutually regard each other
thus. Sexual inversion is a notorious example of this; not a good one in the present
connection, however, for inversion is a mental malformation, while intra-buccal kissing,
cunnilingus and fellatio are, it is hoped to show, essentially physiological.

* Recorded exceptions may be due to the recorders' non-recogniiion of the nature
of the sexual kiss proper. Thus Ellis (Sexual Selection in Man, 1911. Appendix B.
The Origins of the Kiss. P. 220) says that a medical correspondent in Ceylon told
him that the Tamils do not kiss during coitus; the informant adding, however, that
they rub noses and lick each others* mouth and tongue.' then.

7. C. Nyrop: The Kiss and Its History. Translation by W. F. Harvey. London.
1901, p. 178 et seq.

8. E. Bisland: Life and Letters of Lafcadio Heam. Vol. II, p. 263.

9. B. Taylor: Northern Travels. London, 1858.

* "Suavia" kisses of passion, between the lips, "basia," of love; "oscula," friendly
kisses.

10. E. B. Tylor: ART. Salutations. Encyclopaedia Britannica.

11. W. P. Pycraft: The Courtship of Animals. London, 1914, 2nd edition.

11. For a discussion of this see Lesson: Les Polynesiens. Paris, 1884. T. IV.,
p. 185.

12. E. B. Tylor: loc. cit.

13. Williams: Narrative of a Missionary Voyage, etc. I/ondon, 1840, p. 110. cit.
by Ling Roth: Journal of the Anthropological Institute, Vol. XIX, 1890, p. 166.
(In a later edition of Williams' book I do not find the passage Roth alludes to. namely,
the first.)

14. A. and G. Grandidier: Histoire de Madagascar, Paris, MOCCCCVIII, p. 20,
footnotes (2) and (a).

15. P. d'Enjoy: Bulletin de la Societe d'Anthropologie, Paris, 1897, VIII, p. 181-

16. Dessoir: AUgemeine Zeitschrift f. Psychiatrie. Hft. V., 1894, cit. by Ellis:
Sex in Relation to Society, 1910, p. 557.

17. H. Ellis: Sexual Selection in Man. Philadelphia, 1911, Appendix B., p. 239.

18. Fournier: Les Chancres Extra-genitaux, Paris, 1897, p. 18.

19. Paget: cit. by Erichsen: Science and Art of Surgery. 10th Edn., London,
1895, p. 606.

20. Pawlow: T he Work of the Digestive Glands. Translated by W. Thompson
2nd English Edn., London, 1910.

21. E. Smith: ART. Mumps. Allbutt's System of Medicine. 1897, Vol. Ill,
p. 318.

22. Osier: Principles and Practice of Medicine. 8th Edn., London. 1912, p. 350.

23. Choyce: System of Surgery, London, 1912.

24. Emmett Holt: Diseases of Infancy and Childhood. 6th Edn., New York,
1912, p. 965.

* Perhaps also the most active one; for according to Stewart, (Manual of Ph>*si-
ology, 6th Edn., London, 1910, p. 371) in ruminant animals the parotid never entirely,
ceases to secrete.

25. Starling: Principles of Human Physiology. London, 1912, p. 741.

26. Marriage Ceremonies and Priapic Rites. By a member of the Royal Asiatic
Society. Privately printed, 1909, pp. 75-81.

27. V. ZeissI: Wiener Klinik. 1901, s. 177.

28. Luys; Gonorrhoea and Its Complications. Translated by A. Foerster,
London, 1913, p. 230 et seq.

ATHETOSIS

{Review of the Literature with Clinical Report of a Case.)

By Hagop Davidian, M. D.

Washington, D. C.

'T'HAT a well-regulated and coordinate nervous mech-
■■■ anism is requisite, not only to effect a normal
motor discharge, but also to inhibit and control such
needless impulses, is conceded. Hence any derangement
or destruction in any or several parts of this system will
eventuate either in the partial or total abolition of its
function, or in the production of morbid or hyper-function,
with the consequent paresis or paralysis, or else para- or
hyper-kinesis of the innervated muscle.

The latter form, as it manifests itself in different
affections, may be a pure and simple normal muscular
contraction abnormally exaggerated, such as spastic
contractures, which Charcot interprets as "a normal
muscular tone carried to its extreme limit," while para-
kinesis consists of many and varied forms of adventi-
tious movements, which are grouped by Gowers into
(a) tremors, (b) rhythmic movements, and (c) irregular
movements. The last group comprises such irregular and
arrhythmic contractions and relaxations, implicating the
muscles of different sets and functions, that move the in-
volved parts in all directions and planes in space, some
less, others for greater distance, some short, others for
longer intervals of time, almost simulating the voluntary
movement, yet entirely beyond the sway of volition,
becoming economically useless, purposeless and often
harmful. These allied forms of "mobile spasms" may
take place when the muscles are at voluntary rest, or be

(269)

270 Hagop Davidian

superimposed upon normal movements, modifying them
and in turn being modified themselves.

Some of these accessory motions present definite
and circumscribed features, while others are rather ill-
defined, and, especially in the atypical cases, may deviate
so far from the classical description of a certain type
and imitate another as well, as to render the distinction
hazardous, and the nosologist, to keep himself on safe
ground, seeks refuge in modifying the name or compound-
ing the two and hybridizing a new nomenclature, e. g.
"Choreo-athetoid." Such border-line cases go to show,
at least in certain types of abnormal motilities, stamped
out as definite entities, the gradual shading of one variety
of motor disturbance into another, and so serve as the
intermediary links of a whole chain of apparently distinct
diseases, which have been christened so merely for the
reason of their certain outstanding symptom-complices;
though for a rational and scientific method of titling a
disease recourse should be had to the underlying etiologic
and morbid-anatomic characteristics.

Therefore, all the motor disorders, as such do not
constitute disease, but the manifestation of a syndrome,
dependent upon the physiodynamic laws conditioned b}-
the basic lesions in the course of various diseases.

The so-called athetosis, the subject-matter of this
paper, is one of those specific terms having reference
merely to abnormal motor phenomena, that only in the
typical cases present well-marked differential features.
The originator himself, aware of the inadequacy of the
term, offers the following apology: "I have applied the
term athetosis to the disease, having as yet had no op-
portunity of ascertaining by post-mortem examination
the nature of the lesion to which the symptoms are due."

In 1869 Wm. Hammond of New York observed this
disorder and isolated it first, out of kindred types of
spasms, as a distinct malady, and published it in 1871
under the title of athetosis, a term coined by him, from
Greek origin (A6T)Toa; ot = negating prefix, Tibivixi=to
place) to signify, as he expressed it, "without a fixed

Athetosis 271

position." In the years immediately following and there-
after it gained a wide reception as a sharply outlined
entity, here and abroad, by a host of eminent neurologists,
among whom worthy of mention are: Allbutt, Charcot,
Oulmont, Erb, Cowers, Ewald, Kuessner, Hughlings
Jackson, etc.

Hammond describes the condition as a "disease
characterized by an inability to retain the fingers and
toes in any position in which they may be placed, and
by their continual motion" due "to involuntary con-
tractions" that take place "slowly, apparently as if with
deliberation and with great force. The toes are not in-
volved to the same extent as the fingers." He also thinks
that "movements appear to be due to continuous dis-
charging lesion" of the cerebro-spinal system, that gives
rise to "hyperkinesis" and consequent "hypertrophy"
of the muscles.

Cowers prefers the term "the mobile-spasm * * *
in which there is tonic spasm, slowly varying in relative
degree in different muscles, and thus causing slow, ir-
regular movements, occasionally quick, far more often
slow, chiefly conspicuous in hand, and slow irregular
incoordination. It is commonly conjoined with more or
less permanent rigidity, which tends to fix the limb in
a certain posture. * * * "

Frankl-Hochwart says "By this disease, or — more
corTectly—symptom'athetosis, we understand an abnormal
and peculiar movement * * * in which the upper
extremities are chiefly implicated * * * the phenom-
ena are always conspicuous in the distal ends. In rare
cases palate and tongue are also involved; these contrac-
tions are usually unilateral, occasionally bilateral."

Osier terms it a "condition" and gives a terse sum-
mary of the symptoms and the gist of the most prevalent
opinion on the pathology. And many other authors
are unanimous in their definition as to the most promi-
nent characteristics, using different descriptive terminology
to indicate the difficulty in conveying an image of the

272 Hagop Davidian

inordinate movements that verbal portraying fails what
an actual glance could easily reveal.

Strumpell defines the "movements of athetosis" as
"peculiar involuntary and usually quite slow movements,
which are seen especially in the arms and hands, but also
in the head, trunk, etc. The fingers make slow but often
very extensive movements, are extended, spread apart,
flexed and moved over and around one another in the
most remarkable way. This form of motor irritation
occurs as a special disease, 'athetosis', or as a symptom
in certain central nervous diseases, especially the cerebral
paralysis of children."

Although comparatively, and fortunately, rare, yet
they are by no means extremely so, as there are re-
ported a dozen or more cases yearly, leaving us to assume
scores of others that never come to light through the press.

It is asserted that no hereditary or familial morbid
influences can be discerned, though Massalongo met three
cases in one family, and Oppemheim has seen it once
in a mother and the daughter, and on two occasions
in the members of a family. Turney reports cases (of
athetosis, as he thinks,) in three sisters. Athetosis in
collaterals may be uncommon, but various nervous and
developmental disorders in brothers and sisters, and
particularly serious affections, such as tuberculosis, syphilis
and alcoholism, in the parents are by no means rare.

As to age, infantile and adult forms have been recog-
nized, but no sharp line of demarcation separates them.
It is far more prevalent in the former age than in the
latter. A great many cases are congenital, whether
they display the athetoid motility soon after birth or at
a later date, period of voluntary active motions, or
"even as late as the age of 3-6 years" (Freud.) These,
however, generally show one form or another of disorder,
referable to the central nervous system, dating from
birth. Again, special infectious diseases of childhood and
several diseases of the central nervous system peculiar
to children, with which athetoid movements are associated,

Athetosis 273

play the greatest role in its predominence in the earlier
years of life.

Gowers explains "The frequency with which the condi-
tion follows infantile hemiplegia," because of "the greater
facility with which the growing and developing nerve
cells recover, and their greater susceptibility to disorder
of function when their development is perverted."

Of the recently reported cases only a few state the
age of the patient at the onset of the motor disorder.

Age

Number of Cases

Age

Number of Cases

1

3

11

2

1

18

3

2

24

4

2

29

5

2

33

6

3

48

7

2

50 + ....

8

1

It is to be admitted that the total number of cases
here (23) are too few to derive any conclusive results
from them. But by comparison with different writers'
conclusions, at which they have arrived by statistical
data, there is a broad parallelism, even if they differed
in minuter details.

From birth to 10 years of age — 16 cases; 10 to 30
years — 4 cases; 30 to 50 years — 2 cases; 50 years and over — 1
case. Of all the cases of athetoid disorder two thirds occurred
during the first seven years of life; that is, in the first
seven years it was twice as prevalent as in the subse-
quent years. The highest number of cases in any indi-
vidual year is the first twelve months (in this series the
sixth year being excepted.)

Etiologically two types of athetosis are still in favor —
idiopathic and symptomatic. Symptomatic comprises the
cases that are secondary to a causative factor or a disease,
and are preceded or followed by, or associated with,
other neuropathic manifestations, either in the sensory
or the motor fields. It is said that of all the motor dis-
orders following paralyses, athetoid movements are the

274 Hagop Davidian

most common; commoner than tremors, choreiform or
agitans types of movements.

The following are collected from both the current
and staid literature as having preceded the onset of
athetoid motor disorders: Developmental defects (arrest
of growth or retrograde changes of the nervous system,
due, among others, to parental syphilis, probably alcohol,
injury to gravid uterus, maternal shock,) also premature
birth, trauma to head during delivery, thrombus, embolism
and hemorrhage of local vessels, focal anaemia and soften-
ing, infantile cerebral paralysis, Friedreich's ataxia, tumors,
gliosis and clot (in the focus directly or in the neighbor-
hood,) focal tubercle, localized tubercular meningo-encepha-
litis, measles, mumps, scarlet fever, diphtheria, small-
pox, vaccinia, pneumonia, influenza, and by far, whooping
cough, hyperpyrexia from any cause; also alcohol, uremia,
diabetes and saturnism. Although the above have been
gathered from various sources, how far they were actually
responsible and each in what percentage, it is almost
impossible to ascertain. Cerebral abscess is not considered
to cause this type of motor disorder, but Berger reports
an undoubted case.

Of the series reported in this paper, in only eighteen
could the etiology be determined with reliable certainty.
Number of Cases :

5 — Congenitals: in whom some form of disease of cen-
tral nervous system was apparent from birth .28%
4 — Tumor or gliosis: in whom the first symptoms were
gradually advancing athetoid movements,
later associated or not with other nervous

manifestations 22%

6 — Vascular: embolic, thrombotic, hemorrhagic and

non-determinable cases with sudden onset 33%

2 — Whooping-cough: not known whether due to em-
bolism, hemorrhage, or encephalitis followed

by neuroglia formation 11%

1 — Acute illness with pulmonary localization 6%

The word idiopathic has almost lost its etymological
meaning in the medical writings, and has come to be

Athetosis 275

recognized virtually as a synonym to obscure diseases
with unknown causations. But as in other diseases,
so in athetosis its boundaries have been slowly but pro-
gressively contracting and losing ground in favor of
symptomatic. The more detailed information obtained
concerning the case, the more thorough, gross and es-
pecially histological search is made of lesions, the less
the idiopathic cases are being reported. Claye Shaw
gave the first description of the idiopathic type, claiming
that this type was not preceded by hemiplegia nor as-
sociated with other forms of nervous disorder, as were the
reported cases heretofore (St. Bartholomews Hospital
Reports, London, 1873.)

Gnauck accepts only those case? as idiopathic athe-
tosis which are not associated with other symptoms of
organic cerebral disease, unilateral or bilateral. Oppen-
hcim says: "Idiopathic or primary athetosis is a disease
visually of bilateral symmetrical distribution, apparently
of spontaneous onset, and showing no relation to hemi-
plegia, which occurs both in children and in adults.
* * * The symptoms may be the only ones present,
or they may be accompanied by idiocy, epilepsy, and other
affections." He is not certain, however, whether the
affection is sui generis or a disease belonging to the
category of infantile cerebral diplegia, as further on he
cites the apparent recovery of a case, believed to be
idiopathic, by mercurial treatment. Gowers attempts
to efface the conventional delimitation between the idio-
pathic and the symptomatic athetoses, saying: "Such
primary spasnis are similar in character to that which
may succeed hemiplegia, and every gradation is met with
between such cases of extensive movement without
rigidity, and the more frequent cases in which the move-
ments are slighter and arc combined with fixed con-
tracture." In some cases fright, shock, agitation, trauma
and chill apparently have precipitated the idiopathic
type. In accordance with definitions given by neurologists
of the above scries, 16% were apparently idiopathic
and 84% symptomatic.

276 Hagop Davidian

Athetosis manifests itself in partial and in generalized
forms. The partial form usually follows in the train,
and after the fashion of localized spastic paralyses, which
may be of a monoplegic or, as is the case in the majority,
a hemiplegic type, hence the term hemiathetosis, whether
it involves the half of the body throughout, or only the
upper, or very rarely, only the lower extremities, while
the remainder of the half is either entirely free (in cases
following monoplegia,) or more or less spastic, or displays
other varieties of mobile spasms, especially tremors or
choreiform movements (if it succeeds hemiplegia.)

The most common form of motor disorder that ac-
companies secondary athetosis is the residuals of spastic-
ity. Although the spasticity at first may be absolute,
athetoid movements do not start until "there is some
return of voluntary power, not when the paralysis remains
absolute." A rare but peculiar form of spasticity in these
cases is what is called "tonic rigidity" (Frankl-Hochwart,)
or "fixed rigidity" (Gowers,) in which extremities remain
in a rigid state, resisting the passive motion until much
stronger force overpowers the fixed muscles. Sinkler's
case well illustrates it. In this the affected left arm
remained in some odd attitude for months at a time,
thus, arm adducted and pressed against thorax or ex-
tended in horizontal direction, while forearm points up
vertically, later by itself changed into a different poise
for another similar length of time, while in the mean-
time the fingers continuously were displaying characteristic
athetotic motions.

Tremors are often noticed in these secondary types,
either bilaterally or unilaterally, particularly on the
affected limb. Other jacticatory motions, entirely distinct
from the athetoid type, are observed in the contralateral
or the other set of the extremities, so-called "associated
movements" or "consensual movements" are not uncommon.

But the most common is the association of choreiform
motions in the other limb or limbs. Sometimes even the
athetotic extremity does not have the pure characteristics
of the motion, but a mixed phase, hence the alluded

Athetosis 277

term "Choreo-athetoid." At times these different varie-
ties of mobile spasms interchange and succeed each other,
as described in a case by Kahler and Pick; "Both fingers
and toes were in the first place in rapid, ceaseless motion,
later movements were extended and jerky as a typical
hemichorea, finally became slow and distinctive of athe-
tosis."

The interval between the onsets of paralyses and
the athetoid movements may be months or years (Oppen-
heim) after a certain degree of voluntary motion returns
(Putnam); that is, if the hemiplegia owes its origin to
hemorrhage, the immediate shock and the pressure of
extraneous substance produces complete paralysis, and
by the absorption of the clot and the probable re-establish-
ment of circulation, and especially after fibrous tissue
formation, the irritation gives rise to motor disturbanc^.
While in neoplasmic formations, also if the origi«s!tl
trauma has not been sufficient to cause paralysis, the
motor disorders may precede by irritating at the initial
stages until gradually extreme pressure causes paralysis.
Therefore symptomatic athetosis generally follows, seldom
precedes, and at times in tumors of slow or arrested
growth, etc., are associated with hemiplegic symptoms
throughout its course.

Among the symptomatics, in the above mentioned
series, 33% started with athetoid movements, without
any preceding sensory-motor disturbance; 55 — 60% of
cases were associated with motor disturbances, such as
stiffness in the legs, or weakness and paresis in the arms,
tremors or choreiform movements, etc. Of the congenital
cases, 5 in all, 3 displayed the abnormal movements,
sometime during the first year, the fourth at the second
year, and the fifth at the fourth year. Both of the latter
showed neurologic abnormalities dating from birth, leaving
no doubt that they were congenital. ••

The sensory disturbances are also manifold. In the
cases which date from childhood, sensation is always nor-
mal. A lesion of the brain in childhood seldom, if ever,
causes persistent loss of sensibility (Gowers.) But in

278 Hagop Davidian

the symptoinatic form the sensory disturbances are
usually present. Hemianesthesia is quite often a con-
comitant symptom in symptomatic athetosis. In fact,
Charcot believes that "hemianesthesia is usufilly present
at one time or another in the course of the affection."
Forty-two and one-third per cent of cases experienced it,
in the collection of Putnam, who adds that in a number
of others no search was made; while in the scries collected
for this paper 45 — 50% constituted all sorts of sensory
disturbances, such as hyper-, para-, and hyp-aesthesias,
headache, pain during athetoid movements, asynergia,
asteriognosis, incoordination, etc., and in one case optic
atrophy with no other sensory disorder. Reflexes also
exhibit some anomalies. While most of the cases in this
series had normal tendon reflexes both of the upper and
the lower extremities, a few had the reflexes exaggerated,
more marked on the affected side, still fewer had them
somewhat diminished, in one case abolished. Guilian
and Dubois report a case of Double Athetosis (similar
to which have been observed in other upper neurone type
of motor disorders) in which Babinski reaction was ob-
tained by the stimulation of the cutaneous surface of the
entire body, v/ith pin-prick, but not with cold or hot
application. Further, stimulation above the tibio-tarsal
joint on the left, and above the hip joint on the right
brought out the Babinski phenomenon bilaterally (Rev.
Neurologique, Paris, May 80, 1914.)

The generalized form affects bilaterally, and according
to the degree of severity, it implicates the muscles of the
face and neck, as well as of the tnink, therefore the clinic-
al tenn Double Athetosis. This form was first recog-
nized and described by Oulmont, while Allbutt has re-
ported a case affecting all the four extiemities as early
as January 27, 1872. It occurs both in children and
adults. Again of the above series 43 1/2% double,
about 39% left, and about 17% right hcmiathetoses;
90% of the double in children, leaving only 10% in the
adult age.

I

Athetosis 279

As stated above, seeing a case is more instructive
to the student than pages of description. When the case
is not available, illustrations have come to aid. Photo-
graphs and sketches of deformities of hands, various
poises of fingers, peculiar hyperextension of joints give
some idea of the condition, but not sufficient and just
conception of the malady, as the athetosis is not an ob-
ject but a pathological process.

The movements are not rhythmic oscillations of a
single muscle, nor alternate regular contractions of counter-
acting muscles, but a compound and complicated play
of different systems of muscles of the involved region,
that defies verbal description. Therefore following the
example of others in the study of mobile spasms, De Castro
(N. inconog. de la Salpetrierc, Paris, 1912) has gotten
the cinamographic reproduction of the movements, which
copies, not only the motions as they go along, but their
character, their varying amplitude, and their rates per
second.

The muscles involved first and the most are the
smaller muscles of the distal extremities (lumbricales and
interossii) and of the lower half of the face, including
those of the mouth. The other muscles do not altogether
escape but are affected late and least. The motions
of athetosis can readily be distinguished from other
types of spasms, except from those of chorea. In fact in
the anomalous cases distinction is almost impracticable.
But the following table of differential diagnosis by
Monakow brings out fairly well the main features of
either condition:

Hemichorea.

1. Face, trunk and all extremities are attacked;
in any case, all extremities.

2. The movements are active and manifold, they
resemble tremor, are more marked with intended move-
ments, and are ptirposeless. After short stimulation there
is a brief transitory relaxation of the muscles.

3. Contracture is often absent; frequently the limbs
are flaccid. No deformities are noted in the joints.

280 Hagop Davidian

4. Hemianesthesia common.

5. Rest during sleep.

6. Intended movements and attempts to suppress
the unrest increase the tremor.

Hemiathetosis.

1. The forearm and hand (fingers) as well as the
lower leg and foot (toes) are chiefly or solely attacked;
the other parts of the body show slight paresis with
increased muscular tension.

2. The movements are slow, rhythmical and hyper-
extensile; there is elastic resistance; the contortions appear
to be voluntary; the joints are fixed, although with
varying intensity, during the movements.

3. Contracture, i. e., involuntary fixation of the joint,
is common, but is subject to continuous change; there
are deformities in the joints.

4. Hemianesthesia rare.

5. Rest during sleep not invariable.

6. The movements are limited by the will to only
a slight extent.

Here, instead of recounting all the possible phases of
the movements of a hypothetical case, it is deemed
convenient to report a case of doublc-athetosis, at present
still under observation.

George West, colored, age 32 11/12 years, single,
education and occupation none. The history of the
antecedents and collaterals excellent. Wassermann with
father's blood negative. Patient is the first child of
parents; labor lasted 4>< days, delivery difficult. The
skin at birth was "green like grass." During, as well as
after, delivery, child was inactive as if "still." About
ten minutes after birth general convulsions set in, each
lasting about 5 minutes, at intervals of 15 minutes, for
five days and nights, then stopped spontaneously. Breast
fed for two years or more. For the first six months
child cried a great deal. At no time was there extra-
ordinary vomiting, apparently never cerebral. As a rule
child was very quiet, "lying in crib like a log," and
every now and then a hand or foot began to move.

Athetosis

281

The abnormality of this motion attracted the attention
of the parents, only after the child was 6 months old.
He was small for his age. Nothing unusual remembered
about teething. He could not sit up without propping
all around, until he was 5 years old. Between five and
six he could stand up with support, and about six years
of age he commenced to walk. All this time he had the
abnormal movements of all the extremities. Like ordinary
children he learned and understood the spoken language,
but never talked. When about 4-6 years old he made his
wishes known by signs and signals, could carry out simple
orders, differentiating the articles and colors at about 7-8.
From ten years on he has been quite "intelligent and memory
very good," according to father's statement, who also
says that about that age he taught him the shame of
exposing himself. Prior to that he was indifferent and
ignorant, but up to the present there have been no
evidences of involuntary emissions, masturbation, or any
sexual manifestations. From the first to the tenth year
he was under medical supervision with no improvement.
No electrical treatment at any time. Once or twice he
was taken to Johns Hopkins Clinic. Had small-pox at
6-9 months, whooping cough at 3-4 years, measles at
4-5 years of age, with no complications or sequalae.
Mental examination — On account of inability to co-
operate, and want of speech no routine test could be done.
He differentiates persons and places, but orientation is
rather elementary, memory for faces very good. Emo-
tionally is quite tractable and pleasant, always smiling.
Occasionally shows stubbornness, also inadequately bursts
into hilarious laughter. On mentioning home and parents
becomes lachrymose. This certain amount of easy emo-
tional disturbance appears to be due to mental condition
and not to thalamic irritation. According to Binet-
Simon scale he seems far above the idiotic age, and proba-
bly the general intelligence combines and represents the
various ages of a child between five and nine, hence an
imbecile.

282 Hagop Davidian

Hammond's original case was an alcoholic and showed
deterioration, not due to athetosis, but alcohol. Other
similar cases are cited by Hammond and others.

Oulmont says: "Those that date from childhood, or
are congenital * * * apt to be associated with idiocy
and imbecility."

"Strumpell believes the "intelligence of the patients
'suffering with idiopathic form' is sometimes, but not
always, diminished."

Marie maintains that in bilateral athetosis mind
remains intact. Oppenheim, while discussing cerebral
infantile paralysis, says intelligence may remain quite
unimpaired. Sinkler's patient of "14 years old, was fully
equal to or more advanced than boys of his age" in
school. But the congenital cases, though they may show
no impairment in the sensory field, intellectually are far
below par, while in the adult it may vary according to
the underlying factors.

Physical examination — Height 57yi inches, weight
93 lbs. (stripped). Teeth ground down somewhat. Tongue
rather hypertrophic. All the skeletal muscles well de-
veloped and prominent, especially hyperactive muscles.
Tarsal arch obliterated. Heart's action fairly regular in
rhythm and force, 96-100 per minute, during comparative
quiescence. Second pulmonic slightly accentuated. Pubic
and axillary hairs normal. External genitals rather
large. Urinalysis negative, specific gravity 1.024. Was-
sermann with blood and spinal fluid in all dilutions nega-
tive; of the latter protein content increased. Cells
normal. Lange's colloidal-gold reaction not characteristic
of syphilis of central nervous system.

Neurological examination — No atrophies or hyper-
trophies, except those mentioned above. General ap-
pearance puerile. Under-developed osseous system, hyper-
trophied skeletal muscles and tongue. Tone of muscles
rather below par. Grip comparatively weak and unsteady.
On passive movement of extremities all the flexions
are done readily, the extension meets a great resistance;
only after some seconds do they give way gradually.

i

Photograi'h I.
Feet wide apart so as to be able to steady himself.

Athetosis 283

On account of defective cooperation of the patient,
examination in certain respects was unsatisfactory, but
tactile, pain and thermic sensations were appreciated
well to all appearances. Special sensations also showed
at least a fair amount of development. Audition rather
impaired, vision and taste indicate nothing abnormal.
There is probably some blunting of general as well as
special senses, but its actual existence, the extent of
deficiency, and whether the defect is iri the sensory
apparatus or due to general mentality of the patient
it was impossible to determine.

While sitting, patient keeps the feet locked, which
show some degree of varus. On standing legs wide apart so
as to be able to steady himself. (See Fig. I.) Gait some-
what stiff and shuffling, with a tendency to drag the left foot.
Romberg's symptom negative. Coordination of upper
extremities also fair. The inability to do finer work
seems to be due to his particular motor unrest. He could
remove the cap of a pencil and insert it on the other
end. Can place a pencil or a match behind each ear
with right hand, not with left, and ordinarily he cannot
button his shirt, lace his shoes or thread a needle. No
tremor of tongue, fingers and other muscles. Tongue
protrudes in mid line, spreads out widely, jerking forward
and backward.

Reflexes — Cutaneous reflexes are present. Babinski
or Oppenhcim phenomenon not elicited during compara-
tive rest or sleep. Abdominal and cremasteric nonnal.
All the sphincters well controlled. Deep reflexes are all
present to normal extent. Size of pupils moderate, round
and equal, and regular in outline. React promptly to
direct and consensual light reflexes. Reaction to ac-
commodation and sympathetic could not be tested. No
paralyses could be detected, but in standing and walking,
particularly if patient's attention is distracted, there is
a noticeable left lateral flexion of the trunk; right shoulder
much higher than left. Jn walking patient drags the
left foot. Left upper extremity also is less active. Patient
can stretch out the arm or take hold of articles in a

284 Hagop Davtdian

peculiar way, but very awkward and clumsy in perform-
ing any act. He uses it less than the right. If ordered
to do anything he will reach with the right; if ordered
to do it with the left he will start doing it with the left,
but may assist it with the right, or at least in elevating
the left elbow or carrying the left arm or hand with the
right hand. The above mentioned test of placing a
pencil behind the ear was ultimately done with the right,
but repeated attempts failed with the left hand, even
arm being assisted with right hand. On active or passive
motion of the muscles and joints of left side no appreciable
fiaccidity or spasticity can be made out, yet there seems
to be some weakness of the entire left side.

But the most prominent symptom in the case is the
accessory motions. During sleep they are entirely absent.
In comparative rest also may be absent, especially if
hands and feet are interlocked with each other, but
ordinarily any casual stimulus is likely to give slight un-
rest to fingers and toes. But the exacerbation of the
movements of these parts and progressive spreading to
all the musculature is proportionate to (1) sensory (general
or special) stimulation; (2) still more with psychic and
emotional excitation and (3) becoming almost violent
on attempt at voluntary motion. With a supreme effort
of will only momentarily patient can control and restrain
the abnormal movement, but during the forced restraint,
it appears, the efferent impulse accumulates and as soon
as it is overcharged, as if an explosion of motor discharge
ensues, compensating for the total sum of motions that
was due for the whole period of forced inaction. As to
rate and range, the rapidity and amplitude, the move-
ments are not uniform in all muscles. But most marked
in the most distal parts of the extremities, by far, of the
uppers than of the lowers. At one and the same time
all the fingers are set in different directions. One or more
are held in a tonic condition in extension, others in
hyperextension, the remainder in various degrees of
flexion. All or several are widely separated, and poised
in what is called interosseal position. From this tonic

Photograph II.

The fingers are set in different directions. Rifht shoulder elevated.
Bodv twisted. Lips open wide, draw the angle of the mouth to one
side. Eye-balls directed to left and upward.

(This photograph was taken but a few seconds after the Photograpli
III by another camera. This phase lasted only a few seconds.)

Photograph III
Lips are pressed tightly and puckered. The contractions of
frontales and levator-palpcbrae muscles producing all possible contor-
tions, grimaces, etc. Contraction of sterno-mastoid produces torticollis.
(See also Photographs II and IV.)

Athetosis 285

state no abrupt relaxation takes place, but a slow change in-
to an entirely different attitude. (See Fig. II.) The contrac-
tion and relaxation of each individual muscle is very much
alike to the effect produced, after the stimulation of
a veratrinized muscle-nerve. At times it happens that
all extend or flex, or while the thumb and index finger
are held in extension and the last in flexion, the inter-
vening fingers assume different relative gradations, giving
the hand a fan-like appearance. The bilateral corres-
ponding fingers do not undergo the same motion at the
same time. This is also true for the muscles of the arms
and the legs, that no similar motions occur bilaterally.
At times fingers intertwine, ride and roll over each other.
These movements are irregular and arhythmic, do not
have the rate and amplitude of a tremor, nor the ease
and the rapidity of a normal movement. The character of
the movements, especially of the fingers, has given rise
to numerous descriptive phrases and similes: vermicular,
serpentine, writhing, cramp-like, like tentacles of polypi,
ameboid, etc. All these seem to be fairly well fulfilled
in the fingers of this patient. Arms are adducted and
abducted, retracted and protracted, flexed and extended,
at shoulder, elbow and wrist joints. Forearms pronate
and supinate, displaying all the conceivable motions in
all planes. During these agitations tongue is constantly
churned and rolled about in the mouth, forces itself
between the teeth, presses against the lips or into the
check and smacks against the palate. It shows notable
hypertrophy on protrusion. Masticatory muscles cause
ruminating motions, retraction or forward protrusion
of chin, perpetual gnashing and grinding of the teeth.
Lips arc tightly pressed or open wide, draw the angle
of the mouth to one side, then the other, and pucker
them alternately. The contractions of frontalis, levator
palpebrae and facial muscles produce all possible expres-
sions,contortions and grimaces, forced smiles and grins of the
face. (Sec Fig. III.) On extreme excitation extrinsic ocular
muscles give rise to occasional and transient internal
strabismus. With the play of neck muscles head is

286 Hagop Daoidian

strongly arched backward, or by the contraction of op-
posing muscles chin is butted against the sternum, or may
rotate right or left, or incline the head on right or left
shoulder, or again by unilateral contraction of sterno-
mastoids a typical but temporary torticollis is produced. (See
Fig. IV. While walking the involuntary motions of the feet
are not noticeable, but as soon as patient sits down and es-
pecially on attempt to resume the walk, or any other
muscular action, toes start to wriggle about and show
dorsal extension; also the feet, from ankle joint down,
display a lateral or flexo-extensor type of unrest. The
movements of toes and particularly of lower extremities,
as mentioned above, are less active than those of uppers.
The muscles of the trunk also contract irregularly and
incoordinately, twisting the body and causing now one
variety of scoliosis and now another. When a general
type of motility spreads itself to lower extremities while
sitting, suddenly patient is rotated to one side, and the
thigh thrown out laterally, soon followed by crossing of
the knee, etc.

If the patient is ordered to stand up, or turn his
head to one side, or catch hold of an article, he is unable
to perform it promptly. At first a sudden restraint
comes on, soon followed by inordinate typical athetoid
movements, and only then is he able to force liimself
to carry out the command, the normal motions being
modified by the abnormals to give rise to irregular zigzag
routes. The fingers are involved to such an extent as to
be almost beyond the control of volition. It is extremely
difficult to oppose the thumbs against the forefingers
voluntarily. Patient picks up and takes hold of small
objects, as pins and pennies, with the thumb and the
middle or ring finger, sometimes with the thumb and
dorsal aspect of inter-phalangeal joints, while he uses
his spoon and other articles of that dimension in his
palm, closing all his fingers against the handle and spoon
sticking out of the ulnar edge of the hand, in which man-
ner he usually feeds himself. During the performance
of an action the involuntary motions are so aroused that

Photograph IV.
Tongue churned and rolled about — forces itself between the teeth,
presses against the lips. Chin butted against the sternum.

Photograph V.

Most characteristic feature is the abnormal degree of mobility
of the joints.

Athetosis 287

after the start of an act, to finish it is almost impossible,
such as, while carrying the spoon to his mouth suddenly
the hand is withdrawn but a few inches away from him,
patient is unable to take it into his mouth and looks
after it longingly. He is now so aware of this interference
that he balances the spoon for a second or two, then with
supreme force, before any opposite reaction sets in,
shoves the spoon into his mouth with lightening-like
rapidity. The same way with dressing and undressing,
the same in using a handkerchief, he concentrates his
entire will and the application of a handkerchief, blowing
his nose, wiping it clean takes but a fraction of a second,
then the arm, the hand and fingers are all distorted,
carried away from him. He may even lose control of
his fingers and drop the handkerchief. These abnormal
involuntary movemetits, engendered by the voluntary
acts of feeding or dressing, encumber and tax him so
completely that patient is drenched in perspiration,
heart's action mounts up to 120-130, respiration labored
and makes him take deep sighing breaths, loud and
repeated belching and involuntary escape of gas per
viam ani are very common at the table. At the end he is
completely exhausted and worn out. These motions
that have been going on since birth have affected, and
very naturally, certain morphologic changes. In spite
of the enormous appetite of the patient the amount of
adipose tissue is negligible, hands and fingers short and
proportionate to the rest of the body, yet well padded
and stocky. Muscles stand out well outlined and promi-
nent. But the most characteristic feature is the ab-
normal degree of mobility of the joints. This is considered
as characteristic, a symptom of athetosis as the involun-
tary movements. Metacarpo-phalangeal joints are hyper-
extended to produce a curve that cannot be imitated by a
normal hand. Interphalangeal joints also display this to
marked extent. (Sec Figs. V. and VI.) The cubital fossa of
the elbow, especially on the left, is rotated forward and out-
ward, decidedly, supinating the forearm, but the extreme
pronation of hand at the wrist joint counterbalances it.

288 Hagop Davidian

giving it a normal appearance at first sight. While the
arm suspended on the side if the patient is ordered to
turn his hands forward and outward, the dorsum of each
hand can readily and completely lie against the thighs,
each palm facing directly outward. During a paroxysm
he can even overdo this, further rotating the palms
postero-laterally. Also while the knees are extended
completely thighs can be flexed over the abdomen up to
right angle with the body, and abducted up to right
angle with the body that ordinarily on normal persons
cannot be duplicated.

The aetiological factors, enumerated above, as it is
evident, are not specific that invariably and exclusively
cause athetoid movements. But apparently all give rise
to such changes in the nervous system that ultimately,
though indirectly, bring forth this motor disorder. There-
fore the mode of production of this end, by all these
dissimilar and heterogeneous factors, could be resolved
into several groups :

1. Developmental defects.

2. Degenerative changes.

3. Mechanical irritations.

4. Toxic irritations.

5. Miscellany.

(1) The best instances to this group are supplied
by cases of infantile cerebral paralysis, to which athetosis
is a frequent secondary symptom. Frankl-Hochwart says:
"It is probable that prenatal defects of development
play a role in the forms acquired in intra-uterine life,"
and enumerates, among others, such morphologic stigmata
that some undoubtedly, others likely to fall into the
evolutional period; anomalies in cerebral membrane,
defects in the structure, microgyria, porencephaly (Kund-
rat), irregularities of cerebral convolution (Dejerine-
Sollier, also Oppenheim); porocrania, depression in the
skull, decrease in the circumference (Peterson and Fisher
and others). Further, cases revealing alike symptoms
have other developmental stigmata, such as atrophy of
generative organs (Lannois and Oppenheim), disalignment

Photograph VI.
Hands and fingers short, yet well padded and stocky. Muscles
stand out well outlined and prominent. Mctacarpo-phalangcal joints
are hypcrextonded to produce a dorsal curve. Intcr-phalangcal joints
also display this to a marked extent.

Athetosis 289

of fingers (Fere), microphthalmia, etc. The association
of athetosis and irabeciHty or epilepsy point strongly
to the defective or arrested development of the brain.

(2) The mobile spasms are far more frequent after
cerebral softening from vascular occlusion, than after
cerebral haemorrhage (Med. — Chir. Trans., 1876.) Soften-
ing pervades through greater territory, and effects extensive
yet incomplete damage. While in athetosis accompanying
infantile cerebral paralysis it is common to find softening
and cysts in the brain tissue, abscess is rare. Berger
met a single instance in his review of the reported cases
(Jahrbuch fur psychiatric, Bd. XXIII.)

(3) Pressure, directly or indirectly, sufficient to cause
stinuilation of cells or their fibres by mechanical irritation :
Clot, tumors, cicatrices and neuroglia formation and "in
exceptional cases compression" (Hochwart.)

(4) Toxic substances in the blood, either extraneous,
such as lead alcohol, etc., or metabolic as in diabetes,
uraemia or any other morbid processes that "impair the
nutrition of nerve cell and alter its function" (Gowers)
are likely to give rise to motor irritation.

(5) This group is reserved as a compartment for
such conditions, where all doubtful and unintelHgible
factors could be thrown in for the time being, until a
future light will either dismiss them or categorize them
into one of the above groups, or provide a new and
rational one. Do such causes as shock, fright, chill,
agitation, etc. give rise to motor irritation and how
they do so, appears as inexplicable as an idiopathic
disease usually is.

The above causative factors and the process of their
operation, incomplete as they may be, still less is the know-
ledge possessed concerning the actual size where they
bear their baleful influence.

Hammond himself, without any opportunity of a post-
mortem examination, and concluding from the character
of the accompanying symptoms, guessed the lesion to be
cerebro-spinal one. Since his observation there have been
numerous autopsies.

290 Hagop Davidian

Strumpell in a case of idiopathic, and Gordon Holmes
in an infantile cerebral paralysis with secondary athetosis,
found no lesion whatever macroscopically. There are
reported other cases with negative findings. In these,
however, it is not known whether microscopical exami-
nation also was done or not. As stated above, Oppenheim,
as well as Dejenire and SoUier met cases with no lesion
except convolutional irregularities. Putnam cites a re-
port by Ewald and Kuessner of a case of paresis with
athetoid movements in whom also no gross lesions were
found. While the latter observers^ found in another case
of paresis with typical athetoid type of movements, a
localized lesion in the cortex of the temporal lobe.

Demange reports a case with a lesion only in the
cortex, and is certain that athetoid symptoms may result
from disease limited to the cortex (Rev. de Med., 1883.)
Boinet, and also Boncarut, found, in a case with ehoreo-
athetoid movements, a localized meningo-encephalitis in
the region of Rolandic fissure. Horseley operated on
several cases of athetosis, on the corresponding cortex,
and in his Linacre lecture reported one in which he
demonstrated, among other things, vascular, meningeal
and convolutional abnormalities, reduction in depth of
cortical grey-matter, but above all histological morbid
changes in the cortex of the involved area. (Br. Med.
Jour. June 17,'09)

Also Strumpell and Beevor believe the lesion causing
athetoid movements is a cortical one. On the other hand
Rosenbach first observed, in cases of tabes dorsalis
"slight involuntary and slow movements of the hands
and feet," and since, others admitted seeing similar
cases, proving the association of mobile spasms with
lesions in the cord.

But the above reported cases, altogether, though some
of them exact and accurate both gross and microscopically,
constitute exceptions to hosts of other reports by numerous
observers, among whom several of the above mentioned
pathologists included. These tend to localize the focal

Athetosis 291

lesion producing mobile spasms in general, athetosis in
particular, in the region of basal ganglia.

Without entering in detail into their various findings
and consequent individual opinions, some of these cases,
which presented only isolated single lesions, are collected
here to obtain the ratio of the regions involved. Cortex
3%, cerebellum 2%, internal capsule 15%, lenticular
nucleus (on two occasions involving caudate nucleus also)
18%, and about 62% optic thalamus. From the earliest
times of post mortem examinations in the athetoid cases,
opinion has strongly prevailed to attribute the pathogenic
focus to optic thalamus.

Osier says: "Athetosis is the result of thalamic
lesion and not of lesion of corpus striatum, as was at
one time believed. Choreic movements, ataxia, and in-
tention tremor may result from lesion in the cortical
motor pathways, but athetosis does not. In several
cases of athetosis recently studied microscopically, lesions
of the red nucleus, the tegmentum and the vicinity have
been found." Gowers, Nothnagel and Stephan incline,
as the result of frequent association of hemiathetosis and
hemi-chorea with localized lesions of optic thalamus, to
ascribe these conditions to this ganglion. Other recent
observers do not neglect the cases of pure athetosis
with single circumscribed lesion outside of thalamus, and
it is thought, no matter where the lesion is, the symptoms
are due to the irritation of the neighboring pyramidal
tract; therefore a lesion situated anywhere in the vicinity
of motor tracts in the middle or posteiior area of optic
thalamus, lenticular nucleus, superior cerebellar peduncle,
cerebellum, internal capsule, pons, bulb, or even below,
under certain circumstances may produce this peculiar
symptom group (Kahler and Pick.) Pineles' case proves
that a lesion in the cerebellum, conditioned by some yet
unknown features, gives rise to athetoid type of motor
disturbance.

Charcot believes that the essential lesion will turn out
to be that of centripetal fibres. Monakow affirms this
view that irritation passes from thalamus and midbrain

292 Hagop Davidian

along afferent fibres to the cortex. Anton thinks there is
a counter-action between thalamus and lenticular nucleus;
the thalamus originating automatic actions and lenticular
nucleus checking them, and a lesion of the latter would let
loose the former ganglion. Bonhoffer concludes that
hemiathetosis and hemichorea are produced by focal lesions
along the tract of superior cerebellar peduncle, "i. e. in the
fibres which pass from the cerebellum through the superior
cerebellar peduncle and the red nucleus to the thalamus
and their terminations," and many others, among whom
are Berger, Pineles and Oppcnheim, and Gordon Holmes,
sustain this view. Various theories have been formulated
as to how a lesion situated in any part of this cere-
bello-rubro-thalarao-cortical tract gives rise to motor
irritations; but all these views have their ardent adherents,
opponents and modifiers. Out of all the pros and cons
Oppenheim constructs the following statement:

"Post-hemiplegic motor disorders, hemichorea, and
hemiathetosis are caused by direct or reflex stimulation
of the automatic motor centres in the optic thalamus,
therefore (1) by small, irritative foci at certain sites
in the thalamus; (2) by foci which are situated in the sen-
sory fibre bundles passing into these thalamic centres,
and particularly in the cerebello-thalamic tract or the
tract of the superior cerebellar peduncle; (3) especially
in childhood, by morbid foci which permanently cut off
the motor cortical centres and thus cause the thalamic
centres to acquire an excessive independence as regards
involuntary movements, which is revealed by the chorea
and athetosis (especially in infantile cerebral paralysis.)"

The treatment of the athetoid movements, and by
far the best, is the preventive. But preventive and symp-
tomatic measures for pain, sleeplessness, etc., is thought
to be superfluous to discuss here in detail. After the
onset of the motor disorcler treatment may be aimed
at the central nervous system, or at the region involved.

Someone recommended suspending an iron-plate from
involved arm, so by sheer weight to counteract the
contractions. Another similar remedy has been recom-

Athetosis 293

mended — enveloping the athctoid limb or limbs in plaster
of pans cast and leaving it so for months at a time; in
limited and milder cases this latter method has shown
some improvement at least. Hammond treated his
original case at first with galvanic current by placing
the positive along the neck, and the negative pole over
the involved muscle; his result was not conclusive.
His example was followed by others, with variable results.
Gowers used it on a symptomatic case with hemiplegia.
Gnauck also treated a patient of idiopathic type with
electricity and K. Br. and both the cases were recovered.
Gullain and Dubois applied pressure over the eye-balls.
This first maneuvre, first used by Lesieur, Vernet and
Petzetakis, had produced certain systemic effects, such as
exaggeration of reflexes, polyuria, albumin- and glycos-
uria. And Loeper and Mile. Weil noted nausea, astasia
and syncope; further, it dispelled anxiety, distress and
suffering, and vertigo, and checked such reflex acts as
hiccough, yawning and sneezing. Gullain and Dubois
practised this "ocular compression" on a case with double-
athetosis, eliciting what is termed "oculo-cardiac reflex."
Apparently this method caused the stimulation of vagus,
reducing the heart's rate. Compression was applied
sufficiently to effect palor, tendency to syncope, which
symptoms constituted signals to stop the process. And
by this means the incessant choreo-athetoid movements
completely ceased during the compression. (Bull, and
Mem. de Societee Medicale, d'Hop. de Paris, May 14,
1914.) This initial attempt apparently neither cured nor
permanently improved the disorder, but suggests a new
mechanical means for further trial.

The most hopeful tactics to cope with this distressing
affection, however, seems to lie along surgical lines. And
we are indebted to Hammond, who not only originally
discovered and described the affection, but also success-
fully treated his original case. He stretched the in-
volved median nerve; some writers state that the patient
was considerably improved, while others say permanently
and entirely cured.

294 Hagop Davidian

Wm. Spiller attempted a plastic method, by coupl-
ing the distal ends of the motor nerves of the in-
volved muscles, to a nearby normal nerve trunk, with a
certain amount of success. In one case he divided the
ulnar and median nerves and did a lateral anastomosis
of the peripheral segments of these nerves to the musculo-
spiral nerve, and in the same patient and same ann
divided both the circumflex and musculo-cutaneous, one
of which was affected, the other normal, and performed
an end to end anastomosis, suturing the peripheral seg-
ment of the involved nerve to the central end of the
normal, and vice versa (Spiller, Frazier and Van Kaatho-
ven, Am. Jour, of Med. Sciences, 1906.) The various
modifications of this technique as the author proposes
and especially more attenipts in this line extend much
hope for success. A limitation to this, however, is the
type of cases that must have normal neighboring nerves
to fall upon.

Media and Bossi, on several occasions, performed "a
partial resection" of the involved nerves. After exposing
the nerve-trunk they isolated the fibres out of the common
trunk by pinching, unlike the customary electrical stimu-
lation in delimiting the cortical areas, which tends to
spread the excitation to the contiguous zones. By this
means they isolated the pronator fibres, which were in-
volved in their case, at the elbow and cut away about
5 c. m. length, half of the thickness of the nerve fascicle.
They further state that after recovery, while the athetoid
motions disappeared entirely, the normal voluntary
movements were retained. They cite at least two success-
ful results (Revue Neurologique, March 7, 1912.)

On the other hand Sir Horsley, in the case mentioned
above under his name, excised the cortex, after limiting
the so-called "motor" region by electrical excitation.
In this case also all the adventitious motions disappeared,
but at the time he made the report the voluntary motions
regained, after the initial paralysis, was not complete.
He states that he had arrested athetoid and clonic move-
ments on two previous occasions by similar procedure.

Athetosis 296

All the above aims are for such cases in which the ab-
normal motions are limited to certain muscles or a limb.
In bilateral types when almost all the muscles are involved,
especially in some idiopathic cases with imbecility and
epilepsy to indicate a more or less general and diffuse in-
volvement of the brain, even surgical means give no ray
of hope.

Athetosis, after all, is worth differentiating, if not as a
disease, at least as a distinct clinical manifestation. So
long as it repeats itself in typical cases with well outlined
and definite features, (even though as the result of unlike
causes, and in the course of different diseases) it foretells
a specific and definite underlying lesion.

In conclusion — Athetosis is a motor disorder, charac-
terized by a lesion, probably in the central ganglia or the
fibres issuing from them, that, directly or indirectly, irri-
tate the nerves of the involved muscles, giving rise to ad-
ventitious movements, that are involuntary and incoordi-
nate, tonic and deliberate, slow, irregular and writhing;
provoked by any peripheral (sensory) or psychic stimulation
and highly aggravated on attempt at voluntary muscular
action which becomes modified and distorted; in milder
cases only, in the severer forms mostly, the distal segments
of the extremities, the uppers more than the lowers, and
gradually advancing centralward to involve next the head
and the neck, and in most severe cases the whole skeletal
musculature. As a rule the paroxysm subsides during
rest, and in the majority of cases is entirely quiescent in
sleep, and in consequence the morbid excess of motions
produces permanent anatomic changes; such as hyper-
trophy of muscles, and particularly hypermobility of
articulations.

SELECTIONS

NEUROSURGERY

Choosing the Locus Operandi for Incorrigible
Juvenility is a Puzzling Proposition. — Trephining the
cranium has lately been found effectual in one instance
of arrested development but the most effectual results
appear to have resulted from the practical, judicious ap-
plication of King Solomon's plan of operating on the
other extremity of the body. The nates receive more
attention from parents than from surgeons. All depends,
however, on the aspects from which the subject is viewed
and the viewer.

CLINICAL NEUROLOGY

The Number and Kinds of Bacteria in City Dust.
— "In the street dusts, B. coli was usually present;
in the street dust an average of 51,000 per gram was found
and in two samples over 100,000, while none showed less
than 100. The indoor dust, on the other hand, showed
an average of between 1,000 and 2,000. Acid-forming
streptococci, such as are characteristic of the mouth,
were present to the extent of over 1,000 per gram in
three-fourths of the street samples and one-half of the
indoor samples. The average for the street samples was
about 40,000 per gram; for the indoor samples about
20,000 per gram. The large proportion of these organ-
isms, particularly in the indoor dusts, appears to be sig-
nificant of buccal pollution." — Pacific Medical Journal.

(296)

Selections- 297

Winslow and KHgler found in 107 samples of school
houses, other public buildings and New York City streets,
almost innumerable bacilli, especially bacillus coli and
acid-forming streptococci. A large proportion were mouth
pollution baccilli from indoors and streets. The pre-
cautious hygienic significance of this is clean antiseptic
floors and street sprinkling and washings, including the gut-
ters and curbs which are too much neglected by city
sprinkling carts.

The Discovery of the Spirochaetes in the
Brain. — "The discovery of the spirochaete in the brains
in twelve cases out of seventy by Moore and Noguchi,
confirmed by further observations and by other workers,"
says F. W. Mott in Apl. Jour, of Ment. Science, "has
not only forged the last link in the chain of evidence
necessary to show that syphilis is the essential cause of
general paralysis and tabes, but it has made it necessary
to regard the pathology of these diseases in a new light,
and in future to speak of them as 'parenchymatous
syphilis.' Noguchi later examined 200 brains from cases
dying from general paralysis, and twelve spinal cords
from tabes dorsalis. He has obtained positive results in 25
per cent, of the cases of general paralysis, whilst only one of
the twelve cases of tabes gave a positive result. He re-
gards general paralysis as a chronic parenchymatous
encephalitis.

"Soon after Noguchi published his paper a number of
observers — Berial, Jakob, Levy, Marinesco and Minea,
Marie, Levaditi and Banchowski, Mott, Ranke, Schmorl,
Verse — confirmed the existence of spirochaetes in the
brains of paralytics. Very soon Forster and Tomasczewski,
followed by Noguchi, demonstrated the presence of spiro-
chaetes in small cylinders of brain removed during life
by the Neisser-PoUak puncture method."

This seems true beyond doubt of G. P. but we are
not so sure as to tabes dorsalis.

208 Selections.

Nervous Shock in War. — W. A. Turner, Brit.
Med. and N. Y. Jotar. for May, distinguishes three groups
of cases. In the first there is a definite type of mental
shock in which the symptoms are essentially of a psychical
character. In the second group there is a spinal type
characterized by a limitation of the symptoms to the ex-
tremities and usually to the lower limbs. In a third
group the symptoms are referred more particularly to
the special senses. In this class the remarkable cases of
blindness or amblyopia, deafness and deafmutism have
been included. More specialized sjrmptoms, such as
stammering or hesitation of speech, local palsies and
tic-like movements, have been included in a fourth group.
In the more severe class of case the patient is entirely
unconscious of his surroundings. All the usual tests
applied with the object of arresting attention — such as
throwing a bright light onto the eyes, pinching the skin,
or clapping the hands close to the ears — fail to provoke
a response. The deep reflexes, however, are normal or
brisk, and the plantar response is of the flexor type.
The pupillary light reflex is frequently impaired or lost.
Urine is passed normally; swallowing is carried out usually
without difficulty. There are cases of loss of memory
or transitory amnesia which are admitted to the base
hospitals for further observation. Deafness of a transient
character is not an uncommon symptom resulting from
the explosion of big shells in close proximity to the patient,
while blindness or impairment of vision from the same
cause is relatively infrequent. Hesitation of speech has
been observed in several cases. The outstanding symptom
of spinal shock is loss of power in the legs. There is
observed a form of temporary "nervous breakdown"
occurring in those who have been strong and well, and is
ascribed to a sudden or alarming psychical cause, such
as witnessing a ghastly sight or undergoing a harrassing
experience. As the result of such a shock the patient
becomes unduly emotional and shaky, his sleep is dis-
turbed by bad dreams. The dreams are of experiences

i

Selections. 299

through which he has passed, of shells bursting, of duels
between aeroplanes, or of the many harrassing sights of
the war in the trenches.

NEUROTHERAPY

An Error Concerning Chloral-Hydrate Correct-
ed.— The editor of the London "Hospital" says: "The
statement frequently made, that chloral hydrate depresses
the heart is of very questionable value. It has lead to
much timid prescribing and to the neglect of an excellent
hypnotic."

Cur experience of many years' practice concurs.
We concede no exception, even in our early interim of
country practice, where we gave it in the second stage
of hard labors before the so-called twilight sleep, (a new
term devised for this old labor aid) with a single preceding
dose of morphia.

The Intracranial Treatment of Paretic Demen-
tia.—(Ralph C. Hamill, M. D., Chicago, 111., Med.
Jour., March, 1915.) — In December, 1913, Marinesco
and Minea reported the injection of salvarsanized serum
into the subdural cavity in two cases of paretic dementia.
Each case received 20 miilligrams dissolved in 2 c.cm. of
the patient's inactivated serum injected into one side ot
the skull only. — Medical Fortnightly.

The Rum Ration in the English Army. — Sir Victor
Horsely, in more than one open letter and paper printed
in several late issues of the British Medical for February,
1915, inveighs in forcible language against the continued
use of the rum ration of ages past in the British army
of today as now fighting on the continent. He claims
that no less than 250,000 gallons of rum were sent across
the channel in November of 1914, and asserts that it
produces loss of moral sensibility, drunkenness, decadence,

300 Selections.

loss of endurance, loss of efficiency in loading, aiming and
firing and hitting the mark. He also claimed that out
of total abstainers, it tended to make drunkards by
telling the men that rum was good for them and that
the surgeons had ordered it (by compulsion of the govern-
ment.) The rum ration is, in his opinion, an inheritance
from the days of ignorance. When ships were obliged
to stand off and fire at one another at 500 feet the worst
tipsified sailor could hardly fail to hit the mark, but now
that they fight sea combats at miles distant, great skill
is needed and the clearest hands and brains to see
and to aim and to hit the mark which, in its turn, is
doing its best to blow you out of the water. So, too,
in the land campaigns of today, the greatest temperance
and sobriety are essential to a good result against a
skillftil enemy. — Maine Med. Jour., April, 1915.

Treatment of Diabetes in the Field. — Rudiger
states that many soldiers at the front have diabetes. A
dietetic treatment is out of the question, for at the
front there is but one diet. The medical treatment must
be chiefly symptomatic, and the author knows of but
three remedies — opium, bromides and salicylic acid. The
first named controls the polyuria, thirst, and excretion
of sugar and holds back the inevitable loss of weight.
Diabetics have besides a natural tolerance towards opium.
The action of the latter even persists after its with-
drawal. Bromides are of use only when it is desirable
to suspend the opium for a brief period — about one
week. Salicylic acid in some way lessens the production
of sugar in certain patients by whom it is well tolerated.
As not all patients bear opium well, it may be tested
as a substitute. The author does not believe in the high
initial doses of opium. At most he would limit the
daily dose to about two grains of the drug given in three
doses. One-half or less of this amount should give the
desired effect. The daily dose of bromides should be
from 3 to 5 grams. — London Lancet.

Selections. 301

The Startling Statement has been made by Dr.
Katharine B. Davis, Commissioner of Corrections of New
York City, that the city's crime age has dropped in a
generation from 35 to 25 years. "Our sociologists,"
says Commissioner Davis, "are at a loss to explain this
phenomenon." May not one of the factors helping to
produce young criminals be the wide use of drugs.'' The
enforcement of the anti-drug law has brought to light
hundreds of victims who are suffering terribly through
the cutting off of dope suppHes. The average age of six
wild-eyed dope fiends, who surrendered to the New York
police at one time, was 28 years. An eighteen-year-old
boy, a victim of the cocaine habit, was arrested on a war-
rant asked for by his father. One heroin victim, who died
while being taken to the hospital, was only twenty years
old, and it is said he had a large circle of friends of his
own age addicted to the habit. Dr. Perry M. Lichtenstein,
the physician of the Tombs prison, who has the treat-
ment of drug victims on his hands, says that many
drug users commit petty crimes, either stimulated by
drugs or to obtain money with which to buy drugs.
One of the things that all prison authorities have to
contend with is the smuggling of drugs into the prisons.
The strict enforcement of the anti-drug laws has left
many victims in a pitiful plight. — Leslie's, May 13, 1915.

In this connection police neglect of children's im-
proprieties on city streets and premises is much to blame
for juvenile crime developed for later years.

Studies in Prostatic Obstruction and Vesical
Atony. — In a paper by Dr. Bransford Lewis, of St. Louis,
with the above title, read before the American Urological
Association, June 18th, 1914, at Philadelphia, the follow-
ing were the conclusions:

1. The exact causation of urinary retention should
be sought for in all cases before adopting a plan for
treatment.

2. It should always be found in one of two factors,
viz.: (a) physical obstruction of some kind, or (b) dis-
turbance of the nervous mechanism controlling urination.

302 Selections.

3. There is no such thing as "unaccountable" atony
or urinary retention; such a term represents an incomplete
diagnosis.

4. There is no such thing as "incurable atony"
except when it is caused by some nerve-degenerative
process (tabes, etc.) that precludes restoration of the
expulsive power; and it is unjustifiable in the most of
these cases.

5. Even when the retention and atony are caused
by nerve degeneration much can be done in the way of
treatment, both locally and internally, to facilitate urina-
tion and improve the conditions -prevailing.

6. Where the cause is a physical obstruction, its
complete removal paves the way to restoration of the
expulsive power.

7. The most frequent and important of the obscure,
unrecognized causes of obstruction are: (a) ill-defined
contracture at the vesical neck (demonstrable sometimes
only by palpation through the opened bladder or urethra);
(b) unrecognized syphilis, acquired or hereditary, affecting
the spinal centers.

8. Such conditions are by no means confined to
adult life, and should be looked for and recognized at
any age, from infancy up; diagnosed and treated in ac-
cordance with the defined diagnosis always demanded
by cases of urinary obstruction.

9. Syphilis is a surprisingly frequent cause of such
conditions. Lack of syphilitic history or general nerve
symptoms, in obscure cases, should not preclude investiga-
tion by means of a Wassermann blood-test; and if this
proves doubtful, a Wassermann test of the spinal fluid
should be made, as well.

10. The supreme value of early recognition and dif-
ferentiation of such cases appears in the opportunity it
offers of affording appropriate treatment before the case
has assumed the hopeless phases that preclude reclamation
or benefit.

A final, but too-late, recognition is but poor solace
for a life time of suffering due to delinquencies in diag-
nosis.

Selecitmi':

303

Some may regard the above as out of place in this
Journal but local vesical trouble often accompanies
and aggravates and may cause or proceed from marked
neuropathic (peripheral or central) breakdown and what-
ever local disability may be found with neurasthenia,
psychasthenia or other nervous states should be looked
into and remedied and vice versa. Neuropathy and
psychotherapy should not be overlooked. Ante or post
operative nerve sedation and support should be invoked
in all cases as well as operative procedure where indicated.

By psychotherapy here we mean the allaying of
apprehension, the diminishing of pain irritability, the pro-
motion of ample rest and sleep, etc.

It is claimed by the makers of Hagee's Cordial that
medical men, for a generation, have subjected this medi-
cine to the most exacting clinical tests, showing it to
possess nutritive properties of a high order and in view
of its added advantage of palatability a front place
among reconstructives is claimed for Morrhuae Comp.
(Hagee) for females and children.

NEUROPHYSIOLOGY

Sajous' Recent Comments on the Ductless
Glands. — Thymus: An organ of temporary functional
activity, whose function it is to supply, through the agen-
cy of its lymphocytes, the excess of phosphorus in organic
combination or nucleins which the body, particularly
the osseous and nervous systems, requires during its de-
velopment and growth.

Pancreas: Produces an internal secretion which gov-
erns carbohydrate metabolism in the organism at large,
and supplies ferments which take a direct part in the
protein metabolism of tissue cells and also in the defensive
reactions in these cells and in the blood stream.

Adrenals: The secretion of the adrenals, while
possessing a marked affinity for oxygen, inevitably reaches
the pulmonary air cells where it absorbs oxygen and

304 Selections

becomes a constituent of hemoglobin and of the red
corpuscles. It further possesses the power of dilating
the bronchioles, thus increasing air-intake.

Thyroparathyroid : The secretion from these organs
enhances oxidation by increasing the inflammability of
the phosphorus which all cells, particularly their nuclei,
contain.

All pathogenic elements in which phosphorus is
present, bacteria, their toxines and endotoxines, toxic
wastes, etc., are thus rendered more vulnerable to the
digestive action of the plasmatic phagocytic or cellular
defensive ferments. — Abstract from St. Paul Med. Jour.

Dry Vegetable Cure in Diabetes Mellitus. —
M. Labbe, in Bulletin de I'Academie de Medicine for
January 13, 1914, states that the oatmeal cure does not
sufficiently support nitrogenous metabolism. A diet of
dry vegetables yielded excellent results in the author's
hands. The patient took daily ten ounces (300 grams)
of vegetables, five ounces (150 grams) of butter, three to
six eggs, and the same number of aleuronat or gluten
rolls. A small amount of green vegetables may also be
permitted, but no meat. For the ordinary dry vegetables,
peas, beans and lentils — soy bean may be substituted. —
Med. Fortnightly.

THE

ALIENIST AND NEUROLOGIST

Vol. XXXVI. St. Louis, August, 1915. No. 3.

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This magazine must not be expected to print whole pages of commercially devised,
fulsomely laudatory puffing of proprietary advertisements, prepared by non-medical
commercial agencies who know nothing of the facts of therapeutics nor of the medical
code of ethics. Some of the puflfs are so far from the truth that they are an insult
to medical intelligence and do more harm than good to worthy proprietaries.

Such proprietaries as we carry speak for themselves with physicians, especially
when their composition appears. Our readers are discriminating judges of what
they want.

CONCEBNINO RENEWALS OF STTBSCBIPTIONS
This magazine would be much indebted to its regular subaciibers and advertisers
if they wotdd renew by direct communication with this office, especially in the United
States, and not through news agents.

CHAS. H. HUGHES, M. D., Editor and Publisher.

H. L. HUGHES, Manager.
Editorial and Business Offices, 3858 West Pine Boul.

EDITORIAL

Surgeon General Gorgas says that General Goeth-
als, when Governor of the Canal Zone, interfered with the
sanitary work in such a way as to render it much less
effective than it should and might have been. General
Goethals is a great engineer. He accomplished a marvel-
ous work in completing the canal. But he is not a
sanitary engineer nor a disease expert. He should have,
as the shoemaker is enjoined, stuck to his last. So says
the St. Louis Star and so say we all of us physicians.

(305)

306 Editorial.

An Ordinance Providing for the Employment op
Municipal Visiting Tuberculosis Nurses has been
drawn and presented to the City Council of Los Angeles,
California, by Dr. Geo. E. Malsbary, Editor of the
Southern California Practitioner, similar to that in
operation in other of the principal cities of the Union,
which ought to be put to work in St. Louis and with
it an auxiliary ordinance compelling city sprinkling up
to the curbs and with more water so as to lay the tubercle
and other nncrobe and bacteria laden dust, even though,
thereby an occasional auto may skid against the curbing.
The auto and the motor cycle are not everything to be
considered in our day of rapid going. We are going
som.e in advancing sanitation and the health of sidewalk
pedestrians is worthy of consideration.

Why Should Secretary Daniel prohibit the use of
the prophylactic venereal package which our men of
the navy use on the advice of the surgeons of the navy?
And how could this preventive packet tend to subvert
the foundations of our moral and Christian belief? as
the Secretary maintains in defense of his inhibition of
this personal right and poison-dissemination preventive.

Dissolute sexually obsessed sailors have poisoned the
earth with venereal disease. Women of lewd character
will take the risk in every part of the world and they
reciprocally spread the inoculation.

In this connection the unsanitary peril of our shore
leave navies might be considered by our surgeons-general
of the Army and Navy.

Since This is a Popular Non-Monarchical Govern-
ment it is proper and patriotic that all parties should ex-
press themselves on matters of popular concern, especially
on such subjects as pertain to the possibility of or the
promotion of peace. With this view of the interests
this Magazine represents — the maintenance of the right
and the rights of peaceful scientists to pursue their peace-
ful work and purpose for humanity's welfare the world

Editorial. 307

over — we demand that Great Britain and all her allies
abandon her purpose against the non-combatant people
of the world only needing sustenance from food carrying
vessels. The laws of humanity as to non-starvation of
the underaged, the overaged and otherwise non-belliger-
ent non-enlisted. Let the sea be free for food and rai-
ment for the needy civilian in peace or war.

Fatalities from Sudden Morphia Deprivation
IN Chicago. — Dr. Wm. D. McNally, coroner's chemist
of Cook County, Ills., in correspondence to Journal
American Medical Association, May 10th, 1915, found
among eleven deaths attributed to morphine that seven
of these fatalities resulted "indirectly from the sudden
cessation of the use of morphine."

Four also died from an overdose, one also from an
overdose of Wetherby's morphine cure. This shows the
danger to old habitues of sudden withdrawal. Old mor-
phine takers sometimes abstain so long as they can, then
resort again to the large habitual dose all at once and
poison themselves. The safe way is to go back with
gradually but rapidly increasing dose and then begin
to reduce gradually, substituting quinine and other
support in full dose, in the meantime adopting re-enforc-
ing, amply digested nutrition and reconstruction and in-
duced ample sleep and rest.

The Prayer op Medicine for More Laboratory
Light has been nobly answered by the Vanderbilt, Rocke-
feller and the more recent munificent gift of 0. H. Payne
of four millions to Johns-Hopkins and lesser but no less
significant gifts elsewhere, so that medical men have no
longer now, as heretofore, to draw upon their scanty
financial resources to promote the foundation needs of the
healing art beyond the clinic chamber.

But what a debt of gratitude is due to the charity
and self-sacrificing medical men who from their own
comparatively slender purses and inadequate time, devoted
both to the founding and maintaining of colleges, labora-

308 Editorial.

tones and clinics for the sake of humanity and scientific
medical progress before the public had appreciated or
provided for the higher needs of medical education.

All honor to our multi-millionaire philanthropists
who have heard and munificently responded to the cry
of medical educational need, gloriously helped to lift this
charitable burden of the centuries from the shoulders of
the medical profession. They have added (in sanitary
aid) more than armies would in time of war to the public
weal.

The Indianapolis News and the. State Medical Journal
of Indiana deserve the profession's thanks and those of
the people for noting anew the benefactions of these
munificent scientific philanthropists and we join in
the well deserved acknowledgments.

When the Great Malady (War in Europe) has
passed, that the life organs of civilization will begin their
normal functions again (Elbert Hubbard) is the wish and
hope of every lover of humanity, for much of the world is
now in distress and mourning and "the rivalry of commerce
is not settled by war."

Acquitting an Unfrocked Dissolute Inebriate
Clergyman Murderer on the ground of insanity and
setting him free at the same trial is a judicial farce.

Murderous impulses in dissolute drunkards too often
recur to justify such judicial mistrials. Society should
here have the benefit of the doubt. Disease of brain
that leads to murder is more liable to recur than is safe
mental stability to return and stay stable in such dis-
ordered brains.

Court's verdicts of acquittal in miurder trials on
grounds of insanity are too often wrong by reason of
inexpert, non-clinical, pseudo-psychiatric medical testimony.
Brain disease impulses that lead to murder are not
usually evanescent maladies. These often recur, from
periodic nocturnal disease, like epilepsy at night, a recurrent

Editorial. 309

night-time malady of the brain, with substitutive paroxysmal
impulses to violence and destruction, like murder or pyroma-
nia. Courts need more caution here.

Dr. Shufeldt's (Maj. and Surg., U.S.A.) New Book,
just off the press, on "The Negro Peril" will prove of in-
tense and startling interest to all patriots.

Doctor Sajous' New Clinic in the Charity
Hospital, Philadelphia. That useful and valuable maga-
zine, the Nurse, and that standard medical periodical,
the New York Medical Journal, thus refer to the eminent
Dr. C. de E. M. Sajous' new clinic:

"The remarkable researches of Doctor Sajous on the
functions of the ductless glands are well known to all
medical readers. It is gratifying to know that he is
to have better opportunities for continuing his studies
and enlightening the world on these obscure questions.
If he can find means of improving our present treatment
of backward children and dementia praecox — as he is
likely to do with his new facilities for observation —
he will place the world under increased obligations for
his untiring work in the field of his choice."

From the New York Medical Journal we take this
announcement of the new clinic for Doctor Sajous' new
specialty.

"Paris has an institution for the study of the diseases
of the ductless glands, created and endowed by Baron
Henry de Rothschild, and directed by a well-known in-
vestigator in this essentially modem line of work. Doctor
Leopold-Levi. Philadelphia is also to possess in the
Charity Hospital, which has been completely remodeled
of late, a clinic, the first on the American continent, for
the thorough study of the same class of diseases. The
disorders to be studied include the following: Exophthal-
mic goiter or Graves' disease, myxedema, cretinism,
hypothyroidism, infantihsm, goiter, thyroiditis, idiocy,
imbecility, backward children, microcephaly, dementia
praecox, obesity, andiposis dolorosa or Dercum's disease,

310 Editorial

adipositas cerebralis of Frohlich, adiposogenital syndrome
of Launois, symmetrical adenolipomatosis and fat neck,
pituitary infantilism, acromegaly, pituitary tumor, stunted
growth, achondroplasia, Addison's disease, hypoadrenalism,
terminal hypoadrenalism, hyperadrenalism, adrenal hema-
toma, hypernephroma, chronic hereditary trophoedema,
enlarged thymus, status lymphaticus.

"In addition to researches upon the diseases of the
ductless glands per se, which diseases are now in sufficient
number to warrant the creation by Dr. Charles E. de
M. Sajous of a new specialty he has termed hemadenology,
the relations of the internal secretions to general diseases
and diseases of special organs, will also be studied in
conjunction with members of the hospital staff in charge
of other departments.

The importance to our profession of the researches
to be carried on in the new clinic at Charity is suggested
by" the fact that over 6000 children in Philadelphia
schools are victims of backwardness, who could in many
instances be greatly benefited, while dementia praecox has
been regarded as the starting point of one-fourth of the
cases in our insane asylums."

Inordinate Health-Harming City Noises. — One of
the remarkable things of city life is the patient tolerance
of health-hurting noises, especially, of unnecessary night
steam whistles and the night and day rasping, scraping
city tramway, iron wheeled, often flat wheeled cars,
running on uneven, unlevelled, badly jointed or rather
disjointed iron tracks. Our office building shakes from
these street car jolts and the needless noises make con-
versation, while windows are open, exceedingly difficult,
and conversation in the streets is almost impossible.

While we write, a contractor is repairing the chimney
tops of our office building where the chimney pots and
top chimney bricks have been shaken loose. The street
railways have driven property owners, who desire reason-
able quiet in their libraries, parlors and dining rooms,
to the suburbs — only to have what were the suburbs

Editorial 311

invaded again and again by the intolerable street cars
with the same sleep-disturbing noise. There is no need
of jangling chains, flat wheels, iron trucks, uneven, un-
jointed rails and all the racket that takes no thought of
the public health or comfort, compelling the public
to resort to megaphones in order to converse on our street
corners.

Physician's Tax Annulled. — The section of the local
license ordinace of Turlock, which imposed a tax of $10
a day on transient physicians practising in that city, was
declared unconstitutional by Superior Judge L. W.
Fulkerch, April 28, when he granted a petition for the
release of Dr. J. H. Berry, on a writ of habeas corpus.
The proceeding held that the section was "discriminatory,
prohibitive and unreasonable."

Not only that but violative of a physician's right to
practice wherever called in a State and of the people's
right to have him. The sick or wounded have a right
to the best source of relief whether it comes from far
or near.

Death of Doctor Clouston. — The London Hospi-
tal and the Journal of Mental Science record the death,
last May "in Edinburgh, of Sir Thomas Clouston, M.D.,
late physician-superintendent of the Royal Edinburgh
Mental Hospital, Momingside. Educated at Aberdeen
University, he graduated M.D. in 1861, and in 1863 he
was appointed superintendent of Carlisle Mental Hospital,
a post which he held until he became superintendent at
Momingside in 1873. The principal post of the kind
in Scotland gained increased prestige during his lengthy
tenure of office, owing to the way in which he negotiated
the important, indeed radical, changes which were effected
in mental hospital procedure and treatment during this
period. He combined the rarely associated gifts of a
first-rate administrator with a student's intei-est in science
and carried out administrative reforms and scientific
investigations into mental neuroses — 'The Neuroses of
Development' was the title of one of his publications.

312 Editorial

To instance the thoroughness of his work in the ad-
ministrative field one may recall another work of his,
'An Asylum or Hospital House, with Plans,' which reveals
his appreciation of institutional problems. At one time
he edited the Journal of Mental Science, and among a
host of distinctions we may recall his Presidency of the
Royal College of Physicians, Edinburgh, in 1902-03. He
was knighted in 1911. It is to his honor that he was
one of those who turned attention to the relation between
environment and mental disease; and the result was a
cheerfulness and diversity in every institution, indeed in
every room, which was open to Ms influence.

The Honor of the Degree of LL.D. bestowed
upon the Editor of this Magazine by that worthy "Yale
of the North and Central West," Grinnell College, is
grateftilly acknowledged, with high thankful appreciation.

This College, when it was a young Academy, at
Davenport, was the school of Doctor C. H. Hughes
in his youth and he has noted with pride and pleasure
its growing usefulness and greatness. A great and potent
destiny for the welfare of the American people, especially
of this section of our coimtry, is before Grinnell, greater
than even the record of its beneficent past has been,
in educational fruitfulness. Great and good men of merit
for mankind have gone from its halls of learning to help
the uplift of humanity.

The Harrison Bill. — Physicians' duty. In compH-
ance therewith :

"Register with the Collector of Internal Revenue
on or before March 1, 1915.

"Take inventory of all goods on hand coming under
this Act.

"When writing prescriptions, give name and address
of patient, your name in full, your address and register
number.

"When dispensing, keep a record of quantity and kind
of drug dispensed, name and address of patient and the
date on which dispensed.

Editorial 313

"When administering, no record need be kept.

"When purchasing, fill out order blank issued by the
Internal Revenue Department, retain duplicate of order
for two years from date of issue.

"Dispensing physician must register in a dual capaci-
ty, as p,hysician and dealer.

"No prescriptions containing such drugs can be re-
filled; a new prescription must be written.

"The drugs embraced in the Harrison Act are: Opium
and coca leaves, their compounds, derivatives, salts and
preparations, excepting 'preparations and remedies con-
taining not more than 2 grains of opium, or more than
1/8 grain of heroin, or more than )4 grain of morphin,
or more than 1 grain of codein, or any salt or derivative
of any of them in one fluidounce, or, if a solid or semi-
solid preparation, in one avordupois ounce; or to lini-
ments, ointments, or other preparations which are pre-
pared for external use only, except liniments, ointments
and other preparations which contain cocain or any of
its salts or alpha or beta eucain or any of their salts or
any synthetic substitute for them' " — Jour. Ind. State
Med. Assn.

An onerous obligation imposed on our overburdened
profession and no equivalent duty imposed upon dispensing
proprietary medicine manufacturers. But this law will be
a deterrant of drug-habit formation.

The Unregretted Summer School. — "The Republic
regrets that the Board of Education is short of funds, as
proven by its decision to hold no summer schools this year,
but it is far from regretting the discontinuance of the
summer schools. We trust that when the financial tide
rises again the money may be employed in some other way.
Vacation is as much the child's right as school is. The
normal child longs for it with a longing that cannot be
put into words. Cannot we all see ourselves in retrospect
as we look at him? Those days of "gladsome idleness,"
when we went swimmin', picked berries, gathered wild
flowers, or just lay on a hillside and watched the piled-

314 Editorial

up clouds in the summer sky! To deprive of a full vaca-
tion the delicate child who has fallen back a little in his
school work is like putting a heavier load on a beam
simply because it sags. To do the same with the over-
grown child who is apparently somewhat dull intellectually
is to disregard Nature's own danger signals. Schools are
made for children — not children for schools. The M'Choak-
umchild philosophy of education ignores this capital
fact. The St. Louis school system, in its gratifying
development of handicraft, its outdoor schools, its special
schools for the deaf, the defective and the otherwise
incorrigible, and its night schools which carry educational
opportunity into the lives of ambitious wage workers,
shows keen sensitiveness to the practical application of
the principle just enunciated. In the interest of the
inalienable right of every American boy and girl to "the
long vacation," unvexed by pedagogues and pedagogics,
we welcome the passing of the summer school. May
innocuous desuetude be its changeless fate!"

The St. Louis Republic of June 1st, ult. has this
timely and considerate editorial concerning the sanitary
rights of the school-age kids. If more hygiene were im-
pressed upon the minds of pedagogues and parents and
people, the vacation days of summer time would not be
thought of for the housing of children for school tasks
and confinement in school.

The Republic writes like an alienist and neurologist
on this subject, for the care of the human mind (of
children,) as Grotius wrote, is the noblest branch of
medicine.

Eccentricity vs. Insanity. — A plea of eccentricity
was lately made in the Probate Court of St. Louis where
some legitimate mature children disinherited in a mother's
will, because the mother considered the children were
unfilial, whereas the mother appears to have held only
a morbid aversion, the result of a previous unrecovered
insanity, the recurring morbid antipathy being similar
to that held by her towards her husband, (later deceased,)
when she was first insane.

Editorial 315

The testatrix had been previously treated for in-
sanity and placed under the care of an experienced
alienist, in a private sanitarium for insane women. The
lady's physical health was bad and her disease involved
her brain in disorder to such an extent that she took
an unreasonable aversion and unjustifiable dislike towards
her husband. She was taken out of the sanitarium before
being recovered.

Insanity is a peculiar change of character caused by
disease, disordering the brain and mind, not natural to
the individual.

True eccentricity, on the contrary, is a natural and
noticeable peculiarity of mind, not due to disease im-
plicating the brain, but inherent in the character. It is a
natural state. Insanity is a disease-caused condition
of changed peculiarity of speech or conduct or both,
involving brain and mind.

Eccentricity is as natural to the brain as an always
existing falsetto voice is to the larynx, as compared with
the changed voice which results from disease of larynx
or vocal cords, or as natural dumbness or inability to
speak as compared with disease-caused aphasia or aphonia.

Medical dictionaries are generally not plain and ex-
plicit enough in the distinctive differentiation between
mental eccentricity and insanity. The miser and the
spendthrift are presented by Hack-Tuke as contrasting
forms of eccentricity as well as folic du doute.

This dictionary, by the way, gives the most elaborate
discussion of any lexicon extant, to our knowledge, and
we may at a more opportune time, if space and opportunity
should permit, discuss it.

We are tempted even now, as the vision of Doctor
Johnson touching the palings as he passed in absent-
minded meditation, returning to touch one he might
have missed, to write at length on the important subject.
But other demands forbid.

An International Commissio de Lunatico En-
QuiRENDo for Europe would seem to be a need of the
present, to ascertain the sanity of the contending belliger-
ent crowned heads across the ocean.

316 Editorial

But who among the maddened monarchs of the en-
lightened and civilized Europe engaged in the war, might
be qualified as sane enough to sit on such a commission?
Dementia belli seems to be all pervading over there
among the combatants.

The Impeachment of Dr. C. R. Woodson, of St.
Joseph, Mo., after he had been elected President of the
Missouri State Medical Association, on the ground that
he had announced on his card in brackets (nervous
diseases) instead of the code forn^ula: "Practice limited
to nervous diseases" was simply ridiculous. We are glad
to see this erroneous decision of the council reversed.
Such peccadillo decisions smack too much of petty tyranny,
especially when done by a minority of the entire council
and without the confirmation of a majority of the en-
tire Society.

We believe in strict professional ethics but in so
grave a matter, we are also for fair play and reasonable
fraternal consideration.

Not Clinically Correct but Startlingly Untrue. —
Under the caption, "Sleep Unessential to Life or Health"
the Associated Press dispatches from the San Francisco
meeting of the American Medical Association the sani-
tarily and clinically erroneous statement, attributing it
to a Kansas City neurologist.

"San Francisco, June 21. — Sleep is not as essential
to life or even health, as is generally believed, according
to a Kansas City neurologist, who was among a number
of delegates to the American Medical Association conven-
tion here that occupied pulpits yesterday in San Francisco
churches.

" 'The loss of sleep,' Dr. R asserted, 'has never

caused anyone to become insane. Victints of insomnia,'
he continued, 'are likely to develop a morbid fear of
insanity. Re-education of the mind is the most successful
method,' he said, 'of restoring those suffering from such
fear.' "

This is misdirected, injudicious unenlightenment for

Editorial 317

the public, without foundation. In fact Shakespeare
and other non-medical writers who knew the world at large
knew better. The mother of the new-bom babe knows
better as she cradles her infant in sleep the early weeks
of its post partum life. Every insane hospital physician
or nurse knows how essential much sleep is to the recovery
of the insane and the prevention of relapses and neuroses.

It is the loss of sleep and consequent lack of re-
cuperative rest that in the main causes the fear of in-
sanity.

An exhausted, sleep-deprived brain is not in condition
to be successfully re-educated out of morbid fears. Chemi-
cal, electrical and environmental rest with satisfactorily
tranquilizing surroundings are the best preliminary thera-
peutics for obstinate insomnia. The tired insomniac
brain is not especially receptive to psychic suggestion
of re-education or to any other suggestion of self-control
effort.

Harry Thaw Again Free. — After nine years of lawful
restraint as a legally pronounced insane murderer, Harry
Thaw is again at liberty. Though not positively and active-
ly insane now, Thaw is, as he was before the murder of Stan-
ford White, an insanoid with insanity latent in his make-up,
requiring only suitable exciting cause and a return to the
same viciously self-indulgent, unrestrained life, such as he led
before the tragedy, to bring a possible renewal of active in-
sane display.

Men with vicious alcoholic, inadequately restful and
untranquilizing habits, provocative of brain instability,
ought not to be free from rationally restraining brain
and mind surveillance and legal guardianship.

Any brain and mind so organically unstable, whether
judicially sane or insane, that yields to inadequately
provoked brain-storms, to the extent of unjustifiable
murder, should be kept under restraint, personal or by
proxy, for life.

When proven potentiality of murder is in the unstable
organism or abnormal make-up of an individual, only
an exciting, unrestrainable impulse or brain-storm to over-

318 Editorial

master self-control is needed to cause murder or other grave
outbreak. All the life before such a person should be guard-
ed from excitation to mental explosion, vicious indulgences
in sensual passion and alcohol. There is no surety for
a sane life for such henceforth, without abstention from
damaging self-sensual indulgence, yet Thaw says he will
never drink intemperately again. Men of his make-up
cannot drink at all and be safe from relapse. Absolute
sobriety and a physiologically reformed life is their only
possible hope.

If leaking bottles are refilled they will leak again
and it is wise to be cautious about trusting the once
insanely exploded brain and mind. This country has a
superabundance of weak erratic brains and minds at large and
fit for serious psychic crime, on slight inadequate excitation.

IN MEMORIAM
Sir William R. Gowers, M. D., of London, Eng-
land, our eminent and well beloved friend, author, writer
and lecturer on diseases of the nervous system, died on
May the 4th, at the age of 70 years. He was consulting
physician to the University College Hospital, in London,
and to the National Hospital for the Paralyzed and Epi-
leptic. His treatise on the diseases of the nervous system
and his ability as a neurologist were recognized throughout
the world and expecially esteemed in America.

CORRESPONDENCE

Acute Heroin Poisoning and the Harrison Law. —
On the evening of April 16th, 1915, a man applied at
the office of the Superintendent of the Peoria State
Hospital and asked for admission to the institution as
a voluntary patient. He gave his history as being a mor-
phine habitue and said he had been taking cocain and
heroin in large doses and begged for a "shot." He evi-
dently was under the influence of liquor as his breath
denoted. He begged so hard for "dope" that he was
given a hypo tablet containing 1/8 grain of heroin to
relieve him of the withdrawal symptoms from which he
was suffering. The patient crumpled the tablet in his

I

Correspondence 319

palm and snuffed it up his nose. He sat down again
and within ten minutes was drowsy. He rapidly became
cyanosed and in a short time was unconscious. He was
immediately transferred to the hospital. He was given
l/30th of a grain of strychnine sulphate and l/50th of
a grain of atropin sulphate. The writer saw him at
6:45 P. M. at which time his pulse was 146 and his
respiration was 7 per minute. Artificial respiration was
instituted and continued for five minutes at the rate of
20 per minute. Alternate hot and cold packs were
applied to chest, abdomen and limbs. The patient
was intensely cyanotic, he was given aromatic spirits of
ammonia inhalations and at 7 P. M. his pulse was 132 and
his respirations had increased to 12 per minute. These,
however, were very superficial in character. The treat-
ment, including packs and inhalations, continued and at
7:15 his pulse was 120 and respirations 17 per minute.

At 7:30, Pulse was 120, Respirations 22.

At 8:00, Pulse was 108, Respirations 22.

At 10:00, Pulse was 100, Respirations 18.

The patient was seen the next morning at 8:00 A. M.,
and his pulse was 72 and respirations 18. He was con-
scious and told a very different story than when admitted.
He said he was a heavy drinker and that the day before
he had mixed his drinks freely and since he was drunk
and had been bothered with a left inguinal hernia, he
decided he would like to have it relieved. A bartender
told him he could gain admittance to this place as a
voluntary patient if he would pretend he was a "dope-
fiend." He denied using drugs to any great extent since,
as he says, all drunkards use "dope" to some extent
sooner or later. He gets on sprees every two or three
months, lasting several weeks. His demeanor was cer-
tainly that of a morphine habitue and if he is not addicted
to drug using, his powers of imitation are excellent.
He has no doubt learned a lesson and will never again
imitate such a condition, especially since it came so
nearly costing his life. — Fred'k. Cansey, B. S., M. D.,
Peoria State Hospital.

REVIEWS, BOOK NOTICES, REPRINTS, ETC.

Oliver Wendell Holmes' Priority Concerning Septic
Infection in Puerperal Fever, Erysipelas and Simple
Peritonitis.

An interesting contribution by Dr. Henry Swartz
of St. Louis before the St. Louis Medical Society, show-
ing Dr. Holmes' priority of this important discovery
as to child bed-fever contagion. ^ We take pleasure in
putting this matter on record again in this Magazine.

Holmes 1843

Holmes in 1843 made the following recommenda-
tions :

"A physician holding himself in readiness to attend
cases of midwifery should never take any active part in
the post-mortem examination of cases of puerperal fever.

"If a physician is present at such autopsies, he should
use thorough ablution, change every article of dress, and
allow twenty-four hours or more to elapse before attending
to any case of midwifery. It might be well to extend the
same caution to cases of simple peritonitis.

"Similar precautions should be taken after the
autopsy of surgical treatment of cases of erysipelas, if
the physician is obliged to unite such offices with his
obstetrical duties, which is in the highest degree inexpe-
dient.

"On the occurrence of a single case of puerperal
fever in his practice, the physician is bound to consider
the next female he attends in lator, unless some weeks
at least have elapsed, as in danger of being infected by
him, and it is his duty to take every precaution to
diminish her risk of disease and death.

"If within a short period two cases of puerperal
fever happen close to each other, in the practice of the
same physician, the disease not existing or prevailing

(320)

Reviews, Book Notices, Reprints, Etc. 321

in the neighborhood, he would do wisely to relinquish
his obstetrical practice for at least a month, and endeavor
to free himself by every available means from any noxious
influence he may carry about with him.

Semmelweis 1847, Four Years Later
" 'In 1847, Semmelweis, then an assistant in the
Vienna Lying-in Hospital, began a careful inquiry into
the causes of the frightful mortality attending labor in
that institution, as compared with the small number of
women succumbing to puerperal infection when delivered
in their own homes. As a result of his observations, he
concluded that the morbid process was essentially a
wound infection, and was due to the introduction of
septic material by the examining finger. Acting upon
this idea, he issued stringent orders that the physicians,
students, and midwives should disinfect their hands with
chlorine water before examining parturient women.
In spite of almost immediate surprising results, — the mor-
tality falling from 10 to about 1% — , his work was scoffed
at by many of the most prominent men of his time,
and his discovery remained unappreciated until the in-
fluence of Lister's teachings and the development of
bacteriology had brought about a revolution in the treat-
ment of wounds.'

"To this should be added, says Swartz. that since
that time Hungary, the native country of Semmelweis,
has honored his memory by having his ashes removed
from Vienna and deposited in an honor-grave, which the
city of Budapest gave for that purpose; that this grave
is graced by a suitable monument; that a tablet has been
placed on the house in which Semmelweis was born;
that a grand Semmelweis-monument has been erected
on one of the finest public squares of Budapest; that the
means for this monument have been brought together
by international subscriptions; that the unveiling of the
monument took place on September 30th, 1906, and was
the occasion of a great international gathering of obstetri-
cians; that the final report, of how the medical profession

322 Reviews, Book Notices, Reprints, Etc.

of Hungary has honored itself by honoring Semmelweis,
was presented last fall to all the members of the gyneco-
logical section of the international congress of Budapest, in
the hope that they might carry the fame of Semmelweis
over land and sea.

"In the meantime the medical profession of the
United States has almost forgotten that Oliver Wendell
Holmes has equal, if not greater, claim to be remembered
as the discoverer of the nature of puerperal infection.
A great many of our teachers of obstetrics have been
educated abroad, and all of them have been influenced by
German obstetrical literature, and thus it happens, that
most of them forget in their text-books to mention the
epoch-making essay of Oliver Wendell Holmes.

"It is pleasing to note one exception to this rule;
Barton Cooke Hirst, the present professor of obstetrics
in the University of Pennsylvania, in the latest edition
of his text-book, gives Holmes due credit for his great
discovery."

Dr. Holmes' views are more lengthy, together with
his defense against the doubting assaults of Hodge and
others of his day. His defence appears in Holmes' complete
works and even more fully vindicate his priority. In the
field of meritorious life-saving priority let us zealously chron-
icle and guard our own honored pioneers in discovery.
We should ever cherish and defend our great and good,
in the cause of humanity, as well as those of the rest of
the world. Place a monument to his memory and one
to Epraim McDowell in Washington.

"Labor.\tory Week" for Visiting Physicians at
the Research Laboratories of Parke, Davis and Company,
Detroit, Mich., was held June Seventh to Eleventh,
Nineteen Hundred and Fifteen.

"Laboratory Week Lectures:

Introductory Address — E. M. Houghton, Ph. G.,
M. D., Director Biological and Research Laboratories.

Scientific Research, the Basis of Pharmaceutical
Progress — Dr. J. M. Francis, Chief Chemist.

Reviews, Book Notices, Reprints, Etc. 323

Immunity— N. S. Ferry, Ph. B., M. D.

Chemistry and Application of the Coal-Tar Disin-
fectants— H. C. Hamilton, M. S.

Actively Immunizing Agents— N. S. Ferry, Ph. B., M. D.

Ozena— H. C. Ward, M. S.

Serum Therapy— W. E. King, A. M., M. D.

Organo Therapy— Carey Pratt McCord, A.B., M. D.

Spirochaetal Diseases — ^F. W. Baeslack, A. M., M. D.

Glandtilar Syndromes — Carey Pratt McCord, A. B.,
M. D.

Anaphylaxis and Serum Sickness — N. S. Ferry, Ph. B.,
M. D.

The Cancer Problem— F. W. Baeslack, A. M., M. D.

Tuberculins — A. W. Lescohier, M. D.

Sero Diagnosis— F. W. Baeslack, A. M., M. D.

Protective Enzymes — Carey Pratt McCord, A.B., M.D.

Autogenous Vaccines — N. S. Ferry, Ph. B., M. D.

The Propagation of Experimental Animals and Main-
tenance of Large Animals for Biological Purposes — R. H.
Wilson, D. V. M.

"Laboratory Week" Demonstrations:

Sero-Enzyme Tests for Pregnancy, Syphilis and
Tuberculosis— H. S. Ward, M. S.

Anatomical Specimens of Glands of Internal Secretion
—Carey Pratt McCord, A. B., M. D.

Rat Sarcomata, Spirochaeta Pallida and Trypanosomes
— F. W. Baeslack, A. M., M. D.

Filterable Viruses— W. E. King, A. M., M. D.

Pharmacological Action of Drugs — R. C. Hamilton,
M. S. L. W. Rowe, B. S.

Sterilization with the Ultraviolet Ray — L. Davis, S.M.

Rabies— L. T. Clark, B. S.

Luetin— F. W. Baeslack, A. M., M. D.

The Propagation of Experimental Animals — R. H.
Wilson, D. V. M.

These demonstrations display actual work in progress,
with a comprehensive exposition of the apparatus and
technique employed in advanced medical research.

Opening Session, Monday, 9:30 A. M., June 7, 1915,

324 Reviews, Book Notices, Reprints, Etc.

This is an elaborate showing of the work of this
well-known firm. The program reads like a Medical
College announcement of its biological department. It is a
good plan for our well-meaning proprietary friends to get close
to the profession in this way and show what they are doing
and how they are doing it. On a former occasion we
have visited the laboratory of Parke, Davis & Co. and
derived information and satisfaction from the visit.

Destitution and Disease in Serbia. — Report of
the Rockefeller Foundation for the Relief of Suffering
Non-Combatants in Evirope.

The Rockefeller Foundation War Relief Commission
— sent to Europe to recommend the most effective methods
of relieving the needs of non-combatants — has reported
concerning conditions in Serbia.

Acting upon this report, the Foundation has joined
with the American Red Cross in sending to Europe a
Sanitary Commission to help Serbia control the present
epidemic of typhus and the threatened epidemic of
cholera.

Essential portions of the War Relief Commission's
report on conditions in Serbia are published herein.

This report and plea for aid comes to us late. No
one appears to have shown great philanthropic interest
concerning this war impoverished country when the plea
went out for relief of Belgium. Why?

The Serbians are Christians and a worthy people.
They are mostly small land and homestead owners,
frugal and upright. Serbia suffered much in the previous
Turkish and second Balkan war and has now one-fifth
of her two and a half million men of fighting age, mobiliz-
ed and eighty thousand of them already either killed or
wounded.

Her peace deahngs having mostly been with Austria
are now cut off by her war with the latter country.

The commissioner's impression is that Serbia's dis-
tribution has reached a condition in which it has nothing

Reviews, Book Notices, Reprints, Etc. 325

to give to its own unfortunates and her epidemic of
deadly typhus adds to the force of charity's plea in her
behalf.

Doctors take notice, consider and respond accordingly
to offices 61 Broadway, New York City.

What to do With the Sub-Normal Child. — The
Seventh of a Series of Monographs on the Improvement
of the Human Plant. Henry Smith Williams, M. D.,
LL.D., Editor. Issued by Luther Burbank Society,
Santa Rosa, California.

The author considers heredity is more of a factor
in human life than in plant life — more of a menace —
more of a hope. And nothing in the world of living
things responds so quickly to new environments as the
human mind — child and adult.

CURSCHMANN-BURR TeXT BoOK ON NeRVOUS DISEAS-
ES.— The New Book on Neurology. By G. Aschaffenburg,
Cologne; H. Curschmann, Mayence; R. Finkelnburg,
Bonn. R. Gaupp, Tubingen; C. Hirsch, Gottingen;
Fr. Jamin, Erlangen; J. Ibrahim, Munich; Fedo Krause,
Berlin; M. Lewandowsky, Berlin; H. Leipmann, Berlin;
L. R. MuUer, Augsburg; H. Schlesinger, Vienna; S.
Schoenbom, Heidelberg; H. Starck, Karlsruhe; H. Steinert,
Leipsic. Authorized English edition edited by Charles
W. Burr, B. S., M. D., Professor of Mental Diseases
in the University of Pennsylvania; Neurologist to the
Philadelphia General Hospital. With 156 text illustrations
in two volumes. Price twelve dollars net for the set.
Philadelphia, P. Blakiston's Son & Co., 1012 Walnut St.

"The German contributors to this book should need
no introduction to American physicians, as they are all
men of established reputation. The articles are based on
personal knowledge and experience and each writer
presents his own well thought out and mature opinions."

The work is purely scientific in tone and conservative
in attitude. The translators have endeavored to do their
work faithfully.

326 Reviews, Book Notices, Reprints, Etc

At this particular time in the history of Europe, when
war and its alarms occupy so many of the best medical
minds over the sea, it is particularly fortunate that the
enterprising publishing house of Blakiston's Son & Co.,
and Professor C. W. Burr should have bethought them-
selves to offer to the English and American medical
profession this elaborate, interesting and up-to-date
reproduction of German neurological and psychological
literature. Until the present unfortunate war, involving
so many men of eminence and merit in medical literature,
now in the ranks of war, shall have ceased, these vol-
umes present almost the last words from over there,
where the fields of medical science have been illustriously
adorned by the eminent names whose works are here
translated and submitted for our consideration and en-
lightenment. Some at least of these eminent authors'
names may be memorial before the present European
war shall have ended and every appreciative admirer
of advanced German medical literature should have these
great books in his library.

Thirty Second Annual Report of the State
Board of Health and Bureau of Vital Statistics
OF Missouri, 1914-1915.

This interesting, valuable report is fuU of statistical
information interesting to physicians, sanitariums and the
public generally obtained with much diligence and due
consideration for the public interest and presented for
its welfare.

It gives statistics of tuberculosis, cancer, etc., and
indicates by a valuable map, locations of the mortality
of the latter. Pellagra is considered, also the eruptive
fevers.

The cause, control and statistics of cancer are re-
corded and will appear elsewhere in this magazine.

Scarlet fever, whooping cough and poliomyelitis are
not overlooked. In fact the statistics of nosological
medicine have not been slighted in this report. This
entire report displays an exceptional appreciation of the

Reviews, Book Notices, Reprints, Etc. 327

information needs of the intelligent practicing physicians
of the State, even to the inclusion of the pneumonia,
ente'ric affections, visceral diseases, accidents, suicides
and homicides.

The number of still-births recorded is rather large
for so live a State as Missouri.

Not the least interesting feature of this interesting
report is the handsome and intelligent facial expressions
of the group of the members of this Board which adorn
the initial page of this valuable report. There is no
grouch nor dullard among them. They are as good look-
ing and confidence-inspiring as the work of their combined
brains here before us manifests in merit and confirms our
previously entertained confidence in our Excellent Gover-
nor's ability to judiciously select his subordinate public
servants. And this is always a commendable feature in
a State's Chief Executive.

In Memoriam. — Elliston P. Morris deceased on the
3rd day of twelfth month, 1914, in his 84th year. Became
a Manager in 1858 of the Friend's Hospital of Philadelphia.
He served for 26 years before any of the now remaining
Managers were appointed. His term of service of 56
years is the longest on record for this or any other similar
hospital. Samuel B. Morris, the father of Elliston P.
Morris, served as a Manager from 1834 to 1842, and his
son, Samuel Morris, was a Manager for 45 years, from
1857 to 1902.

During the period that Elliston P. Morris served as
Manager he saw many changes in the methods of treat-
ing the insane, and he was interested at all times to
further measures that would improve the conditions or
increase the comforts of those committed to the care of
the Asylum. Owing to impaired health,- he has not been
able to be present at the monthly meetings of the Mana-
gers, since third month, 1913, but a letter written to the
Board six days before his death, expressing his views on
a certain proposed action, gave evidence of his continued
interest in the affairs of the Asylum.

328 Reviews, Book Notices, Reprints, Etc

The foregoing is from the minutes of a Stated
Meeting of the Board of Managers held Twelfth Month,
7th day, 1914, and is a high and just tribute to the in-
dustrious and devoted fidelity of a great and glorious
cause — the care and welfare of the insane.

Similar silent, meritorious, though not so long, service,
has been and is being given to the welfare of the insane,
in this United States since Pinel struck the shackles from
the chained lunatics of Bicetre and Chiarugi and the Tukes
and Yorks recognized them as children of affliction and
not as fiends incarnate and transformed the name of
Bedlam into that of Hospital.

Volume IX Publications op the American Socio-
logical Society is before us and exceedingly interesting
reading, especially the contribution of Henry Schofield
of Northwestern University Law School on "Freedom
of the Press in the United States," a theme which must
command the attention and concern of every editor and
publisher in our free speech and free press country. But
all of the contributions of this valuable volume, contributed
as they all are by eminent and forcible writers (mostly
mature educators), appeal to the highest sentiments of
American philanthropic patriotism and cultured intelligence.
They all concern the important subjects of "Freedom of
communication, ' ' which, like the right of petition, should
be held to be sacred in this "land of the free" (and we
hope of the brave enough to protest every phase of the
tyrannies manifesting themselves in our free speech and
free press Republic.) We hope to see this good, patriotic
Society increased and its publications extensively read.

President Ross on "Freedom of Communication and
the Struggle for the Right" is masterly and patriotically
American in tenor and text and spirit.

Henry Pritchett's contribution on "Reasonable Re-
strictions Upon the Scholar's Freedom" and the discussion
will interest all concerned in teaching, no doubt as it has
the writer hereof. All the writers and disputants being
eminent scholars of merit, nothing seems unworthy of

Reviews, Book Notices, Reprints, Etc. 329

meritorious consideration in this excellent volume of
transactions. We commend it and its predecessors to
all students of American Sociology.

The Commercial Lure of a Scientific Physiolog-
ical Philosophy. — Preliminary to a commendation of
Pepto-Mangan (Gude) for anaemic palor, etc., as a
consequence of school fatigue and confinement, our
proprietary friend of Pepto-Mangan fame, gives the
medical profession the following sage observation and
advice :

"The Delicate School Girl. — Even the most robust
and generally healthy children show the deleterious
results of the modern system of educational 'forcing'
that prevails in most of our larger cities. The child that
starts the school year in excellent physical condition,
after the freedom and fresh air of the summer vacation,
in many instances, becomes nervous, fidgety, and more or
less anemic, as the term progresses, as the combined
result of mental strain and physical confinement in over-
heated, poorly ventilated school rooms. How much more
likely is such a result in the case of the delicate, high-
strung, sensitively organized, adolescent girl? It is cer-
tainly a great mistake to allow such a girl to continue
under high mental pressure, at the expense of her physical
health and well being, and every available means should
be resorted to to conserve the vitality and prevent a
nervous breakdown. Regularity of meals, plenty of sleep,
out-of-door exercise without fatigue, open windows at
night and plenty of nutritious food, should all be supplied.
Just as soon as an anemic pallor is noticeable, it is a good
plan to order Pepto-Mangan (Gude)."

Fuller's Anatomical Models of the Brain, Pons
AND Medulla — By Dr. William Fuller of Grand Rapids,
Michigan, Graduate of McGill University, Demonstrator
of Anatomy, etc., are the best, most accurate and ser-
viceable for the study and demonstration of the cerebrum.

330 Reviews, Book Notices, Reprints, Etc.

cerebellum, medulla oblongata, pons varolii and upper
spinal cord, extant.

No teacher or student of this region of the human
body should be without them. They cannot be excelled
or even equaled anywhere. We exhibited them at
several foreign international congresses, including Petro-
grad (then called St. Petersburgh.) at Paris, Copenhagen
and Spain. Savants in neurology and psychiatry
there pronounced them a marvel of anatomo-expert
mechanical genius, especially Dr. Fuller's thirty-two-sec-
tion hinged brain slides for interior brain study and
demonstration purposes. No teacher of brain anatomy
and brain function should be without this wonderful
model and marvel of anatomical knowledge and genius.
Dr. Fuller's book on anatomy accompanying these great
models and casts is equallly valuable.

Applied Eugenics. — By Sanger Brown, M. D.,
Chicago. From American Journal of Insanity.

What Sanger Brown writes is worth reading and
this is his conclusion:

"As a general proposition, it will be conceded that
the school is by far the most practical agency which may
be depended on to insure a widespread diffusion of know-
ledge; however, since pupils naturally and properly dis-
cuss among themselves the topics taught them, it follows,
logically, that a topic which should not be so discussed
should not be given a place in the authorized list of
subjects to be presented.

"To impart to the young opportunely correct infor-
mation on various aspects of sexuahty is the province of
parents and guardians. Such an intimate acquaintance
with the temperament, tendencies, and perhaps critical
experiences of the young person as a parent or guardian
is in the best position to gain, is highly essential in
reaching a decision as to the time, place, and nature
of the required precepts.

"Let correction proceed along the line of urging
parents to seriously study and duly meet these important

Reviews, Book Notices, Reprints, Etc. 331

obligations; let us not, however, hastily and rudely molest
our most precious and venerated possessions; rather let
them be carefully reviewed and gently re-adjusted, if
need be, to meet the march of genuine enlightenment."

American Public Health Problems— Panama- Pacif-
ic Exposition, Memorial publications of the Prudential
Insurance Company of America, 1915.

Many valuable statistical mortality records are given
in this report. We have not space for the analysis the
report deserves but it is interesting to note, from the tables
herein, the exemption of the negro from cancer, the
preponderance with him of certain other diseases and
of accidents.

The death rate records and elements of mortality
are especially interesting to physicians and it is especially
pleasing to note the marked decrease in this regard in
the just past century, showing a decrease in deaths per
thousand of nearly forty per cent in comparison — a good
exhibit of the profession's efforts and the popular apprecia-
tion of sanitation and hygiene.

These thirty-two charts ai;e inclusive of every im-
portant phase of modem public health activities. They
are all the result of original investigations. They repre-
sent in brief outline the changes in the American death
rate during variable periods of times, including a his-
torical review of the mortality of four large cities during
the past one hundred years. The original data for the
large majority of the charts are derived from the official
health reports of American states and cities.

Great Men and How They are Produced. By
Casper L. Redfield. This mooted question is discussed
by Redfield in favor of the offspring of late marriages who
are the product of the children who are issues of conjugal
unions beyond the third generation. The author main-
tains that superior stock is the result of slow breeding
and that rapid breeding necessarily results in producing
an inferior stock.

332 Reviews, Book Notices, Reprints, Etc.

He contends that four generations of offspring in a
century is too many for sound parts and greatness and
gives examples from history of historic greatness re-
sulting chiefly from older matrimonial unions.

He thinks the educational periods should not be pro-
longed beyond the early twenties.

He takes issue with Prof. R. H. Johnson of Pitts-
burgh, as the latter records himself in the March,! 914,
Journal of Heredity.

This monograph is interesting reading. He thinks
four generations to a century instead of three or less will
tend to national degeneracy or rather national mediocrity
and inefficiency.

Two Perils to Good Government is from the pen
of Henry Watterson of the Louisville Courier Journal
attacking the woman's rights movement and alcoholic
prohibition, with the usual specious personal liberty plea,
a plea that would permit all sorts of vicious conduct,
violative of the proprieties, and allow many of the present
day health, comfort and general welfare movements of
social life, to run riot and rampant without legal inhibi-
tion.

Its personal application would annul the Harrison anti-
narcotic law, prohibit the prevention of self-poison or
other forms of suicide, self-harm, etc. We are surprised
to see such sophistry emanate from so concededly an in-
tellectual source, in political circles. His argument for
free liquor would admit the claims of woman to the suffer-
age, which he opposes.

Sixteenth Annual Reiort of the Board of Educa-
tion, St. Louis, Mo., year ending 1914, full of valuable
information. It is gratifying to see the open air school
and garden play work for children favored and the
sanitary aspects of education duly regarded.

Superintendent Blewett's contribution to this report
is worthy of special consideration. He is the right man
for the right place.

Reviews, Book Notices, Reprints, Etc. 333

The prominence given to the history and geography
of Missouri and, as promised for future courses of instruc-
tion, is a pleasing and profitable feature and everything
that aims to eliminate the "dry as dust," monotonous
and unattractive should, so far as practicable, be elimina-
ted. It is hoped some day that object teaching through
the popular "movie" may soon come into vogue for illus-
trative purposes, in our public schools.

Report to the Governor on the Institutions
FOR the Insane of the State of West Virginia. — By
Carios F. MacDonald, A. M., M. D. (of New York) 1914.

This is a well written report from a proper and
competent source of alienistic, clinical and executive
experience containing recommendations for the construction,
arrangement and government of such hospitals, the quali-
fications of physicians for their right treatment, nursing
and care of patients as generally approved by the
best psychiatrists. The suggestions of this report
should be favorably acted upon for the welfare of all
inmates and the profit of all states, wherever such condi-
tions do not now exist. It is profitable as well as humane
to rightly care for and minister to minds diseased.

In the Saint Paul Medical Journal for April and
May, Dr. John Knott's articles on the Fatal Illness of
Napoleon the Great ought not to be overlooked by any
reader of the Alienist and Neurologist.

The Methodist Episcopal Church and Wine of
Cardui (editorial) in the May number will likewise
interest any physician who discountenances quackery in
religious high places. This always interesting monthly
medical periodical has much other good matter, some of
which we abstract from Sajous, Ritchie, Kline and
Plondke on the prostate. Shuman's "mistaken gastric
ulcer diagnosis" will interest our surgical readers and
so will Paronis lingual tonsilitis.

334 Reviews, Book Notices, Reprints, Etc.

Infantile Paralysis in Massachusetts in 1909.
Board of Health Report by Robert W. Lovett, M. D.
Infantile Paralysis as Observed in Health District No. 15,
during 1909, by Lyman A. Jones, M. D. Methods of
Treatment in Infantile Paralysis, by E. H. Bradford, M.D.,
Robert W. Lovett, M. D., E. G. Brackett, M. D.,
Augustus Thomdike, M. D., Robert Soutter, M. D.,
Robert B. Osgood, M. D. The Diagnosis of Infantile
Paralysis in the Prodromal and Early Acute Stage, as
Found in the Experimental Study of Acute Poliomyelitis
in Monkeys. With Report of Findings in Four Human
Cases. By WilHam P. Lucas, M. D. Reprinted from
the Monthly Bulletin of the Massachusetts State Board
of Health for June, 1910.

Transactions of the College of Physicians of
Philadelphia.— Third Series, Volume the Thirty-sixth.
These transactions are always interesting and instructive
to the medical profession, coming as they do from the
oldest center of medical education in our country and
a center still of up-to-date advance.

The chief attractions of this volume, aside from its
strictly scientific medical communications, are its several
splendid memorial tributes to that Corypheus in neurology
Dr. S. Weir Mitchell, and the presentation of the portrait,
through Lady Osier, of her distinguished husband. Prof.
Wm. Osier, Regius Professor of Medicine in Oxford.
formerly our fellow citizen.

America's Greatest Problem: the Negro. — Dr.
R. W. Shufeldt's latest book. Major, Medical Corps,
U. S. Army. Fully illustrated with fifty highly interesting
half-tone engravings. Royal octavo, 377 pages. Special
pattern cloth. Price, S2.50. Is certain to arouse a
vigorous nation-wide discussion.

It is a wonderfully startling book. We endorse all
the pubHshers say of the merits of this timely, remarkable
book. For over thirty years the author has been a diligent
first-hand student of the negro problem, and is especially
well qualified as a scientist to write this long-needed work.

Reviews, Book Notices, Reprints, Etc. 335

Some Important Memoranda. — Compiled from recog-
nized authorities by Fellow's Compound Hypophosphites
Co., for the medical profession, embracing important
chemical tests and signs, including Abderhalden ferment
tests. Osier's spots, etc. All useful for ready reference
to any practicing physician especially the country doctor
at a distance from his home library, concluding with a
detail of the virtues and dosage of the hypophosphites,
have come to our review table, presented in convenient
form for saddle bags or coat pocket and free to physicians
for the asking.

Second Annual Report of the State Charities
Commission to the Governor of IlHnois, Springfield, Ills.
These reports are always interesting and well worth the
attention of physicians and philanthropists and especially
to the people of Illinois. We regret that we have not
more space in our pages for abstracts from this and similar
reports and the many excellent hospital reports from this
and other States, several hundred of which come to us
each year.

The University of Missouri Bulletin, Volume 16,
Number 6, Journalism Series 9, gives an exceedingly
interesting account of the world's journalism, by its
able editor, Walter Williams, Dean of the School of
Journalism, University of Missouri, summarising the editor's
observation on a world tour made in visiting two thousand
newspaper offices, June 13th, 1913 to May 14, 1914.
You will miss much valuable information if you do not
read it. Editor Williams sees things and records them
right.

The Medical Organisation of State Hospitals
FOR the Insane — How New York has systematized the
medical care and treatment of her dependant insane.
By William Mabon, M. D., Superintendent and Medical
Director, Manhattan State Hospital, Ward's Island, N. Y.
Contributions like this from such competent sources of

336 Reviews, Book Notices, Reprints, Etc.

experience should be spread among the members of the
medical profession, legislators and people.

Proceedings of the American Medico-Psychologic-
al Association at the Seventieth Annual Meeting held
in Baltimore, Md., May 26-29, 1914. Published by
American Medico-Psychological Association. Always inter-
esting and instructive. Should be generally read by
general physicians as well as those within the specialty
and so should all reports from the hospitals for the insane.

A Plea for Simplified Laboratory Reports for
Hospitals. ^Single sheet for all forms has advantages
of safety from loss and less bulky character of case records.
By Howard T, Child, M. D., Pathologist, Kankakee
State Hospital, Kankakee, IlUnois. — Reprinted from The
Modem Hospital, July, 1915.

An Earthquake of One Minute's Duration,
Friday at 1:30 P. M., Feb. 10th, 1914 is also recorded in
sanje report. No damage. Other matters in this Report,
especially causes of death in the insane, as well as in the
other hospital reports of 1914, are of interest, but we
have not space to record them. The profession, however,
generally gets them or should get them direct.

America's Pressing Mortality Problem. — Extra-
ordinary Increase in the Death Rate from Organic
Disease of the Heart and Other Hard Worked Organs,
as Indicated by the Mortality Records. Urgent Need of
Action. By E. E. Rittenhouse, President Life Extension
Institute, Inc. A public address (condensed) prepared
at the request of the Committee on Public Health Educa-
tion of the Medical Society of the County of New York,
and delivered at the Academy of Medicine, February 2.
1915.

America's Leadership for Peace, by Lucia Ames
Mead, is a plea for a defenseless Army and Navy.

Reviews, Book Notices, Reprints, Etc. 337

This might be considered a natural stand for a woman
to take, though she appears quite pugnacious in the divorce
courts. George Washington, however, has answered this
pamphlet in advance, having advised: "In time of Peace
prepare for War."

MiCROPHOTOGRAPHIC StUDY OF THE TuBERCLE BACIL-
LUS.—By Wm. J. Manning, M. D., Medical Officer, U. S ,
Governnlent Printing Office, Washington, D. C. Show-
ing a detailed enlargement of the organism approximating
4,000 diameters. Panama-Pacific Exposition. From New
York Medical Times.

Loss OF Vitreous in the Intracapsular Cataract
Operation and Its Prevention. — Read at Meeting of
Am. Acad, of Ophth., etc., Boston, October, 1914. Re-
printed from Archives of Opthalmology, January, 1915.
By W. A. Fisher, M. D., Chicago, Ills. Professor of
Ophthalmology, Chicago Eye, Ear, Nose and Throat
College.

Les Fugues de L'enfance — Influence des Milieux
Scolaires et Familiaux. — Par R. Benon, interne de
la Clinique des maladies mentales et P. Froissart, ancien
interne de I'lnfirmerie speciale de la Prefecture de police.
Extrait des Annales D' Hygiene Publique et de Medecine
Legale. Paris.

Twelve Consecutive Intracapsular Cataract Op-
erations and their Visual Results. — Read before the
Chicago Ophthalmological Society, November 16, 1914.
Reprinted from Ophthalmology, January, 1915. By W. A.
Fisher, M. D., Chicago, Ills. Professor of Ophthalmology,
Chicago Eye, Ear, Nose and Throat College.

Arequipa Sanatorium (Bothin Convalescent Home
Inc. Foundation.) For the Treatment of Early Cases of
Tuberculosis in Wage Earning Women. Fairfax, Marin
County, California. First Annual Report, Sept. 1, 1912.

338 Reviews, Book Notices, Reprints, Etc.

The Advantages of Medical Associations. — By
Edward C. Register, M. D., Charlotte, N. C. Editor
of the Charlotte Medical Journal; President of the Char-
lotte Sanatorium; Ex-President North Carolina Medical
Society, etc. From the Medical Record.

A convincing address from a meritorious source, ably
presented.

The Treatment of Senile Cataract by the General
Practitioner. — Read before Illinois State Medical Society,
May, 1914. Reprinted from Illinois Medical Journal,
November, 1914. By W. A. Fisher, M. D., Chicago, Ills.
Professor of Ophthalmology, Chicago Eye, Ear, Nose and
Throat College.

Psychic Therapy, Clinical Psychology, and the
Layman Invasion. — By J. Victor Haberman, A. B.,
M. D., D. M., (Berlin.), New York. Instructor in
Clinical Psychology and Psychotherapy at the College of
Physicians and Surgeons, Columbia University, etc.
From the Medical Record.

A Case of Infantile Uterus Appendages With
Result of Treatment.— Henry R. Elliott, M. D.,
Washington, D. C, Associate Professor of Physiology,
George Washington University Department of Medicine.
From Journal of American Medical Association.

One Hundred and Seventeen Cases of Infantile
Diarrhea Treated by Intestinal Implantation of the
Bacillus Lactis Bulgaricus. — Ralph Oakley Clock, M. D.
From Journal of American Medical Association.

An enlightening contribution on a psycho-clinical
subject from a competant source of psychiatric clinical
experience, especially valuable reading for the general
practitioner of medicine as well as the alienist and
neurologist.

Reviews, Book Notices, Reprints, Etc. 339

Insanities of the Puerperal State — F. W. Lang-
don, Prof. Psychiatry, University of Cincinnati and
Superintendent Cincinnati Sanitarium. From The Lancet-
CHnic, March 13, 1915.

Mental Obliquities — How Caused and How Reme-
died is the Eighth of this Series of Monographs on the
Improvement of the Human Plant by the same author
and from the same source of publication.

Dr. MacDonald's House, Central Valley, Orange
County, N. Y., is an attractive place, well managed.
But there are others for knowledge of which see our
advertising pages.

Narcotic Drug Addiction. — By George E. Pettey,
M. D., Memphis. From the New York Medical Journal
for February 27th, 1915. A timely contribution on a
timely subject for medical and pupular concern.

Acute Insular Sclerosis and Its Concomitant
Visual Disturbances. — Foster Kennedy, M. D., F. R. 8.
(Edin.), New York. From The Journal of American
Medical Association.

Statistics of Public, Society, and School Li-
braries.— Having 5,000 Volumes and Over in 1908.
United States Bureau of Education, Bulletin 1909, No. 5,
Washington.

Where is the Fundus of the Bladder? — Bransford
Lewis, B. Sc, M. D., St. Louis. Read before theAmerican
Urological Association, at Boston, April 16, 1913. — Re-
printed from Jour. A. M. A.

Choked to Death by Teeth, upper plate found
on autopsy far back in throat is reported from St.Lawrence
State Hospital, Ogdenburg, N. Y.

340 Reviews, Book Notices, Reprints, Etc.

Hereditary Syphilis in Connection with Clinical
Psychology and Psychopathology. By same author.
From Jour. A. M. A.

The North Pole Aftermath. — Speech of Hon.
S. D. Fess, of Ohio, in the House of Representatives,
Congress of the United States.

Spina Bifida. — An Experimental and Clinical Study.
By Norman Sharpe, M. D., of New York. From Annals
of Surgery.

Thirty-Ninth Annual Report of the Managers
and Officers of the New Jersey State Hospital at Morris
Plains. For the Year Ending October 31st, 1914.

Common Factors in Mental Health and Illness.
— By Dr. F. Lyman Wells. From The Popular Science
Monthly, December, 1914.

Ictus, Epilepsie-Jacksonienne et Astheno-Manie.
— Par les Drs. R. Benon et P. Bonvallet, Saint-Jacques,
Nantes. Extrait des Annales Medico-Psychologiques.

Hobson's Arguments for Prohibition and an
Ade(..uate Navy which comes in the same mail are far
more plausible.

The Schick Test, Illustrated for Determining
Susceptibility to Diphtheria and the Need of Prophylactic
Injections of Antitoxin.

Mulford's Luetin Reaction for the Diagnosis
of Syphilis.

Mercurialized Serum, (Mulford) for the Intra-
dural Treatment of Cerebrospinal Syphilis.

ALIENIST AND NEUROLOGIST

Vol. XXXVI. St. Louis, November, 1915. No. 4.

MODESTY AMONG THE NORTH AMERICAN

INDIANS.

By R. W. Shufeldt, M. D.,

Major, Medical Corps U. S. Army, (ret.)

Washington, D. C.

X^ANY opportunities of the most varied kinds have
■*- -■• been afforded me to study a number of the tribes
of the Indians in this country, within the confines
of civiHzation, as well as for much longer periods in the
regions where they reside. So close have been my re-
lations with them on various occasions that little or no
difficulty was experienced in observing their most in-
timate sexual customs and their views of morality.

One of the best chapters that has ever been published
on the subject of the evolution of modesty is the thorough-
ly classical one that occurs in one of the Parts of Dr.
Havelock Ellis's "Studies of the Psychology of Sex,"
a work known to every student of the subject the world
over. But in that volume, in the chapter treating of
modesty, there are less than two dozen lines devoted to
the consideration of this all-important psychical secondary
sexual character as it is exemplified among the aborigines
of North America, north of the Mexican boundary.
A part of the information in question consists simply
of a quotation from Professor Otis T. Mason's "Woman's
Share in Primitive Culture, ' ' and refers only to the fact

(341)

342 Modesty Among the North American Indians

that among the Indian tribes "the skirt of the woman
is longer than that of the men," — a statement that
evidently is intended to carry with it the impression
that the Indians (including the Esquimaux) are a very
modest people. Now the wearing of the long skirts
is by no means an indication of modesty among women,
and in some parts of the world has quite the opposite
significance, and we are all weU aware that many Esqui-
maux women are anything but either chaste or modest.
A curious instance of Sioux notions of modesty I
met with in Washington, D. C, a number of years ago.
Four or five big "bucks" had come to that city from
their reservation to pay their respects to the President.
One warm day during their visit they all took a trip
down the Potomac on one of the regular steamboats that
plied that stream. Gotten out in their full "togs," they
attracted not a little attention, and among their admirers
there were, as usual, not a few women. Several of
these, apparently regardless of the fact that they were
stirring up the passion in these untrained sons of the
prairies, who had not been with their squaws for quite
a while, vied with each other in their attempts to command
their notice, or induce them to use the few words in
English they knew. The party was grouped on the deck
of the steamer, in full view of many other passengers,
who were all standing about, like themselves. Owing to
the warm svm, the light summer attire of the females
facing them in such close proximity, and the effect of
various odors that were in evidence, the Indians, as I say,
were not long in being influenced by such a combination.
One buck in particular, a superb specimen of barbaric
physical development, seemed to gradually gain the idea
that the pretty and very attractive young woman standing
in front of him, was intentionally taking an undue ad-
vantage of his position, — indeed exciting him, where the
feelings she engendered were not likely to lead to any-
thing in the way of sexual gratification. He was losing
his control; the emotions working within him were not
difficult to be seen in the gleaming of his deep-brown

HOPI CHILDREN AT WALPI.

R. W. Shufeldt 343

eyes, and in the soon iU-concealed, though slight, twitching
movements he made. But no part of this seemed to
dawn upon the unsuspecting women, whose presence
alone was now all that was needed to excite this tawny-
skinned warrior to that point where further restraint
ceased to be a virtue. When he acted, it was with the
suddenness of a lightning-flash, and the act was of the
most extraordinary nature imaginable. Quicker than
thought, and with a dexterity almost surpassing belief,
he made a pass beneath her clothing with his hand,
and with no gentle pull, secured rather more than a
generous sample of the hair from her mons veneris.
Never heeding the shriek that followed from the electri-
fied and tortured victim of his audacity, or the excited
commotion it caused among the other passengers — this
stolid specimen of humanity simply grinned with pleasure
at his success, divided the trophy among the other bucks
who were with him, and then calmly viewed, with a far-
off look in his eyes, the river scenery and the deep blue
sky overhead.

On the 24th of December, 1906, my friend, George
Wharton James, sent me from Pasadena, California, a
very excellent photograph "of some Hopi youngsters"
which is, by his permission here reproduced in Figure I.

In a later letter (Jan'y- 8, 1907,) he wrote me
"The word Moki is the name we .used to give the Hopi
Indians before we understood that they themselves did
not like it. The term has now dropped into disrepute,
for the Bureau of Ethnology has decided, in the future,
to call them Hopi. Hence, if you simply change the
title to The Hopi Children at Walpi, it will be all right.

"I made (the photograph) myself at

Walpi sojne years ago. The story connected with it,
to me, is rather interesting. These children were very
fond of me, and always used to come to my camp as
soon as I reached the foot of the Mesa. On this particular
morning, the thought suddenly occurred to me, 'Why not
take a photograph of these youngsters?' The boys were
in the condition shown in the photograph, but the little

344 Modesty Among the North American Indians

girl had her short dress on, and they instinctively took
the position which the photograph shows, and when my
head was under the focusing cloth, the little girl evidently
realized the nudity of her brothers, and without a word
of suggestion from me, slipped her little dress off and stood
nude with her brothers. As you are familiar, it is only
very recently comparatively, that either boys or girls
have worn clothes at all until the period of puberty."
The fact Mr. James mentions here was known to
me many years ago, and I was visiting the Zuni Pueblo
in the early 80's, when all the Indian, children of that age
never thought of wearing any clothing during the summer
months, except on special occasions. It is quite otherwise
now, I believe, and, since the advent of the whites, all
that charming pristine innocence has come to be a thing
of the past. From babyhood to old age, those people
lived through their lives in the most natural way, nor
knew they anything of all the pseudo-modesty that sur-
rounds the rearing of children among our own people,
nor the vice that follows in its wake in later years as
an inevitable consequence.

Indeed, were our vice-suppressing societies enabled to
succeed in carrying out all the putrid notions they enter-
tain in regard to modesty and sexual matters in general,
all morality would be at a discount; thousands of grow-
ing boys and girls would become perverted and ruined,
and the entire atmosphere be rendered so rotten that no
moral person could long exist in it. All those who under-
stand such matters know full well that it is bad enough
as it is. So far as pure mental and physical well-being
are concerned, and leaving the questions of custom and
opinion entirely out of the case, it would seem that the
normal sexuality of the Indian made for a far better race,
cleaner in mind and stronger in body, than our own, reared
under the unnatural rulings of a distorted and entirely un-
natural demand in such matters. As I knew the Sioux over
thirty years ago, they openly fulfilled the requirements
of the normal sexual impulse; while we, protected by brick
walls and a hundred other kinds of places of absolute

R. W. Shufeldt 345

seclusion, give way to no end of abnormal sexual practices,
so foul in nature that more than half of them would cause
a very Nero to blush with shame, not to mention the
detrimental effect it is constantly exerting upon the mental
and physical organization of the race as a whole.

In the days to which I refer, I have seen many a
young Sioux buck and squaw do their courting standing
up under a buflEalo robe or blanket, in the midst of a
big camp, with no one paying any special attention to
the couple, who would quietly separate and walk away
after they had communicated their sentiments in full to
each other. Then, too, late at night I have taken a
"smoker" with them in one of their big wigwams, with
a few young married couples present, and six to eight
old "bucks," — the place being lit only by a very low
fire in their midst. If any one of the couples were
seized with the desire to copulate, the ever present buffalo
robe or the trader's blanket was the only shield from
observation they needed, and none of the company
present paid them any regard during the operation.
It shook up my preconceived views a little at first, for
an experience or two; but after that it seemed not an
unnatural thing to do — and they were very modest
withal. They were truly modest, whereas all our modesty
is modesty through fear. Such modesty is only too often
at once converted into the rankest sexual license when
the restraint is suddenly removed.

Precisely as the Indian has suffered by the intro-
duction of syphilis, rum, and tobacco, through his contact
with our race, so has his modesty and morals suffered
through the same cause. Never shall I forget the scene
I once witnessed, many years ago, out on the plains of
Wyoming — a scene that could only have been enacted
by the modern Indian, whose mind and morals had come
under the influence of the Indo-European, with his false
and prudish sexuality. It chanced that I had been over-
taken by a storm some ten miles from the military post,
where I was in charge of the medical department. A
fine snow filled the air, and the thermometer registered

346 Modesty Among the North American Indians

fifty-two degrees below zero, with a piercing wind blow-
ing, emphasizing the meteorlogical conditions of that
terrible night. My companion was a young contract
surgeon, who, belated by the storm, was on his way of
to join the station on temporary duty. At a distance
of five miles from the post, we entered the ranch-house
of a cattle-man, and here we found some dozen cow-boys
and a black m.an-servant of mine, driven in by the
severity of the weather. A big game of draw poker
was on, barrels being used for tables, while the air of
the place was simply 'fixed' with the fumes of foul
tobacco and the rankest of whiskey. Hardly a word
was being spoken, the men being as silent as their "guns"
at that time were in their holsters. At the further
end of the long single room, a dirty white sheet had been
hung across, and beyond it a lit kerosene lamp had
been placed on top of a barrel. This arrangement made,
as it were, a small separate room, the only furnishings
of which were a pile of buffalo robes thrown on the floor
next to the sheet. Here sat two Sioux squaws — mother
and grown daughter — whose forms, in whatever position
they assumed, were thrown with telling accuracy upon
the sheet as a moving silhouette. From time to time a
man would drop out of the game and retire behind this
flimsy curtain, for the purpose of having sexual inter-
course with one or both of these women; and, although
every detail of the performance was converted into a
moving picture upon the screen, so engrossed was the
audience with their winnings and losses, their drinks and
their vile cigars, that no one paid any special attention
to the depravity being enacted at the other end of the
room. Such an episode would have been an unheard-
of thing in the history of these Indians at any time prior,
to the coming of the whites among them, and, to me, it was
a sad commentary upon our boasted civilization and the
Christianizing influences of our missionaries.

Modesty, of course, is a character that is very
differently exemplified by different individuals of both
sexes belonging to the same tribe of Indians, as well as

R. W. Shufeldt 347

by an entire tribe of a distinct race of them. This I
found to be the case in my studies of the Crows, the
Navajoes, the Sioux, the Arapahoes, and the Zunians,
as well as with other tribes. Climate does not appear
to have any especial effect here, for some of the northern
tribes, as the Crows, seem to possess strong sexual
impulses, and with strong sexual impulses often is as-
sociated marked immodesty, while the reverse seems to
obtain among some of the southern races.

One time, when post surgeon at Fort Wingate, New
Mexico, and while engaged in making many photographs
for the Government of a young "buck" Navajo Indian,
employed in the various stages of the manufacture of a
buckskin, I discovered, much to my surprise, that I
could by no means induce him to allow me to photograph
his naked feet — he protested against this with quite as
much vigor as a Chinese woman would do; yet upon
another occasion, while I was out hunting on foot on
the prairie near the post, I came by chance, in the low
scattered sage-brush, upon this same man, who at the
time was having sexual intercourse with a squaw of his
own tribe. My sudden appearance by no means in-
terrupted him, for he simply looked up with a laugh,
and informed me in broken and not altogether chaste
English what he was up to, a fact that was sufficiently
apparent to not require any particular explanation
from him. She at the time was munching a mouthful
of sugar from the trader's store, as the price of the
privilege she had bartered. This incident is interesting
from the fact that this Indian, so intensely modest with
respect to his feet, experienced none of it when enjoying
normal copulation in the presence of a third party, and
that person not even a representative of his own race.
It is as well to remark in this connection that both of
these Indians were clothed from head to foot, and only
such parts had been opened as were necessary to admit
of coitus. This was also the case with the Sioux described
by me on a former page.

348 Modesty Among the North American Indians

I have referred above to the matter of modesty
among the Crows, and, in closing this question for the
present, I desire here to quote the following truths from
Ellis's chapter on "The Evolution of Modesty" in his
"Studies of the Psychology of Sex." What he states is
taken from Doctor A. B. Holder's article in the "American
Journal of Obstetrics" (Vol. XXV, No. 6, 1892), who
says: "A sense of modesty forbids the attendance upon
the female in labor of any male, white man or Indian,
physician or layman. This antipathy to receiving as-
sistance at the hands of a physician is overcome as the
tribes progress toward civilization, and it is especially
noticeable that half-breeds almost constantly seek the
physician's aid." Dr. Holder mentions the case of a young
woman who, although brought near the verge of death
in a very difficult first confinement, repeatedly refused to
allow him to examine her. At last she consented. "Her
modest preparation was to take bits of quilt and cover
thighs and lips of vulva, leaving only the aperture ex-
posed Their modesty would not be so

striking were it not that, almost to a woman, the females
of this tribe are prostitutes, and for a consideration will
admit the connection of any man." This tallies with
my own observations upon this tribe, made in the latter
part of the 70's, at Fort Custer, Montana. I also
know of a similar instance among the Sioux, and one
that had a fatal termination, as the woman declined
utterly to allow the military surgeon of the post to
interfere in the case. She, too, was a primipara struggling
with a transverse presentation, that their own attendant
(squaws) failed to correct. Most Sioux women, however,
are entirely virtuous, though there are exceptions to the
rule among them.

HAS THERE BEEN AN INCREASE OF SUICIDE

AMONG THE OPIUM ADDICTS SINCE

THE PASSAGE OF THE HARRISON ACT,

AND IF SO WHY?

By C. B. Pearson, M. D.

Hillsdale, Baltimore Co., Md.

SO far as absolute knowledge goes as to whether the
victims of the various forms of the opium habit
have been committing suicide in greater numbers since
March 1st last, I must admit that I do not know. So
far as newspaper reports go, it would appear that suicides
among this class have been very much more frequent.
There are good reasons why this should be so. It is the
purpose of this article to show what these reasons are.
A study of the peculiarities of the opium psychosis will
reveal these reasons.

I use the word opium, because that covers morphine,
heroin, laudanum, opium smoking, and other varieties
of the habit. By the opium psychosis I mean the ordinary
mental and moral symptoms induced by opium. I do
not mean the insanity or mental breakdown that very
rarely follows straight opiumism but frequently follows
opiumism complicated by alcoholism, cocainism, chloral
hydrate and other addictions. The most common ad-
dictions among our people are the tobacco, alcohol,
opium and cocain addictions in the order named.

Before going into a consideration of the opium
psychosis, a consideration of the motive that calls for a
continued use of these agents, will I believe, prove
profitable.

A cozy fireside, an easy chair, a paper or magazine,
and a pipe or cigar spell forth comfort of a winter's
evening. Sensible wives are aware of the fact and make

(349)

350 Suicide Among the Opium Addicts

but little objection to use of tobacco by their husbands.
The prime motive for the continued use of tobacco is
its real or supposed increase of one's comfort. Alcohol
is associated with hilarious good fellowship, later on
it is apt to develop very insistent demands of its own.
The prime motive, however, is a desire to escape through
its use from the cares and worries of life for a time.
Cocaine produces a peculiarly fascinating form of inebriety
and it is the desire to again experience these sensations
that is responsible for the continued use of the drug.
As soon as one discovers that he has become an opium
addict, the motive for its continued use is not comfort
as is the case with tobacco, not a desire to forgfet for a
time the cares and worries of life as is the case of alcohol,
nor yet a desire to again experience the seductive sensa-
tions of inebriety as is the case with cocaine. The drug
is continued in order to escape from the terrible mental
and nervous depression and the physical suffering that
invariably follow in a few hours after its discontinuance.
So the opium addict is in much the same predicament
as the man who had the tiger by the tail. The opium
addict finds it irksome indeed to continue his addiction
and he is too much afraid of the consequences to let go
of the drug. Alcohol makes a person self assertive, care-
less of other people's opinion and increases one's self
importance, etc. Opium on the contrary causes self-
depreciation. The addict feels ashamed and mortified
to think that he is in bonds. Out of this self-depreciation
arises the secretiveness, the tendency to prevarication
and to seclusion that are nearly always prominent sjonp-
toms. It may not at first appear that the fear, timidity
and cowardness that accompanies every case of opium
addiction to a greater or less degree also follow from self-
depreciation. A little reflection will show us that this
is the case however. Self confidence is the foundation
upon which all courage rests. An incident that occurred
in Paris just after the Napoleonic wars illustrates this
point very well. A French officer, reputed to be the best

C. B. Pearson 351

swordsman in Europe, was in the habit of publicly in-
sulting one officer after another of the allied armies then
stationed about Paris. The code of those days demanded
that a public insult given by one entitled to call himself
a gentleman, should be answered by an immediate
challenge to a duel. In this case, the choice of weapons
rested with the Frenchman. His skill with the sword
was so great and his confidence in his skill was so un-
bounded that the killing of one officer after another
was nothing more than an agreeable pastime. An English
officer took it upon himself to stop all this. He walked
into a cafe where the Frenchman was sitting at a table,
stepped up to him and gave him a hearty cuff on the
side of the head and spat in his face. No challenge
followed. The Frenchman had no confidence in his skill
with the pistol and did not have the courage to offer
himself as a target for the Englishman's weapon. He
resigned his commission in the army and retired from
public view, a hero no longer. So we can readily see
how a lack of self confidence tends to undermine and
finally destroy the addict's courage. This lack of courage
is essentially pathological. In many cases, however,
it becomes very much intensified through rational causes.
Many an addict has destroyed syringe after syringe in
vain attempts to free himself from the drug. There can
be no doubt but that these repeated failures intensify
to no small degree the addict's cowardice. As the years
go on the dread of being separated from his drug supply,
through lack of funds, through accident, through impaired
earning capacity, etc., hangs over the addict like a per-
petual nightmare. The newspaper writers who have
lightly referred to morphine as "happy dust" have but a
faint perception of the real truth of the matter. I
know of nothing that can so completely rob one of all
enjoyment as opium. The opium addict passes through
life in fear and trembling at the best. And now that
the Harrison Act is in force naturally his fears have be-
come greatly intensified. That he should think of suicide
is not to be marveled at. And that he actually takes the

352 Suicide Among the Opium Addicts

fatal step need not cause surprise to one who knows the
peculiar workings of his mind. But, says the reader,
with sanitariums all over the country, hospitals and insane
asylums standing ready to receive and care for the addict
it is silly for the addict to even think of suicide. His
outlook upon life and its problems is that of the opium
addict. His mental operations are in harmony with those
of other opium addicts and not in harmony with your
mental operations. If it were possible for the normal
individual to experience in his own person the mental,
nervous and physical suffering of opium withdrawal, he
would not wonder at the addict's dread of this ordeal.
This matter of opium induced cowardice is one
of degree. Very many addicts retain a creditable amount
of fortitude and we need not look for suicide among this
class. On the other hand I do not believe that anyone
can use opium to excess for ten or more years without
considerable impairment of their courage. And some
addicts are truly abject cowards. To make the addict's
view-point clear to the reader, let us suppose a normal
person to be in mid ocean in an open boat without food
or fresh water. Will the person endure to the end and
die in the boat? Or will he become delirious and jump
into the sea? Or will he be overcome by the actual
suffering and deUberately jump in the sea? Or will the
intensity of his fright caused by the harrowing nature
of his predicament drive the man insane and cause him
to jump into the sea? The obviously correct thing for
a man to do under these circumstances is to endure
till the end, because many ships are coming and going
over the waters of the ocean and help may come before
it is too late. But need we upon this account be sur-
prised, because the man fails to do the obviously correct
thing? But, says the reader, the comparison is unjust!
The comparison is just except that the man in the boat
is in a more favorable situation so far as the chances
of manifesting fortitude are concerned. The man in the
boat is a normal man with a normal man's courage to
begin with. The addict is not a normal man and his

C. B. Pearson 353

courage has been undermined by many years of abuse of
opium. The suffering that the man in the boat is about
to endure is not as great as that which the addict faces
when his present drug supply becomes exhausted. Further-
more, death will come as a relief very soon to the man
in the boat in case no help arrives. Death mky or may
not come to the addict, it is a matter of uncertainty.
Again if help does come to the man in the boat in a few
days he will become a normal man again. In the case
of the addict even if help of the right sort does come to
him, it will be weeks and months before the addict is
really and truly a normal man again. This does not mean
that the addict need suffer very much in getting rid of
his trouble; if he falls into really skillful hands he certainly
will suffer but little. However, as this fact is utterly
unknown to those addicts who would be at all likely to
commit suicide, it is of no avail as a preventative. But,
says the reader, there is at least one feature of the man's
situation in the boat where the comparison is unjust.
The man in the boat adrift upon the vast waste of the
waters of the ocean is utterly alone, while the addict
touches elbows with his fellow man upon every hand
and is within reach of sanataria that are not only ready
but eager to assist him. Let us examine this feature of
the matter a little. I have known addicts who have used
some form of opium over ten years without mentioning
the fact to a single soul. How can anyone under any
circumstances be any more alone than such an addict? But,
says the reader, if the opium addict is alone in his trouble
he is voluntarily so. I say that he is not voluntarily so.
This may seem like an absurd statement. I will en-
deavor to show that the statement is founded upon de-
monstrable facts.

We have seen that opium can and often does make a
despicable coward of a person. Opium generally causes
a most intense and peculiar form of secretiveness. The
opium addict is not secretive because he chooses to be
so but because the opium compels him to be thus and
not otherwise. So when I say that the opium addict

354 Suicide Among the Opium Addicts

is not voluntarily alone in his trouble, I mean just what
I say. The addict bears his troubles alone because it
is one of the peculiar features of his disease that causes him
to do so. The symptoms of cancer are physical and tan-
gible. The psychological changes induced by long years
of indulgence in the use of opium are every whit as constant
as are the physical changes induced in the body by cancer.
Some secretive addict may go to his family physician
and say "Doctor, I have a friend who has been taking
morphine for ten years and is now taking 30 grs. daily,
is there any help for him?" The doctor says no, he
may go to some sanitarium, but even if he gets cured
he will go right back to it. After a long time he again
musters up enough courage to approach another doctor and
gets the cheerful advice to tell his friend to cut the
thing out at once. As the addict has already tried this
many times, such advice does not tend to dispel his
gloom to any great extent. There has been so much
written recently upon the subject of opiumism that it
does not seem that any doctors could be found today
who would give expression to such deplorable ignorance.
I wish all doctors had the manliness and common sense
to say that they don't know when they don't. Such
medical conmsel as the above may have been largely
responsible for more than one suicide. Some friend may
approach the addict and say to him: "I know of a sani-
tarium where they are curing morphinism, why don't
you go?" To some addicts who have not lost all of
their courage an appeal of this sort may be pleasing, but
to others the word "Sanitarium" brings to them no
more cheerful thoughts than padded cells, restraining
sheets, straight jackets, locks and bars, constant sur-
veillance and misery and horror upon a most extensive
scale. Other addicts have already been to some "fake"
institution and received no more cheering experience
than punishment of the most horrible description and a
depleted purse. Others have put themselves in the
hands of some doctor who meant well but whose method
of treatment is more vigorous than wise and have since

C. B. Pearson 355

relapsed. One cannot very well blame these addicts
for being a little skeptical, and especially one cannot
blame them for being skeptical about being cured without
undergoing intense suffering. One recent writer in describ-
ing his method says the patient will suffer merry well
and so he should. I fail to see the philosophy of this view
of the matter. Suffering is no preventative of relapse. And
I have very good reasons for believing that it contributes
in a marked degree to relapse. A study of these reasons
belongs to a discussion of the treatment of the disease.
Some of the doctor's former patients may have since
relapsed and have since committed suicide on account
of that very suffering that he seems to consider to be
so salutary. Harsh methods of treatment only serve
to frighten these people and tend to cause them to put
off trying to get well on account of the harrowing tales
that they have heard from others. They really can
be kept comfortable during the greater part of the treat-
ment, and I believe there are good sound therapeutic
reasons for doing so. ^ut let us return to the considera-
tion of suicide among these people.

I can readily see how the fear of being separated
in the near future from their drug supply may drive
some of these addicts temporarily insane and then to
suicide. In other cases the self depreciation and shame and
the resulting secretiveness may have become so great that
they elect suicide rather than face the publicity of their
misfortune, that they think will inevitably follow separation
from their drug supply. Some of the laity, especially,
come to look upon opium as their only support and cannot
conceive of life without it, as being otherwise than un-
endurable. I think that we need not look for suicide
except among those addicts, where the psychological changes
are extreme, or among the mixed drug takers where general
mental breakdown has already taken place. The recent
addict is not in much danger. The wealthy addict can
assure himself of a continued supply, if need be by re-
siding in some country where the laws are less severe.
Those who are not so secretive but that they have in-

356 Suicide Among the Opium Addicts

formed themselves of sanitaria that they can resort to in
case of need are not in much danger of suicide. In the
underworld opiumism is more or less a social vice. These
addicts assist one another, keep one another informed
of sources of supply, and of places where they can secure
humane treatment. Now that the shock of the Harrison
Act has spent itself, I think there will be very few more
suicides, there ought to have been none. A time limit
in all laws of this character would have avoided whatever
loss of life there may have been. The Harrison Act of
itself did not cause so much alarm except in those states
where there was already a severe state law. A time limit
I believe would render all laws of this character more effect-
ive rather than less so. Because we could all of us obey
the law then out of respect and approval of the law and
in the confidence that we cotild do so without doing harm
or endangering the lives of the unfortunate opium addicts
among us. At present there is the fear of the law on the
one hand and the fear of working harm to an unfortunate
addict on the other. That is, this must be the dilemma
that all physicians find themselves In except those who are
innocent of all knowledge of opiumism. A time limit
would have saved much embarrassment. In such a case
every addict could have been informed by his physicians
that all prescriptions calling for opium after such a date
were to stop and the matter of a suitable sanitarium or
plan of treatment could have been talked over at leisure.
Opiumism is a curable disease. Whether it be large or small,
the loss of life from suicide on accoimt of opiumism could
have been prevented.

THE PREVENTION OF MENTAL DEFECT

THE DUTY OF THE HOUR.

By Martin W. Barr, M. D.

Chief Physician Pennsylvania Training School for F. M. C.

Elwyn, Pa.

TTHAT the prevention of the transmission of mental
■*• defect is the paramount duty of the hour, is a
truism not to be questioned; and to this end, honest,
rational eugenics is an absolute necessity to stem the tide
of degeneracy, now steadily on the increase.

Life stands not as the product of the Demogorgons,
but as a gift of the great King Himself; and is revealed
in many forms; no one form left to chance, but made
according to law from a pattern for which the forebears
are responsible. This may be hidden, like the ocean
drift-wood, but at last, it is cast up.

Heredity, the law of life for human, as truly as for
beast or plant life, is clearly proven. To be bom aright,
one must be born again; but the inception must be with
the forefathers. Degeneracy once permitted to invade a
lineage can never be wholly eradicated; lessened materially
and even reduced to a minimum it may be, but sooner
or later, in one generation or another, a defective is
bound to appear.

The carelessness or ignorance of an apparently
normal mother during parturition; or that of a physician
at the birth; the neglect of a nurse — all may become
tributary to defect; and the concentration of neuroses
in a child, frequently unsuspected, may date back a
century before a physiological house-cleaning takes place.

The Registrar General's last statistics in Great
Britain show that in England and Wales, with a popula-
tion of 36,070,492—161,963 were returned as suffering

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358 The Prevention of Menial Defect

from mental infirmity — 106,660 being insane and 55,303
mentally defective; and since 1901 shows an increase of
insanity 27.3 per cent, and of mental defect 13.2 per cent.

In the United States there are over 350,000 avowed
cases of mental defect, showing one to every 200 or a
little less than }4 oi I per cent of the entire population.

Some 21,000 of the feeble-minded and epileptic
are provided for by 27 States in 37 institutions; in ad-
dition, about 1,000 are cared for in private schools.
Therefore, there are at least 328,000 mental and moral
defectives at large, perpetrating, unrestrained, the de-
filement of the race.

Throughout the entire United States no less than
$94,000,000 is annually spent in the care of the insane,
and $90,000,000 for the feeble-minded; making a total
of $184,000,000 expended yearly upon our helpless popula-
tion.

The percentage of mental defect among the foreign
element in the city of New York, where our immigrants
are mainly admitted, is 2.48 times greater than that of
the native-born. A study made there in 1912, of the
alien insane and feeble-minded cared for in the State
hospitals, shows no less than 13,163 foreign-bom patients.

For these, at a cost of $262 per capita, the annual
expenditure amounted to $3,448,706, and as the average
hospital age is eleven years, the sum of $37,935,766 will
have been paid by the State at the end of that period
for the care of mentally defective and diseased aliens.

Herein is clearly shown that the physiologic, psycho-
logic and sociologic researches of the 18th and 19th
centuries have, within the 60 years portrayed, certainly
produced practical results in providing protection for the
defective. But it also shows that the greater aim of
protection for the race has not been attained.

A glance at the exposition which science has given
in relation to cause and effect, may make clear the means
by which the ultimate suppression of so great an ill
may best be attained.

Martin W. Barr 359

That heredity is naturally a dominating factor in all
life is clearly proven in the researches of Mendel, which
exhibit unerringly how definite characters are formed in
the individual, and how directly they are transmitted, so
that decendants to at least the fifth generation may de-
velop the characteristics of their forebears in greater or less
degree. Not that the child will necessarily exhibit actually
the same defects, or qualities of the parent, but it does in-
herit a strain, be it good or bad, which will be stimulated
or kept in abeyance according to the prepotency of
connection.

Science, following up this principle, has shown further-
more that by a careful study of family history, recog-
nizing peculiarities, or traits lacking, it may be possible
to suppress, but not to eliminate this strain. The Mendel-
ian law clearly affirms that the germ plasma of normal
male and female contains a "determiner element," for
every tissue of the body; and when these "determiner
elements" are of equal potency, and blend perfectly,
the decendants will possess characteristics of both parents.
Whenever there is a defect in the germ plasma in one
parent, the analagous "determiner" of the other will
assert itself, and the child inherits the stronger character-
istic, be it good or evil. Thus it is not infrequently
observed that apparently normal persons produce feeble-
minded children ; or there are families where some members
are bright, and one or two, for no apparent reason,
feeble-minded; while on the other hand is seen a normal
child, the offspring of parents — one normal and the other
abnormal. Such are clear examples of the prepotency
of the infusion of pure blood ; the taint is there all the
same, in abej'ance, ready to respond to the first call of
inheritance or accident.

This is especially to be noted of mental defect;
imbecility will brede imbecility, and where there is a
trace of feeble-mindedness in a family it is sure, sooner
or later, to reappear, the defective "germ plasma" pro-
ducing an abnormal.

360 The Prevention of Mental Defect

Insanity and defect — mental, moral and physical —
inevitably find a corollary in the after family history.

Recently my attention was called to a family where
both parents being feeble-minded, there were 22 imbecile
children; in y«t another were 18 idiot children — also (rf
defective parents — the community in which these latter
lived, taking pride in exhibiting them as curiosities.
One family shows in four generations, 34 imbeciles;
and two other families, each with an idiot mother, show
in the one 7, in the other 9 illegitimate children.

Surely some one should have suggested that these
cases required surgical aid; yet no steps had been taken
to such end.

Venereal disesaes cause much idiocy and imbecility,
and both directly and indirectly are potent factors;
nullifying the wage-earning capacity of the father and
reducing the poor, innocent mother to a state of hopeless
invalidism. In thus destroying domestic happiness they
lower the whole morale of family life, and finally are
visited on the unborn child who enters life the diseased,
starved victim of an unhealthy heredity and environment.

Syphilis is fitly named the "King of Abortionists"
and "Gonorrhoea the Queen of Sterility."

In a study of harlots numbering 424 — 80 per cent
plus were found to be distinctly imbecile, their mental
age never exceeding twelve years. The 20 per cent
adjudged normal were found to be unable to carry on a
consecutive conversation; and, never reading papers or
books, were absolutely ignorant of the ordinary topics
of the day. A large majority of the whole had contracted
vereneal diseases, and were pronounced alcoholics and
drug addicts.

Of some studies made in the Juvenile Courts, number-
ing 1487 — 61 per cent were found imbecile beyond a
peradventure, their mental age averaging from 7yi to
11. Of these, over 50 per cent were victims of venereal
diseases.

Unfortunate results may be traced to the abuse of
drugs and to alcoholism, which latter, with its deleterious

Martin W. Barr 361

effect on cell and germ-life may, even in moderation,
according to Darwin, Gladstone, Cobden and Comte,
accomplish more harm than a combination of famine,
pestilence and war.

From this brief scanning of statistics, one cannot
fail to recognize the necessity for the enforcement of
measures which experience has demonstrated as absolute-
ly needful steps toward prevention, viz: the Separation,
Sequestration and Asexualization of degenerates; and fur-
ther revision of Marriage Laws forbidding increase.

Such separation protects society from contamination
and the defective from a world where, brought into
competition with normal people, he is forever misunder-
stood and driven backward — be it in the home, the
school or in business circles.

Separation, first, of normal from backward children
in the schools; second, the massing in classes those of
similar mental capacity, that they may be trained in
occupations proven possible for them — industrial, manual
or intellectual — such as farm and house work, shoe-making,
carpentry, dress-making, painting or printing; in these
aiding also in living expenses.

In order to effectually accomplish these aims, there
must be permanent Sequestration, otherwise the trained
imbecile is a greater menace to society than is the un-
trained, in that with latent powers and talents developed
to the point of concealing defect, he is no longer recog-
nized, and has opened to him a larger field for the in-
dulgence of emotional or criminal instincts.

Training schools for defectives, without the pro-
tection of permanent sequestration, find themselves often
twice defeated in the aim of preventing increase and
lessening crime; and by the loss of their trained laborers
aiding in self-support and in the care of the helpless.
For this evil, legislation offers no remedy, no state in the
union providing for indeterminate sequestration.

Why may not the Government rather set aside
a reservation for such? Surely they are as deserving
as are the Indian or the Negro, and such protection

362 The Prevention of Mental Deject

more reasonable and cheaper than penitentiaries for which
there wotild soon be no need.

Asexualization has at last won its way to legal
recognition as the only assured means of dealing with
present numbers, not only preventing increase but lessen-
ing the exaggerated sexual impulses and contributing
to the happiness of the individual, thus insuring a certain
amount of freedom in home or community life.

In this matter the past decade seems to present a
new trend of thought, in that what was formerly termed
brutality, is beginning to be viewed as simply the safe-
guarding of the innocent, and the preservation of nations
from racial degeneracy. Some 12 States have concurred
in affirming the necessity for sterilization; Indiana lead-
ing the way in finally gaining the endorsement of legisla-
tive action.

The application of the principle in these states cannot
fail to correct prejudice and misunderstanding in the mind
of the general public, making clear the nature and sim-
plicity of an operation involving no danger and almost
no discomfort to the subject, and insuring benefit to all.

The removal of the organs is not always essential,
but is to be preferred as giving absolute security, and
when performed upon youth, desire almost entirely
ceases, or at least is held in reasonable abeyance.

There is no reason why the operation should not be
so safe-guarded as to prevent license. It should be
permissible only after study of and testing by accredited
alienists and surgeons, and this is best attained in the
grouping of numbers by separation and segregation.

In the reconsideration of Marriage Laws, progress
is also shown in that a large majority of states — some
38— make proven defect in either or both parties, a
nullification of marriage; but none as yet require for
obtaining a marriage license a certificate exhibiting a
clean bill of health for two generations back; notwith-
standing the large number of cases recorded showing the
reappearance of unsuspected defect, usually intensified,
in the third or fourth generation.

Martin W. Ban 363

It has been urged that stringency of marriage laws
would encourage vice; but why not make illicit cohabita-
tion with a defective a penal offense, as does the "Mental
Deficiency Act" recently brought into operation in Eng-
land?

It is to be hoped that the day is not far distant
that shall bring a consensus throughout the union, re-
garding the prevention of procreation by the unfit, as
absolutely necessary to stem the tide that is polluting
the race.

The separation, segregation and asexualization of
the unfit in one generation, must in the nature of things
bring a two-fold blessing, not only reducing numbers in
one, but raising and accentuating the standards of suc-
cessive generations.

With such division of classes presenting a permanent
object-lesson, of fit and unfit, the question with each
individual being simply "to which shall my descendants
belong?", eugenic marriage will, as the outgrowth of
such civilization, become a natural custom with all,
as it is now with a few, needing no law to enforce it.

The experience of the ages shows that the progress
of a nation is coequal with its maintenance of race-ideals,
and that the survival of the fittest can never be attained
if no restriction is placed upon the propagation of the
unfit.

In this study of imbecility the vital importance of
its early recognition is a point arrived at by science
in many lines — physiologic, psychologic and pedagogic —
a dictum which workers in social welfare also endorse,
as being clearly proven in their varied experiences.

That the general public — the entire lay world —
be brought to regard every imbecile as a social menace,
and the segregation and asexualization of such imperative,
has long since been affirmed by leaders in charge of them;
and was clearly acknowledged by the women of our land
when the subject being broached before a conference
of mothers, I was urged by them not only to preach this

364 The Prevention of Mental Defect

doctrine, but to preach it in terms that he who runs
might read.

With public thought so crystalized, the demand for
increased facilities for the care of irresponsibles must
meet with better success than in the past, being accepted
by legislation not as contributions to charities, but a
protection to the safety of the general public — an ounce
of prevention being recognized as truly worth a pound
of cure.

The effect of such conditions and environment upon
a rising generation would tend to create a far higher
education than the much-vaunted teaching of sexology in
schools. Under present conditions a subject forbidden
general discussion is often greedily swallowed as forbidden
food by semi-defectives, to the detriment of themselves
and others. Whereas the evils of heredity, guarded by
legislation, and as openly discussed as are the evils of
war upon a nation, will bring to our youth a normal
consciousness that the right of marriage is not a mere
legalizing of the cohabitation of the sexes — the sentiment
of too many of the present day — but is a sacred entrance
to the vocation of parenthood to which all are not called;
a vocation for which the fitting of ones self by the cultiva-
tion of the being — mental, moral and physical — toward
the gaining of a noble self-hood is the truest religion as
well as following the dictates of the highest patriotism.
Such preservation of things sacred would lead, surely,
to a day of chivalry greater than that of past ages.

When the world shall be brought to recognize that
the production of maimed life is a greater crime that it
at present regards its destruction; when the arm of law
shall be extended to control sexualism as it now does
brutalism; then growing generations, viewing in family
and community life the result of true self-control in the
noble self-hood attained by their elders, will press onward,
inspired by high race-ideals, in this work of race preserva-
tion.

NOTES ON THE HISTORY OF PSYCHIATRY. X.

(Cont. from May, 1911.)

By Smith Ely Jelliffe, M. D., Ph. D.,

Adjunct Professor of Diseases of the Mind and Nervous

System. Post Graduate Hospital and Medical

School, New York.

IT is nearly two years now since the last contribu-
tion which 1 published in the Alienist and Neurologist
on the History of Psychiatry. In the August number,

1913, I finished a translation of Falk's celebrated study
on the Psychiatry of the Ancients, promising to return to
the classical work of Friedreich, the chapters from which
I have had in preparation for some time, chiefly through
the courtesy of Dr. C. Bruder while interne in the Govern-
ment Hospital for the Insane in Washington.

Work on the two large volumes of Modern Treatment
of Nervous and Mental Diseases, with Dr. W. A. White
of Washington, published by Lea & Febiger in 1913,
on the Translation of Dejerine's Psychoneuroses, published
by Lippincotts in the same year and a second edition in

1914, on the Diseases of the Nervous System, a Text-
book of Neurology and Psychiatry, by Dr. White and my-
self. The translation and publishing in the Nervous and
Mental Monograph Series of Rank's Study on the Myth
of the Birth of the Hero, and in the Journal of Nervous
and Mental Disease of P^ppinger & Hess' Study on
Vagotonia with Dr. W. M. Kraus of this city, these with
a steadily increasing and arduous practice have interrupted
me in the fulfilling of my promise to continue this series
of Notes on the History of Psychiatry.

I have indulged in this personal reference largely
because Dr. C. H. Hughes has encouraged me to continue
these notes, advising me that some of his readers have
found them of interest, and furthermore, because the original
sources are mostly inaccessible to students of psychiatry.

(;i65)

366 Notes on the History of Psychiatry. X.

In 1906 when I began the translation of Friedreich's
History, there were only four copies known to me in the
libraries of this country. In the same year I found a
copy of it in Berlin and was about to "get away with it"
when to my interest I found it had been obtained for
Dr. Adolf Meyer for the Phipp's Institute. Shortly
thereafter I secured a copy for my own library.

In February, 1910, February, 1911, and in May, 1911,
in the Alienist and Neurologist the work of Friedreich
on the Ancient Period was begun. I purport going
on here from where we left off in May, 1911, and took
up the work of Friedreich.

XVI.
Celius Aurelianus

Celius Arelianus in ^the writings^ of Grainger^ is
placed before Galen and Aretaus with respect to his
writings on mental disturbances. His discussion* of
mania and melancholia and especially of mania is a very
detailed dissertation.

I. The chapter on Mania begins with the exact
etymology of the word, which follows: "Plato in the Phae-
drus mentions two kinds of madness; one a mental strain,
caused by the body, the other divine or instilled and that
Apollo is the inspirer of it and it is called divination,
by the Ancients, however, called madness."

"The very ancient Greeks used to call by the name
mania what is now called mantike (prophecy.)"

"Likewise another, he says, comes from Father Bacchus,
another from love and he calls it erotikon. Another from
the muses, which he calls protreptikon, (stimulating)
which appears to inspire song. The Stoics said madness
was twofold, one a kind of folly, which they thought
made every fool insane, another from the alienation of
the mind and sympathetic (affection) of the body. The
followers of Empedocles say one is caused by the purging
of the soul, another by the alienation of the mind,
caused by unevenness (lack of balance) of the body,
about which we are about to write which the Greeks,
if anyone has a great uneasiness, call mania or what un-

Smith Ely JelHffe 367

duly relaxes the soul or the mind; for they call it manon
(loose), abandoned or soft; or truly what pollutes invalids,
for the Greeks call lumainein to pollute; or truly what
makes the patient desire wildernesses or solitudes, for
the Greeks call being left alone and seeking the wilderness
monosthai (nzto be solitary) ; or what holds the body too
tenaciously and is driven off with difficulty; on account
of that the Greeks spoke of it as mania or surely what
makes the invalids hard and enduring, which the Greeks
call hypomonetikous (patient.)"

Mania is a chronic ailment without fever, this
differentiates it from phrenitis. It occurs in youth and
manhood, is more common in males than females, and
more common in youth than in old age. Sometimes its
causes are obscure, at other times they are known and again
largely so it may arise because of psychic disturbances.
If the disturbance does not appear suddenly it is preceded
by symptoms similar to those that precede epilepsy
and apoplexy. Following® this, Aurelianus gives a detailed
description of the disease as given by earlier writers.
It appears from the following:

"So then one mad man thinks himself a sparrow,
another a cock, another a God, another an orator."^

That he mixes illusion (Fixenwahn) with delirium
(Wuth). It is strange to note that he maintains* that
mania is not a disease of the mind;* first because the
philosophers had written nothing of its treatment, and
secondly because bodily ailments preceded the condition.

The treatment, he says, is the same as for epileptics.
He especially points out the need for complete rest,
and the keeping away of disturbing influences as light
and contact with strange persons, etc. It is noteworthy
that he gives especial instructions to the attendants,
and that he gave thought to psychic treatment. He
is the first one to recommend the use of the leech in
the corporal treatment of the insane. ^^ The balance of
his treatment is quite similar to that of his predecessors.
He is very insistent on sleep for the patient. For the
convalescent he gives various psychic directions, such as

368 Notes on the History of Psychiatry. X.

reading and conversational practice, and the seeing of
plays. Each should be amused according to his education.
For the uneducated, shows only are suitable. In addition
bodily activity, baths and friction rubs should be provided.
In closing, Aurelianus censures some of the methods of
treatment used by other physicians.^^ It is in this
criticism that we learn the methods of Asclepiades in
which he makes use of singing, music, the lash, binding,
compulsion through hunger and thirst, wine, and kindness.
It is these that Aurelianus censures.

Caelius Aurelianus discusses melancholia with a few
words.*' He gives depression as its chief characteristic
and seeks for its cause in the disturbance of the digestive
system, and as a psychic cause he gives fear and sorrow.
It is more common in the middle aged and men, than in
women and other periods of life. His description of the
disease is quite similar to that of Aretaeus. He discards
blood letting and hellebore and his entire treatment
centers around astringents and cathartics.

Outside of this his therapy here is the same as that
given for mania. He recommends a mixture of aloe
and absinth as a potion.

XVII

G.\LEN

Claudius Galen, born in Pergamos, in Asia Minor
in the year 131, supplies less on the pathology and
therapy of diseases of the mind in his numerous writings
than one would expect, although Daniel Halback writes
a whole book about him in reference to this subject.
Both of Galen's discussinos on the diagnosis and treat-
ment of the errors of every soul (On the diagnosis and
treatment of the diseases peculiar to every soul) are not
pertinent here. Their contents are ethical and censure
the customs of his time. What material would be of use
here is scattered in single passages.'* and there is noth-
ing in them that has not been given in the previous
chapters. Therefore, I will consider his works briefly.

In melancholia he makes a marked difference as
to whether it is the entire mass of blood that is affected

Smith Ely Jellife

or only that of the brain; he says this makes an essential
difference in treatment, for in the first instance where
the entire body contains melancholic blood, it is essentially
necessary to let the blood, while in the second instance,
it is unnecessary, unless there are other indications for
doing so.

Galen sets forth at length and in detail, what kinds
of meats and noruishment are the cause of melancholic
blood. As other writers of his time he mixes melancholia
with a fixed delusion (Fixenwahn). All melancholies
are similar in that they suffer from fear, sorrow, and
misanthropy, and are tired of life, however, all do not
wish to end their life. Some even fear death. Just as
the external darkness instills fear in persons who are not
stout hearted, black bile produces fear in melancholia
by darkening the spirits of life in the patient. The
physician and philosophers are agreed that the humors
of the body had a distinct influence on the function of the
spirit. Therefore, those physicians who do not write
of this influence of the humors (for example Erasistratus)
did not trust to write on melancholia.

In a similar manner as told of by Erasistratus,
Chap. XI, Galen disclosed the secret love of a woman
for the dancer Pylades, through feeling her pulse**:

CI. Galeni, de dignotione atque medela erronun in cujusque animo ;
Graece ed Joh. Casel, Helmst. 1592, Graece et lat Rudolst 1715.

CI. Galenus, de dignoscendis curandisque animi morbis. Basel 1587.

Dan Halbach von der Porten. De Cognoscendis et curandis animi
morbis ex Galeni sententia Regiomont. (Konigsberg) . 1515.

XVIII

Marcellus
About Galen's time there lived in Rome, Marcellus,
born in Sidas in Pamphilian (therefore he bore the
surname Sidetes.) He wrote*^ forty-two books on medicine
in hexameter, in which appears a description of lycanthropy,
which I mentioned in Chap. IV.** These patients howl
like wolves, and wander about at night in graveyards
and other out-of-the-way places. The disease appeared to
grow worse in the spring of the year.

370 Notes on the History of Psychiatry. X.

Oribasius^' and Aetius^" have saved fragments of
the writings of Marcellus.^^ They will be quoted when
discussing Aetius.

XIX
Oribasius

Oribasius,^ a friend and contemporary of Emperor
Julian,^^ as is well known, made extracts from the pub-
lished medical works of his time and systematically
arranged them into seventy books.^ From these books
he drew the most important matter and gave the work
the title of Synopsis.

Oribasius therefore ranks only as a compiler;^* and
it will not be necessary to dwell on him long since most
of what he has to say has been given in extracts from
the authors previously quoted.

Of his essay on melancholia we only have a fragment,
for he begins with a third type of melancholia.^* Ac-
cording to his description it is hypochondriasis. Fear
and depression are the chief S5rmptoms given. Treat-
ment consists of proper diet, baths, and in the deep
rooted sickness aloe, absinth, colocynth, and black helle-
bore shotdd be given. He differentiates melancholia
from insanity, and designates the latter as the ripened
fruit of the black biled ills. The article is titled "ex
Philumeno." The treatment of insanity is the same as that
of melancholia.

The tenth chapter^' deals with lycanthropy taken
from Marcellus.

With regard to psychic dietetics. Oribasius teaches
that the bodily development of a child should be looked
after before trying to cultivate the mind. A good educa-
tion consists in allowing the mind to rest until the seventh
year, and not till then should a child be given literature.
Grammar and geography should not be attempted until
the fourteenth year.

1. Prom Sicca in Numidia. The dates of his life are not accurate. It appeara
that he quotes Galen and Galen quotes him, therefore, it is taken that they lived
about the same time. (J. G. Voss, de natur. artium. Lib. V. Cap. 12.) It is taken
according to barbarian Latin that he lived about the 5th century (Reines var. lect.
Lib. III., Cap. 17.) In other general respects we can take him as a contemporary of
Trajan and Hadrian.

Smith Ely Jelliffe 371

2. De morbiB acutis et chronicis, Libri. VIII. (Amstel 1755.)

3. De febre anomala batava, Altenb. 1770, p. 87.

4. Morbor. chron. Lib. I., Cap. V, VI. (P. 325-341.)

6. The word "furor" was generally used by the ancients in a protracted sense;
BO that it can be taken to signify an unruly display of pleasure, as for example in
Horace Carra. Lib. II. Carm. VII, Vera. 27, 28. ". . . . recepto. Dulce mihl
furere est amico." "It's sweet to me to be mad (with joy) over a friend regained.'*

6. Page 326, etc.

7. Page 328.

8. Page 329.

9. The statement that the presence of psychic disease is not to be sought in
the mind, but in the body. I tried to prove in my sketch on the general diagnosli
of phychic diseases. Wurzburg, 1829. Sec. 6.

10. Page 329-339.

11. And if the countenance or face is much affected, the whole body will have to
be relieved by bloodsuckers, which we call leeches.

12. Page 335-339.

13. Page 339-341.

14. In the books: de symptomat caus., de symptom different and de loc. affect.
Lib. Ill, Cap. 6, 7, 10 (Vol. VII) Edition of Charter, Paris: 1679 fol.

15. De loc. affect. Lib. III. Cap. 10.

16. De praecognitione. Cap. VI (Zacutus Lusitanua (de medical princip. Htat.
Lib. I, Histor. 40) comments on this story of Galen.

17. Sprengle, Hist, of Medicine, II B. S. 172.

18. Eudocia, apud Villoison, anecd. graec. I. 299.

19. Synops. Lib. VIII. Cap. 10.

20. Tetr. II., Serm. II. Cap. II.

21. Fabricli Bibl. graec. ed. Harles T. I. p. 15.

22. Born in Pergaraus according to Eunapiua (vit. sophist, p. 181) and according
to Philostorg (hist, ecclesiast. Lib. VII. Cap. 15, p. 520) in Sardis. He lived up to
the middle of the 5th century.

23. pribasius accompanied Emperor Julian on his last campaign, who appointed
him questor at Constantinople, and he was sent on several important missions, for
example to the Oracle at Delphi. (Cedren, chronic. Paris, 1647. ed. Fabroti, p. 250.)
The followers of Julian, Valens and Valentinian, banished and took from him his
title, but later seeing their injustice, recalled him and made public restitution. (Eunap.
a. a. O. p. 182.)

24. Only 17 of these books remain to us.

25. Heinroth, a. a. O. S., 89.

26. Synops. Lib. VIII., Cap. 7.

27. Syn^ops. Lib. VIIL, Cap. 10.

28. Aetius gives the same fragment from Marcellus. I will quote it under
Aetius.

29. Synops. Lib. V., Cap. 14.

(To Be Continued.)

THE CIGARETTE FROM A MEDICAL STANDPOINT*

By David S. Booth, M. D.,

St. Louis

Professor of Nervous Diseases, Medical Department

National University of Arts and Sciences; Neurologist

to the Missouri Pacific-Iron Mountain and

St. Louis Southwestern, Railway Companies,

Etc.

ALTHOUGH a great deal has been written upon the
subject of the effects of cigarette smoking upon the
human body, much of it is without either scientific or
practical value, as it is based upon false premises, or is
the result of erroneous reasoning, if not of sophistry, or
is the conclusion drawn from too Umited observations.
In order to arrive at a correct conclusion upon the
subject of this symposium, it is necessary that the in-
vestigator divest himself of prejudice, ascertain of what
the cigarette is made, and then learn the effects, if any,
the materials, or their active principles, have upon the
body, and finally determine if these are taken into the
body in the act of smoking in sufficient quantity to
produce effects. In other words:

"In a contemplative fashion,

"In a tranquil frame of mind;

"Free from every kind of passion,

"Let us the solution find."
It will be necessary to draw on scientific works for
much of the data, therefore, in order that all may under-
stand, I shall, even in my quotations, substitute Enghsh
for technical language. ;^j

*Read before the Sorority Circle of the Mothers' Congress, sa p«rt of a Symposium
on "The Cigarette," St. Louis, March 11, 1915.

372

The Cigarette from a Medical Standpoint 373

"In order to make rabbit stew, first catch the
rabbit," is a commonly used expression; in like manner,
in order to "roast" the cigarette, we must first get a
proper "hold" on it, by learning of what the cigarette
is composed. As this has been the subject of no little
controversy, I have attempted to learn, if possible, the
exact composition; that I might have all the available
data.

I not only consulted scientific works and articles,
but mailed to six of the large manufacturers of cigarettes
a request for any literature or facts which would aid me
in this work. I received replies from four; three of whom
sent me a copy of the same booklet, "The Truth About
Cigarettes," and the other referred me to magazine
articles. One of those sending a booklet stated the
company had another one in preparation and would mail
me one as soon as published.

"The Truth About Cigarettes" contains reprints
of articles, mostly scientific, originally appearing in
scientific magazines. One is a report of an investigation
made by one of our leading medical journals, the London
Lancet, in 1899; others were reports and investigations
made by members of the New York Medico-Legal Society
in 1897 and 1898.

It, also, contains reports of the findings of a number
of chemists of recognized ability who analyzed several
different brands of cigarettes, and all reported them free
from such poisons as opium, morphine, strychnine and
arsenic (substances often stated to be present) or other
drugs or poisons foreign to tobacco, though the report
of the London Lancet states that cigarettes also contain
glucose, sugar and glycerine, but concludes with the remark
that "the addition is perfectly harmless." This is from
the Lancet of December, 1899; we shall later quote
from the report of a more recent investigation by the same
journal on this point.

The wrappers were found to be of excellent quality,
mostly rice paper, and free from arsenic, white lead or
other poisons. Copper in minute quantity was found in

374 David S. Booth

some Turkish cigarettes, which contained a gilt label
printed on the wrapper.

Since I am unable to find an3^hing authoritative to
the contrary, I feel we are justified in assuming that
cigarettes are usually made of sweetened tobacco and pure
paper, though it is possible there are exceptions.

Bastedo's Pharmacology, a very recent text book
upon the study of drugs, has the following description
of tobacco: "Havana tobacco, noted for its deUcate aroma,
usually contains one to three per cent, of nicotine; some
of the Virginia and French tobaccos may yield from
six to seven per cent.

"Examination of Virginia tobaccos by the Virginia
Agricultural Experimental Station in 1899, showed 1.68
to 6.17 per cent, nicotine. Turkish tobacco contains
about 2.5 per cent, of nicotine."

There is a diversity of opinion as to the amount of
nicotine destroyed in the smoking; some investigators
finding that only one-fifth is recoverable from the smoke,
while others report the recovery of as much as four-
fifths.

Contrary to the earlier report of the London Lancet
made in 1899, a more recent report of that journal made
in 1912 states that the sweetening, i. e., sugar or glucose,
and probably glycerine, is harmful, in that when it bums,
furfural is formed.

Furfural is a constituent of the fusil oil of alcohol,
and the London Lancet experiments disclose the iact
that it is fifty times as poisonous as ordinary alcohol,
and that a single cigarette may contain as much of it as
two ounces of immature or unripe whiskey. Furfural
is practically absent from Turkish cigarettes, but is
formed in large amount in the cheapest American cigarettes
which are nearly always made of Virginia tobacco, which
contains least nicotine and ammonia, but most furfural.

Tobacco smoke, also, contains prussic acid, ammonia
and carbon monoxide, the latter of which is about ten
times as poisonous as carbonic acid gas, which is normally
present in expired air from the lungs. Ammonia, as is well

The Cigarette from a Medical Standpoint 375

known, is a powerful irritant to the nostrils, and certainly
not less so to the throat and lungs. Prussic acid is one
of the most deadly and quickly acting poisons known;
a drop on the tongue is almost immediately fatal.

Bastedo further states: "Though tobacco is used
externally as a poultice and internally as an emetic, and
the smoke inhaled in certain cases of asthma, owing to
it being such a deadly poison, and to the great difference
in human susceptibility to its action, it is dangerous as
a remedy and has, therefore, been omitted from the
United States Pharmacopoeia," which, by way of ex-
planation, is an authoritative work upon the preparation,
action and use of drugs, which is revised and issued
every ten years, under the supervision of a national
committee.

Again quoting from Bastedo's work: "Tobacco,
combined with other drugs is a constituent of many of
the asthma cigarettes and cigars."

Poisonous effects of tobacco are chiefly due to
nicotine, of which two drops placed on the tongue or rubbed
into the gums of a small dog or cat, will produce death in
one or two minutes. A cigar may contain enough nicotine
to kill two unhabituated adults.

"The action of nicotine on the body: Its main action
is a brief stimulation of the brain and spinal cord, of
the nerves governing the action of the heart and of the
motor nerves in the muscles, the stimulation being followed
by depression," — certainly a sufficient cause for a demand
of the system for a repetition of its use.

Acute nicotine poisoning is frequently seen after the
first cigar or when an unusually large quantity of tobacco
is consumed in a short time. The symptoms are, viz.,
paleness of the skin, sweating, sick stomach, and, perhaps,
vomiting, diarrhoea, muscular weakness, faintness, dizzi-
ness and weakness of the circulation; for which the treat-
ment is fresh air and rest, lying down, with stimulants,
such as aromatic spirits of ammonia, whiskey, etc."

More tobacco can be borne when one drinks liquor
at the same time, but in so doing one adds the additional

376 David S. Booth

harmful effects of alcohol upon the body. Tolerance
is readily established up to a certain limit, which differs
widely with different persons. This does not mean it be-
comes less harmful to the body, but that the system becomes
so habituated to it, that is requires much larger doses to
produce acute poisoning.

Again quoting from Bastedo: "As a habit drug, tobacco
is peculiar in that the effects desired are not to be attrib-
uted in any great degree to its most active constituent,
nicotine.

"To the beginner in smoking the pleasure is sadly
lacking; but to the habitual smoker tobacco is narcotic,
promoting the feelings of ease and relaxation; though its
pleasurable effects seem quite unrelated to the extent
of its action upon the system, for to most smokers, there
is Uttle satisfaction from smoking in the dark, or from
using the tobacco in some unaccustomed way, as in a
pipe instead of cigarette or as a snuff." However, I
have frequently noted that darkening the room for a
stereopticon exhibition, is the signal for Ughting cigarettes.

"Also," writes Bastedo, "those who have the habit of
inhaUng, and are, therefore, accustomed to bringing the
smoke in contact with a large surface of mucous membrane,
get little, if any, satisfaction, no matter how strong the
tobacco, unless they inhale to bring the smoke to the
accustomed membranes." This, I beheve, is generally
true.

"Another noteworthy fact," says Bastedo, "is that
there is no great physiological demand created, hence the
repetition is not so much for the demand of the system
to the nicotine, but a mental demand for the satisfaction
of the habit. The smoker's pleasure seems to be derived
largely from the presence of something in the mouth,
from the studied inhalation and exhalation, and from the
soft circling up of the smoke. In so far as it is a habit,
the smoker may feel ill at ease if he fails to get his usual
smoke; yet excessive smoking may be given up at once
and absolutely without any rebellion on the part of the
body."

The Cigarette from a Medical Standpoint 377

This does not harmonize with this author's own words,
previously quoted, when he stated that "stimulation of
the brain, spinal cord and heart, etc., is followed by de-
pression," which would naturally be a demand for a
repetition, or, with the following personal observation
of the author:

A number of years ago, a friend, whom I had re-
peatedly advised to discontinue smoking, finally did so
one morning, without my knowledge, and in the afternoon
of the same day, sent for me in great haste, as he thought
he way dying. I found him gasping for breath and his
heart beating forcibly and rapidly, or, as commonly
expressed, "going like a trip hammer."

Though, myself, only an occasional smoker, I took
a social cigar with him to disarm suspicion as to my ob-
ject, since he did not connect his condition with its
disuse. We talked over his condition, and it was but a
few minutes until his symptoms had disappeared. This
certainly indicates that there is a demand created by
its continuous use, and that the system does become so
habituated to the use of tobacco, as to demand it, as is
the case with such other similar narcotic drugs as mor-
phine and opium; since, in this case, the system rebelled
when deprived of the accustomed smoke and was rapidly
readjusted when the need was supplied. This case is,
also, evidence that the active principles of the cigar are
inhaled in sufficient quantity to produce effects, which is
denied by many who admit that tobacco does contain
poisonous principles, but contend that they are not present
in the smoke.

As further evidence that the poisonous principles
do affect the smoker, I would cite the various immediate
effects which often follow its use: for example the sick
stomach, vomiting, dizziness and faintness, which usually
follow the first cigar.

Again, it often acts as a laxative upon those not
habituated to its use, and this action usually follows
immediately, or very soon, after smoking.

378 David S. Booth

Another condition which may be produced by an
unusually strong cigar, even in an habitual smoker, is
hiccough. I once witnessed a demonstration of this,
in which a cigar which had produced hiccough in one
smoker, was taken by a second one, with the remark
that "he could smoke anything," and upon causing the
same condition in him, the cigar was then taken to a third
habitual excessive smoker, who wagered he could
smoke it, but failed.

The effects produced upon the system by the pro-
longed use of tobacco, is more diflBcult to demonstrate,
since there are various incalculable sources of error;
among which, is the natural difference in the normal
bodily vigor and resistance of different individuals, as
shown by one individual living to a "ripe old age"
despite the continuous and, perhaps, excessive use of
tobacco, as well as the liberal use of alcoholic liquors,
while another, having "none of the vices and all the vir-
tues," is "cut down in the hey-day of his youth."

Another source of error is due to idiosyncracy, by
which is meant a peculiarity of constitution whereby
substances do not act upon the body in accustomed
manner; then may be mentioned conditions growing out
of other excesses, dissipation, etc., which may or may not
be known to the observer.

In other words, there is a difference between theory,
though it be based upon pure science, and practice, or
the application of known facts to the variable and oc-
casionally undiscoverable peculiarities of the human
organism.

However, the fact that smoking does often have
immediate, decided and, sometimes, unpleasant effects
upon the body, should be sufficient evidence that its
continued use is harmful; since it is a well known fact
that anything which causes continuous, or very frequent,
disturbances of a part or organ of the body, will event-
ually produce disease of the part so disturbed.

Another reason why exact data cannot in all instances
be obtained, is due to the fact that while tobacco may

The Cigarette from a Medical Standpoint 379

not produce disease directly, it may do so indirectly
by lowering the normal bodily resistance, thus making
it susceptible to the development of diseases, which may
have their own specific causes, but which would not have
attacked an individual in the "pink of health."

It is generally recognized that there are always
present two causes in the development of all diseases:
first, the predisposing cause, i. e., the condition of the
system; the other, the direct, or exciting, cause. It is
only upon this theory that we are able to explain why
certain people may not contract contagious or infectious
diseases, when exposed to them, or why, failing to contract
them at one time, become infected at another.

Carefiil and prolonged observations of competent
and unbiased observers have certainly proven that tobacco
smoking does produce certain ill effects and does cause
certain diseased conditions. The following list, compiled
by Bastedo, appeared in his recent work on the action
of drugs, to which we have previously referred, under
the heading, "Some of the Effects of Prolonged Smoking."

"1. Derangements of digestion.

"2. Headaches, depressed states of the mind, lack
of energy and irritability of temper (from auto-intoxication) .

"3. Dimness of vision or loss of sight (technically
called Tobacco Amblyopia) from affections of the
nerves of sight.

"4. 'Tobacco heart' — rapid, irregular heart action.
Heart very susceptible to nervous influence. Sudden
death may be caused by high altitudes, and a number of
persons with tobacco heart have died in the train, while
crossing over the western mountains.

"5. Arterio-Sclerosis (hardening of the arteries)
produced in rabbits by nicotine, and by the inhalation
of tobacco smoke.

"6. Deafness — either from its effects on the throat,
which stops up the tube from the throat to the niiddle
ear, or from its direct effect on the nerve of hearing.

"7. Cancer of the tongue."

380 David S. Booth

Furthermore, "moderate smoking is a mental de-
pressant, favoring ease and comfort, rather than effort
and work and energy. It is truly narcotic," i. e., relieves
pain and produces sleep.

Though most of these effects from excessive smoking
are too well recognized by the medical profession to
need further comment, I desire to add some additional
evidence regarding some of the more serious conditions.

Of dullness of vision (so called "Tobacco Amblyopia"),
a well known text book on diseases of the eye, has this
to say: "The patients are almost without exception men,
and at, or beyond, middle life. With very rare exceptions,
they are smokers, and have smoked for many years, and
a large number are, also, intemperate in alcohol."

"In the common cases, in the opinion of an in-
creasing number of observers, tobacco is the sole excitant.
It is important to remember that the disease may come
on when either the quantity or the strength of the
tobacco is increased, or when the health fails and a
quantity, which was formerly well borne, becomes ex-
cessive."

A recent text-book on nervous diseases states:
"Tobacco excessively used is the most common cause of
these conditions," i. e., loss of sight and dimness of vision.

I have, myself, seen several cases, which were un-
mistakably due to tobacco, and so far as I can now recall,
they all resulted from cigarette smoking.

"Tobacco heart" is "a condition, not a theory,"
and not unfrequently comes to the attention of the physi-
cian, and, while it begins as a nervous disturbance of
the heart, it may result in incurable disease, and I
have known death to have resulted directly from disease
of the heart, the result of excessive smoking.

Many admit that tobacco smoking in other forms is
injurious, but contend that the cigarette is harmless,
because of the small amount of tobacco it contains:
evidently failing to take into consideration the fact
that the cigarette's smoke is nearly always inhaled,
i. e., the smoke is drawn into the lungs, and caused

The Cigarette front a Medical Standpoint 381

to pass out slowly through the nostrils (a most unnatural
smoke pipe, as the novice can easily demonstrate upon
himself); consequently, the smoke is in contact with a
much greater area of absorbing surface for a much greater
length of time; nor do they apparently appreciate the
harm which must result from the local irritation of the
smoke upon the delicate membrane of these parts.

Though some deny that the smoke reaches the lungs,
I have had physicians, from personal experience, contend
that it does.

That the smoke contains substances that are irrita-
ting to the nose, throat and lungs is evident from the
discoloration which is left when the smoke is exhaled
through a white handkerchief*, as well as from the stained
fingers of the habitual cigarette smoker.

The cigar smoker rarely does more than draw the
smoke into the mouth, in which he usually retains it
but a fraction of the time cigarette smoke is ordinarily
held.

The fact that the cigarette is what is called a "short
smoke" is often the excuse for frequent smoking, thus
keeping up a more continuous action upon the body than
a "longer smoke" less frequently indulged in.

I know of cigarette smokers who smoke between
courses at meals, and when they awake nights; probably
"awaken to smoke."

In addition to the effects of cigars and smoking
tobacco free from sweetening, we have, as mentioned, in the
smoke of cigarette tobaccos, furfural, which even in small
doses, is said to cause trembling and twitching of the
muscles, with inability to control muscular movements,
thus explaining the "trembling hand" and so styled
"characteristic handwriting" of the cigarette boy, which,
however, I have not personally observed. In adequate
quantities, furfural is reported to "give rise to fits,
resembling epilepsy, and general muscular paralysis,

^Specimens were exhibited to show the diacolorations made by both cigars and
dgarettes.

382 David S. Booth

ending in paralysis of the muscles of respiration, i. e.,
muscles which carry on breathing.

One writer says cigarette smoking is the most difficult
of the tobacco habits to cure.

The Medical Director* of a large insurance company,
in recent articles of advice for its medical examiners and
agents, has the following to say:

"The cigarette habit, carried to excess, often produces
enough disturbance of the heart to render the appUcant
uninsurable. Other deleterious results may follow the
excessive use of tobacco. Cancer of the lip and tongue
may be mentioned in this connection."

All condemn excessive smoking, no matter in what
form, but much is said in defense of moderate smoking,
which is at best, a relative, as well as an uncertain
quantity, since what would be moderate for the average
individual, may be excessive to others, that is so far as
its effects upon the body are concerned; besides, what may
be moderate at one time, may become excessive at
another by virtue of unrecognized diminished bodily
resistance or failing health.

Furthermore, smoking is, at best, a habit, and, as
with all habits, will probably grow, especially if smoking
is begun when young, even were it true, as contended
by some, that the use of tobacco does not create a bodily
necessity for its continued use, which my own observations
do not sustain, as exemplified in the case elsewhere
reported, of the man who had violent and distressing
symptoms when he discontinued its use, and was relieved
almost at once by indulging in a single cigar.

Finally, I feel justified in the following conclusions:

1. That tobacco used in excess in any form is
harmful to both young and old.

2. That it is impossible to draw a line of demarcation
between excess and moderation in smoking, either for
individuals or for a given individual at different periods
of life, or under varying conditions of health and environ-
ment.

♦Dr. W. W. Beckett, Pacific Mutual News, Jan. and Feb., 1915.

The Cigarette from a Medical Standpoint 383

3. That smoking in any quantity is injurious to the
growing body and developing mind of the young, in whom
there is a strong probabiHty that the habit will grow
into dangerous excess.

4. That the cigarette, owing to its composition,
small size and usual method of smoking, is the most harm-
ful tobacco habit.

Metropolitan Bldg., St. Louis, Mo.

I

IS GENIUS A SPORT, A NEUROSIS, OR A CHILD
POTENTIALITY DEVELOPED?*

By James G. Kibrnan,
Chicago, III.

Formerly Assistant Physician Manhattan State Hospital

(1874-8) and Superintendent Chicago State Hospital

(1884-9;

Fellow Chicago Academy of Medicine, Foreign Associate Member French
Medico-Psychological Association; Honorary Member Chicago Neuro-
logic Society, Honorary President Section of Nervous and Mental
Diseases Pan-American Congress 1893, Chairman Section on
Nervous and Mental Diseases American Medical Asso-
ciation 1894; Professor Neurology Chicago Post-
Graduate School 1903; Professorof Nervousand
Mental Diseases Milwaukee Medical Col-
lege 1894-5; Professor of Nervousand
Mental Diseases Medical Depart-
ment Loyola University 1905;
Professorof Forensic Psychi-
atry Kent -Chicago
College of Law.

Byron's uncongenial relations to his wife have been
for years a stock illustration of the alleged genius ir-
ritability. Taking this superficial absolute ideal for a
guide, repeated texts have been drawn for the comfort
of the bourgeois mediocre on the subject. Sidney
Low,^ starting his preachment with the assertion that
statisticians might do well to ascertain whether the pro-
portion of the celibates and the ill-married is really
as high among cheesemongers and stock brokers as it
has been among the poets and plajrwrights.

He cite^, as follows, 68 eminent men of letters as
furnishing but a small per centum of happy marriages.
The reason for this is that the writer does his work at

*Coutinued from AuguBt, 1915.

(384)

\

Is Genius a Sportf 385

home. He sits in his study with his wife, so to speak,
outside the door. If she is a discreet lady she does
not lift the latch too often. But it is inevitable that the
couple shall see a great deal of each other. They take
their various meals together, they have opportunities for
communication on and off through the twenty-four hours.
There is no occasion for the husband to embrace his
spouse on the suburban doorstep after breakfast, before he
staYts to catch the 9:15 train to town. He can caress
her all day if he likes. Privileges so easily obtained are
not always valued. One has heard the story of the con-
scientious person who had a painful revelation to make
to a married friend. 'I think it my duty to tell you,'
he said, 'that I have seen X. kissing your wife.' 'Fancy
that!' replied the injured husband; 'and he is not obliged
to do it!' And I have been told of a wise virgin who,
before marriage, said to her adorer: 'I have only one
thing to ask you, and that is that you will promise not
to be in to lunch.' But the literary man is often in to
lunch. He is 'about the house' most days, and his
wife is about him more or less; and if they get on each
other's nerves a little, who can be surprised? For the
man of action the little drama of domesticity may pro-
voke some interest when it is enacted for him retro-
spectively; but the literary man has too many opportuni-
ties of witnessing it in rehearsal. Not all wives would
resist interrupting the composition of an epic by de-
ferring till the late evening the announcement that the
cook was drunk, or that the kitchen boiler had burst;
not all authors would accept the interruption in the right
spirit."

The following are among those cited:

Shakespeare — Married at eighteen, with hasty ir-
regularity, a woman of humble origin, eight years older
than himself. The union seems to have been unsympathet-
ic, and the terms of the poet's will point to an estrange-
ment between husband and wife.

Milton— Married three times. The poet's first wife
left him after a few weeks. He wrote tracts on divorce

386 James G. Kiernan

and paid his addresses "to a very handsome and witty
gentlewoman" until the wife returned.

Dryden — M arried ; unhappily .

Bunyan — Married twice; satisfactorily.

Hobbs — Unmarried.

Pepys — Married. Unfaithful to his wife, and fre-
quently quarreled with her.

Samuel Butler — Married late in life.

N e wton — Unmarried .

Locke — Unmarried.

Swift — Secretly married to a woman with whom he
never lived, and whom he hardly ever saw except in
presence of a third person.

Defoe — Married; had several children. Little known
of the circumstances of his domestic life.

Addison — Married three years before his death. The
marriage "is generally said to have been uncomfortable."

Steele — Twice married; happily, in spite of irregulari-
ties of conduct.

Congreve — A bachelor and professional "man of
pleasure."

Otway — Unmarried. Life wrecked by an unhappy
passion.

Pope — Unmarried.

Prior — Unmarried.

Fielding — Married twice. Devotedly attached to his
first wife; after her death married her maid.

Richardson — Unmarried.

Smollett — M arried ; satisfactorily .

Samuel Johnson — Married a vulgar and affected
widow twenty years his senior; marriage considered a
grotesque affair by Johnson's friends and contemporaries;
childless.

James Thompson — Unmarried.

Gray — Unmarried.

Hume — Unmarried.

Sterne — Married; got on badly with his wife, and had
various love affairs and sentimental philanderings.

Adam Smith — Unmarried.

Is Genius a Sportf 387

Boswell — Married; frequently unfaithful to his wife.

Goldsmith — Unmarried .

Gibbon — Unmarried.

Sheridan — Married; not unhappily.

Cowper — Unmarried.

Bums — Married a woman who had been his mistress;
occasionally unfaithful to her afterward.

Crabbe — Married; satisfactorily.

Bentham — Unmarried.

Wordsworth — Married satisfactorily.

Scott — ^Married; not quite sympathetically.

Southey — Married twice. First wife became insane.
Married his second wife at the age of sixty-six, just be-
fore complete failure of his own mental faculties.

Coleridge — Married; unsatisfactorily. Husband and
wife became almost completely alienated, and lived
apart.

Shelley — Made an imprudent marriage early in life.
Separated from his wife who committed suicide.

Keats — Unmarried; tormented by an unhappy love
affair.

Byron — Separated from his wife after a great scandal,
and entered into various irregular unions.

Charles Lamb — Unmarried.

Hazlitt — Married twice. First wife divorced him;
second refused to live with him.

Tom Moore— Married; satisfactorily.

Leigh Hunt — Married; not quite happily.

De Quincey— Married; happily, as far as the husband's
habits permitted; wife died at the age of thirty-nine.

Macaulay — Unmarried.

Edward Bulwer Lytton — Separated from his wife.

Newman — Unmarried.

Carlyle — Married; bickered a good deal with his
wife.

John Stuart Mill — Unmarried.

Herbert Spencer — Unmarried.

Darwin — Married; satisfactorily.

Ruskin — Marriage annulled.

388 James G. Kiernan

Landor — Quarreled with his wife, and lived many
years apart from her.

Dickens — Separated from his wife.

Thackeray — Wife became insane.

Charles Reade — Unmarried.

Froude — Married; satisfactorily.

Matthew Arnold — Married; satisfactorily.

Kingsley — M arried ; satisfactorily .

Tennyson — Married, satisfactorily.

Browning — Married; satisfactorily.

Rossetti — Unsatisfactory married life; ended by wife,
two years after wedding, dying of overdose of laudanum.

Edward FitzGerald — Separated from his wife.

James Thomson ("B. V.") — Unmarried.

William Morris — Married; satisfactorily.

Walter Pater — Unmarried.

It is obvious that the axiom of verifying your refer-
ence has not been followed by Low and he has likewise
committed the error of not analysing his statements or
statistics. John Stuart Mill, who as elsewhere shown^
was precociously pushed by his father, which probably
led to a sexual retardation. His relations with Mrs.
Taylor, whom he married, Low to the contrary not-
withstanding, were ideal. His social sense of injustice
led to the famous "Subjection of Womanhood," a gospel
of the feminist. Nearman being a Roman Catholic
ecclesiastic and Pater having like predelictions, necessarily
didn't marry. There were excellent reasons for Carlyle's*
bickerings aside from his impotence and his "study isola-
tion."

The sex retarding influence of precocity pushing
has been illustrated in the Sidis case, which had been
prophesied four years ago.* In a recent interview the
young man (now seventeen) remarks;

"I resolved never to marry, following a certain
episode that took place in my life. A woman had some-
thing to do with it. My oath was taken beneath an
oak tree after I had reasoned the whole thing out.

Is Genius a Sport? 389

"I had a medal struck off, so that I might remember
the vow I took at fourteen. I have no desire to marry
or have children.

"The superman can be produced not so much by
our plans for eugenics as by changing our system of
education. The superman would develop himself auto-
matically provided we started human beings right.

"I have received six proposals of marriage and have
refused all. Women do not appeal to me. You speak
of a pretty woaan. It means nothing to me. I cannot
understand what a person has in mind when declaiming
on what they term beauty."

There is here, it would seem, clear evidence of the
adolescent state which Stanley Hall^ points out. The re-
marks on beauty are rather suggestive. The conception
of Pepys and Boswell as victims of study isolation seems
rather comical to students of literary history. The
famous Diary was written in shorthand and hidden.
Pepys was notoriously an active pleasure seeker and
business man at a notoriously corrupt period, when any
type of virtue was a theme of ridicule. Boswell's vanity
and egotism would have made him an unhappy mate in
any station of life. Johnson's marriage was notoriously
happy.® His wife's defects were never apparent to him.
He always thought her a pretty creature. Low has a
rather peculiar way of judging a happy marriage if
the judgment of others (not the husband himself) must be
taken. The same is true of Scott's marriage, as I have
elsewhere pointed out.'' Addison's and Dryden's marriages
were rather of convenience than affection and even in a
business man such marriages are unhappy. Swift had a
sexual defect. The reason for Milton's first unhappy
marriage (the others were happy) was a hysteric refusal
to allow consummation aggravated by prejudice of the
wife's parents (royalists)® against Milton's politics.

The terms of Shakespeare's will are, as I have else-
where shown, susceptible of other explanations than
that of marital estrangement.* Taking Low's figures
as they affect first marriages, there are foimd twenty-

390 James G. Kiernan

three celibates, four insane wives; twenty unhappy mar-
riages and twenty-one happy. Deducting three cases of
sexual defect, the percentage of satisfactory' marriages is
a little too large to admit of the influence Low has
discovered. Deductions on account of female hysteria
would probably show as high a percentage of happy mar-
riages as among people in the same station of life.

George A. Coe^° and Stanley Hall'^ have indicated
effects of adolescent stress which permanently arrested
and expanded into paranoia, as it appeared in the Swedish
dramatist Strindberg, just now the vogue. According
to Claud Fitch,^^ a translator of his dramas, Strindberg
had a struggle with four terrible inner foes all his life:
doubt, suspicion, fear, sensuality. His doubts destroyed
(according to Fitch who subsequently contradicts this)
his early faith. His ceaseless suspicions made it impossible
for him to be happy in love or friendship. His fear of
"invisible powers," as Strindberg calls them, (really
persecutory delusions based upon supposed ability) robbed
him of all peace of mind. His sensuality dragged him
into the mire.

Here is an unrecognized paranoia based on adolescent
stress with logical perversion in the foreground. The
anxiety neuroses developing into suspicional states and
the egocentricity developing into megalomaniac ideas.
Strendberg was the post-marital child of a servant who
had previously bom three illegitimate children to his father.
Relations of this kind have, as Vedeler^^ and Eklund"
point out, not quite the same significance in the Scandi-
navian working class that they do among Anglo-Celtic
peoples. The marriage does not seem to have improved
the environment of the post-marital offspring. The
father was a narrow-minded shop-keeper; the mother
was also ignorant and narrow-minded, but kind and
affectionate to children. His training during childhood
and puberty resembled, but was more tr3ring than, that
of Rousseau. Punishment made Strindberg, like the
latter, a liar. Like Rousseau, Strindberg had bourgeous
characteristics. He criticized all that were above him

75 Genius a Sport? 391

in order to observe that it was not so high after all, nor
so much worth striving for. Strindberg was thrice
married and thrice divorced. He claims that one mar-
riage was the result of a plot by a married pervert.

To judge from Ekhund, Strindberg's free speech
on the subject of his seduction is quite natural. Ekhund
remarks anent such speech in Sweden: "We rarely hear
anyone speak of a woman having been seduced simply
because lust is at the worst in the woman, who, as a
rule, is the seductory partner." To a certain degree
here, as elsewhere, cost and legal difficulty of marriage
play a part in these social conditions.

From the first marriage he secured a divorce, he
claims, in phrases that remind one of Rousseau's^^ cant
about his transgressions. As P. H. Grunnemann^® points
out, he must have been perverse himself to have fallen
a victim to this woman and so repeatedly to return to
her for "enjoyment of delicate emotions." He once
wrote three volumes of auto-biography anticipatory of
suicide which he didn't commit. His persecutory de-
lusions made him errabund. He was certainly not a
victim of the psychoses called by the much abused term
"dementia precox." He certainly was not a dement in
any sense of the term. Paranoia developed after the
stress of adolescence. The seeming contempt for women
of his dramas resembles the tone of certain roues as
well as that of victims of adolescent stress.

There are evidences in current literature that he is
to be the head of a cult like Nietzsche. He prepared for
this by his "Zones of the Spirit." This, the Norwegian
critic, Nils Hjar, says, is "More comprehensive than any
modern collection of aphorisms, chaotic as the Koran,
wrathful as Isaiah, as full of occult things as the Bible,
mote entertaining than any romance, keener edged than
most pamphlets, mystical as the Cabala, subtle as the
scholastic philosophy, sincere as Rousseau's confession,
stamped with the impress of incomparable originality,
every sentence shining like luminous letters in the dark-
ness—such is the book in which this remarkable writer

392 James G. Kiernan

makes a final reckoning with his time and proclaims his
faith as unconsciously as if he were a descendant of the
hero Lutzen." All of which reminds one of the blatant
praise of what Nordau called the Nietzsche gang in the
early days of German enthusiasm over the discovery of
the superman.

Claud Fitch says in englogistic comparison with
Nietzsche: "He never relapsed into the great cynicism of
the worn out debauchee, nor did he, like Nietzsche, try
to explain away conscience as an old wives' tale. Conscience
perpetually tormented him and finally drove him back
to believe in God, nor the collective Karma of the Theos-
ophists which expressly repudiated nor to any new
good expounded in New Thought magazines, but to the
transcendent God who judges and requites.

Nietzsche, unlike Rousseau and Strindberg, evidently
never suffered from the adolescent morbid obsession
of a conscience. The religious revival in Strindberg was
an unrecognized phase of the sexuality which Grunne-
mann depicts. As E. C. Spitzka^^ and Macaulay^* state,
Bunyan suffered from all the stress of adolescence, but
made a complete recovery. Bunyan, however, had a
healthier mental back-ground. His married life was
happy and there was present an element of the secondary
ego, absent in Nietzsche, Strindberg and Rousseau.
As E. C. Spitzka^^ remarks, in Bunyan's case logical
perversion was in the back-ground.

Adolescent stress, as George Coe^^ and Stanley
Hall^" pointed out, produces what Sir Walter Scott^^
finely designated the forced impudence of the bashful.
This often is in evidence in the social revolts of conven-
tionally unconventionals.

A British newspaper writer has lately startled Great
Britain and Ireland by pointing this out in Bernard
Shaw.^^ The writer admits that ,,this assertion that Mr.
Shaw is a shy man may excite laughter, but it is a true
one. I have seen him blush upon entering a room full
of strangers. When he greets you there is a certain
hesitation in his manner, as if he were anxious to run

Is Genius a Sport? 393

away and hide. When he is in a crowded place, he seeks
some obscure seat, and remains there until it is time to
go home. Mr. Shaw can talk entertainingly on occasions,
but in the main he reserves his conversation for his
plays, and it is this fact, as much as any, which shows
that he is a shy man. The talk is there, but he is too
hesitant to say it, so he writes it. The good talker is a
man without reserve. He must denude himself of ret-
icence, and he must hold his auditors in contempt.
It is essential that the brilliant conversationalist should
be an arrogant man, that he should take up the position
of one who is not arguing with you, but is a-telling of you,
and he can only do this by assuming, rightly or wrongly,
that the views of those who listen to him are negligible.
Mr. Shaw might like to monopolize speech, but he is
too shy to do so. It is possible that he might like to
take up the 'I am a clever man' attitude in private life,
but the very nervousness which makes hjm do it in
public probably prevents him from doing it in private.
His humility becomes more apparent as he grows older.
When he argued with Mr. Belloc about the Servile State,
he stood up and said, 'I am a servant.' The bigger a
man is the more willing he is to serve. It is the newly
freed slave who is most perturbed about his rights. It
is the bondman who wants to do what he likes. The
man who has made himself free of all men is always
willing to stand aside or to say, 'I am a servant.' It
is so with Mr. Shaw. His career is full of service to
one cause or another. He has addressed big crowds and
little crowds, done big work and donkey work, submitted
willingly to the drudgery of committees and campaigning
for the sake of Socialism at times when the call of his
own work was insistent. He has worked and spoken
for little men, and been content with a second place
while they had the first. His industry is terrifying;
his generosity is astonishing. No man has ever seen his
name in a list of subscribers to charity, but there are
dozens of men in England, poor workers for art, who have
been helped by him. His chivalry and loyalty are quixotic;

394 James G. Kiernan

he will fight for a friend far more keenly almost than
the friend will fight for himself. He pays tribute to
men frequently far in excess of their deserts, and gives
advice and assistance to those who need them even at
inconvenience to himself."

latrophobia of decidedly sophomoric adolescent type
appears in the "Doctor's Dilemma." Here is depicted
a surgical charlatan who violates all ethics of the medical
profession, but is set forth as typical of it. Much of
Shaw's work is a sophomoric unconventionally convention-
al revolt of immature manhood. Here he aligns
with the Anglo-Saxon philistine rather than with the
Anglo-Celt, as whom he poses. A similar tendency
appears in Retif de la Bretonne, well known as a porno-
graphic writer and whom C. Lombroso^^ pictures as a
typical genius precocity. He had read much at four;
seduced girls at eleven, and at fourteen composed a poem
on his first twelve mistresses. He, at the age of nine,^*
passed for a Narcissus, but his thoughts as soon as he was
alone by night or day, had no other object than the
sex he seemed to flee from. This was a combination^^
of sensitive precocious ardor and excessive shyness. Data
about early awakening of sexual ardor are rather lacking.
The reports about this in connection with legislation
about the age of consent led the New York legislature
to fix it ten for the boy and eight for the girl as being
the lowest age when parenthood became possible. The
object of the law was to protect the coming child by
giving father and mother the right to consent to marriage.
The fate of the illegitimate child is lost sight of in later
legislation. Of course details are lacking as to anything
but capacity for parenthood. Later researches show
that boys are often seduced by women at early ages.
Sometimes this is done for maternally protective reasons
against the consequences of masturbation or as prophylac-
tic against acquiring venereal contagion from harlots.
Louis XIV^^ was seduced at fifteen by a maid of Anne
of Austria's bedchamber. Wolbart^^ reports the cases of
boys of 4, 10 and 12 years seduced by girls of from 10

Is Genius a Sport? 395

to 12. In one case a girl of 12 forced the boy. In
France (where female responsibility is more easily estab-
lished under the Napoleonic code than it is in England
or English speaking countries) there were from 1874-84,
according to P. Bernard,^® 181 women between 20 and
30 convicted of assaults on boys under 15. Alleged sexual
precocity in genius would hence not appear to vary widely
from sexual awakening in the general population.
(To Be Continued.)

1. Nineteenth Century Dept., 1909.

2. Alienist and Neurologist, Aug., 1910.

3. Alienist and Neurologist, 1895.

4. Alieniet and Neurologist, February, 1911.
6. Alienist and Neurologist, February, 1910.

6. Macaulay Essays, Samuel Johnson.

7. Alienist and Neurologist, October, 1910.

8. Alienist and Neurologist, July, 1901.

9. Alienist and Neurologist, 1899.

10. Child Study Magazine, 1897.

1 1 . Adolescence.

12. Booltman, 1910.

13. Medical Standard, 1895.

14. NorEk. Mag. of Laege, 1896.
16. Confession.

16. Kevue des Deux Moudes.

17. Insanity, 1900.

18. Essays, Bunyan.

19. Op. Cit.

20. Op. Cit.

21. Essays, Dryden.

22. Literary Digest, 1900.

23. Men of Genius.

24. Secret Cabinet of History.

26. Jour. Amer. Med. Ass'n., 1906.

26. Arch. Anthrop. Grim. 1900.

THE COLLOIDAL GOLD TEST IN PSYCHIATRIC

CASES.
A Report of 126 Spinal Fluids.

By Frederick C. Potter, M. D.,

Pathologist, Central Indiana Hospital for the Insane.

Read before Marion Co. (Indianapolis) Ind. Medical Society,

May 18, 1915.

TODAY the exarAination of the cerebro-spinal fluid
is essential in the study of most of the psychiatrical
cases. In this institution the blood serum of all patients
is examined for complement deviating body, as soon after
admission as possible. When the blood serum gives a
positive Wassermann reaction or when the history or
clinical examination of the patient suggests lues as an
etiological factor in the psychosis, lumbar puncture is
done.

The difficulty of differentiating cerebro-spinal syphilis
and early paresis is well known and it was with the hope
that the colloidal gold reaction of Lange would help us
in this matter that the work, the report of which follows,
was undertaken in June, 1914.

In 1857, M. Faraday^ noted that the additibn of
an electrolyte to a solution of colloidal gold caused an
immediate change in color, but it was not until 1901
that Zsigmondy^ laid the foundation for the present test,
when he successfully used colloidal gold for the quantita-
tive estimation of protein substances. He found that
solutions of protein give protection to colloidal gold solu-
tion up to a certain point, and later determined the
"Goldzahl" (i. e. the number of milligrams of protein
just sufficient to prevent the precipitation of 10 c.c. of
.0053% colloidal gold in the presence of 1 c.c. of 10%
NaCL solution) of many proteins.

(396)

Gold Test in Psychiatric Cases 397

In 1912, Lange^ attempted to apply Zsigmondy's
method to the study of the proteins in spinal fluid but found
that instead of giving protection to the gold solution,
the reverse occurred, especially where the spinal fluid
contained an abnormal amount of protein. Briefly,
Lange found that when the globulins and nucleoproteins
in spinal fluid are held in solution by a A% NaCL
solution, which in itself is not sufficiently strong to cause
precipitation of the gold, a characteristic change of color
is noted in the colloidal gold solution in certain diseases
of the nervous system.

In his first report, Lange described the results of this
test in 18 cases of general paresis with 18 positive curves
in a dilution of 1:40 and 1:80, also 17 cases of cerebro-
spinal syphilis which all showed a characteristic curve,
and 20 tabetics, 19 of whom gave a positive curve in
1:40 to 1:80 dilution.

Grulee and Moody* have reported 9 cases of clinically
congenital syphilis with the most marked reaction oc-
curring in 1:40 and 1:80 dilutions, and 7 cases of suspected
congenital syphilis giving similar results in 5 cases;
also 8 non-Iuetic cases where the results varied, and later
these authors^ in a study of 18 cases of congenital
syphilis; 12 cases of suspected congenital syphilis; 4
congenital luetic cases with a paretic-Iike reaction; 8
cases of tubercular meningitis; 11 varied cerebral condi-
tions, and 11 miscellaneous conditions, concluded first,
that in congenital lues the spinal fluid reacts with a
marked degree of regularity in dilution of 1 :40 and 1 :80
and that this reaction is only simulated in those condi-
tions which show a slight inflammation of the meninges
or brain, and are not likely to be confused clinically
with syphilis; second, in tubercxilar meningitis, the re-
action is most marked in dilution 1:160 and 1:320.

Miller and Levy®, report 49 cases of general paresis,
all giving a gold curve in the paretic zone, 10 cases of
congenital lues, 8 of which gave results in the luetic
zone; 5 secondary luetic cases, 4 with resulting luetic
zone curve; 11 tertiary cases showing luetic zone curve;

398 Frederick C. Potter

10 tabetics, and 13 out of 15 cerebro-spinal luetic cases
with resulting curves definitely within the luetic zone.
Their 71 cases classified as miscellaneous, purulent and
tubercular meningitis, gave inconstant results.

Lee and Hinton', report 12 cases of general paresis;
24 of tabes; 10 of cerebro-spinal lues; 3 of cerebral lues;

4 of spinal lues, all of which gave a typical reaction for
syphilis.

DeCrinis and Frank* obtained constantly positive
results in 120 cases of paresis, tabes, cerebral and spinal
syphilis.

Solomon and Koefod^ report 20 characteristic paretic
reactions out of 25 cases; of 12 cases of congenital syphilis,
only one, a case of juvenile paresis, gave a marked re-
action; of 33 cases with positive Wassermann reaction
in blood serum and not diagnosed syphiUs of the nervous
system, 30.3% gave some reactions in the syphilitic
zone; of 53 cases with negative Wassermann reaction
and no clinical evidence of syphilis, 33.9% gave a reaction
in the syphilitic zone.

Brock^" reports 50 cases of general paresis, 40 of
which gave a typical paretic curve.

Kaplan and McClelland^^ report 19 cases of general
paresis with 19 characteristic curves; 5 paretic curves in

5 cases of taboparesis; 8 positive reactions out of 36
cases of tabes; 15 positive and 13 negative reactions in
28 cases of cerebrospinal lues; 1 positive (multiple sclerosis)
and 27 negative reactions in 28 non-luetic cases.

Eicke^^ reports the typical reaction in 22 of 24
tabetics, and in 54 general paretics, and states that the
test is especially valuable in differentiating early general
paresis and neurasthenic disturbances in a luetic.

Moody,^^ while demonstrating the reaction before
the Chicago Neurological Society, stated that in over
300 cases the colloidal gold ran parallel with the Nonne
test and bore such a constant relation to the Wassermann
reaction that he could predict the result of the Wasser-
mann reaction from the colloidal gold curve. However,

Gold Test in Psychiatric Cases 399

in summing up the discussion, he states that other tests
as well as the clinical diagnosis must be considered.

Solomon and Wells, ^* in a study of 2G post mortem
fluids with this method found that the results are compara-
ble to those obtained antemortem on similar cases if the
body is well preserved and the fluid obtained early.

Weston, Darling and Newcomb^* in a report
of 239 examinations of spinal fluid from 198 patients
suffering with mental diseases, found an almost constant
paretic curve in 3 cases of cerebro-spinal syphilis and
34 cases of general paresis. In 161 cases of dementia
praecox, manic-depressive insanity, epilepsy, arterio-sclerotic
insanity and unclassified psychoses, 8 cases gave a gold
curve within the limits of the luetic zone and one, a
possible case of general paresis, a paretic zone curve.

Swalm and Mann,'^ reporting the results of 135
examinations of spinal fluid on 111 patients suffering from
a psychosis, found 88.5% paretic curves in 70 clinical
cases of general paresis; 2 of 4 cases of tabes gave a curve
in the luetic zone; of 10 cases of cerebrospinal lues, 6
gave a luetic zone curve.

V. Kafka'^ recently discussing the cerebro-spinal
fluid in diagnosis, states that in his experience the findings
with the goldsol test were often contradictory and the re-
sult with this test should not be heeded unless it confirms
the results from other tests.

The technique and materials used are as follows:

1. Double distilled H2O, (distilled over glass without
rubber connections to insure chemical purity.)

2. 1% solution chloride of gold (Merck) in double
distilled H2O.

3. 2% potassium carbonate (Merck) in double
distilled HgO.

4. 1% solution Formalin (commercial) in double
distilled H2O.

5. 0.4% solution NaCL C. P. (Merck) in double
distilled H2O.

400 Frederick C. Potter

Experience has taught us that this NaCL solution
should be freshly prepared each time a set of fluids are
to be examined, as old NaCL solution gives end re-
actions which are not as clear as when the solution is
fresh.

6. Jena flasks (2000 c.c.) seem to us to be easier
to handle in making up the gold solution, than the beakers
recommended by other authors.

7. Clean sterile 1 c.c. pipettes, graduated to the
tip in tenths, 10 c.c. pipettes graduated in c.c.'s, and
chemically clean and sterile test tubes 100x15 mm.

All glass must be free from acids, since acids, even
in very weak solution, precipitate the gold solution; from
alkalies because they protect the gold solution and do not
allow the proteins to reduce it. We have found it best
to wash all glassware coming in contact with the gold
solution with strong nitrohydrochloric acid, followed by
tap and distilled H2O, and thorough drying before steriliza-
tion. We have sets of test tubes, flasks and pipettes
which are used only in this test.

In preparing the reagent, the only really difficult
part of the test, our procedure is as follows:

Place 1000 c.c. (or any multiple thereof) of fresh
double distilled H2O in a large Jena flask and heat slowly
to 60°C., add as quickly as possible 10 c.c. (i. e., 1 c.c.
to each 100 c.c. double distilled H2O) each of the 1%
gold chloride solution and the 2% potassium carbonate
solution. Heat as rapidly as possible to 95°C. (control
by a clean thermometer,) agitating constantly as the
temperature nears this point. Now remove from flame
and add, a few drops at a time, 10 c.c. (i. e., 1 c.c.
to each 100 c.c. double distilled H2O) of 1% solution
formalin, with constant agitation. A play of colors
resulting in a brilliant, clear red solution is obtained.
All solutions not meeting the requirements for a standard
colloidal gold solution as laid down by Miller and Levy*,
have been rejected. In addition to this, each fresh solu-
tion has been tested with one or two spinal fluids gi^dng

Gold Test in Psychiatric Cases

401

a known curve with a former gold solution. It is absolute-
ly useless to attempt to "doctor up" a solution not meeting
the above requirements.

Technique of test:

10 clean and sterile test tubes are placed in a rack
and numbered from one to ten; 1.8 c.c. of fresh .4%
NaCL is placed in tube No. 1 and 1 c.c. NaCL solution
in each remaining tube. .2 c.c. of spinal fluid is added
to tube No. 1 and thoroughly mixed, giving a dilution
of 1 :10, after which 1 c.c. is transferred to tube No. 2,
giving a dilution of 1:20. This is repeated with each
succeeding tube making a series of dilutions ranging from
1:10 to 1:5120. 5 c.c. of the gold reagent is added and
the tubes quickly agitated. A control tube containing
1 c.c. of .4% NaCL and 5 c.c. of gold solution is set up
with each group of fluids. Final readings are made at
the end of 20 to 24 hours, and always by strong day-
light, the tubes being left at room temperature.

Reports have been made in figures representing
colors :

No. 0 — red, original color.

No. 1 — red-blue.

No. 2 — lilac or purple.

No. 3 — dark blue.

No. 4 — pale blue.

No. 5 — colorless.

For typical curves see diagram.

Dilutions or : j t i i i i ■ I '~ i i i ''

Spinal Fluid. 1 1-10; l-aO!l-40! 1-80 ;>-160! 1-320 !l-640il-ia80! 1-2660:1-61201

! I : " " "

6 toolorless t'- • — :— <

..+... — -♦- .

4 :psle blue i

— « — .4»..».

3 tdu-k Une i

— ♦ .—♦—-.

2 :lilao or i
I purple. t
— ♦-■ — ——♦—«.*-— ^♦.•«+»,
1 ired blue i z jf x

1. — — Paretic Curve.

2. Syphilitic Curve.

3 Meningitic Curve.

402 Frederick C. Potter

Routine Followed in Study of Spinal Fluids.

All spinal fluids reported have been examined as
soon as possible after being withdrawn (cell counts were
made with the Fuchs-Rosenthai chamber, always within
an hour after withdrawal; the globulins, tested by Nogu-
chi's butyric acid, Ross ammonium sulphate, Pandy
carbolic acid and Kaplan's butyric acid and ammonium
sulphate methods, and the Lange gold test, within three
to five hours after removal.) The Wassermann reaction
was done with two antigens (one alcoholic extract of nor-
mal liver and the other, alcoholic extract of beef heart
reinforced with .4% cholestrin,) spinal fluid used in
dilutions of .05, .1, .2, .4, .6 and .8 c.c, in 12 to 36 hours
after removal.

No spinal fluids containing blood have been reported,
as experience has taught us that the presence of a few
red cells varies the reading of the gold curve.

The blood serum Wassermann reaction has been done
with the same antigens as the spinal fluid, the serum
used in .1 and .2 c.c. doses with anticomplementary and
antisheep amboceptor controls equal to the largest dose
of serum used. The complement and amboceptor have
been titrated on the day they were used. A 5% suspen-
sion of sheep cells, in .85% NaCL was used as an indi-
cator.

The tabulated results may be summarized as follows: —

Gold Test in Psychiatric Cases

403

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Frederick C. Potter

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410

Frederick C. Potter

Gold Test in Psychiatric Cases 411

Of 78 cases diagnosed clinically as general paresis
(Table 1), 61 cases or 78.2% gave a reaction in the
paretic zone, i. e. the first three to six tubes giving a
characteristic water clear "5" reaction. 10 cases, 12.8%
(Nos. 4, 8, 25, 29, 37, 38, 41, 43, 52 and 99) gave a curve
which while not absolutely typical of the paretic curve,
is very suggestive and should be included with the 61
cases, making 71 or 91%. The remaining 7 cases (9%)
gave curves in the luetic zone, i. e. the first four to five
tubes showing a precipitation which usually does not
exceed a "4" reaction. Of these last seven cases, the
diagnosis in one (No. 58) was confirmed by autopsy;
one (No. 65) had a strongly positive Wassermann reaction
in the blood serum, a doubtful positive Wassermann re-
action with .8 c.c. spinal fluid on two occasions; two
cases (Nos. 50 and 122) died after a typical course of the
disease; the remaining three cases (Nos. 33, 44 and 101)
are living and present the usual clinical picture of general
paresis. Five or 6.4% of this group (paresis), Nos. 7,
23, 25, 43 and 62, gave a persistently negative Wasser-
mann reaction in the blood serum with a strongly positive
Wassermann reaction, increased proteins and cell count
in the spinal fluid.

The cases included in the 91% of positive findings
with the colloidal gold all showed an increase in the globu-
lins and an average cell count of 81.5 per c. mm. The
spinal fluid frbm 32 cases, 45.07%, gave complete inhibi-
tion with .05 c.c; 19 cases, 26.7% with .1 c.c; 12 cases,
16.9% with .2 c.c; 6 cases, 8.4% with .4 c.c; 1 case,
1.4% each with .6 and .8 c.c

Five of the fluids (Nos. 17, 42, 63, 88 and 89), giving
the typical paretic curves, were drawn three to five hours
after death.

Of the 15 cases diagnosed clinically as cerebro-spinal
syphilis, (Table II,) 12 cases or 80% gave a reaction
within the luetic or meningitic zone and one case (No. 3 ),
was definitely in the paretic zone, (possibly a case of
paresis in remission.) The other two cases (Nos. 24 and
102) both gave a strongly positive Wassermann reaction

412 Frederick C. Potter

in the blood serum and spinal fluid, with positive tests
for globulins and a cell count of 142 and 14 respectively.
In four of these cases, there was a weU marked "Verschie-
bung nach oben," a term introduced by Lange, indicating
a reaction maximum in the higher dilutions. All of these
cases gave a positive Wassermann reaction in the blood
serum and 12 a positive Wassermann reaction in the
spinal fluid with increased globulins and an average cell
count of 90 per c. mm. The three cases, (Nos. 73, 82,
83,) with a negative Wassermann reaction in spinal fluid,
gave negative or weakly positive globulin tests and had
an average cell count of 6 plus.

Of four cases of Tabes (Table Til) 2 or 50%, 11
gave a suggestive luetic curve. This number of cases
is too small to draw any definite inference from it.

Of the 29 miscellaneous cases (Table IV), whose
spinal fluids were studied either on account of suggestive
physical findings or history, 13 gave a negative Wasser-
mann reaction in the bood serum and spinal fluid; one
(No. 49), a positive serum and spinal fluid reaction; one,
(No. 107), a positive serum and a doubtfully positive
reaction with .8 c.c. spinal fluid; the remaining 14, a
positive Wassermann reaction in blood serum and negative
reaction in the spinal fluid. The gold curve varied
greatly in these cases. In one clinical case of dementia
praecox (No. 49), the reaction would suggest a luetic
meningitis; one case (No. 81), clinically manic-depressive
psychosis, with a left facial palsy which cleared up later,
the gold curve would lead one to consider an acute
basilar meningitis, involving the fifth and seventh nerves
as its cause; one case (No. 31) of tuberculous spondylitis
(necropsy), in which the spinal fluid was drawn twenty
minutes after death, a typical reaction, maximum in
dilutions of 1 :320 and 1 :640, was obtained. In the
remaining cases, most of the gold reactions were too
irregular to admit of any definite interpretation.

In the majority of cases reported there is a marked
agreement between the Wassermann reaction, the globulin
reaction and the Lange test, which leads us to agree with

Gold Test in Psychiatric Cases 413

Moody in his statement that the result of the Wassermann
reaction may be foretold from the gold test.

It is also to be noted that of the 78 cases diagnosed
clinically as general paresis, 93.5% gave a positive Wasser-
mann reaction in the blood serum and 96.1% gave a
positive Wassermann reaction with .4 c.c. or less of spinal
fluid.

Conclusions:

1. It is absolutely essential that the directions laid
down for the preparation of the reagent be followed
exactly and that all glassware be absolutely clean and
free from either acids or alkalies.

2. The Lange colloidal gold reaction is an aid in
the diagnosis of general paresis, when used in conjunction
with the results of the Wassermann reaction on the blood
serum, and the Wassermann reaction, the cell count
and protein estimation in the spinal fluid, as well as the
careful study of the case clinically.

3. This test is of value in confirming a clinical
diagnosis by examination of the spinal fluid three to
five hours after death.

I desire to express my appreciation to our Superin-
tendent, Dr. George F. Edenharter, for the privilege of
doing this work and to Dr. Max. A. Bahr and the staff
physicians who have co-operated by furnishing the clinical
diagnoses.

1. M. Faxaday, quoted by V. Poschel, "Chemist, of Colloids," 1910.

2. Zsigmondy, ztachv. f. anal. Chem. 1901. XL-697.

3. Lange, Berliner Klin. Woch., 5, 6, 12. No. 19.

4. Grulee & Moody, Joum. A. M. A., 1913, Vol. LXI, No. 1.

5* Grulee & Moody, Amer. Jour. Diseases of Children, Jan., 1915.

6. Miller and Levy, Bulletin Johns Hopkins Hospital, May, 1914.

7. Lee & Hinton, Amer. Journ. Medical Science, July, 1914. Vol. CXLVIII,
No. 1.

8. DeCrinis & Frank, Munchener Med. Wochenachrift, LXI, No. 22, 6/2/14.

9. Solomon & Kocfod, Boston Med. & Surg. Journ., 12/10/14.

10. Brock, 111. Medical Journal, October, 1914.

11. Kaplan & McCleUand, Journ. A. M. A., Feb. 14, 1914.

12. H. Eicke, Munchener Med. Woch., 12/9/1913.

13. Moody, A. M., Journ. A. M. A., January 17, 1914.

14. Solomon & Wells, Boston Med. & Surg. Journal, 3/18/1915.

16. Weston, Darling & Newcomb, Amer. Journ. Insanity, April, 1915.

16. Swalm & Mann, N. Y. Med. Journal, April 10, 1916.

17. V. Kafka, Munchener Medizinische Wochenschrift, Jan. 26, 1916.

ZIEHEN'S CONCEPTION OF ACUTE HALLUCINA-
TORY PARANOIA (AMENTIA)*.

By Max A. Bahr, M. D.,

Indianapolis, Ind.

Central fo'diana Hospital for the Insane.

EVER since the fundamental conception of paranoia
was laid by such writers as Westphal, Esquirol,
Mendel, and many others, and especially in recent years
by Kraeplin and Ziehen, this subject has been one of
the most interesting in the realm of psychiatry.

Since the earliest conception of the disease, there
have been many stages of transformation and many
variations, and no little confusion has resulted from
the diverse opinions of men who have made the most
careful and scientific analysis.

Kraeplin's recent "paraphrenia," which forms a
subgroup of endogenous dementia and in which, during
the height of the disease, delusional ideas and hallucina-
tions are the prominent symptoms, has attracted consider-
able attention in the recent hterature of psychiatry.
Kraeplin's paraphrenia simulates in many ways his
dementia praecox but there is none of the characteristic
disturbance of the emotion and vohtion to the extent
of bringing about disintegration of the personality.

Ziehen's acute hallucinatory paranoia or "amentia,"
as he terms it, is an acute functional psychosis, whose
dominating sjrmptoms are hallucinations and illusions.
Out of the hallucinations and illusions, delusional concepts
develop.

In the typical form, all primary emotional disturbances
and association disturbances are wanting. Secondary

^Authorized permission for translation.

(414)

Acute Hallucinatory Paranoia 415

emotional disturbances which correspond to the content
of the hallucinations (e. g., the fear of threatening voices)
and secondary association disturbances (e. g., secondary
flight of ideas in consequence of massive accumulation
of sensory deceptions) are very frequent. In the same
manner, the disturbances of action in the typical form,
are exclusively dependent upon the hallucinations and
delusional concepts springing from them.

Corresponding to the differences of opinion mentioned,
the most variable names have been given to acute hallucina-
tory paranoia. Some still in use at the present day, are,
for example, "hallucinatory insanity" (Fijrstner), "hallucin-
osis" (Wernicke), "acute hallucinatory delusion" (Krafft-
Ebing), "Amentia" (Meyert), etc. In reference to
the secondary hallucinatory incoherence, "acute hallucin-
atory confusion," or "distraction" has also been spoken
of (Fritz and Conrad).

In reference to a frequently demonstrable etiological
factor an "aesthenic confusion" (Mayser) has also been
spoken of. The designation amentia is best reserved
for those cases which are connected with severe primary
incoherence.

The cardinal symptoms of hallucinatory paranoia are
the sensory deceptions, hallucinations as well as illusions.
Visual deceptions generally predominate. The majority
of the hallucinations are to be included amongst "the
mediate ones," that is those in which the content of
the hallucination does not generally correspond to the
actual concept of the patient at that moment.

The hallucinations also stand in no intimate connect-
ion with each other.

Often the sensory deceptions are so massive and so
changing, that every orientation by the patient is im-
possible. The content of the sensory deceptions is ex-
tremely variable. Flames, grimaces, shadows, and naked
forms, predominate, amongst the visions; threats, calls
for help, harsh words, complaints, fire alarms, explosions,

416 Max A. Bahr

amongst the akoasma. The floor sways under the patient,
so that he believes he is in a ship. Everything turns
in a circle about him.

The real objects as well as the hallucinatory forms
appear at times to be changed, at times diminished.
The patients feel hedge-hogs, leeches, toads, and snakes
in the bed. One patient had the feeling that his blood-
vessels were "bursting open" and that he would explode
at any moment. Besides sensory deceptions, hyperaes-
thesias and hyperalgesias are frequently observed. Instead
of the latter, in severe cases, pronounced hypalgesias and
analgesias also occur.

Disturbances of the concept outflow, in the typical
form, depend exclusively upon the content of the hallucina-
tions. At times, the secondary inhibition predominates,
especially in frightful, fascinating, and many imperative
hallucinations. At times secondary flight of ideas pre-
dominates, as in very changeable, pleasing hallucinations.
At times, finally, secondary incoherence predominates,
as in massive accumulation of separate contradictory
hallucinations.

In the latter case, there is frequently complete
disorientation: the patient cannot give the month nor
the year, believes that he has been in the institution
a hundred years, and imagines himself to be at times in
this, at times in that city. Often hallucinatory aprosexia
is superimposed; less frequently, especially, when secondary
flight of ideas predominates, hallucinatory hyperprosexia.
In the description of the varieties of hallucinatory paranoia
it is to be noted that sometimes, not only intercurrent
(i. e., occasional and transitory) and secondary, but
especially at times, also persistent and primary disturbances
of the concept — outflow arise as dominating symptoms
in the disease picture.

Sometimes the secondary deceptions of the patient
are so fragmentary, flighty and numerous, that the
formation of the delusional concepts from them is
omitted. More frequently, the secondary deceptions
lead to the formation of numerous delusional-concepts.

Acute Hallucinatory Paranoia 417

The patient believes that a conflagration threatens
the house, that relatives are imprisoned, that poison is
mixed in the food, that his marriage is being celebrated,
that he had become president, that God had selected
him for His instrument, etc. On the whole, persecutory
ideas predominate over grandiose ideas. Very frequently
there is a delusion of annihilation. The patient believes
that all kinds of furious battles are going on, that every-
thing is dead, that the world is coming to an end.

Countless mistakings of persons are added thereto.
In consequence of illusions, strangers are taken for relatives.
Objects are likewise mistaken; the house is taken for a
castle, or for a dungeon; the ventilation openings for
underground passageways out of which voices echo;
stupefying odors escape; electrical discharges proceed.
These secondary delusional-concepts springing from sensory
deceptions, change according to the place of residence,
the education and the life experience of the patient in
the most manifold way.

Exceptionally concepts of having sinned also occur
intercurrently : ("I have squandered all the world"); ("I
have been a prostitute"). More frequently there are
hypochondrical concepts. Thus a patient after his
recovery related that on account of a remarkable sensation
in the limbs, he had a concept that he must die "of
tetanus." Another acute hallucinatory paranoiac said
"all my internal parts are lost, etc." If the sensory
deceptions give the patient sufficient time, he engrafts
further delusional concepts upon the delusional ideas
immediately springing from the sensory deceptions. This
does not reach a logical systematization, for this, the
changing of the sensory deceptions in acute hallucinatory
paranoia is far too great. Therefore, the delusional
concepts often stand in glaring contradiction to each other.

The patient beHeves he is a "dancing teacher,"
because he continually perceives electrical currents and
at the same time, feels all kinds of hallucinatory move-
ment-perceptions in his limbs, (here dances are induced
by electricity); in the next moment, he perceives that he

418 Max A. Bohr

is infected by the plague, ("voices have told me so"),
and is to be locked in a tower, etc. Careful observation
further teaches that besides these direct and indirect
secondary delusional concepts springing from the sensory
deceptions, also primary delusional concepts arise. Prim-
ary delusional explanations especially in which illusions
^nd hallucinations in iio way co-operate, are not rare,
Thus, a patient referred to scars, the result of an injury
long before his psychosis, and stated that he had been bitten
by a dog. Any kind of an hallucinatory perception may
be demonstrated. At the cry of a water fowl, a
patient cried; "that is the Night of St. Bartholomew."

On occasion of an injection, an educated patient
asked me excitedly "why should I be nailed fast?" Often
these delusional explanations are exceedingly fantastic.
Many patients also reach the conclusion, that a theatrical
performance is taking place about them, that the fellow-
patients are disguised personaUties, for example, that
attendants are disguised men, and collectively play a
definite role. Between the forms of hallucinatory paranoia,
gpst described, in which the massiveness of the hallucina-
tions does not permit a delusional formation to take
place, and the form last mentioned, in which an ex-
tensive delusional formation is engrafted upon the sensory
deceptions, there exist the most graded transitions.

The emotional disturbances in the typical form, like
the disturbances of the associations are collectively second-
ary. Their direction depends upon the content of the
hallucinations, therefore, the severest fear emotions are
found in connection with the most unrestrained exaltation,
brutal anger emotions in connection with religious rapture.
Even in one and the same patient the most variable
emotions occur in succession corresponding to the changing
content of the sensory deceptions. The most sudden
emotional fluctuations may take place in the presence of
the physician. In many cases it is unmistakable, that
hallucinations show one and the same feeling-tone. For
example, persistent exalted sensory deceptions or persistent
fearful sensory deceptions govern.

Acute Hallucinatory Paranoia 419

In these cases, self-evidently, the secondary emotional
disturbance is a unified one. For weeks and months,
secondary exaltation or secondary fear, or religious rapr
ture, etc., governs. Even in these cases, it n^ay be supt
posed, that the uniform feeling-tone of the sensory
deceptions indicates that besides the hallucinations, a,
primary emotional disturbance co-operates, and that the
emotional alterations accordingly are not looked upon
wholly as secondary phenomena of the hallucinations. This
is wholly unquestionable in other cases, in which from the
beginning of the disease, either occasionally or persistent-:
ly, a morbid exaltation or depression arises; for the one
sufficient explanation for the sensory deceptions sometimes
happening cannot be ascertained, and for reasons they are
not to be comprehended as primary.

The intercurrent appearance of primary fear-emotions
especially is not very infrequent. The persistent appear-
ance of primary exaltation or depression (sometimes
governing the disease picture) is most frequent in the
variety characterized by flightiness of ideas or in the
stuporous variety of acute paranoia.

The primary exaltation is here connected with primary
flight of ideas, the primary depression and fear with
primary thought inhibition.

In very numerous and incoherent sensory deceptions,
a well marked helplessness is at times also found. The
disturbance of action which patients with hallucinatory
paranoia present, is extremely variable. In the typical
form, the disturbance of motility depends entirely upon
the content of the hallucinations and delusional concepts.
The agitating influence most frequently predominates.

Therefore, a continuous or remittent delirious excita-
tion is found extremely frequently. Sometimes fear
is the impelling motive, sometimes anger, sometimes
exaltation. Correspondingly, sometimes, cries of anguish
and attempts at flight predominate, sometimes assaults
against the environment, sometimes singing and dancing.
At times the disturbances are manifested as pantomimic
and gesticulatory movement-deliria.

420 Max A. Bahr

In this the rythmic tendency of emotions is not infre-
quently manifested, for example, in rhymes, couplet
singing, etc. Often the motor agitation is also wholly
traceable to the massiveness of the instreaming pathologi-
cal percepts, without the emotions co-operating in any
decided measure. Likewise, a well marked motor inhibi-
tion is very frequent. Indeed it is almost always of the
catatonic form. Simple resolution is very infrequent.
This inhibition is sometimes occasioned by hallucinations
of the muscular sense, sometimes by terrifying or fascinat-
ing visions or threatening voices. If the sensory decep-
tions arise massively, and, at the same time, stand with-
out any connection with each other, there is a high
degree of secondary incoherence of movement and action
of the patient. He wanders about aimlessly, and lays
hold of things without purpose. Catatonic attitudes
alternate irregularly with senseless agitation.

Often there are the wildest jactations, which give
the unexperienced the direct impression of ataxia or
chorea. Uncleanliness of various forms makes its appear-
ance very early along with the incoherence. Besides
these secondary disturbances of the motor associations,
a primary acceleration, or inhibition, or incoherence of
the motor associations also occurs intercurrently.

The individual actions and movements of the acute
hallucinatory paranoiac show the most striking variations,
corresponding to the manifold content of the sensory
deceptions and delusional concepts lying at the basis.
While the general demeanor of all maniacs (and likewise
of all melancholiacs) is very similar, one paranoiac
scarcely resembles another. Indeed the demeanor and
actions of one and the same paranoiac may vary from
day to day, while in spite of this, the attentive observer
is able to separate certain types out of the multiplicity
of the motor pictures, and is also often able to recognize
many constant features in the motor picture, in all the
changes of action and movement.

This is because, on the one hand, the just mentioned
formal motor association disturbances give to the various

ActUe Hallucinatory Paranoia 421

motor pictures a common stamp, and on the other hand,
definite hallucinations always recur in individuals with
similar educational training and similar social position;
and sensory phenomena often show a definite constancy in
the isolated individual, corresponding to the educational
training, social position, and recent experiences in the
course of the disease.

Sometimes, also, primary motor excitations occur
which are entirely dependent on the sensory deceptions -
and delusional-concepts. Thus, a female patient stated
very characteristically, "something in me makes me
dance." "I don't know what it is that makes me dance,
but I cannot resist." Another patient remarked, "I am
compelled to sing, it is forced out of me from within."
Other peculiar movements often recurring in a stereotyped
manner in the same patient, depend upon very indefinite
hallucinatory perceptions. Thus, a patient who during his
psychosis had shown the most bizarre rotations of his
body, reported after his recovery, "I was compelled to
do it:" "It passes through me like a cutting sensation
through my entire body." "Afterward I wanted to adjust
my body correctly." Another patient opened her mouth
wide for hours because she felt as if her "blood was being
extracted from her teeth."

The nutrition of the patient as a rule, suffers decided-
ly. Even without there being refusal of nourishment
or severe delirium, the body weight decreases.

The vasomotor manifestations are very changeable.
The pulse-picture generally shows an increased tension
of the arterial wall (excitation emotions,) at times a
spastic contracture of the peripheral arteries. The daily
course of the body temperature shows very irregular
fluctuations. In those cases which run a course with severe
incoherence, disorientation, and agitation, there are
often high temperatures. The picture of the condition
which such patients present is , also designated acute
delirium.

Not infrequently there also exists excessive salivation,
especially in iuvenile individuals. The hydrochloric acid

422 Max A. Bohr

secretion of the stomach is more frequently increased
than diminished. Defecation and menstruation show
irregularities. Reflexes, motility, and sensibility, in un-
complicated cases, are ^nerally normal. The tendon
phenomena are often markedly increased. Ankle-clonus,
however, seldom occurs. Pressure points, wholly apart
from complications with hysteria and neurasthenia, are
frequently found, especially in juvenile individuals.

The field of vision is at times decidedly contracted.
Analgesia, which accompanies the severest cases, has
already been considered.

Acute hallucinatory paranoia often sets in with a
prodromal stage. In this the patient's own person and
his own environment become changed. Relations, full
of secrecy, appear to exist. A feeling of uneasiness steals
more and more over him. He associates every proceedure
in the outer world in some manner with his person; he
feels himself observed, and threatened on every hand.

"It appeared to me as if a form, invisibly and silent-
ly always went behind me." In this stage, already
illusionary falsifications of the perceptions arise.

The fantasy of the patient plays him all kinds of
tricks. He believes that he sees disguised persons, and
dreams himself into all kinds of fantastic situations.
Sleep therefore, becomes deficient. Often intense head-
aches and congestions occur. The dreams are sometimes
increased in a quite striking manner and become morbidly
active. Often the patient himself, states that he fears
he is going insane. The prodromal stage sometimes
extends over some months. Now and then it only lasts
a few days. The principal stage of the disease develops
exceedingly rapidly, generally engrafted upon these
prodromal symptoms. Massive hallucinations and illusions,
increasing avalanche like, make their appearance.

Not infrequently, they are, on the first and second
day, already so numerous and over-powering, that the
orientation of the patient is completely aboUshed.

Thus it happens that the patient often goes astray,
takes aimless journeys, or goes tramping. Upon the basis

Acute Hallucinatory Paranoia 423

of hallucinations there now arises a catatonic condition of
inhibition, or an outbreak of intense agitation. In the form-
er case, the psychosis runs a course under the picture of a
pseudo-stupor; in the latter, the excitation is often increased
to a well marked delirium. A sharp demarcation does not
exist. Not infrequently, the pseudo-stupor is interrupted
by attacks of excitation, and the agitation by episodic
states of pseudo-stupor.

The whole course lasts on an average about six
months. Yet cases exist, in which the psychosis runs
its course in a few days or hours, and gives throughout,
the picture of a transitory insanity. On the other hand,
the psychosis at times lasts over a year, and still finally
passes into a complete recovery.

Very frequently, the course is a remittent one. Very
often, two stages can be distinguished: in the first agita-
tion predominates; in the second inhibition.

In very acute cases, the recovery may take place
immediately. More frequently the sensory deceptions
diminish in number within a few days or weeks.

The delusional concepts often disappear more slowly
than the sensory deceptions. Many patients still de-
clare after weeks, and even months, that thej' are sur-
rounded by mysteries, that all occurences of the environ-
ment have a relation to them, etc. Retrospective in-
sight into the disease appears only slowly.

Exceptionally there are frequent severe relapses oc-
curing in the course of convalesence. In those under-
going recovery, the memory of the experiences during
the disease is throughout retained, but is still often some-
what deficient.

As to the prognosis of acute hallucinatory paranoia,
it may be stated that these cases terminate either in
recovery, recovery with defect, secondary dementia,
chronic hallucinatory paranoia, or death. Recovery with-
out defect occurs in nearly 70 per cent of all cases.
At any rate it is here to be noted that relapses are ex-
tremely frequent in acute hallucinatory paranoia. Not
infrequently it is observed that within one, two or three

424 Max A. Bohr

years, after complete recovery, the psychosis recurs.
Such a relapse may again recover, but finally, frequently
in the third or fourth relapse, there follows, the termina-
tion in secondary dementia or chronic hallucinatory
paranoia. About 30 per cent remain cured permanently
(49 per cent over ten years). Recovery with defect is
observed especially in individuals whose mental endow-
ment was originally somewhat deficient, moreover also
after a very protracted course of the illness.

Sometimes, moreover, such defect, at least partially,
re-adjusts itself gradually by careful medical training.
Secondary dementia is observed in 20 per cent of all
cases. This unfavorable termination in the typical form,
generally reveals itself in that the patients outside of
their hallucinatory excitation also speak confusedly and
answer in a silly manner. The actions and emotions
of the patients do not stand in harmony with their
sensory deceptions and delusional concepts. The body
weight increases without physical improvement being
noticeable. The careful observer discovers these traces
of intellectual loss often very early. In juvenile individuals
especially, termination in secondary dementia is to be
feared. This termination in secondary dementia is also
to be feared in those cases in which stereotyped motor
excitations arise, i. e., not produced by sensory deceptions,
delusional concepts, or emotions and not catatonic in
character. Why these cases are particularly endangered,
only about 30 per cent completely recovering, has not
yet been determined.

On the other hand, these primary motor stereotypies
not infrequently take place in the acute hallucinatory
paranoia of the weak minded without the prognosis being
essentially made more favorable. The transition into
chronic hallucinatory paranoia takes place either in the
above mentioned manner, by the continuous appearance
of relapses, following at shorter intervals, or also directly
engrafted upon an acute individual hallucinatory attack.

Acute Hallucinatory Paranoia 425

In the latter case, it happens that even where the
hallucinations subside, the patient remains wholly under
the influence of the delusional concepts springing from
the hallucinations.

The immediate and intense action of the hallucinations
upon the emotions becomes lost. The delusional formation
predominates over the hallucinatory processes. Amongst
the hallucinations themselves, the auditory deceptions,
in the transition to a chronic course, often gain pre-
dominance over the visual deceptions in quite a striking
manner. Fatal termination in cases running a course under
the picture of acute delirium, is very frequent. Inter-
current diseases (pneumonia, intestinal catarrh, phlegmon,
endocarditis, exhaustion) are among the important causes
of death. Fat emboli in the pulmonary arteries (for
example, after bony fracture during excitation) may like-
wise bring about a fatal termination. Suicide also at
times occurs.

The most important varieties of acute hallucinatory
paranoia are brought about by the engrafting of primary
association-disturbances or primary emotional disturbances
upon the cardinal symptoms of the psychosis, namely,
sensory-deceptions and delusional-concepts. These primary
association disturbances are flight of ideas, thought
inhibition and incoherence (agitation, motor inhibition,
and motor incoherence). The primary emotional dis-
turbances are exaltation and depression. On the former,
anger-emotions, on the latter, fear-emotions are frequently
engrafted. The characteristic of these varieties does not
lie in the fact, that in general, flight of ideas, thought
inhibition, incoherence, exaltation, or depression arises
in an acute hallucinatory paranoia, but in the fact that
those disturbances arise primarily, i. e., independently
of hallucinatory and delusional concepts. It has been
expressly emphasized above, that secondary association
and emotional disturbances arise exceptionally frequently,
and in a certain measure evidently correspond to, the
content of the hallucinations and delusional concepts in
question.

426 Max A. Bohr

That in a patient whom a voice threatens with death,
the thoughts stand still and extreme fear arises, is compre-
hensible from the hallucinations alone.

Thought inhibition and fear are here not to be re-
garded as a new disease symptom, but as entirely
secondary. Such cases throughout remain in the realm
of typical hallucinatory paranoia. However, it has already
been mentioned above, that now and then primary
association disturbances and primary emotional disturb-
ances also arise intercurrently. The patient, e. g., has
a fear attack of some hours' duration, without any form
of sensory deception or delusional concept that can be
made responsible for it. This intercurrent arising of
primary association and emotional disturbances is still not
important enough to establish particular varieties of acute
hallucinatory paranoia upon the basis of the same.
Now, however, the same primary disturbances and
emotional disturbances occur not only intercurrently,
but also not infrequently permanently in the disease-
picture accompanying the hallucinations and delusional
concepts.

In this way arise some important varieties of acute
hallucinatory paranoia. They are:

1. The flightiness of idea form: with persistent
flight of ideas (association-acceleration).

2. The stuporous form: with persistent primary
thought inhibition (association retardation).

3. The incoherent form: with persistent primary
incoherence (dissociation).

4. The exalted form: with persistent primary exalted
mood.

5. The depressive form: with persistent primary
depressed mood or fear.

Since persistent exaltation almost never occurs
without persistent association acceleration, and persistent
primary depression almost never without persistent
association retardation, therefore the variety "4" essentially
comes under variety "1" and variety "5", under variety

Acute Hallucinatory Paranoia 427

"2". Therefore, primary persistent exaltation and de-
pression will be directly included in the description of
varieties "1" and "2".

1. The cardinal symptoms, according to the above,
are hallucinations, delusional concepts, and primary
flight of ideas, besides corresponding agitation.

Often, but not always, a well marked primary ex-
altation is added thereto.

The content of the hallucinations on the whole,
corresponds to the exalted emotional state. Among the
delusional concepts, grandiose ideas therefore predominate.
At times, in a high degree of increase of the association
acceleration, there arisesa secondary, so called flightiness
of idea incoherence.

Often verbigeration and rhymes occur. Apparently
this flightiness of idea variety of acute hallucinatory
paranoia, represents a transition from the latter to mania.
If it is imagined that the hallucinations subside more
and more, and the primary flight of ideas and exaltation
alone govern more and more the disease-picture, then the
transition into mania is given. As a matter of fact,
between the hallucinatory variety of mania and the
flightiness of idea variety of paranoia, quite graded cases
are observed.

The cardinal symptoms of the stuporous variety,
are hallucinations besides secondary delusional-concepts,
and primary thought-inhibition besides corresponding
motor inhibition. At times, but not always, well-marked
primary depression is added thereto (with or without
fear.) The content of the hallucinations in the latter
case correspond on the whole, to the depressed type;
amongst the delusional-concepts, ideas of persecution,
of impoverishment, and of having sinned predominate.
The motor inhibition is generally a catatonic one.

Often it is suddenly interrupted by a jumping of the
patient, to whom, for example, a voice addresses a
command. Often mutism occurs for days. Only slowly,
with frequent pauses, the patient carries a spoon to the

.428 Max A. Bohr

mouth, or often abstains from eating. To questions he
answers not at all, or extremfely slowly.

Quite simple questions are often calctilated. DiflBculty
in recollection and aprosexia are never wanting. At
times this stuporous variety represents a transition form
of acute hallucinatory paranoia into melancholia, at times
into stupidity, according as to whether the inhibition
affecting mostly the association and depression, predomin-
ates, or that affecting mostly the memory-pictures and apathy.
As a matter of fact, cases are often observed, which re-
present graded transition-forms between the hallucinatory
variety of melancholia, and the stuporous variety of
acute hallucinatory paranoia, and others which represent
graded transition forms between the hallucinatory variety
or stupidity and the stuporous variety of acute paranoia.
Very frequently, the flightiness of ideas form combines
with the stuporous form in a so-called cycle.

At times, the condition rests with such a cycle, at
times it repeats itself regularly at definite intervals.
This form of circular insanity is also briefly designated
as "circular paranoia." Not infrequently circular paranoia
is observed at puberty. In the flightiness of idea form,
elated and stuporous depressive phases are always ir-
regularly manifested. Intervals are generally entirely
wanting. The prognosis, in contrast to the peculiar
regular circular paranoia is entirely favorable. One must
be aware of the possibility of the mistaking the disease
for a hebephrenic dementia running a circular course.

The prognosis of the flightiness of ideas form and
of the stuporous variety is, on the whole, more favorable
than that of typical acute hallucinatory paranoia. In
the flightiness of ideas form, especially, the termination
in secondary dementia is rare. The cardinal symptoms
in the incoherent variety, or amentia are hallucinations,
secondary delusional concepts, and primary incoherence
of the concepts out-flow, besides corresponding motor
incoherence.

A pronounced disorientation always exists. The
motor incoherence often leads to paramimia and pseudo-

Acute Hallticinatory Paranoia 429

paraphasia. The emotional excitation shows quite ir-
regular fluctuation. At times exaltation on the whole
predominates, at times, depression. Flight of ideas, or
thought inhibition may also be superadded as a complicat-
ing symptom. On the whole, motor agitation is more
frequently superadded than motor inhibition, to the
incoherence, and the motor agitation is frequently carried
to the extent of senseless and helpless jactation which
were formerly described as chorea magna. In these
cases of severest incoherence with agitation, fever also
frequently arises and thus appears the dangerous symptom-
triad of acute delirium.

Not infrequently the primary incoherence appears
in the foreground, while the sensory deceptions and de-
lusional concepts subside more and more, and indeed
are entirely omitted for days and weeks during the course
of the disease. The course of the incoherent form has
many peculiarities. Often for months, an eccentric
exalted conduct preceeds the outbreak of the disease.
That peculiar feeling of doubt and secrecy with which the
typical form sets in, is rarely in evidence. The main
stage as a rule sets in very suddenly, with rapidly increas-
ing incoherence. Fear is generally definitely denied.
Frequently complaint is made of "heat and unrest in the
head." A secretive, paramimic expression of laughter
appears which is puzzling to the patient himself. The
next day the patient talks a great deal, but he often
loses the thread of the conversation.

Hiallucinations and illusions are often completely
wanting. Hereditary taint is demonstrable in about
one-half of the cases. Probably rachitic hydrocephalus
also occasions a predisposition. In female individuals,
acute hallucinatory paranoia is more frequent than in
males. The forms of acute hallucinatory paranoia may
occur at any age, at the age of puberty, as well as the
climacterium, and at senility it appears to occur ex-
ceptionally frequently and without any especial exciting
causes. At middle life a more definite, special exciting
cause for the outbreak can almost always be shown.

430 Max A. Bohr

The chief causes of acute hallucinatory paranoia
are exhaustion, acute or chronic intoxication, and acute
infection. The factor of exhaustion appears the most
manifest in the cases where the disease develops from
physical fatigue, insufficient nourishment, and deficient
sleep, after severe intellectual over -exertion, upon the basis
of severe anaemia, especially after hemorrhages, after
frequently repeated child-births, or difficult labor. The
intoxication cases, include those especially of alcohol,
lead, and cocaine poisoning. Infection following child-
birth plays one of the main roles as an etiologic factor.
Not infrequently it is shown anamnestically that to these
essential etiological factors, an exciting cause is also
finally superadded, and has contributed immediately
to the outbreak of the disease. Thus not infrequently
in an exhausted puerperal case, an emotional shock,
e. g., fright because of a convulsion in or death of a
child, etc., some weeks after child-birth, has induced
the outbreak of the disease. The same has often been
observed in the acute hallucinatory paranoia of puberty
and of the climacterium.

Trauma furnishes a further etiological factor. Acute
hallucinatory paranoia may be engrafted immediately
upon a trauma, or may first break out after an interval
of some hours and even some days. The psychogenic
neuroses, especially hysteria, also show a decided pre-
disposition to acute hallucinatory paranoia.

The acute hallucinatory paranoia of puberty is
characterized by its tendency to intercurrent flight of
ideas. Stereotyped attitudes and movements also are
not infrequent without decided clouding of consciousness.
The climacteric form is often introduced by depression
lasting for weeks. The outbreak and recovery take place
very suddenly, but it is frequently observed that
after the disappearance of the hallucinations, the patients
pass through a short stage of delusion in reference
to their surroundings.

The senile form in the prodromal stage oft«n mani-
fests headache, pressure of the head, dizziness, sleepless-

Acute Hallucinatory Paranoia 431

ness, gastro-intestinal disturbances, and irritable lachry-
mose moQd. The outbreak takes place very suddenly. Ex-
ceptionally one observes in senility an attack of loss
of consciousness before the beginning of the psychosis.
In the course of the psychosis, the intensity of the
disorientation generally becomes apparent. Thus a patient
believed that he held the whole world in his outstretched
hand, and that if he should let go^ the whole world would
be destroyed. Sensory deceptions and delusional concepts
of fearful content predominate. The actions often bear
a clearly, impulsive character.

Slightly fleeting pareses easily contribute to make an
unfavorable prognosis, upon the basis of the wrong
diagnosis of a senile dement. The exhaustion and in-
fection-forms correspond to the picture forming the basis
of the main description. Very often, however, primary
incoherence sets in very early so that the disease- picture
of amentia of the dissociative form arises. The puerperal
form, which may exceptionally recur after every confine-
ment shows variable pictures, according as to whether
exhaustion or infection, etc., plays the important role.
The average duration is from six to ten months. The
percentage of recoveries may be as high as 70%. The
most frequent prodromal manifestations are motor unrest,
sleeplessness, frightful dreams, ringing in the ears, seeing
objects before the eyes, headache, lassitude, irritability,
and apprehension. At times also a peculiar aversion
for the child appears.

The same sentence and same action is often aimlessly
repeated. Even before the outbreak of the hallucinations,
the incoherence may announce itself by aimless actions.
The course is often a remittent one. Recovery generally
takes place slowly. In the toxic forms, the massiveness
of the sensory deceptions is particularly striking. The
alcoholic is particularly important.

The disease picture corresponds mostly to the picture
for the basis of the main description. Incoherence
is less frequent and when it arises, is generally secondary.

432 Max A. Bahr

Primary fear emotions are frequent. In the traumatic
form, feelings of dizziness and vestibular hallucinations
appear to play a particular role.

The hysterical forms generally show a strong pre-
dominence of visual and organic hallucinations. Delusion-
al explanations of the latter play an essential role. Beside
genuine sensory deceptions, numerous phantasies also
occur.

The feeling-tones and especially the expressions of
the feeling-tones are strikingly active. The disturbance
of orientation is much more superficial than it appears
from the expression of the patient. Often a moderate
consciousness of illness is present, 'at least intercurrently.
The polyneuritic form is characterized above all by an
enormous disturbance of the capability of attentiveness
and therefore also orientation. As a rule, hallucinations
predominate at the beginning of the disease, and occasions
intense agitation or stupor, while in the further course,
disturbances in the capability of attention appear in the
foreground.

Very frequently, there are also fantastic confabulations.
Physical symptoms are never absent. Most frequently
there are neuritic paralyses in the crural and the perineal
regions. Very frequently also the nerves of the upper
extremities are involved, particularly in the distal branches.
The sensibility disturbances, because of the physical
state, are deprived of an exact determination. At times,
ataxia predominates instead of pareses, so that tabes may
be simulated (peripheral neuro-tabes) . Occasionally the
cranial nerves are also involved. Complete recovery is
rare. Generally only recovery with defect is attained.

Frequently the further course is subacute. Not in-
frequently, death takes place in the deliriant phase.
Secondary dementia may also often develop. By complica-
tion with hemorrhage and hemorrhagic softenings, mani-
fold clinical complications may also arise. Like all the
special forms described, the poly-neuritic form is also
in no way specific. A similar course with a similar

Acute Hallucinatory Paranoia 433

picture occurs also in alcoholics with polyneuritis, after

acute infectious diseases, in other intoxications, in brain
syphilis, in the course of paresis, etc.

HEAVENLY BRIDEGROOMS

By Theodore Schroeder
AND Ida C.

The Sons of God saw the daughters of men that they

were fair; and they took them wives of all that

they chose.

Genesis 6:2.

Explanatory Note. — In the course of my studies on the ero-
togenesis of religion I became interested in the life work and mental
characteristics of one Ida C, a woman who committed suicide in
her forty-fifth year. I first heard of her after her death, but it seemed
to me that a psychologic study of her would yield rich materials as
a contribution to the psychology of religion. Consequently, I bestirred
myself to secure information, both biographical and auto-biographical.
Among the materials gathered was her life long correspondence with
friends, a number of published essays written by her, some scraps
of manuscripts, and two completed but unpublished book manuscripts.
This material will later constitute the subject of my analysis. Ida

C was for a number of years a college teacher and for a long time

associated with various kinds of free-thinking heretics. She was
never married. In due time she became the victim of erotic hallucina-
tions to which she gave a "spiritual" interpretation. Later, when her
conduct brought her to the verge of incarceration in a jail or in an
asylum, she endeavored frankly to meet the issue of her own insanity.
The resultant investigation to her mind seemed a complete vindication ,
not only of her sanity, but also, of the objective reality and spirituality
of her erotic experiences. This vindication she reduced to writing.
The manuscript is now in ray possession. It seems to me under the
circumstances of this case and the future studies which I am going to
make, partly from other papers of the same author, that this is too
valuable a document to be mutilated by editing. Furthermore, others
should be given equal opportunity with myself in the interpretation
of this material. The manuscript had been revised by its author and
in a number of places it was quite impossible to decipher the pen-
interlineations, or replace words destroyed by the tearing of the manu-
script through frequent handling before it came into ray possession.
At such places a word may be occasionally omitted or a connection

(434)

A

Heavenly Bridegrooms 435

left defective, otherwise the following document is in the exact words
of its author. This essay, I believe, was written before her thirty-fifth year,
that is ten years before her suicide, and twenty-two years before the
present publication. Her subsequent development will be brought
out in my own study of her. Just before she wrote this she was a
short time a voluntary inmate of an asylum and pronounced incurably
insane. She left the country to escape legal commitment.

THEODORE SCHROEDER.

Preface.
TT has been my high privilege to have some practical
•■• experience as the earthly wife of an angel from
the unseen world. In the interests of psychical research,
I have tried to explore this pathway of communication
with the spiritual universe, and, so far as lay in my
power, to make a sort of rough guide-book of the route.
For not all wives of heavenly bridegrooms travel the same
path at first. There are roads running into this one
from every religion and folklore under the sun, since the
pathway of marital relations on the Borderland was
once, and still is, as I hope to show, one of the main
thoroughfares connecting our world with the world beyond
the grave. This thoroughfare, along part of which I
hope to conduct the reader in imagination, is marked with
signposts, many crumbling under the religious storms
of centuries, others preserved as sacred trellises upon
which to train a rank growth of flourishing superstition,
and still others fresh with modern paint and gilding.
Part of this thoroughfare runs straight through the
Christian Church, or, to speak more accurately, the
foundations of the Church are laid upon this very princi-
ple. For Jesus himself is said to be the child of a union
between an earthly woman and a heavenly briedgroom
who (however godlike, and whatever the details of the
relation) certainly seems to have manifested to Mary
on the occult plane. If it be objected that Mary's Border-
land spouse was not an angel, but God himself, and
therefore Borderland laws could be laid aside in His
case. I reply that modern philosophy holds apparent
miracles to be no violation of natural laws, but to have

436 Theodore Schroeder

happened in accordance with some law as yet unknown
to us, for God never breaks His laws, and if He became
a Borderland spouse to Mary, it must have been in
accordance with Borderland laws. And we, as made in
His likeness, are bound by the same natural laws as
God. Moreover, as Mary and me are sharers in a com-
mon humanity, she and me are bound alike, sharers
in the glorious possibilities of Borderland.

The abraded survivals of an ancient religious teach-
ing of marital purity and self-control of so lofty a type
that it has been obscured by the fogs in the lowlands
of modem sensuality. Enlightened by my experiences
as the wife of my unseen angel visitant, I wrote a de-
fence (from a folklore standpoint) of the Danse du Ventre,
which was published in the New York World. This
1 afterwards added to, and issued in a typewritten essay
for private cirulation. As the essay showed that I wrote

from experience; as I was still "Miss" C. . and as

my social standing had hitherto been above suspicion; I
deemed it only prudent to state to my readers that I
had acquired my knowledge from a spirit husband.
This I did on a little slip of paper pinned to the last
page of the essay. The persecutions which in consequence
of this straightforward effort to tell the truth simply and
clearly — I suffered at the hands of those who deny the
possibility of angelic communication, need not be dwelt
on here. Suffice it to say that, while my non-occultist
readers who did not know me personally, pooh-poohed
the idea of a spirit husband, declared that I must surely
speak from an illicit experience, my non-occultist friends,
who knew my habits of life from day to day, cotdd
find no explanation for the essay but that I must have
gone crazy; and two physicians made efforts to have me
incarcerated as insane. One of the latter remarked.
"Had that essay been written by a man, by a physician
or by any other scientist (and the paragraph about the
spirit husband omitted) it would have been alright;
but coming from an unmarried woman, neither a physician
or a scientist, and with that claim of a spirit husband,

Heavenly Bridegrooms 437

there is no explanation possible but (1) illicit experience,
which is denied by all who know her, or (2) insanity."
That is to say, because I had, by means of knowledge
gained through channels of which he was ignorant,
given utterance to what would have passed unquestioned
if coming from a scientist, therefore, I must be insane.
To put it more tersely, a diamond of truth is to be con-
sidered genuine only when discovered by A or B; if
the same diamond be discovered by X, Y, or Z, it is to
be considered paste. My worst offense, however, in
his eyes, seemed to be that, as a woman, I was out of
my province in openly preaching marital reform, however
high the ideals advocated; and, as my sense of duty
did not conform with his conventional prejudices, he felt
justified in seeking to incarcerate me until I should
recant my heresy.

The factors in this case were:

1st. An unmarried woman of known reputation
and integrity.

2nd. An essay written by that woman, dealing with
the marital relation along lines not known to one married
couple in a thousand.

3rd. A claim by the essayist, that she wrote from
an experience gained as the wedded partner of a ghost.

To ignore any one of these factors in arriving at
a theory to explain the other two, is to invalidate that
theory.

Now, there is one creed to which all genuine Free-
thinkers are faithful. It is to seek the truth, wherever
it leads, and whatever the traditional belief upon the
subject under investigation. This being so, I feel that I
may confidently appeal to Freethinkers to consider care-
fully the evidence herewith submitted as to marital
relations on the Borderland.

Last, but not least, I appeal to Spiritualists, The-
osophists and Occultists generally. Psychics and sex,
Laurence Oliphant has shown, are so interwoven that you
cannot take up one wholly separate from the other.
Only an occultist — -and somewhat experienced occultist.

438 Theodore Schroeder

at that — knows anything of the perils which await the
developing psychic on the Borderland. The Middle
Ages are strewn with wrecked lives — mainly those of
iUiterate women, who, beginning by dabbhng with magic
in an empirical fashion, ended by confessing themselves
as witches, devil-haunted in body as well as in mind,
and pledged to sins against nature. Within the sheltered
precincts of the most conservative of all Christian churches
— the Roman Catholic — "Congressus cum daemants."
And among the non-churchly practisers of modem oc-
cultism we too often find a tendency, on the one hand,
not only to justifiable freedom, Vmt also to unjustifiable
looseness of life; or on the other hand, to a rigid asceti-
cism and unnatural suppression of the sex instinct as
impure. All these things point to the necessity for
some teaching as to the fundamental principles of sex
morality on the Borderland — all the more, as spirit
bridegrooms and spirit brides are much more frequent
than is generally supposed. Between the witch who
held diaboHc assignations as a devil's mistress, and the
psychic who has been trained to self-control and reverent
wedlock with an angel, it must surely be admitted, there
is a wide stretch of road. Nevertheless, both are on
the same road, and the downward grade is very slippery.
In so far as I have been able to explore this road, therefore
I think it my duty to map out its perils and its safe-
guards, as help to my fellow occultists. For, no matter
on what obscure by-path a psychic starts, he or she can
never be sure of not coming upon this road unexpectedly,
since it is, as I have said, one of the main thoroughfares
of occultism.

To all three classes, then — to Occultists, Freethinkers
and Christians — I respectfully offer this treatise for
consideration in the hope that each may find in it some-
thing of interest, and, mayhap, of profit.

i

Heavenly Bridegrooms 439

HEAVENLY BRIDEGROOM.

The celestial being, who. whether as God or angel,
becomes the Heavenly Bridegroom of an earthly woman,
is better known to the literature of the Christian Church
than most people who are not theologians are aware.
But he is not peculiar to Christianity. He has been
known and recognized throughout the world in all ages.
The woman to whom he comes, is as a rule, distinguished
for her purity of life. Usually she is a virgin; but where
already married and a mother, she must be recognized
as chaste, or, at least, there must be no stigma of im-
purity upon her reputation. I am not at the present
writing aware of a single exception to this.

Let us, however, first consider the Heavenly Bride-
grooms of Christianity, from the popular orthodox stand-
point.

There are two Heavenly Bridegrooms — the Holy
Spirit and Christ. The first of these, the Holy Spirit,
is, according to the New Testament, the Being through
whose agency she whom the Catholic Church delights
to honor as the Blessed Virgin became incarnate with
Jesus. The second of these, Christ, is the Being honored
alike by Catholics and by Protestants as the Bridegroom
of the Church; by CathoHcs also as the mystic Spouse
of the ecstatic and purified nun, as in the case of Saint
Teresa; and by Protestants as the Bridegroom of the Soul,
in that popular hymn beginning:

"Jesus, Lover of my soul.
Let me to Thy bosom fly!"

I once attended a young women's revival meeting
at Ocean Grove, held under the auspices of an evangelist
who was noted for his success in converting young girls.
When the enthusiasm flagged, and his hearers were slow
in responding to his appeals to "come to Christ" he started
the above hymn, and the ardor of his fair congregation
was at once kindled, girl after girl rising to publicly give
herself to Christ. That which earnest pleading for their
soul's salvation had failed to accomplish, was brought

440 Theodore Schroeder

about by this simple suggestion of the "Lover of the Soul."
In thus stimulating the untrained emotions of the maiden
to aspire to the Divine through the symbolism of earthly
affection, this revivalist not only showed keen insight
into human nature, but he was also instinctively true to
the teachings of the innermost truth of all religion, as
I hope to show further on.

In the Bible an entire book — the Song of Solomon —
is given up to expressing the raptures of the Heavenly
Bridegroom and his Bride. At least, this is the interpre-
tation which the Christian Church universally puts upon
Canticles — the reciprocal joys of Christ, the Bridegroom,
and His Bride, the Church. Various phases of the sensu-
ous relations of husband and wife are there set forth,
in figurative but unmistakable terms of passion — passion
which the Christian world has. unfortunately, long since
forgotten how to utilize as the most important means of
growth toward the Divine.

But there are other Heavenly Bridegrooms besides
Christ and the Holy Spirit referred to in the Bible. In
the sixth chapter of Genesis may be found a curious
text, which reads :

"The sons of God saw the daughters of men, that
they were fair; and they took them wives of all that they
chose."

"The Septuagint originally rendered the words
'Sons of God' by a (angels of God)

and this rendering is found in Philo, de Gigantibus,
Eusebius, Augustine and Ambrose. This view of Genesis
VI. 1-4 was held by most of the early fathers."

(See the Book of Enoch, translated from Professor
Dillman's Ethiopic Text, by R. H. Charles. Oxford, 1895.)
In fact, in the Book of Enoch, these sons of God are
spoken of all through as angels who wedded earthly
women; and it is further stated that these angelic husbands
broke the law, living in depravity with their earthly
wives, and laying the foundation of evils which required
the Deluge to sweep away. Critical scholarship usually
holds these angels to be fallen. But St. Augustine protests

Heavenly Bridegrooms 441

against this very saying: "If I truly believe that God's
angels could never fall so at that time."

Nevertheless we find in the Book of Enoch, XV: 4,
the following:

"Whilst you were still spiritual, holy, in the enjoy-
ment of eternal life, you have defiled yourselves with
women, have begotten (children) with the blood of flesh,
and have lusted after the blood of men, and produced
flesh and blood, as those produce who are mortal and
short-lived."

Here we see that the angels, whatever their after
depravity, were "still holy" when they united themselves
as heavenly bridegrooms with earthly women.

However, from the above, and from other texts in
Enoch, it would appear that the angels are blamed for
having broken the laws of right living so far as to turn the
relations existing between them and their earthly wives
into the grossest sensuality. They, rather than the women,
seem to be credited with the responsibility for evil-doing.
But it is noticeable that Genesis is silent as to the charac-
ter of these angelic bridegrooms, while it lays stress on
the fact that the imaginations of men's hearts were evil
continually, as though this last were the real cause of
the wickedness which required the purification of the
Deluge.

Now, let us remember that the Book of Enoch,
although referred to in Jude, is not canonical. It belongs
to the Hebrew Apocalyptic literature, and was for some-
time lost, save for a few fragments preserved in reference
made by ecclesiastical writers. However valuable to
scholars, it is uncanonical and thus cannot be accepted
by Christians as the Word of God. Genesis, on the
contrary, is accepted by Christians today as the Word
of God; and therefore, the total omission of this sacred
book to bring any charge against these angelic "sons of
God," while the depravity of man is dwelt upon at this
period of the world's history, is not a matter to be
passed over lightly by a Christian.

442 Theodore Schroeder

According to the Christian Scripture, then, it was not
the wickedness of the angels who wedded earthly women,
but the evil imaginations of the human heart that brought
about the punishment of the Deluge. And in this. Genesis
is in strict accord with modem theosophy — the only
philosophy, so far as I know, which professes to know
the Alpha and Omega of occultism. Theosophy lays
stress on the punishment which awaits the black sorcerer —
the earthly being who uses magical powers for selfish
or impure purposes. But Theosophy is not alone in this
teaching. All occultism, by whatever name it is called,
however imperfect in deductions, learns at least to beware
of the occultist who breaks the moral law, or who,
whether wilfully or carelessly, through prejudice or
through crafty desire to advance his own selfish interests,
closes his eyes to the truth. In other words, clear thinking
and correct living are the only passport to trustworthiness
in an occultist.

I have said that all occultism learns this lesson at
last.

It is true that there are many psychical phenomena
which at first sight do not seem to require any special
exercise of morality on the part of the percipient. Such
are the carefully attested phenomena of thought trans-
ference and wraith-seeing (especially of the astral form
as "double" of people at the point of death or undergoing
a sudden shock) which the Society for Psychical Research
have collated from a multitude of sources, in the case of
the double to the number of some three thousand. The
percipients in these instances are probably average sort of
folks, no better and no worse than their fellows. Yet
they see or they hear by means of senses which are still
unrecognized by most people, and which are therefore,
termed occult; and what they perceived is afterwards
proved to be an actual occurrence, often of something
taking place miles away. But it is to be observed that
the reliable cases collated by the Psychical Research
Society are furnished by people who seem to be clear-
headed enough, at least, to form definite mental concep-

Heavenly Bridegrooms 443

tions. That the majority of these cases are perceptions
of occurrences in this earthly life. Where the thing claim-
ed as seen or heard by the percipients no longer belongs
to this world, but to the world beyond the grave, as
in the case of visions or voices of those now deceased,
the phenomena, collated by the Society of Psychical
Research seem not only to be but they also seldom
furnish a veridical capricious (i. e., truth telling) communi-
cation.

In the case of Spiritualist mediums, professional or
amateur, where the phenomena assume some show of
regularity, and are claimed by the medium to come en-
tirely from the world beyond the grave, or through its
aid, one always has to be on one's guard against the
subtle interpolation among otherwise truthful matter of
fantastic or misleading statements made apparently by
the communicating spirits themselves. Occultists in
all ages have invariably assumed such statements to be
the work of "lying spirits." But it is noticeable that the
medium of correct life and clearness of intellectual con-
ception is less troubled by such lying spirits than is the
medium of halting intellect or morals. This of itself
should indicate to the thoughtful student of occult
phenomena that the medium, and not the spirits may be
to blame when lying communications are made.

It is generally assumed that the false or fantastic
remarks so subtly interpolated into communications
which are otherwise truthful and uplifting are due to
evil spirits getting temporary control of the medium.
But this theory presupposes a state of society in the spirit-
world far worse regulated than with us. It is often claimed,
for instance, that throngs of spirits crowd about a power-
ful medium as a crowd of people on earth sometimes
flock about a telegraph operator in times of excitement,
each man selfishly striving to get his message sent off
first. But, even in our imperfect civic life, is such an
occurrence usual? By no means. Is it likely that in a
new life with its added experience, such gross violations
of law and order should be allowed to continue right

444 Theodore Schroeder

Eilong? By no means. Even if Heaven be not as Christ-
ians believe, the abode of God and the angels. Even
supposing that it is merely, as most Spiritualists claim,
an improved edition of this worid; it is but logical to
infer that law and order will obtain there as here, and
even more so, because the tendency of human society
is always in the direction of systematizing its work for
mutual convenience of its members. The idea of a good
spirit may at any moment be temporarily displaced by
an evil one, and that the laws of that clearer thought-
world beyond the grave are powerless to cope with this
annoyance is absurd, and contrary to common sense.
The fault of imperfect communication is just as likely
to be ours as others. Let us see to it that the lines of
telegraphic communication are laid in correctness of
moral living, and clearness of intellectual conception,
(on our side of the abyss of death) before we rashly
assume the fault to be theirs. In other words, if they
are in a world where new laws of matter obtain, as they
must be, if they live at all after the death of the body —
to communicate intelligently with us may not be so easy
for them as we imagine. They may find themselves
confronted at every turn by such difficulties. Therein
will be found also a statement requiring an occult principle
which seems not only to forbid spirits from communicating
accurately with an immoral medium, but which seems to
positively enjoin upon them the utterance of all the foolish,
depraved and even criminal ideas that the medium is
willing to receive, and places us mentally at a standpoint
where all else is out of focus. Thus the slightest pre-
judices on any given subject under discussion between
our celestial visitors and ourselves will render us liable
to distorted conceptions of their ideas. Such is the law
of our own thought-world here on the earthly plane; and
we must remember that they have left our plane and
entered into a far wider thought-world than ours. Hence
the need for rigidly clear thinking on the part of every
would be occultist. And, since, as has been well said:
"All badness is madness," we must not forget to also

Heavenly Bridegrooms 445

reckon a well ordered moral life as among the attributes
of the really clear-headed man or woman. This correct
living ahd clear thinking go hand in hand as vouchers
for accuracy of mediumship between this world and the
world beyond the grave. The philosophy which deals
with the subjective consciousness, as an important factor
in fantastic and misleading psychic phenomena from
spirits, I will be found set forth at length. Sufficient to
say here that in all such cases, however varied the
manifestations, whether of an abnormal sub-consciousness
or of outside intelligences, failure to think clearly as to live
in accordance with the moral requirements of self-control,
duty, aspiration to the highest, unselfishness and genuine
purity, will be found responsible for the disappointing
psychic manifestations on the Borderland.

When, therefore, the Book of Enoch blames the
angelic sons of God, rather than their earthly wives for
the depravity of relations said to exist between them as
spirits and mediums, we may well ask if this be not a
matter on which the writer of the Book of Enoch has
carelessly accepted current legends. May it not be that he,
too, believed all depraved psychical manifestations to
be due to "evil spirits" and that he was totally unaware
of the occult law which brings these things to pass with
a medium who,' ignorantly but persistently, fails in clear
thinking or correct living on the Borderland?

Once more let us note that the Book of Genesis,
which is Canonical, lays stress on the fact that at this
epoch the imaginations of men's hearts were evil con-
tinually.

When the Christian Church appeared on the stage
of history, it found several varying traditions current
about those sons of God who, so many centuries before,
had taken unto themselves wives from among the daught-
ers of men.

One after the other the early Church Fathers wrestled
with these traditions, and strove to fit them into the
Christian theological system. Beginning with Paul, we
find that he asserts in the 1st Chapter of 1st Corinthians,

446 Theodore Schroeder

that a woman ought to be veiled, as a token of her in-
feriority and dependence upon man, and he adds: "For
this cause ought the woman to have a sign of authority
on her head because of the angels?" Irenaeus, in his
work Against Heresies, quoting this text makes it read,
"A woman ought to have a veil upon her head because
of the angels." From TertuUian we learn what this
means. He says in his work Against Marcion (V. 18.):

"The apostle was quite aware that spiritual wicked-
ness (Ephesians, VI, 12.) had been at work in heavenly
places when angels were entrapped into sin by the
daughters of men."

In sundry places TertuUian waxes wroth over this
supposed "entrapping" of angels by earthly women.
In a treatise On the Veiling of Virgins — written for the
purpose of compelling all unmarried women to be veiled
as were the married, one reason being that they were
"Brides of Christ" — he speaks his mind thus:

"So perilous a face, then, ought to be shaded, which
has cast stumbling-stones even so far as heaven; that when
standing in the presence of God, at whose bar it stands
accused of the driving of the angels from their (native)
confines, it may blush before the other angels as well;
and may repress that former evil liberty of its head —
(a liberty) now to be exhibited not even before human
eyes."

On Veiling of Virgins, VII.

The author of the Testaments of the Twelve Patri-
archs is, if anything, more severe. He remarks:

"Hurtful are women, my children; because, since
they have no power or strength over the man, they
act subtilly through outward guise now they may draw
him to themselves; and whom they overcome by strength,
him they overcome by craft ********
By means of their adornment, they deceive first their
minds, and instil the poison by the glance of their eye,
and then they take captive by their doings, for a woman
cannot overcome a man by force ***** niy children
****** command your wives and your daughters

Heavenly Bridegrooms 447

that they adorn not their heads and their faces; because
every woman who acteth deceitfully in these things
hath been reserved to everlasting punishment. For thus
they allured the Watchers before the flood."
Testament of Reuben, 5.

He adds that these angelic Watchers manifested as
apparitions to the women at the times of their union
with their earthly husbands; "and the women, having
in their minds desire towards their apparitions, gave
birth to giants, for the Watchers appeared to them as
reaching even unto heaven."

Here we see an attempt to account for the resulting
progeny of "giants" by such simple and natural means
as Jacob made use of when he desired to produce "ring-
straked, speckled and spotted" goats (Genesis XXX).
No mention is made of marital relations being estab-
lished directly between earthly women and angels. Else-
where the same writer (Testament of Naphthali, 3) he
speaks of these same Watchers as having "changed the
order of their nature, whom also the Lord cursed at the
flood, and for their sakes made desolate the earth."

This follows a reference to Sodom, the writer seeming
to trace a similarity between the two causes of the two
punishments. Justin Martyr, however, makes the offence
of the sinning angels to consist rather in ambition for
power over mankind. He says:

"God ***** committed the care of men and of all
things under heaven to angels whom He appointed over
them. But the angels transgressed this appointment,
and were captivated by love of women, and begat children
who are those that are called demons; and besides, they
afterwards subdued the human race to themselves,
partly by magical writings, and partly by fears and the
punishments they occasioned and partly by teaching
them to offer sacrifices, and incense, and libations, of
which things they stood in need after they were enslaved
by their lustful passions; and among man they sowed
murders, wars, adulteries, intemperate deeds, and all
wickedness."

448 Theodore Schroeder

These things, according to Justin, the poets (unaware
that they were due to sinning angels) ignorantly ascribed
to God (Jupiter), and to those who were called his broth-
ers, Neptune and Pluto, and to the Olympian deities
in general.

Lactantius lays the blame principally upon Satan.
Speaking of the repeated efforts of the serpent ("who
from his deeds received the name of devil, that is, ac-
cuser or informer") to corrupt mankind, he adds:

"But when God saw this. He sent His angels to
instruct the race of men, and to protect them from all
evil. He gave these a command to abstain from earthly
things, lest, being polluted by any wily accuser, while
they tarried among men, allured these also to pleasures,
so that they might defile themselves with women. Then,
being condemned by the sentence of God, and cast forth
on account of their sins, they lost both the name and the
substance of angels. Thus, having become ministers of
the devil, that they might have a solace of their ruin
they betook themselves to the ruining of men, for whose
protecting they had come."

Lactantius Epitome of the Divine Institutes. Chap.
XXVII.

Thus from angels the devil makes them to become
his Satellites and attendants. But they who were bom
from these, because they were neither angels nor men,
but bearing a kind of mixed (middle) nature, were not
admitted into hell as their fathers were not into heaven.
Thus there came to be two kinds of demons, one of heaven,
the other of the earth.

Lactantius, The Divine Institutes, Book II, 15.

(To Be Continued.)

DEMENTIA PRECOX STUDIES.
ADRENALIN: A NEW DIAGNOSTIC TEST FOR
DEMENTIA PRECOX.
By Bayard Holmes, M. D.,
Chicago.

A NYTHING that will assist in an early diagnosis of
•**■ dementia precox is a welcome scientific fact, and
will receive wide appreciation, for the frequency of this
disease seems to be increasing in the records of admissions
to our state institutions. The absolutely unfavorable
prognosis that this diagnosis carries with it leads the
early consultants in any suspected case to institute delay,
hedge an unfavorable diagnosis behind indecision or to
attribute the acts indicative of mental aberration to
youthful waywardness. The pupillary condition which
was noticed by Westphal and more extensively studied
by Bumke is present in about three-fourths of the cases
of the early stages of the disease but it is an anomaly
sometimes seen in perfectly normal minded youths.''
Its presence also in some cases of manic depressive in-
sanity is not only confusing but is an added indication
that we are now including under manic depressive psycho-
sis two quite distinct conditions.

The Westphal-Bumke reaction is not easy to elicit
and when observed once should be confirmed by repeated
demonstrations. The pupils of the dementia precox patient
are almost invariably enlarged but they contract promptly
when a bright light is thrown into them. : This contrac-
tion, however, is not as uniform in the two eyes as it is
in health. If now the eye is exposed by raising the upper
lid and the observer touches the conjunctiva -on the outer
side of the globe with the tip of the index finger, there

(449)

460 Bayard Holmes

is, in the normal individual, a contraction of the pupil
equal to that when a bright light is suddenly thrown
into the same eye, but in the dementia precox patient
there is no pupillary contraction to touch. This reaction
has been much used by a considerable number of psy-
chiatrists, some of whom have made clinical and statistic-
al reports, though the rationale of the reaction still
remains a source of mystery.^

The very positive indications of the Abderhalden
reaction in dementia precox strengthen the pluri-glandular
hypothesis of the condition of these unfortunate victims
of an unknown toxaemia.^ Following Fauser's and Wegen-
er's serologic studies in which, very uniformly, the sex
glands and one or more of the other glands of internal
secretion gave a reaction indicating the presence in the
blood of a definite ferment against these organ albumins,
the Italian psychiatrists have published a series of careful
reports on the histologic morphology of these glands
in health and in mental disease. Gorrieri, (Riv. spr. d.
Fren., 1913, 39, p. 263) made a careful study of all the
organs in the body in a few cases of mental disease of
every sort and kind and Todde, (Riv. spr. d. Fren., 1914,
40, p. 23^-300) studied the testicle alone in 200 men of
whom twenty-five were dead with dementia precox. There
were perfectly obvious morphologic defects in the great
majority of these .glands not to be accounted for by the
immediate cause of death, and this was notably the case,
not only with the testicle but also with the adrenal, the thy-
roid and the parathyroid. The studies of Southard on
twenty-five brains from dementia precox patients also
show obvious physical focal deteriorations in the cerebral
hemispheres.

The blood pressure in dementia precox has long
been known to be low, but this condition has not
aroused much curiosity or research because these
patients are so inactive that little else could be
predicted. However, Willi Schmidt (M. m. W., 1914,
61, p. 360) early last year published his observations
on the inefficiency of the adrenalin to raise the blood

Dementia Precox Studies 45l

pressure in dementia precox. When 0.5 ccm. of the
1-lQOO adrenalin solution (Parke, Davis & Go's.) is in-
jected subcutaneously into manic depressive patients or nor-
mal individuals, the blood pressure rises forty to eighty milli-
meters of mercury; but the same injection rarely raises
the blood pressure in dementia precox patients at all
and sometimes even depresses it.

It is not perfectly clear how this reaction is brought
about, but it certainly bears some relation to the West-
phal symptom. When a solution of adrenalin is placed
in the normal eye it produces no dilation of the pupil.
In the eye of a large proportion of dementia precox
patients, mydriasis appears, however, and is so prompt
and so protracted that its action can not be mistaken,
f Cords) Neither as a pressor nor as a mydriatic does
adrenalin act in a normal manner in patients with this
terrible disease.

In 1849, Thomas Addison connected a destructive
condition of the adrenal gland with a wasting disease
in which a peculiar bronzing of the skin appeared, (Syden-
ham Societies Publications). This far off observation led
to little research until Brown-Sequard in 1856 experimen-
tally destroyed the adrenals and found that the animals
died promptly and that rabbits in particular lived only
about nine hours after both adrenals were removed.*
At the same time Vulpian noticed some color reactions
peculiar to the substance of the adrenal glands ; a rose
red with iodine and a green with ferric chloride.

Not till 1849 was the blood pressure raising or
"pressor" action of the gland extract discovered by
Oliver and Schafer, (Jour, of Phys., 1894, 17, p. i.)
During the following decade the study of this reaction
and its biochemistry proceeded with the greatest rapidity
in every direction, but all efforts to separate the active
principle of the adrenal secretion were unavailing, until
in 1901, (1903) J. Takamine isolated a substance which
he called "adrenalin" to which T. B. Aldrich assigned the
correct empirical formula Cg H13 O3N. In 1904 Dzierz-

452 Bayard Holmes

gowski succeeded in synthesizing a substance having the
same or similar physiologic action and a German patent
for its manufacture was issued.

There are many ways of recognizing adrenalin. The
color reactions are very sensitive and recognize high
dilutions. Borberg has recently reviewed the coloriraetric
quantitative methods. (Skand. Arch, of Phys.. 1912,
27, p. 341-420). While the ferric sesqui chloride, he finds,
recognizes one to a one or even to a three hundred thous-
and dilution ; the persulphate of potassium (or of sodium)
test of Pancrazio, (Gas. d. hosp. e. d. clin., 1909, 30,
p. 1513) and Ewins (Jour, of Phys., 1910, 40, p. 317-326)
detects adrenalin in solution of 1-5,000,000. The method
of Folin, Cannon and Denis (Jour, of Biol. Chem., 1913,
13, p. 477-483) is almost as sensitive, if not quite so, and
has many other advantages. It detects adrenalin in
dilutions of one in 3,000,000, but, unfortunately, it also
reacts equally to uric acid in solutions of one-third that
dilution, namely one in 1,000,000.

Comessati, (D. m. W., 1909, 35, p. 576) and Frankel
and AUers (Biochem. Z.. 1909, 18, p. 40). Zanfrogini
(D. m. W., 1909, 35, p. 1752) and Watermann (Arch,
f. d. g. Physiol., 1909, 128, p. 48-66) have each proposed
tests for adrenalin having some special advantage in the
experience of the authors.

The physiologic action of adrenalin is so prompt,
so intense and so uniform that the most sensitive methods
of recognizing this substance are biologic. Following
the almost coincident discovery of the "pressor" action
of extract of adrenal gland by Oliver and Schafer (1894)
and Szymonowicz (1895) many ingenious and cunning
appHcations of it have been made. Extremely small
quantities of adrenalin, 0.000,3 mg. per kilo, are large
enough doses to inject intravenously in rabbits and bring
about characteristic symptoms. (Cameron, Pro. Roy.
Soc. Edin., 1906, 26, p. 157-171). The reaction is
very sharp and appears in a few seconds, but it is tran-
sient and the blood pressure after a few (at most two to
six) minutes falls sharply and then more slowly and after

I

Dementia Precox Studies 453

a few minutes there is a secondary wave of action raising
the blood pressure very sHghtly and then disappearing
for good. If the blood from such an animal, however,
is now injected intravenously into a second animal,
there is still enough unconsumed or uninactivated adrenalin
to produce the pressor reaction again (Weiss and Harris,
Pflugers Arch., 1904, 103, p. 510-514). The rapid return
to the normal of the blood pressure so characteristic of
the intravenous adrenalin injection is not then due to a
chemical reaction between the blood vessels and the base
that results in the consumption or the destruction of the
adrenalin.

There have been many studies of the "pressor"
action of adrenal extracts under various conditions, some
of which must be noticed later, but the extract of each
of the glands of internal secretion has its own peculiar
action. For example, Burgi and Traczewski, (Biochem. zeit.
1914 66, 417-36) have noticed that with a mixed extract
of these glands a stimulating equilibrium was established
in the circulation and the heart maintained its normal
activity. Each of the several glands of internal secretion
has two portions of more or less antagonistic function
when measured by any single action. Thus Ossokin (Zent.
f. Phys., 1914, 28, p. 59) immunized dogs with extract
of the posterior lobe of the pituitary for a sufficient time,
after which their sera when injected into other animals
produced pronounced and long lasting fall in blood
pressure — when the extract of the anterior lobe was used
the resulting immunized serum produced a less pronounced
and transient pressor action!

In man there is also a rise in blood pressure on the
subcutaneous injection of adrenalin, but it is not so
sharp or so high as we observe after intravenous injection.
When given by the mouth adrenalin is without pressor
action but it does cause the contraction of the blood
vessels of the mucous surfaces with which it comes in
immediate contact. It is on account of this property
that it attained its vogue in rhinology. Large doses of
adrenalin are toxic and lethal, and even repeated small

454 Bayard Holmes

doses intravenously encourage and are said to promote
arterio-sclerosis,* but this presumption needs further
investigation.

The smooth or involuntary muscles are also acted
upon by adrenalin while the striped or voluntary muscles
are unaffected. (Yas Kuno. J. of Phys., 1915, 49, p. 139).
The muscles of the intestinal tract generally (except the
sphincters) are relaxed and under full doses of adrenalin,
automatic peristalsis ceases. In most animals on intra-
venous injection of adrenalin the urinary bladder is re-
laxed but in some animals it is contracted! The uterus
of the rabbit and the pregnant cat contracts, that of the
non-pregnant cat relaxes. The isolated uterus of a preg-
nant cat in a bath of one to 350,000,000 adrenalin
solution exhibits tetanic contraction. (Kehrer, Arch. f.
exp. Path. u. Phar., 1908, 58, p. 36G).

The mydriatic action of adrenalin early noticed by
Vincent and described in detail by Lewandowsky was
utiHzed by the Meltzers (Am. J. of Phys., 1904, 11, p.
449-454) as a means of determining the strength of
adrenalin solutions. They used for this purpose the
isolated eyes of frogs. This test is so delicate that quanti-
ties as small as 0.000,000,002 grm. have been detected.
Thus the smooth muscles of the isolated eye are
paralyzed or relaxed by adrenalin, and also in patients
suffering of dementia precox. Karl Basch has recently
(D. m. W., 1913, 39, p. 1456) shown that adrenaHn
reacts upon the pupil of thyroidectomized dogs much
less rapidly than upon non-thyroidectomized dogs of the
same litter.

The mydriatic action of adrenalin (in experimental
animals at least) is heightened or increased by protracted
preliminary feeding of extract of the thyroid gland with
the idea of immunization. It was also the case even
if the pupillary nervous mechanism had been interrupted.
This may be interpreted to mean that the blood of these
experimental animals contained an antithyroid amboceptor.
When a similar experiment was undertaken by feeding
other laboratory animals with the extract of the anterior

Dementia Precox Studies 455

lobe of the pituitary body it produced, after a protracted
feeding, a condition of extreme myosis; that is, the pupils
of these animals were minutelj' contracted. There re-
sulted at the same time an exaggerated reaction of the
pupils to adrenalin. The feeding of the posterior lobe of
the pituitary had no effect on the laboratory animals.
(Mattirolo Ganin & DeGamma). This is a condition
exactly the antithesis of that observed in dementia precox.

No wholly satisfactory explanation exists of the fact
that the uterus of the cat and urinary bladder of many animals
react paradoxically to adrenalin. In the uterus of the
non-pregnant cat it is presumed that the nature of the
myo-neural junctions determines the response of the
muscle to adrenalin and to a large number of related
amines (Barger & Dale, Jour, of Phys., 1910, 41, p.
19-59) (Elliott, J. of Phys., 1905, 32, p. 401-467 and 1912,
vol. 44, p. 374-409). It is possible that the paradox in
dementia precox depends in its pupillary phenomenon
on the abnormal condition of the myo-neural junctions
brought about by the toxins of the primary disease.

There is some reason to think that the toxins, such
as we assume are responsible for dementia precox, are
capable of changing the character of the myo-neural
junctions. These have been furnished by the experiments
of Dale (J. of Phys., 1906, 34, p. 163-206) who showed
that a preliminary injection of ergotoxin into an animal
in which a large rise of blood pressure should be expected
was followed by a distinct fall in blood pressure when the
"pressor" dose of adrenalin was injected into the vein.
Thus the large rise in blood pressure which adrenalin
causes in the normal animal is replaced by a smaller de-
pressor effect if ergotoxin has been previously administered.

The dementia precox patient seems in a constant
ergotoxin-like intoxication, for the injection of 0.5 ccm.
of a 1-1000 adrenalin hydrochloride solution, which is
adequate to raise the blood pressure of the normal man
and most insane persons 40-80 mm. of mercury, slightly
depresses the blood pressure and at the same time fails
to produce the normal mydriatic pupillary phenomenon.

456 Bayard Holmes

This may not, however, be the correct parallel. Further
research by the intravenous method of adnlinistration
of adrenalin is necessary.

Results of experiments on decerebrated cats and
rabbits show that adrenalin, epinine-HCi and other
amines and alkaloids cause constriction of normal bron-
chioles but that dilation results from these drugs after
curare, ergotoxins, apocodeine, pilocarpidine, muscarine,
and physostigmine. Tracheal musculature is uniformly
relaxed by adrenalin, pilocarpin causes its contraction,
and ergomin is without effect. (GoUa and Symes, J.
of Phar. & Exp. Ther., 1914, 5, p. 87-103.) The sub-
cutaneous and intravenous injection of adrenalin in
sufficient doses was shown by Blum (Deut. Arch. f. k.
Med., 1901, 71, p. 146) to produce glycosuria, and Straub,
(M. m. W., 1909, 56, p. 493) determined the minimum
dose that could be safely given without causing glycosuria.
This he found to be 0.002 mgm. per minute. Double
this rate of injection caused sugar to appear in the urine.
The mechanism of adrenalin glycosuria is not yet clear,
but those qualified to judge believe that the pancreas
is not involved in the process. But, on the other hand,
guanin certainly reduces the glucosuric action of adrenalin
and the presence of guanin in the pancreas is in some
way related to the glycochemic action of this organ.
(Degrez & Dorleans, Compt. rend., 1913, 157, p. 946-947.)

It would be interesting to know just how dementia
precox patients would compare in glycosuric sensitiveness
to adrenalin with the clinical experimental experience
of Blum and Straub. This problem lies ready for solution
before some young, ambitious clinical psychiatric bio-
chemist. It is well recognized that early in the acute
form of dementia precox there is an acetone breath and
acetone in the urine, but glycosuria has never been
mentioned as a common or conspicuous symptom of
this disease.

There are other causes of low blood pressure that
must not be overlooked in this connection. The evidences
of adrenal disturbances and adrenal incompetency in

Dementia Precox Studies 457

dementia precox patients are weighty indeed, but there are
poisonous amines developed in the intestine that are
also depressants of the arterial tension. These poisonous
amines are produced from non-poisonous and useful
proteins and probably the most likely one affecting
dementia precox patients is the beta-iminazolyl-ethylamine
which results from the growth of the Bacillus aminophilus
intestinalis on a nutrient media containing histidin.
This amine is a depressor of arterial tension and a con-
strictor of the smooth muscle fibres of the bronchi. The
liver is the great ehminator of this toxin, but we do not
know in exactly what form the excretion appears in the
urine — probably it appears as indol-acetic acid. This
substance has been found in the urine of one-fifth the
healthy and almost one-half of the dementia precox
patients in custody. (Ross, Arch. Int. Med., 1913, 12,
p. 112.)

The secretion of indol-acetic acid in two cases of
dementia precox was greatly affected by the character
of the diet, so E. L. Ross, (Arch. Int. Med., 1913, 12,
p. 231) concluded that this acid is of endogenous origin,
(v. Much, Q. J. M., 1914, 7, p. 439.)

There is one other aspect of the adrenal function
which arouses speculation and ought to lead to still more
optimistic research in dementia precox. The relation
between hydrocephalus and other diseases of the brain
and the adrenals was first noticed by Wagler (Blumen-
bach's med. Bibliothek., 1788, 3, p. 629) in 1788, and
afterwards by many authors, especially by Lomer (Vir.
Arch., 1883, 98, p. 366). Anencephale are devoid of
adrenal bodies. The destruction of the adrenals brings
on morbid cerebral changes. Southard (Am. J. Insanity,
1914-15, 71, p. 383-403 and 603-671,) has found
hydrocephalic conditions in nineteen out of twenty-five
dementia precox patients lately studied. Almost fifteen
years ago Czerny (Cent. f. alg.. Path. u. path. Anat.,
1899, 10, p. 281-286) related hydrocephalus to the adrenals
by injecting the cerebrospinal lake of animals with finely
divided coloring matter and later finding the adrenal

458 Bayard Holmes

medula stained with the coloring matter and connected
with the cerebrospinal lake by a special series of highly
stained lymph canals. He also found the medulla of
the adrenals in hyprocephalus deficient and sclerotic,
(Levy, J., Thesis, Beriin, 1913.)

Can it be possible that some peripheral infection
so acts upon the pluriglandular system in cases of de-
mentia precox as to destroy, pervert or misdirect the
adrenal and bring about those serious cerebral disturbances
that give color to the disease we know as dementia precox?
An analogy is to be found in Grave's disease, or exophthal-
mic goiter, which is often the result of tonsillar and
faucial infection.

It is not unreasonable to expect some method of
clinically determining the adrenalin content of the blood.
O'Connor (M. m. W., 1911, 58, p. 1439, and Arch,
exp. Path. u. Phar., 1912, 67, p. 195-232) and Stewart
(J. exp. Med., 1912, 15, p. 547-569) agree that up to the
present time this desirable end has not been attained.
There may still be means of determining the adequacy
of the various glands in early and subsequent stages
of dementia precox.

In a few instances decompression operations in cases
believed to be cases of dementia precox have been fol-
lowed by an arrest of the disease.* The fact that the
blood vessels within the viscera, especially within the
brain, are affected by adrenalin in a depressing and paralyz-
ing manner, (Cow., J. of Phys., 1911, 42, p. 125-143)
while other blood vessels are contracted, may bear some
relation to the hydrocephalus and the mental symptoms.
The cranial capacity in dementia precox patients is limited
as compared with the brain weight. The index of Tigges'
and the ratio between the brain weight and the cranial
capacity is increased in dementia precox.

I cannot conclude this incomplete and hasty re\'iew
of the evidence that the adrenal gland is under strong
suspicion of having a leading part in the production of
that symptom complex we call dementia precox, without
referring to the influence of adrenalin on the salivary

I

Dementia Precox Studies 469

secretion. In some stage of nearly every case of de-
mentia precox salivation is a conspicuous symptom.
Now Langely claims (J. of Phys., 1901, 27, p. 237-256)
that the injection of adrenalin increases salivary secretion.

Equally significant to the clinical observer is the
fact that asphyxia increases the secretion of adrenalin.
(Cannon & Hoskins, Am. J. of Phys., 1911, 29, p. 274-279.)
Asphyxia is a very common and long continued symptom
of dementia precox, and it seems, in some cases at least,
to be due to the spasm and tetanic contraction of the
muscles of respiration. Sulphhemoglobinaemia is oc-
casionally seen in the course of catatonia. In spite of
everything the blood pressure in dementia precox is low,
(Cazzamili, Riv. spr. fren., 1913, 39, p. 98) and the
injection of adrenalin will not raise it.

The amount of adrenalin in the adrenals is diminished
in asphyxiation. The diminution in the amount of
adrenalin is often regarded as the cause of death. In
fact the lowering of the adrenal content is a result of
the asphyxiation of the organism. (Czubalski, Zent. f.
Physio., 1914, 27, p. 580.) ,

Conclusions

1. Adrenalin is the only chemically established
organ secretion and furnishes an ideal base for physiologic
study.

2. The action of adrenalin on patients with the
clinical diagnosis dementia precox differs from its action
on healthy persons and resembles its action on animals
poisoned with ergotoxin.

3. The insensibility of dementia precox patients
to the "pressor" action of adrenalin and its abnormal
mydriatic action furnish a helpful means of diagnosis which
promise with the coincident application of the defensive
ferment reaction, both suggestive therapeutic possibilities
and avenues of hopeful research.

1. Bumke, Oswald: Pupillen-storungen bei Geistes-und Nervenkrankheiten.
Jena, 1911, esp. pp. 249-268.

2' The increased intracranial pressure which the dilated pupil might reasonably
portend has been assumed to be the cause of death in two cases of catatonia recently

460 Bayard Holmes

studied by NissI, (his last Beitrage published April 11, 1914.) He found "brain
•welling" or "wet brain." As usual in dementia precox the brain was too heavy for
the cranial capacity in both Nissl's cases. See also in this connection Klebelsberg,
"Ueber plotzliche Todesfalle bei Geisteekranlibeiten." Z. f. d. g. Neur. u. Ps., 1914,
Orig. 25, p. 253 and Leppmann, "Ein Fall von Heilung eincr Psyehose dureh Kopf-
verletiung." Jahrb. d. schles. Gesellsch. f. vaterl. Kult., 1884, 62, p. 187.

3. A complete review of the literature of the application of the Abderhalden
reaction in psychiatry was made by Johann Fischer. D. m. W., 1913, 39, p. 2138
and more recently by Niesjytka, D. m. W., 1914, 40, p. 1519. Z. f. d. g., Neur. n. Ps.
1914, Vol. 26, p. 546-563.

4. The experiments of Brown-Sequard have lately been repeated by Elliot (J»r.
of Phy., 1914, 49, p. 38-53) upon a large scale with twenty-five cats. The second
gland was usually removed from three weeks up to nine months after the first. No
one of the twenty-five cats died of the first operation and only one cat recovered
completely after the removal of the second gland. It was examined and killed nine
weeks after the second operation. Nine of the twenty-five cats died on the second
or third day. The second gland that was removed was obviously hypertrophied.
Sixteen of the cats lived for six or ten days and one of these died on the twenty-
Kcond and one on the twenty-third day and one was'killed in the ninth week. Most
of the eats that lived six days or more had two or three acute ulcers of the stomach,
a token of the full digestive powers of the gastric juice. This seems remarkable
when we remember that ulcer of the stomach is not seen in patients with Addison's
disease, (Finzi, Vir. Arch., 1913, 214, p. 413-432, Biblio.)

Elliot notices that the approach of death was announced by the development of
a characteristic weakness. When placed upon the floor the cat would walk a few
steps and then stand switching its tail, bothered by the difficulty of walking.

Despite this characteristic prostration the animal could be aroused by an alarm
to fully coordinated and fairly strong muscular movements. There was no paralysis
of the skeletal muscles or their nerves. This was very evident when the moribund
cat was placed under a large bell jar and smelt the ether intended for its anesthetic.
The cat moved almost as freely and as quickly as a normal animal would have done
and there was also the usual free salivation. The blood pressure of the dying animal
was very low, ten to fifteen millimeters, and was raised very little by its struggles.
The blood supply of the cerebral hemispheres became scant and a stiffness set in the
fore limbs while the hind limbs commenced an automatic walking rhythm. The intra-
venous injection of a small amount of adrenalin restored the blood pressure with the
full circulation, the rigidity disappeared.

5. Since the use of adrenalin in asthma, this observation has been contradicted
by the clinical experience of many reliable observers, (Van Leersum &. Rasters, Beitrag
zur Kenotnis des experimentellen Adrenalin-Atherons. Z. f. eip. Path., 1914, 16, p. 230.)

SELECTIONS

NEUROPHYSIOLOGY

Pituitary Extract and the Salivary Secretion. —
Although the influence of an extract of the posterior lobe
of the hypophysis upon the circulatory system has been
fairly well established, the effect of this extract upon the
process of secretion is stiU a matter of dispute. Some
observers note that the Secretory changes are to be ac-
counted for by the accompanying vascular effects, while
others maintain that there is a direct action upon the
secreting cells. The problem is one of pro/ound interest
in pharmacology as well as in physiology. An important
step toward its solution is provided by the results of an
investigation conducted by G. 0. Solem and P. H. Lom-
men (American Journal of Physiology, September 1, 1915,)
who studied the effects of the extract of the posterior
lobe of the hypophysis upon the secretion of saliva.

The above investigators find that pituitary extract
causes a diminution in the flow of blood and saliva from
the submaxillary gland. The decrease in the flow of
saliva is greater than the accompanying decrease in the
blood flow. The slowing of blood is less marked if the
injection is made during faradization of the chorda
tympani than during pilocarpine stimulation, while the
slowing of saliva is the same. Pilocarpine is relatively
ineffective even when injected seven or eight minutes
after pituitary extract. While suprarenal extract normally
causes a vasodilatation in the gland (contrary to its action
on the vascular system in general) and an increase in
salivary secretion, the substance, during the action of

(461)

462 Selections

pituitary extract, has the normal effect on the blood
flow, but causes a diminution in salivary flow, probably
owing to the greater quantity of pituitary extract coming
in contact with the gland. When pituitary extract is
injected during the action of chrysotoxin the decrease
in the flow of saliva sets in before the vasoconstriction
in the gland occurs. In five out of seven cases the flow
of saliva slowed while there was active dilatation of the
gland.

From the above results the general conclusion is
drawn that the decrease in flow of saliva following the
injection of pituitary extract is due to an inhibition of
the action of the secretory nerves of the submaxillary
gland, but also in part to the accompanying vasoconstric-
tion caused by direct action on the muscle of the arterioles,
on the vasomotor nerve endings, or on both. The de-
crease in output of blood from the gland may also be
due to the decreased activity of the gland. — Med. Rec.

NEURODIAGNOSIS

The Technique of Psychoanalysis.— S. E. Jelliffe
(Psychoanalytic Review, Post Graduate.)

In a series of continued articles, the author takes up
the practical aspects of the methods of psychoanalysis.
In the opening pages he outlines the meaning of the word,
the object to be accomplished and first takes up the
discussion of the type of cases to be left alone by the
beginner. These are the feeble-minded and imbecile,
the stupid and the lazy, the gossips and trouble makers
and scandal mongers. Hysterical young girls, catatonics,
manic depressives, homosexuals, dementia praecox cases
should be avoided or taken only under certain conditions.

J

Selections 463

CLINICAL PSYCHIATRY

Insanity in Relation to Sex and Age. — The Virginia
Medical Semi-Monthly notes from the report on the insane
in the United States, prepared by Dr. Joseph A. Hill and
issued by Director of the Census, that there is more in-
sanity among men than women, as based upon data re-
ceived from hospitals and asylums for the insane for 1910.
In 1880, the two sexes had nearly an equal representation
in these institutions, but on January 1, 1910, there were
98,695 males, as compared with 80,096 females in institu-
tions for the insane. Nearly 25 per cent of the males
in the hospitals in 1910 were admitted for alcoholic
psychosis or general paralysis, resulting from vice and
dissipation. These causes being eliminated, the disparity
in numbers of admissions between the sexes practically
disappears. While the largest percentage of admissions
is between the ages of 25 and 50 years, in proportion to
the number of people in the same period of life, the number
of admissions is larger in old age than ii;i middle life
and in middle life than in youth.

Dangers to Attendants in Mental Wards. — The
Aug. 7th number of the Hospital notes the following:

A male nurse called upon an inmate to assist in re-
straining a patient in the mental ward, when the patient,
a one-legged man, kicked the inmate, who afterwards
died. He was, however, suffering from chronic Bright's
disease, and the medical evidence showed that the man
died from syncope from that disease, which was probably
accelerated from shock consequent upon the injury.
The case shows that it is most inadvisable for Poor-Law
authorities to be dependent on the inmates, and conse-
quently upon untrained men, in cases of this kind, though
there is always the question of keeping a large staff
in waiting for exceptional emergencies.

464 Selections

NEUROPATHOLOGY

The Blood in Epilepsy. — Rosenthal comes to the
following conclusions :

1st. In about half of the epileptics there is an in-
crease of the anti-proteolytic inhibiting cells in the blood
serum examined with relation to the time of the attacks.

2nd. In the preparoxysmal stage there is usually
an increase of the antiproteolytic strength of the serum,
which diminishes rapidly to the normal after the attack.

3rd. In the interparoxysmal stage the antiproteolytic
control in the blood serum is either normal or only
slightly increased.

4th. A marked increase of the antiproteolytic
strength in epileptic women occurs immediately before
menstruation and is often accompanied by the attacks,
although this condition may occur after the convulsive
seizures.

5th. Premenstrual increase of the antitryptic strength
occurs in normal women, although much less frequently
than in epileptics.

6th. The convulsive seizure as such induces a transi-
tional increase of the antitryptic substances. This in-
crease depends upon the intensity of the muscular dis-
turbances during the attacks, is subject to various changes
in intensity, and quickly disappears.

In genuine epilepsy there is congenital defect in
function of the thyroids and parathyroids, which has
definite effect upon the activity of the digestive organs,
possibly in reducing the amount of the digestive ferments
and the muscular activity of the intestines resulting in
absorption of the waste products. In consequence of this
albumens and fats are incompletely digested and their
side-products are not properly eliminated. It is probable
also that inactivity of the breathing apparatus results in
the accumulation of carbon dioxide in the blood. These
are the different factors leading to improper conditions
of the cerebral cortex, to which must be attributed the
convulsive seizures. The three organs that are especially

J

Selections 465

effective in this cycle of events are the thyroid, the hypo-
physis and the thymus. — Dr. Henry Hun (Neurological
Excerpts in Albany Medical Annals) from Die Erklarung-
den Erscheinungen bei Epilepsie and D. C. Bolton
"Deutsche Zeitschrift fur Nervenheilkunde."

NEUROTOXICOLOGY

Hallucinations After Cocain. — V. E. Henderson,
of Canada, quotes numerous cases of erotic hallucinations
following the use of cocaine as a local anaesthetic, and
warns dental practitioners against its use, unless a third
person be present. A case is quoted in which cocaine
pressure anaesthesia was used to deal with an exposed
tooth-pulp. Later the patient, a girl of 16, made charges
of indecent assault against the dentist. — (Dominion Dent.
Jour.) Med. Times.

NEUROTHERAPY

Health Commissioner Goldwater of New York City
has directed the sanitary bureau to investigate conditions
of artificial light, congestion of workers, questions of
ventilation, air cooling devices and other matters in the
financial district. Office workers in sky-scrapers have
been too much neglected. — Physical Culture Items, Sep-
tember.

Temperance 5500 Years Ago. — A foreign exchange
has this interesting paragraph: There is still in existence
an Egyptian papyrus of the date of 3500 years before
the Christian era, which contains the following caution:

46(J Selections

"My son, do not linger in the wineshop or drink too
much wine. It causeth thee to utter words regarding thy
neighbor which thou remembrest not. Thou fallest upon
the ground, thy limbs become weak as those of a child.
One Cometh to trade with thee and findeth thee so.
Then say they, 'Take away the fellow, for he is drunk.' "
This is believed to be the oldest temperance lecture in
existence. — Christian Herald.

Clinical Results with the Phylacogens. — Under
the above caption, Dr. R. W. Locher, Grafton, W. Va.,
in the Memphis Medical Monthly, has this to say:
"In judging the therapeutic value of a new preparation,
it is advisable that a great number of case reports be
considered; and in order that the medical profession may
have a great number of cases from which to judge, it is
the duty of every physician to report such results as he
may have. The Phylacogens are of comparatively recent
origin, and yet even at this early date they have displayed
their ability to produce satisfactory and in some cases
remarkable results in the treatment of a great variety
of pathological conditions."

Quinine vs. Hydrophobia. — Dr. H. L. Harris of St.
Louis gives the clinical history of seven cases of hydrophobia
together with a case clinically similar with recovery following
a similar case under the administration of quinine sub-
cutaneously in exceedingly large doses as follows:

Treatment and Result — At 5 p. m., August 29, 15
grains of quinin and urea hydrochlorid, dissolved in 3 c.c.
of salt solution, were administered intravenously. This
dose was repeated at 7 p. m., 9 p. m., 11:30 p. m.,
60 grs. in six and one-half hours, and on the next day
at 9:45 a. m., and 11:30 p. m., making a total of 90
grains within twenty hours. Following the second in-
jection at 7 p. m. the patient said all pain in the thigh
and over the area of the bite had disappeared. At 7:30,
August 29, he drank without difficulty 6 ounces of milk
and an equal amount at 11:30 p. m. At 7 a. m., August

Selections 467

30, he drank 6 ounces of milk, 6 ounces of coffee, and ate
two crackers and a slice of bread.

He had, however, spent a very restless night, and on
account of a fine tremor and a nervousness which sug-
gested delirium tremens, he was given at 9:30 a. m.
4 drams of paraldehyd, and an equal amount at 1:30 p. m.
He slept at intervals throughout the day and the follow-
ing night. He had no return of the pains or the difficulty
in swallowing and was discharged September 2, four days
after his admission.

The patient was an itinerant umbrella maker, aged
seventy three. The man was greatly excited. This man
had been bitten five or six times before and made but little
of it, but this time when he entered the laboratory he
was greatly excited and nervous and apprehensive with
hot pains tingling and dysphagic contractions at attempt-
ing to drink water, though he once succeeded in swallow-
ing a sip.

Though Dr. Harris gives in his article the record of
seven quinine cases of rabies, this case may possibly
have been one of lyssophobia which the enormous quantity
of quinine given in so short a space of time (the amount
being greatly sedative and taking complete possession
of the brain), may have suspended and dissipated the
psychic hydrophobia.

The record, however, is therapeutically of great im-
portance and should be borne in mind and repeated in
other cases.

CLINICAL NEUROLOGY

Adolescent Insanity and National Health. — C.
W. Burr, in discussing the prevention of adolescent in-
sanity, states that one must stop the present tendency to-
ward the easy life if one wished to develop a strong

468 Selections

race and bring down the insanity rate. Moral and
mental health are closely related, and the newest philoso-
o£ life does not make for mental health. There is too
much education and not enough training. There are too
many people who read and there is too little that is worth
reading. One hears too much of the rights of people, too
little of their duties. Untold millions are spent in money
and effort in trying to remove the stresses and strains of
life, and relatively little in training youths to withstand
stress and strain. Fortunately there are a good many
cave men left, men who do not philosophize and are not
learned and who of course are far from being sweetly good
and super-refined, but who are firm fibred, with healthy
natural instincts and mate with their kind, and train their
offspring to have contempt for weakness, belief in self-
dependence, respect for law, a desire for true righteousness
and love for strength and health. These cave men will
by their descendants regenerate the race. — New York
Med. Jour, and Med. Rec.

Internal Secretions and the Psychoses. — T. B.
Hyslops emphasizes the importance of the internal secre-
tions in their causal, coincidental and sequential relation-
ship to mental disorders. He discusses particularly the
thyroid, the parathyroids, the epithelial layer of the
suprarenals, and the glandular portion of the hypophysis
cerebri. There seems to be a definite interrelationship
between the various internal secretions and clinical
evidence seems to indicate that the periodicity in re-
curring and alternating psychoses may be due to rythmical
variations in the production and elimination of the various
secretions. — E. M. Hammes' Gleanings of Progress for
St. Paul Med. and Surg. Jour.

Dyspnea in Relation to Blood Reaction. — In
1913 Lewis, Ruffel, Wolf, Colton, and Bascroft described
a peculiar symptom complex associated with reduced
alkalinity of the blood occurring in elderly subjects.
This symptom complex comprises continuous dyspnea.

Selections 469

often intensified for short periods, especially at night;
good or fair blood aeration as judged by the absence of
cyanosis; Cheyne-Stokes breathing, with or without full
apneic periods; an increase of pulse rate (80-100 per minute)
and a subnormal temperature. This syndrome may be
associated with uremic or cardiac manifestations, but
the association is not a necessary one.

In a series of further observations upon this subject,
Thomas Lewis and Joseph Barcroft (Quarterly Journal of
Medicine, January, 1915) note that only in rare instances
can the above symptom complex be recognized, owing to
the accompanying conditions — cardiac, renal, or respiratory
— to which the dyspnea is usually attributed. In the
later series of cases the authors have studied the blood
"acidosis," i. e. the excess of acid, exclusive of COg, in
the blood as compared with the bases present, this acidity
being determined by the percentage of saturation of the
blood with oxygen when exposed at 37 deg. C. to 17 mm.
pressure of that gas. The percentage of saturation of
normal blood when exposed to the pressure is 75 to 80.
In proportion as the quantity of acids relative to bases
is excessive, the percentage saturation drops.

A New Theory of Autoserotherapy. — The state-
ment is often made that in certain cases of infectious
disease antibodies are not produced, or not produced in
sufficient quantities. In such way we explain the failure
of the pneumonia crisis, the development of relapses, etc.
Yet we have no proof that antibodies do not form in these
cases. It is probable that they are always present and
that for some unknown reason they are inert, or rather
latent, and require activation by some unknown substance.
Views similar to the preceding were expressed by Koenigs-
feld at a meeting last winter of the Freiburg Medical
Society (Deutsche medezinische Wochenschrift, June 17.)
It occurred to him that if serum containing such latent
antibodies could be taken from the patient's blood and
then reinjected it might become activated and would then
prove an ideal serum. He tested the idea on some

470 Selections

typhoid cases — 26 in number, Into each patient he in-
jected daily from 2.5 to 4 c.c. of the patient's own serum.
The improvement, while transitory, was startling. The
fever fell, the diazo reaction became negative, the mind
became clear, diarrhoea ceased, and appetite appeared.
The average duration of the disease was from 18 to 22
days. In discussion Ziegler bore witness to the astonish-
ing change caused by the injections, which appeared to
prevent the development of complications. Berke had
tested the principle in relatively benign cases of tetanus
and noted the same specific influence. Of great value
is the fact, if fact it is, that the patients carry a specific
remedy with them. — Med. Rec, Sept. 4, 1915.

THE

ALIENIST AND NEUROLOGIST

Vol. XXXVI. St. Louis, November, 1915. No. 4.

Subscription $6.00 per Annmn in Advance $1.26 Single Copy

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I

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come from friend or enemy or "mouths of wisest censure."

NOTICE TO NEWS AGENTS

This magazine must not be expected to print whole pages of commercially devised,
fulsomely laudatory puffing of proprietary advertisements, prepared by non-medical
commercial agencies who know nothing of the facts of therapeutics nor of the medical
code of ethics. Some of the puffs are bo far from the truth that they are an insult
to medical intelligence and do more harm than good to worthy proprietaries.

Such proprietaries as we carry speak for themselves with physicians, especially
when their composition appears. Our readers are discriminating judges of what
they want.

CONCEBNINQ RENEWALS OF SUBSCRIPTIONS

This magazine would be much indebted to its regular subaciibers and advertisers
if they would renew by direct communication with this office, especially in the United
States, and not through news agents.

CHAS. H. HUGHES, M. D., Editor and Publisher.

H. L. HUGHES, Manager.

Editorial and Business Offices, 3858 West Pine Boul.

EDITORIAL

A Deliberate Murder for Fifty Cents refused
on request, was confessed in court by a negro domestic
male employee lately. The confession was made without
police compulsion, no thirty-third degree torture process
being employed to bring out the confession. The negro
stated that he asked for the half dollar the second time
after a short spree and, being refused again, shot the lady.
And this conduct and confession did not suggest the

(471)

472 Editorial

probability of insanity, but brought a prompt judicial
first-degree murder sentence to be executed in sixteen
days.

This recalls the case of an ex-confederate veteran
who, in a public place before numerous witnesses, shot and
killed a friend for declining to change a five dollar bill.
This trivial circumstance, with so tragic an ending, excited
the suspicion of insanity and closer inquiry elicited the
fact of insanity and that the poor fellow had a chronic
suppurating gun shot wound and that he had been confined to
his bed with septic fever before the advent of which he
had acted in many strange ways, one of which was leaving
the field where plowing was being done, running to the
house with the startled cry "the Federals are coming,"
although the civil war had been ended several years before.
A complete psychological inquiry and physical examination
established his mental disease to the satisfaction of judge
and jury.

Disproportionate violence without approximately ade-
quate cause like these trivial circumstances in individuals
of natural evenness of mind prima facie suggest deeper
inquiry as to the existence of disease impairing the mind.

While the so-called insanity dodge has kept sane
culprits from the gallows, latent insanity is in the brains
of many not suspected till a crime disproportionate
to its cause reveals the startling psychopathic brain storm.

The Death of Doctor Carlos J. Finlay of
Havana, Cuba, at the age of eighty years bereaves the
medical profession of one of its great observing benefac-
tors. The world will cherish his memory as the original
discoverer of the mosquito cause of yellow fever propaga-
tion. He first placed this insect under suspicion. The
stegomia faciata was corralled as the murderous culprit
of "yellow jack" and through the co-operation of
medical colleges following his leadership the plague of the
southlands was stayed. Healthy Havana, once a septic
death bed for Northern blood, and Panama with Gorgas'
aid now attest his scientific immortality. Though a native

Editorial 473

Cuban of Scotch descent, he was American educated in
medicine. Throughout the land his immortal name,
with that of Lazear, Gorgas and others is "writ high on
the rounds of Fame's triumphal arch."

The great and appreciative medical profession every-
where now honors his worthy memory.

Ignorance in the Harrison Law. — Congress in its
ignorance has enacted that apomorphin is narcotic and
habit-forming; it must be so recorded under penalty of
fine or imprisonment of the prescriber, although apomor-
phin will still continue to cause vomiting when administer-
ed in proper dose in defiance of congress and all others
in authority. Presumably the Harrison law could only
be brought into harmony with science by catching all the
congressmen who voted for the bill and administering to
them one tenth of one grain of apomorphin hydrochloride
hypodermatically with the hope that they might be
impressed with the fact that an emetic is not a habit-
forming drug. A lie cannot be made truth by act of
Congress.

Dr. Reynold Webb Wilcox thus arraigns this anti-
narcotic law. This Magazine has noted this fact before
in its reference to this law and the improper inclusion of
apomorphia.

Insanoids and Criminal Imbeciles at Large are
perilous and the peril is growing. Legal parole, with a
view to the reform of the most of these unfortunate
defectives is like trying to rub out a hole burned in cloth.
The hole needs a patch of good material from a new birth
loom. Eugenists take notice.

Between the Eugenists and the Anti-Race
SuiciDERS the law should strike a happy physiological
medium, promoting the birth and multiplying the same of
sound in mind and body and preventing the mind vir-
tually unfit, the diseased and degenerate through revoca-
tion of their liberty to Hmit the unfit for the salvation
of the human race from decadence.

474 Editorial

Nurturing foods through congenital inebriety, idiocy,
insanity and other disease fostered by insanity and legal
inhibition of woman's right to limit degenerate offspring will
ultimately make the nation weak.

A Better Measure if Psychoneurone Stability
among the crowned heads of Europe (not excepting the
heads of the Pope and John Bull) might have saved the
world the awful calamity of war throughout the most of
Europe and indirectly the civilized world (God save the
mark.)

Why could not little Servia, big Austria, the Czar
of all the Russians, the "omnipotent" Pope and the balance
of the autocratic Power Gods have averted this calamity?

Sanitation on the East Side Struck a Serious
Obstacle when a dairyman, Karo Stumoff, was found
washing his hands in a pail of fresh milk. He received
from the American Magistrate a short lecture and too
small a fine and it does not appear that the pail of milk
was emptied on the ground after his dirty ablution.
This is a peculiar sample of some of the embarrassments
from ignorant and filthy sources suffered by our sanitary
ofiBcers in their efforts to save the people from micropathic
dissemination.

It does not appear that this is the first time this dirty
thing may have happened. Nor does it appear what
disease may have been traced to this dirty disease spread-
ing habit.

Dr. T. D. Crothers' of Hartford, Conn., appoint-
ment by the Carnegie Eugenic Commission, Chairman of a
Commission for the Study of Alcohol was a good one.
Dr. Crothers' long interest and devotion to the study of
alcohol in its effects on the human system justifies the
wisdom of his selection for this important position.

We shall be glad to have for our pages some of the
research results of this important work.

J

Editorial 475

A Criminal Insane Hospital for Missouri. — The
Governor of Missouri wisely advises this provision for
Missouri's criminal insane, and some day this common-
wealth will be in line with the enlightenment and humani-
ty of the age in this important matter. Many of the
criminal insane have latent propensities that justify their
segregation both from non-insane criminals and from
non-criminal insane. Pennsylvania is the latest State to
provide practically a scientific psychology for the psycho-
pathic insane.

Correctness of Onomatology is even more an
index of character in science than in daily speech.

In medical onomatology, as in ordinary speech,
wanton incorrectness is an offence against both truth
and good manners.

The uncultured mind revels in uncouth expressions.
Incorrect medical onomatology is on a par with slang in
ordinary speech; the use of either betrays ignorance or a
mind devoid of fine feeling. A. Rose.

The Trouble in Europe seems to be coercive
religion and territorial aggrandizement which might be
remedied by a confederated agreement and inviolable
mutually governing constitution among the crowned
heads, enjoining non-intervention in these vital matters;
a sort of Stephen A. Douglas sort of non-intervention
squatter sovereignty, as it were, for Europe and a little
more of the spirit of fair play and level headedness.
But will they ever come to it or will they continue to
fight until they are all bankrupt, only to go at it again
after recuperation? If it ever comes to Europe again!

The Alienist and Neurologist is as good as a book
on Psychiatry and Neurology written by the world's
best authors, at only five dollars a volume and out in
advance of the books' delayed publication.

476 Editorial

The Chicago Medical Society conducted another
epoch-making annual meeting of Alienists and Neurologists
of the United States for the purpose of discussing Mental
Diseases in their various phases, July 12th to 16th, 1915.

This was the fourth meeting of the kind. The pro-
gram was extensive. Much interest was displayed and
great good will come of it to the general profession.

The Noisy, Rasping, Bouncing, Iron Wheeled
Street Car, running on disjointed, uneven, unlevel
tracks, often with flat wheels on screeching rails with
shaking underwork and chains, have made insomnia a
popular ailment, sent city sleepers, who could afford it,
out of town or acrossthe river to sleep, besides depopulating
and depreciating many of the best down-town residences
along the rail lines. And because of all this cruel un-
concern for the public, the jitney has come to stay with
us. Besides all this as a contributory strain on the en-
durance of the brains of city people is the megaphone
strident and falsetto voices of the newsboys crying out,
in discordant unison, their papers, which everybody can
see they have and the head lines thereof. We beat
London, for there the newsboys are only allowed to show
their papers and the head lines are large enough, as here,
for any but the blind and the latter can guess without
all the needless deafening ear-splitting racket such as
our newsies indulge in.

Birth Control for Cause, especially for lawful
medical reasons, should be in effect where parental syphilis,
insanity, alcoholism and other race degenerating influences
affect the offspring.

The present laws interdicting conception without
qualification are indirectly promotive of race suicide through
entailed degeneracy in too many instances.

Apropos of the Student's Time Limit for medical
education we have the Post Graduate Medical Schools.
These valuable finishing and perfecting institutions of

Editorial 477

instruction were wisely conceived by our wise and philan-
thropicly impulsed forebears in medicine, with exalted
and utilitarian conceptions of the needs of the more
hastily made, than now, physicians of more limited time
and means than the present day average medical aspirant
is supposed to have at his command. But these worthy
aspirants to become regular, reputable, ethical physicians
are yet with us in sparsely settled, financially limited
communities which yet need good doctors.

Though Ehrlich Has Gone from Us his memory
abides in the repute of Salvarsan, his side chain discovery
and other contributions from the laboratory to clinical
medicine. He died August 20th at Bad Homburg, aged
61 years.

We miss him as we do our own Austin Flint, who
was a clinician of the highest rank in general medicine
and psychiatry.

Flint's physiology is a memorial of his indefatigable
research. Austin Flint was a worthy son of a noble sire
in medical esteem. He was to America what Ehrlich
was to Germany in professional regard.

Hemadenology is the name of Doctor Sajous' new
clinic specialty connected with the Philadelphia Charity
Hospital. It will include investigation of the relation
of the internal secretions to disease in general and special.

The Massachusetts Society for Mental Hygiene
has opened an office at Room 313, Ford Building, 15 Ash-
burton Place, Boston. The officers of the Society are:
the Honorable Harvey H. Baker, Boston, President;
Doctor Walter E. Fernald, Waverly, Vice-President;
Doctor Charles E. Thompson, Gardner, Secretary; John
Koren, Esquire, Boston, Treasurer; Executive Committee:
Miss Edith M. Burleigh, Boston; Doctor James J. Putnam,
Boston; Doctor Alfred E. P. Rockwell, Worcester; Doctor
Henry R. Stedman, Brookline; Professor Robert M.
Yerkes, Cambridge. Doctor Frankwood E. Williams,

478 Editorial

formerly Resident Physician at the Psychopathic Hospital,
Ann Harbor, Michigan, and first Assistant Physician at
the Psychopathic Hospital, Boston, has been appointed
Executive Secretary.

Photaugiophobia is proposed by Ernest Clarke
(Medical Press and Circular, Aug. 4, 1915) to connote a
shrinking from the glare of light in contradistinction from
photophobia, which signifies literally a shrinking from
light.— (Ed. Med. Rec, N. Y., 10/2/15.)

The Unstably Brained Hazing Ruffian is likely
to get a salutary and merited check in the Colleges,
since the late Indiana tank episode and violent death of
a hazed student and the consequent abolishing of hazing.
The hazing idiot ruffian should be excluded from all
colleges or put in annex lunatic asylum schools for the
idiotic and abnormal minded, with adequate rational
police discipline.

Reputable colleges should aim to train only the stable
minded in right acquisition and level headedness.

What are hazing ruffians fit for outside of institutions
for Golden Rule rational restraint?

The Army and Navy should do away with the
cruel uncivilized business. Brutal hazing minded cadets
are material for martinet officers.

Referring to Psychiatry in Medical Practice
T. D. C. in the Medical Herald says:

"Outside of all theories, speculations and dreams,
there is a great land of practice awaiting the capable
physician; the physician above the average man of today,
with a larger, clearer insight, is the one who is wanted
and will be welcomed and employed constantly, whether
he is in a small village or in a crowded city."

The Alienist and Neurologist, founded in 1880 and
continuously published since that date, was established
and is continued for the very purpose of fostering this

Editorial. 479

line of observation and treatment in general as well as
special practice and it has lived to see the great awaken-
ing in this direction, as shown in the Chicago Medical
Societies and other psychiatrical auxilliary organizations.
This aspect of medicine has been taught by the editor
of this Magazine in his college lectures on psychiatry
and neurology during all the forty years of his lectureship,
even during the brief civil war period, when by invitation
he lectured a few lectures on military surgery in the
St. Louis Medical, by request of Dr. John T. Hodgen.

Diagnosis vs. Autopsy. — Frederick S. Lee Dalton,
P.H.D., Professor of Physiology, Columbia University,
in the December, 1914, Jour, of the A. M. A., on the
Relation of the Medical Sciences to Clinical Medicine
incidentally includes Dr. Richard Cabot's following table
of comparative percentages between what he terms mis-
taken diagnosis found by him of three thousand patients,
who have died in the Mass. Gen'l. Hospital of pathologi-
cal conditions actually found at necropsy and the diagnosis
made during life from the clinical findings. He found
the percentages of what he terms mistaken diagnosis
to be as in the following table:

PERCENTAGE OF MISTAKEN DIAGNOSIS FOUND BY CABOT

Acute nephritis 84 Phthisis, active 41

Acute pericarditis 80 Aortic stenosis.. 39

Hepatic abscess 80 Septic meningitis 36

Chronic myocarditis 78 Brain hemorrhage 33

Vertebral tuberculosis 77 Mitral stenosis 31

Bronchopneumonia 67 Gastric cancer 28

Renal tuberculosis 66.7 Tuberculous meningitis 28

Suppurative nephritis 65 Cerebral tumor 27.2

Peptic ulcer 64 Chronic glomerulonephritis ..26

Acute endocarditis 61 Lobar pneumonia 26

Hepatic cirrhosis 61 Cancer of colon 26

Thoracic aneurysm 60 Aortic regurgitation 16

Chronic interstitial nephritis 50 Typhoid fever 8

Miliary tuberculosis 48 Diabetes mellitus 5

Yet such a comparison of autopsies with previous
clinical findings represents in many cases rather results
or subsequent sequences due in many cases to progressive
disease or intercurrent sequences due to intercurrent
circumstances and environing influences such, for instance,

480 Edilorial.

as a septic hepatic abscess diffusing its toxaemia to men-
inges or heart or other organ reached and infected through
the poisoned blood or even the possibility of an empoison-
ed suppurative nephritis or an abdominal or other peri-
tonitis.

A patient may be put to bed with cerebral conges-
tion which may terminate in arterial rupture and brain
or other hemorrhage, likewise a pulmonary congestion
in the beginning, of the lungs or throat or other organ
may ultimate in tubercular infection and be carried to
the autopsy table.

The inceptions and endings of disease are often dis-
similar and different so that the conclusions are different
at an autopsy finding from the initial diagnosis; that
the latter was a clinical error in diagnosis is not always
to the disparagement of the clinical diagnostic skill nor
just. Post mortem findings at autopsy are results of a
morbid process or of morbid processes which may begin
in one viscus or system of the organism and end fatally
in another. Reasoning a priori from the dead house to
the original disease and the doctor is liable to prove
fallacious. Post hoc ergo prompter hoc can not always
be logically applied. We can not always tell from examin-
ing the debris of a burned out building exactly where
the fire started or who has been the incendiary or how
many may have started the fire. We may only reason
approximately. Microbic and bacterial invasion and the
everywhere traveling blood, the omnipresent and interrela-
ted nervous system and the ductless glands closely and
integrally related also are to be reckoned with in estimating
incipient and continuing disease and their post mortem
ending. Besides though, to seek to put blame to oex-
clusively on a viscus or a few viscera and to confine it
there whereas it is the entire system at fault. We are

Editorial 481

often too prone to confine our observation to a spot
within sight or touch and go no farther in our post mor-
tem conclusions from what we may find and we sometimes
conclude erroneously that the single result if apparently
grave to have been the sole cause ab initio. But we are
learning. Sajous and Ott and others have added some
additional hght to our powers of diagnostic vision to
discern the once unseen, especially in ante-autopsic
neuropathology .

MEMORIAL

A Memorial Monument to Dr. Lazear who gave
his all, even his life, to the proof that the mosquito propa-
gated yellow fever, and thereby made Cuba and latterly
the Canal Zone habitable to the white man, was suggested
in Dr. W. W. Campbell's recent presidential address at
San Francisco, and so say we all of us.

CORRESPONDENCE

The Maximum Mental Power Age of Man,
Sub-Judicae Scientia. We are disposed to doubt Professor
A. Lawrence's recent statement in his late baccalaureate
address to the seniors of Harvard.

The president of this great college is reported to
have said: "Man reaches his full growth physically
at about 18 or 19, and then begins to lose his keener
perceptions at about the age of 23, the physical maximum.
The mental maximum is reached a great deal earlier
than most people suppose; Coleridge wrote his best poems
when 29 years old and many other famous men have
accomplished their best work at about his age."

And many other famous men have records of great
achievements — Edison, Marconi, Osier, the Wrights and
others are yet doing great things as did Goethe, Bunyan
and Milton, Alexander Graham Bell and too many others
to mention.

Observer.

(482)

REVIEWS, BOOK NOTICES, REPRINTS, ETC.

Falta's Ductless Glandular Diseases. — By Wil-
helm Falta, Vienna. Translated and edited by Milton K.
Meyers, M. D., Neurologist to the Lebanon Hospital
and to the dispensaries of the Jewish and St. Agnes
Hospitals, Philadelphia. With a Foreword by Archibald
E. Garrod, M.D. (Oxon) F. R. C. P., (London) F. R. S.

"The influences of the glands of internal secretion
in which category are included other organs besides
the glands which are classed as ductless, hold a very
prominent place in medical thought and investigation,
as witness the many discussions which took place in
various sections of the 17th International Medical Con-
gress, London, 1913, and in many informal gatherings of
its members from all parts of the civilized world. There is
indeed no department of physiology in which more has
been learned from the experiments which nature herself
has carried out." — From the Foreword.

With 101 illustrations. Octavo. About 700 pages.
Now ready. P. Blakiston's Son & Co., Publishers, 1012
Walnut Street, Philadelphia. Price seven dollars net,
and a bargain.

The numerous illustrations present a complete clinical
picture of the author's subject and his theme relating
thereto are fully presented with the illuminating plates.

The text, in fact, supplements from an intellectual
source, as though a lecturer were giving a post graduate
course at the bedside and clinic.

The book is thoroughly up-to-date both in text and
the extensive literature given. In fact the author is
lucidly advanced in his descriptions. The chapter on
diabetes and its complications is exceptionally enlighten-
ing.

The elimination of Ketone bodies, salt, metabolism,
anabolism, catabolism, mongolism, giantism, diseases of

(483)

484 Reviews, Book Notices, Reprints, Etc.

the sexual glands, eunuchoidism, diseases of the thymus
glands of the parathyroids, the suprarenals and the hypo-
physis and the pluriglandular diseases are shown in clear
and somewhat novel light, as well as the insular appara-
tus of the pancreas.

This book should be in every modern medical library.
Though edited by a Falta we find no fault in this valuable
book.

Solution and Remede — Par Dr. J. A. Riviere,
President de I'Association Medicale Internationale contra
la guerre. Annales de Physicotherapie.

As an honorary member of this distinguished Associa-
yion (an honor we fully appreciate) the force of the plea
and all efforts for peace, between the nations of Europe
and all the nations of the earth, appeal to us as philan-
thropist and physician.

The approbation of the Prince of Peace — His Father-
hood and the Brotherhood of man should be sought in
our day and generation of advancing civilization!

The Divine voice — "Peace on earth and good will
towards men," is drowned, just now, in Europe, in the
tumult and noisy carnage of war, unexampled in the history
of human conflict, where the overhead heavens and
the under sea turn with violence and the pestilence of
man poisoned air, have added unprecedented horrors of
international murder on battallioned fields of carnage,
such as former records of inhuman murderous strife never
before witnessed. Humanity and civilization are marching
backward to reciprocal extinction and decadence, in
blood and destruction.

But, Dr. Riviere! the still small voice of conscience
will yet be heard above the din of battle and crippled,
exhausted contestants such as may be spared from the
bloody conflict, will listen to and act upon your plea.

The escaped remnant of death will feebly hear after
a time and approve and attempt an exhausted reparation
of the devastation wrought.

Reviews, Book Notices, Reprints, Etc. 485

Humanity may yet have hopes that all the blood
crowned of Europe cannot postpone forever.

The Onset of General Paralysis, by Charles
Ricksher, M. D., Pathologist, State Psychopathic Institu-
tion, Kankakee, 111. The author, from his standpoint
of extensive clinical observation, is entitled to credence.

He says: (from Johns Hopkins Hospital Bxilletin, No.
291, May, 1915.)

"The dire results which often follow its non-recogni-
tion warrant a more extended study of the early symp-
toms than has heretofore been given to them. The
finding of the treponema pallidum in the brain, and the
almost universal finding of positive Wassermann reactions
in the blood serum prove conclusively that it is one form
of syphilis which, if discovered before gross organic
changes in the nerve cells and fibres have occurred,
may react to ifi^tment."

He cites :

"Two cases to show that paresis may occur with-
out the ordinary physical signs which are emphasized
in the text books" and concludes that "we do not, un-
fortunately, have any definite single mental picture which
is pathognomonic, and consequently must rely to a great
extent, in our doubtful cases at least, upon the laboratory
findings. The lumbar puncture is now recognized as a
means of clearing up some doubtful diagnoses and there
is no reason why it should not be employed in every case
where there is a question. In atypical cases, especially
those with a history of a luetic infection, it should be
obligatory. There is no questioning the fact that in the
early recognition of paresis is our only hope of curing
it, if there is any cure to be made."

Syphilographers and alienists should be especially
interested in this well written paper.

L'Enfance Anormale. — Revue Mensuelle des Ques-
tions de Medecine, de Pedagogic et d'Assistance Rela-
tives aux Enfants Anormaux. Publiee par Le Dr. Ar-

486 Reviews, Book Notices, Reprints, Etc.

mantaire Courjon, Ex-Interne des Hopitaux, de Lyon;
et Louis Grandvilliers, Ex-Prof esseur a 1' Institution
Nationale des Sourds-Muets de Paris, et a I'Asile-Ecole
de Bicetre. (With the collaboration of a long list of the
most eminent medical men of the nation.)

This interesting review of medical and pedagogic
subjects, also designed for the better understanding and
study of abnormal children, came to us shortly before
the present European war with the handsome portrait
of that corypheus of French medicine (69 years, 1840-
1909) Medicin de Bicetre. Bourneville's pioneer

interest and work in these subjects make a gift to the
profession of great interest and value. - Also the same may
be said of Marie's contribution to these subjects as well as
the collaborators of this estimable magazine.

And here we are reminded of the forceful contribu-
tions to the Eugenics of our Am.erican Children by the
work of Robinson Lydston, Havelock Ellis and others,
the latter in Physical Culture Magazine. The latter
also has a fine feature cut of our intellectual and eminent
friend, Havelock Ellis.

The First Volume, Number I of the New Journal
of Laboratory and Clinical Medicine reaches us too
late for the extended review we should be pleased to give
it.

Its editor-in-chief, Victor C. Vaughn, which is prima
facie commendation of its merits and the associated
staff are certainly no detraction therefrom. Its contents
are all of valuable interest to the practicing and philo-
sophic physician who considers his patient in all scientific
relations, especially in all chemico-biologic aspects.

A new method of anaesthesia by Jackson, laboratory
and clinical examinations by Dock, Precancerous Skin
by Engman, all of St. Louis, Specific Treatment of
Typhoid by Gray of California, Staining Sections of Living
Tissue, by Wilson of Minnesota, Intestinal Stasis and In-
toxications by Wooley of Ohio, Probable Toxic Effects of

Reviews, Book Notices, Reprints, Etc. 487

Parathyroid (prolonged use) by Morris of Ohio, Labora-
tory methods and important editorials by the associated
editors make up the contents.

No physician in active practice could well do without
this new magazine. We hope it may live long and prosper.
Price $3.00 per annum. The C. V. Mosby Company,
St. Louis, are the publishers.

We Take Pleasure in calling attention, to commend,
Jelliffe and White's "Diseases of the Nervous System;
a text book of Neurology and Psychiatry," and to ask for it
careful attention. In this text book the authors have de-
scribed the diseases of the nervous system in the order of
their evolutionary development, beginning with those
biophysical and biochemical syndromes which are indic-
ative of disturbances at the phylogenetically lowest,
the vegetative level of the nervous system.

This excellent book is distinctive and up-to-date,
presenting a connected view of the subjects treated in the
light of modem understanding of the internal secretions
of biological and biochemical, as well as clinical. The
evolutions of the biological laboratory are brought to
the bed side. The venereal, arterio-sclerotic and toxic
syndromes and relations are well elaborated and withal
this treatise is eminently practical, as its distinguished
authors are being engaged in daily practical clinical work
in the domains of Neurdlogy and Psychiatry. Phila.
Lea & Febiger, 706-710 Sansom Street, are the well-
known publishers.

The Criminal Imbecile (Illustrated) — An analysis
of three remarkable murder cases, Henry Herbert Goddard,
author. Author of "Feeble-mindedness," "The Kallikak
Family." The MacMillan Co., Publishers, New York,
London, Chicago.

Dr. Goddard, whose study of feeble-mindedness
has disclosed some astounding facts — as is shown in his
books, "The Kallikak Family" and "Feeble-mindedness,
Its Causes and Consequences" — here analyzes three

488 Reviews, Book Notices, Reprints, Etc

murder cases in which the Binet tests were used, accepted
in court and the accused adjudged imbeciles. Three
types of defectives are illustrated in the three cases.
To every thinking citizen this book appeals with potent
interest. It will be found especially valuable and instruc-
tive to all teachers, students of feeble-mindedness and of
social problems and to criminal lawyers and even to
students of civil law. Imbeciles often make improper
and unjust wills.

Diseases of the Nervous System: a text book of
Neurology and Psychiatry. By Smith Ely JeUiffe, M.D.,
Ph. D., Adjunct Professor of Diseases of the Mind and
Nervous System, New York Post-Graduate Medical
School and Hospital and WiUiam A. White, M.D.,
Superintendent of the Government Hospital for the
Insane, Washington, D. C; Professor of Nervous and
Mental Diseases, Georgetown University; Professor of
Mental Diseases, George Washington University, and
Lecturer on Psychiatry, U. S. Army and U. S. Navy
Medical Schools. Octavo, 796 pages, with 331 engravings
and 11 plates. Cloth, $6.00 net. Lea & Febiger, Pub-
lishers, Philadelphia and New York, 1915.

The Present Standard of the Care and Treat-
ment IN State Hospitals. — By Dr. William Mabon,
Medical Superintendent, Manhattan State Hospital, Ward's
Island, New York. Read before the First State Confer-
ence on Mental Hygiene held in Albany, New York,
March 23, 24, 25, 1915. — From Mental Hygiene Number
of the State Hospital Bulletin for May, 1915.

This is a true showing of present day advance
in recognition and care of insanity as a disease and the
necessity, economy and philanthropy of taking adequate
care of and giving adequate treatment to our insane
and applies to existing hospitals for the mentally maimed
in the United States.

Reviews, Book Notices, Reprints, Etc. 489

Removing Visible Restraint from the Harmless
Insane. — By Will H. Solle, Chicago, 111. Reprint from
the Lancet-Clinic, July 10, 1915. This is one of Dr.
SoUe's Dementia Precox Studies and is in line with the
non-restraint system of the modern methods in vogue
since the epochal reforms of the Pinel and Chiaruge.
Invisible restraint precautions such as the substitution
of strong secure screens concealed in various ways for
jail-like iron bars, and numerous attendants instead of
straight waists, recreation and attractive rooms supplanting
monotonous, irksome confinement.

Psychiatry advances, as the paper shows, in the mind
of the profession generally. The author favors the Gheel
Belgium Colony system, now long in successful practice.

Power of Will. — A practical companion book for
unfoldment of selfhood, through direct personal culture,
by Frank Channing Haddock, Ph.D., founder of the power
book library, in five parts, forty-fifth edition, 1915. The
Pelton Publishing Co., Meriden, Conn., is a power, in
fact for stimulating the evolution of individual conscious-
ness to vital education in the direction of strong, potent
and cultured manhood and ambition to attain growth
in self -culture and dominant will for right achievement.

Everybody who would be somebody might profit
by its suggestion pertinent to successful growth of will
in strength and right culture.

Sir W. R. Gowers, M.D., F.R.C.P., F.R.S.— An
appreciation by F. W. Langdon. Reprint from the
Lancet-Clinic, August 14, 1915. This is a high and
just tribute to our deceased English colleague in neurol-
ogy and psychiatry. From a long personal acquaintance
with the eminent author and physician we can verify
much of the merited encomium. The deceased was
in fact, as Dr. Langdon says "a star of the first magni-
tude" in the neurological firmament. But though
obscured, his light has not gone out forever. It
still illumines the literature.

490 Reviews, Book Notices, Reprints, Etc.

Report of Case of Pemphigus in a Paretic
—By Max A. Bahr, M. D., and Fred'k. C. Potter, M. D.,
Central Indiana Hospital for the Insane. From The
Journal of Nervous and Mental Disease. Read before
the Indianapolis Medical Society, October 20, 1914.

Of special interest from a differential point of view
as to whether we are dealing with a case of simple,
non-specific pemphigus occurring incidentally in a
syphilitic, or whether the case is one of bullous syphilide
of very late occurrence in an individual with an ac-
quired syphilis, which is such an exceedingly rare condi-
tion that its existence is scarcely admitted by some
authors.

This case is well written and well illustrated.

The American Journal of Sociology for July
is before us with a table of contents and selections
of interest to the thoughtful and humanitarian sociologist.
Dr. Alfred H. Lloyd of the University of Michigan
contributes the initial original article on the Duplicity
of Democracy. The Idea and Reality of Human Prog-
ress by Victor S. Yarros follows. A Study in Profession-
al Deformation by Hubert Langerock is next, while
The Evolution of Religion by Edward C. Hayes and
Social Interpretation, by J. C. Bodin, conclude the
index.

Les Actualites Medicales. Diagnostic des Mala-
dies de la Moelle.

This little volume contains a mine of neurological
instruction by a neurologist of merit and renown.
Dr. Grasset, as Professor of the Montpelier University
Clinic, has ample opportunities for acquiring the
requisite experience for writing such a book. The book
is brief but accurate and practical, being confined only
to the spinal marrow disease. J. B. Bailliere & Fils
are the well known publishers, 19, Rue Hautefeuills,
Paris.

Reviews, Book Notices, Reprints, Etc. 491

Eleven Cases Roentgenographic and Operative
Findings. — By A. Judson Quimby, M. D., New York
City. Clinical Professor of Roentgenology, New York
Polyclinic Medical School and Hospital, and Roentgenol-
ogist, New York Foundling Hospital, Etc., and William
Seaman Bainbridge, A.M., Sc. D., M.D., New York
City, Professor of Surgery, New York Polyclinic
Medical School and Hospital. Read before the American
Roentgen Ray Society. — From American Journal of
Roentgenology.

Collected Papers from the Research Laboratory,
Parke, Davis & Co., Detroit, Mich. Dr. E. M. Houghton,
Director. Reprints, Volume 3, 1915.

This is a valuable collection of practical laboratory
findings for the physician in his practice. Some of the
phenomena of the life history of the hog will prove
especially interesting to the country general practitioner.
Closson's researches will interest any physician. In fact,
also the entire table of contents.

Retrobulbar Neuritis as an Exact Diagnostic
Sign of Certain Tumors and Abscesses in the
Frontal Lobes. — By Foster Kennedy, M. D., Late
Resident Medical Officer, National Hospital, Queen
Square, London; Chief of Neurological Clinic and In-
structor in Neurology, Cornell University Medical
College. — From American Journal of the Medical
Sciences.

Occupation Therapy. — A Manual for Nerves by
William Rush Dunton, Jr., M. D., Philadelphia and
London. W. B. Saunders Company, 1915.

This volume should prove of service in the enter-
tainment (especially indoors) of convalescent patients
in our hospitals and sanitaria and for private patients.
We commend it to physicians and nurses.

492 Reviews, Book Notices, Reprints, Etc.

A Review of the Theories and Facts Under-
lying THE Treatment of Disease by Soured Milk
Cultures. — By Clement A. Penrose, M. D. Reprinted
from Maryland Medical Journal, Baltimore, Md.,
March, 1915. Read before the Baltimore City Medical
Society, January 8, 1915. A splendid resume of an
important subject which should be read by every
physician.

Dementia Precox Studies. — The Adrenal My-
driasis of Dementia Precox. By Bayard Holmes,
M.D., Chicago. Reprint from the Chicago Medical
Record, issue of July, 1915. Any new test leading to
diagnosis or directing efforts toward research in this
grave and too prevalent disease is most welcome, as
the author says with force.

"The Doctor" sent out free of charge to physi-
cians as an advertisement of Peacock's Bromides and
the Sultan remedies, Prunoids, etc., contains many
judicious selections from the standard medical magazines.

The products of these well known firms are worthy
of professional consideration as well as the selections
adorning the pages of this little literary "Doctor."

Meyer's Theory of the Psychogenic Origin
OF Dementia Praecox. A Criticism. — By E. Stanley
Abbot, M. D., Assistant Physician, McLean Hospital,
Waverley, Mass. Reprinted from American Journal of
Insanity.

A Peculiar Undescribed Disease of the Nerves
OF the Cauda Equina.— By Foster Kennedy, M. D.,
and Charles A. Elsberg, M. D. With a Pathological
Report by Charles I. Lambert, M. D. From the
American Journal of the Medical Sciences.

The Wellcome Photographic Exposure Record
is acknowledged with pleasure. This enterprising firm

Reviews, Book Notices, Reprints, Etc. 493

are good caterers to the needs of the profession in
therapeutic lines. Just now their first aid suggestions
for the wounded are appreciated.

A Study of Locomotor Ataxia and Kindred
Diseases based on the treatment of 600 cases, by
C. H. Burton, M.D., Medical Director of the West
Side Sanitarium, Detroit, Mich; and Frank Burton,
B. S., Member of the American Chemical Society.
Illustrated.

Address in Medicine before the Iowa State
Medical Society, May, 14, 1914. Remarks on Some
Ordinary Headaches. Hugh T. Patrick, M. D., Chicago,
Illinois. From Journal of Iowa State Medical Society,
November, 1914.

The Modern Treatment of Epilepsy. — By
A. Ulrich, M.D., Director of The Swiss Institute for
Epileptics, Zurich, Switzerland. From The Medical
Times, Vol. XLIII, No. 4, P. Ill, April, 1915.

Mental Diseases and Criminal Responsibility.
— By Dr. James V. May, Medical Member of the New
York State Hospital Commission, Albany, N. Y.
From N. Y. State Hospitals Bulletin, November, 1912.

Dementia Precox Studies. The Case for De-
mentia Precox as a Pluriglandular Disease. By Bayard
Holmes, M.D., Chicago. From Chicago Medical Re-
corder, No. 3, March, 1915.

Review of Kent's and Rosanopp's "A Study
OF Association in Insanity." Frederic Lyman Wells.
From the Journal of Philosophy, Psychology and
Scientific Methods.

494 Reviews, Book Notices, Reprints, Etc.

The Symptomatology of Temporosphekoidal
Tumors.— Foster Kennedy, M. D., New York. From
the Archives of Internal Medicine.

Sodium Nucleate. For the Induction of Arti-
ficial Leukocytosis in Dementia Praecox. By Bayard
Holmes, M.D., Chicago, Illinois.

Common Factors in Mental Health and Ill-
ness.—Dr. F. Lyman Wells. From The Popular
Science Monthly, Dec, 1914.

La Forme Asthenique de la Paralysie Gener-
als.— Par R. Benon et H. Cier, (Hospice Genera],

Nantes.)

Welfare Work. The Visiting Nurse Service.
A good move in the right direction.

Index

INDEX

ORIGINAL CONTRIBUTIONS

m

A Contribution to the Study of Pro-
gressive Muscular Atrophy and a
Report of Four Cases With
Mental Disorders 215

A New Theory of Kissing, Cunnilin-

gus, and Fellatio 253

A Report of the Clinical and Patho-
logical Findings in a Case of
Hystero-Epilepsia and Hystero-

Epileptoid 231

Alcoholism 247

Athetosis 269

Cyst of the Lateral Ventricle 162

Dementia Precox Studies. Adrenalin
a New Diagnostic Test for De-
mentia Precox 449

Has There Been an Increase of
Suicide Among the Opium Ad-
dicts Since the Passage of the
Harrison Act, and if so Why?.... 349

Heavenly Bridegrooms 434

Is Genius a Sport, a Neurosis, or a

Child Potentiality Developed?.... 165
Is Genuis a Sport, a Neurosis, or a

Child Potentiality Developed?.... 236
Is Genius a Sport, a Neurosis, or a
Child Potentiality Developed?.... 384

Modesty Among the North Ameri-
can Indians 341

Notes on the History of Psychiatry.. 365

Principles of Criminal Anthropology. 1

Psychiatry in the Dietary 36

Rigidity of the Curriculum an Ob-
stacle to the Progress of Medical
Education 113

The Cigarette from a Medical Stand-
point 372

The Colloidal Gold Test in Psychiat-
ric Cases 39(5

The Harrison Anti-Narcotic Law:

Its Help and Its Harm 155

The Mental Status of Roland P 131

The Prevention of Mental Defect

the Duty of the Hour 357

The Propositions of the Association
of Superintendents of American
Hospitals for the Insane 45

Two Dreams 12

What is Epilepsy? 7

Ziehen's Conception of Acute Hallu-
cinatory Paranoia (Amentia). 414

SELECTIONS

Neurosurgery.
Choosing the Locus

Operandi for
Incorrigible Juvenility is a Frizz-
ling Proposition 296

Neurotherapy.

A Dysentery "Carrier" 67

An Error Concerning Chloral-Hy-
drate Corrected 299

American Therapeutic Notes 68

Before the British Medico-Psycho-
logical Association 67

Clinical Results with the Phylacogens 466
Concerning Gastro-Intostinal Anti-
sepsis 186

Corpora Lutea Now Therapeutically

Available 69

Exophthalmic Goitre 70

Health Commissioner Gold water 465

Looking Backward on Scopolamine

Anaesthesia 188

Nutritional Therapy 189

Pituitary Therapeutics, Etc 66

Quinine vs. Hydrophobia 466

Simple Sterilization of Water 71

Studies in Prostatic Obstruction and

Vesical Atony 301

Successful Treatment of Tetanus

Neonatorum 72

Temperance 5500 Years Ago 465

The Avitaminoses and Their Treat-
ment 72

The Fatigue Toxin and Immunity. 187

IV

Index.

The Harmful Constituents of Roast-
ed Coffee 71

The Intracranial Treatment of Paretic

Dementia 299

The Potato as a Universal Aliment.. 189

The Pumpkin as a Diuretic 69

The Rum Ration in the English Ar-

my..

299

The StartUng Statement 301

The Vitamine Dietary of Stassano .. 187
Treatment of Diabetes in the Field.. 300

Neurotoxicology.

A Fatal Case of Veronal Poisoning.. 63

Alcoholics and War 64

Hallucinations After Cocain _ 465

Inherited Defects from Alcohol 65

Killed by Wood Alcohol 64

The Telephone in Medical Practice.. 184

Two Descriptive Cases 64

Neurodiagnosis.

Sudden Death 59

The Technique of Psychoanalysis 462

Neuropathology.

The Blood in Epilepsy 464

The Cause and Control of Cancer... 185

Dangers to Attendants in Mental

Wards 463

Clinical Neurology.

Adolescent Insanity and National

Health 467

A New Theory of Autoserotherapy 469

Dyspnea in Relation to Blood React-
ion 468

Internal Secretions and the Psychoses 468
The Discovery of the Spirochaetes

in the Brain 297

The Number and Kinds of Bacteria

in City Dust 296

The Pituitary Body 183

Nervous Shock in War 298

Neurophysiology.

Blood Threadlets 60

Dry Vegetable Cure in Diabetes

Mellitus 304

It Should Be Noted 61

Pituitary Extract and the Salivary

Secretion 461

Sajous' Recent Comments on the

Ductless Glands 303

Venous Blood-Pressure 62

Neurosymptomatology.

Crossed Extensor Plantar Reflex 59

Clinical Psychiatry.

Insanity in Relation to Sex and Age 183

In sanity in Relation to Sex and Age... 463

EDITORIALS

An Ordinance Providing for the Em-

A Better Measure if Psychoneurone

Stability '^74

A Case of Hereditary Persistent

Suicidal Impulse 83

Acquitting an Unfrocked Dissolute
Inebriate Clergyman Murderer .

A Criminal Insane Hospital for Mis-
souri

A Deliberate Murder for Fifty Cents..

A Military School Sold to Osteo-
paths

Among the Most Prominent Deceased

St. Louis Physicians 80

Alienist and Neurologist Sub-
scriber Elected Governor 193

International Commissio de
Lunatico Enquirendo 315

308

475
471

192

An

An

ployment of Municipal Visiting

Tuberciilosis Nurses 306

Apropos of the Program 79

Apropos of the Student's Time Limit.. 476
Between the Eugenists and the Anti-
Race Suiciders 473

Birth Control for Cause 476

Candidates for Assistant Surgeon 75

Caution to Surgeons 77

Considerate Kindness to the Insane.. 83

Correctness of Onomatology 475

Death of Doctor Clouston 311

Death of Dr. Jerome K. Bauduy 85

Detectives for Hospitals for the In-
sane 78

Diagnosis vs. Autopsy 479

Doctor Charles Mclntire's Contribu-
tion on the Rigidity of the Med-
ical Curriculum 199

Index.

Doctor Sajous' New Clinic in the

Charity Hospital 309

Doctors 79

Dr. Achilles Rose 84

Dr. C. B. Burr 77

Dr. G. W. Morrow 198

Dr. Shufeldt's (Maj. and Surg.,

U.S.A.) New Book 309

Dr. T. D. Crothers 474

Eccentricity vs. Insanity 314

Erratum 79

Fatalities from Sudden Morphia

Deprivation in Chicago 307

Freud's Method of Psychoanalytic

Diagnosis 74

Harry Thaw Again Free 317

Hemadenology 477

Ignorance in the Harrison Law 473

Inordinate Health-Harming City

Noises 310

Insane Murderers Acquitted 87

Insanoids and Criminal Imbeciles at

Large 473

Internal Hydrocephalus 198

It is Estimated 76

Les Medicins Humanistes 84

Many Insane Hospital Reports 200

Married School Teachers Should be

Retained in Service 201

Medical Officers of Hospitals for the

Insane 196

Medically Enlightening the Public ... 86
Not Clinically Correct but Start-

lingly Untrue 316

Papine... 82

Photaugiophobia 478

Phy.sician's Tax Annulled 311

Prince Bismarck 78

Profes.sor Johnson's Tuberculo-Pho-

bic Su.spender Investment 195

Prosperous Grinnell College, Iowa... 198
Referring to Psychiatry in Mental

Practice 478

Rheumatism and Rheumatoid In-
sanity 82

Roland B. Molineux is Violently

Insane 198

Sanitation on the East Side Struck a

Serious Obstacle 474

Since This is a Popular Non-Mon-
archical Government 306

State Psychologist for Illinois 194

Surgeon General Gorgas 305

Taking Care of the By- Products 80

The A lienist and Neurologist 475

The Alienist and Neurologist 79

The American Academy of Medicine 196
The Appropriation 80

The British Medico-Psychological

Association 201

The Carnegie Eugenic Commission.. 84

The Chicago Medical Society 476

The Council on Medical Education

of the A. M. A 203

The Death of Doctor Carios J. Finlay

of Havana, Cuba 472

The Dual Source of the Cerebro-
spinal Fluid 81

The Dual Source of the Cerebro-
spinal Fluid 198

The Eminent Alienist, Maragliano.... 198
The First Case of Opium Abstention

Suicide 200

The Harrison Bill 312

The Harrison Opium Coca Bill 200

The Honor of the Degree of LL.D... 312
The Impeachment of Dr. C. R.

Woodson 316

The Many Hospitals and Sanitariums 80
The Massachusetts Society for Mental

Hygiene 477

The National Committee for Mental

Hygiene 193

The New Barnes Hospital 75

The Next (Seventy-First) Annual

Meeting 193

The Noisy, Rasping, Bouncing, Iron

Wheeled Street Car 476

The Object of the Visiting Nurse

Association 195

The Pan-American Medical Congress 194
The Philadelphia Post-Graduate

School of Neurology's Faculty... 76
The Practical Side of Masonic Work 202
The Prayer of Medicine for More

Laboratory Light 307

The Prize Dissertation 77

The Psychiatry of Flowers in the

Sick Room 197

The Seventh Pan-American Congress 201
The Suspension of Gazetta Medica

Italiana 198

The Trouble in Europe 475

The Unregretted Summer School 313

The Unstably Brained Hazing Ruffian 478

Though EhrUch Has Gone from Us 477

Trained Men for State Institutions 75
Trench Caused Insanity in the Bat-
tle Area of Europe 79

W. B. Kern, M. D 81

When the Great Malady 308

When You Write for this Magazine.. 81
With the Privilege of Citizenship.. 81

Why Not? 77

Why Should Secretary Daniel 306

VI

Index.

Acute Heroin Poisoning and the

Harrison Law 318

Fatal Accidents Following the In-
jection of Antimeningitis Ser-
um 90

CORESPONDENCE

The Bravest Thing I Ever Did 88

The Maximum Mental Power Age of

Man 482

OBITUARY
The Nestor of Kentucky Medicine 203

IN MEMORIAM
A Memorial Monument 482 Sir William R. Gowers, M. D. 318

REVIEWS

A Case of Infantile Uterus Appen-
dages with Result of Treat-
ment 338

A Case of Pure Psychic Epilepsy 212

A Criticism of Psychoanalysis Ill

Actes du Congres Penitentiare In-
ternational de Washington 110

Acute Insular Sclerosis and Its Con-
comitant Visual Disturbances.... 339

Acute Poliomyehtis 104

Address in Medicine 210

Address in Medicine 493

American Public Health Problems .. 331
America's Greatest Problem: the

Negro 334

America's Leadership for Peace 336

America's Pressing Mortality Prob-
lem 336

An Earthquake of One Minute's

Duration '. 336

An Epitome of the Diagnosis and

Treatment of Nervous Diseases.. 108

An Excellent Contribution Ill

Aimah di Nevrologia 212

A Note on the Retention of Ac-
quired Capacities 212

A Peculiar Undescribed Disease of the

Nerves of the Cauda Equina 492

A Plea for Simplified Laboratory

Reports for Hospitals 336

Applied Eugenics 330

A Program of Practical Measures

for Mental Hygiene Work 100

Archivos Brasileiros de Medicina 100

Archivos Brazileiros Psychiatria,

Neurologia e Medicina Legal 107

Arequipa Sanatorium 337

A Review of the Theories and Facts
Underlying the Treatment of Dis-
ease by Soured Milk Cultures 492

A Study of Locomotor Ataxia and

Kindred Diseases 493

A Unique Case of Syphilis of the

Cranium and Spine 212

Berger's Diagnosis of Cardio-Vascu-

lar Diseases 94

Bulletin of St. Louis University 213

Burger.sdijk & Niermans 210

Carnegie Endowment for Inter-
national Peace 209

Choked to Death by Teeth 339

Christian Science Sentinel 203

Claims Arising from Results of

Personal Injuries 109

Clinical Symptomatology 209

Collected Papers from the Research

Laboratory 491

Common Factors in .Mental Health

and Illness 340

Common Factors in Mental Health

and Illness 494

Concerning Individual Differences

in Reaction Times 106

Contributions from the Phvsiological
Laboratory of the Medico-Chi-

rurgical College 93

Curschmann-Burr Text Book on

Nervous Diseases 325

Dementia Precox Studies 492

Dementia Precox Studies 493

Dental Electro-Therapeutics 212

Destitution and Disease in Serbia ... 324

Diseases of the Nervous System 488

Dr. MacDonald's House 339

Dynamics Psychological 211

Eleven Cases Roentgenographic and

Operative Findings 491

Eugenics, Euthenics and Love — How

They go Hand in Hand 207

Experiments with Emulsions or
Organs Taken from Dead Hu-
man Body and Sex-Glands of the

Lower Animals 212

Extradition of Insane Persons 106

Index.

Vll

Falta's Ductless Glandular Diseases.... 483

From an Editorial on Gorgas 101

Puller's Anatomical Models of the

Brain, Pons and Medulla 329

Furor Caesareus 107

Great Men and How They are Pro-
duced 331

Has the Old Man the Right to Live? 93

Hereditary Syphilis 340

Hobson's Arguments for Prohibition

and an Adequate Navy 340

Human Plumbing — Amelioration and
Cure of Chronic Intestinal Sta-
sis 211

Ictus, Epilepsie-Jacksonienne et As-

theno-Manie 340

Ictus, Epilepsie Jacksonienne et As-

theno-Manie 494

Implantation of the Generative
(jlands and its Therapeutic Pos-
sibilities 96

Infantile Paralysis in Massachusetts 334

In Memoriam 327

Insanities of the Puerperal State 339

Institute di Clinica della Malattie
Nervose e Mentale e di Antro-

pologia Criminalc della 102

Instructions in the Proper Methods

of Securing Tissues Ill

International Clinic Week 209

In the St. Paul Medical Journal 333

Is There an Increase 106

Jahresbericht uber die Leistungen
und Fortschritte auf dem Ge-
biete der Neurologie und Psy-
chiatric in Verbindung 102

Journal of Psycho-Asthenics 95

Laboratory Aids Ill

"Laboratory Week" 322

La Forme Asthenique de la Paralysie

Generale 212

La Forme Asthenique de la Paralysie

Generale 494

La Personalita del Giudicabile 211

L'Aphasie dans ses Rapports avec

la Demence et les Vesanies 107

L'Enfance Anormale 485

Les Actualil'js Mcdicales 490

Les Dysthenies Periodiques 110

Les Fugues de L'enfance — Influence
des Milieux Scolaries et Fami-

liaux ._ 337

Le Traitement des Stenoses Aigues

du Larynx J09

Loss of Vitreous in the Intracapsular
Cataract Operation and its

Prevention 337

Medico-Psychological Assn. of Great

Britain and Ireland 109

Mental Diseases and Criminal Re-
sponsibility 493

Mental Medicine and Nursing 92

Mental Obliquities — How Caused

and How Remedied 339

Mercurialized Serum, (Mulford) 340

Meyer's Theory of the Psychogenic

Origin of Dementia Praecox 492

Microphotographic Study of the

Tubercle Bacillus 337

Mulford's Luetin Reaction 340

Narcotic Drug Addiction 339

Nervous and Mental Diseases 204

Neurosis and Purjxise 109

Notes Sur Quelques Maladies Ner-

veuses et Mentalles Au Bresil... 109

Occupation Therapy' 491

Oliver Wendell Holmes 320

One Hundred and First Annual Re-
port of Trustees Massachusetts

General Hospital 211

One Hundred and Seventeen Cases

of Infantile Diarrhea 338

On the Formulation in Psychoanaly-
sis Ill

Power of Will 489

Present Status of Surgery of System-
ic Goitre, Illustrative Cases 110

Proceedings of the American Medico-
Psychological Association 336

Psychiatry 104

Psychic Therapy, Clinical Psycholo-
gy, and the Layman Invasion. . 338

Psychology in Daily Life 96

Radio-Activity 93

Removing Visible Restraint from the

Harmless Insane 489

Report of Case of Pemphigus in a

Paretic 490

Report to the Governor on the In-
stitutions for the Insane 333

Report of the Director of Sanitation

of Porto Rico 212

Retrobulbar Neuritis as an Exact
Diagnostic Sign of Certain
Tumors and Abscesses in the

Frontal Lobes 491

Review of Kent's and Rosanofl's
"A Study of Association in In-

.sanity" 493

Revue de Medicine 103

Revue des Sciences, Psychologiques,

Etc 103

Revue des Sciences Psychologiques,
Psychologie, Psychiatric, Psych.

Sociale, Methodologie 110

Science for December, 1914 103

Second Annual Report of the State

Charities Commission 335

Vlll

Index.

SirW.R.Gowers 489

Sixteenth Annual Report of the

Board o£ Education 332

Sodium Nucleate 494

Solution and Remede 484

Some Important Memoranda 335

Spina Bifida 340

Statistics of Public, Society and

School Libraries 339

St. Louis Healthy 97

Surgery of the Ileocecal Valve 98

The Acid Test in Therapeutics Ill

The Advantages of Medical Associa-
tions 338

The American Journal of Sociology. . 490
The Announcement of Memories of

My Youth. 1844-1865 98

The Art of Companionship in Men-
tal Nursing 108

The Art of Companionship in Men-
tal Nursing Ill

The Case of Belgium 109

The Certificate in Psychological

Medicine 99

The Chemistry of Neurastheiua 111

The Commercial Lure of a Scientific

Physiological Philosophy 329

The Continuous Warm-Water Bath . 109
The Continuous Warm Water Bath
the Rational Remedy in Tuber-
culosis (Phymatiasis) and In-

fectional Diseases in General 103

The Criminal Imbecile 487

The Diseases of Personality: the
Diseases if the Will and the

Psychology of Attention 210

"The Doctor" 492

The Effects of Goitre Operations

Upon Mentality 108

The Extradition of Insane Persons... 110

The First Volume, Number 1 486

The Hecht- Weinberg Reaction 110

The Intimate Relation of Orthope-
dic Surgery to Neurology .. 108
The Journal of Experimental Medi-
cine 95

The Laws of Heredity— -Their Defi-
nite Meaning and Interpreta-
tion 206

The Medical Organization of State

Hospitals for the Insane 335

The Medical Pickwick 105

The Modem Treatment of Epilepsy. ... 493
The Nervous System and its Con-
servation 100

The North Pole Aftermath 340

The Onset of General Paralysis 485

Two Perils to Good Government 332

The Psvchosis of Adolescence 110
The Phylacogen Treatment of Pneu-
monia 106

The Program of the Medico- Psy-
chological As.sociation 94

The Propaganda for Reform of the

A. M. A 208

The Phychological Monographs 101

The Present Standard of the Care

and Treatment in State Hospitals 488

The Psvchoanalytic Review 105

"The Red Man" - 97

The Schick Test, Illustrated 340

The Sei-I-Kwai Medical Journal HI

The Smith Indian Cataract Opera-
tion jn the Light of Scientific

Investigation 211

"The Story of Bethlehem Hospital".. 105
The Symptomatology of Tcmporo-

sphenoidal Tumors 494

The Systematic Observation of Per-
sonality 107

The Theorv of Psychoanalysis 204

The Treatment of Senile Cataract

by the General Practitioner 338

The University of Missouri Bulletin 335

The Way to Vaccinate HI

The Wellcome Photographic Ex-
posure Record 492

Thirty-Ninth Annual Report 340

Thirty-Second Anual Report of the
State Board of Health and
Bureau of Vital Statistics of

Missouri, 1914-1915 326

Transactions of the College of Phy-
sicians of Philadelphia 334

Trattato di Psichiatria 205

Treatment of Drug Addiction and

Alcoholism 212

Twelve Consecutive Intracapsular
Cataract Operations and their

Visual Results 337

Vagabondage and Begging 108

Virginia State Epileptic Colony Ill

Volume IX Publications of the

American Sociological Society ... 328

Welfare Work 4»4

We Take Pleaisure 487

What to do With the Sub-Normal

Child 325

Where is the Fundus of the Bladder? 339

X-ray Studies 106

Zur Behandlung der Sexualen Neu-
rasthenic 104

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THE CINCINNATI SANITARIUM

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• INCORPORATED 1873

A Private Hospital of Modern Equipment and Methods
F. W. Langdon, M. D., Medical Director.

B. A. Williams, M. D., Resident Physician

Emerson A. North, M. D., Resident Physician
Georgia E. Finley, M. D., Medical Matron

For descriptive yearly report address
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SANITARIUM DIRECTORY-Continued

Drs. Pettey & Wallace's Sanitarium

For the Treatment of

Alcohol and Drug Addiction

Nervous and Mental Diseases

Memphis, Tenn.

958 So. Fifth St.

BEACH SANITARIUM

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Nervous and Mental Diseases

Alcoholic and Drug Addictions

A, J. CAPRON, M. D., Supt.

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THE RIVERSIDE SANITARIUM

FRANK C. STUDLEY, M. D.,
Superintendent

Milwaukee, Wis.

THE LIVERMORE SANITARIUM

Separate departments for Mental

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Board of Directors— J. W. Robertson

V. H. Podstata, Addison Bybee.
Livermore, California.

The Gulf Coast Sanitarium

For Nervous Diseases and Convalescents

DR. RIVES A. MANKER, Supt.
Long Beach, (near Gulfport) Miss.

THE NUGENT SANITARIUM

Alcoholic and Drug Addictions

Nervous and Mild Mental Disorders

DR. P. C. GILLEN, Medical Director

P. O. Box 443 Milwaukee, Wis.

Telephone, Wauwatosa 44

Dr. McCready's Hospital-School

Backward, nervous and deUcate children.

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Address

E. BOSWORTH McCREADY, M. D.

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HIGHLAND HOSPITAL

Asheville, _N. C.

Nervous, Habit and Mental Cases

Especially emphasizing Work and

Educational Therapy

ROBT. S. CARROLL, Supt.

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Gymnasium and recreation buildiaB: physical culture, new "Ziodcr" machines, showex baths.
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