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THE JOURNAL
OF
MENTAL SCIENCE
(Published by Authority of the Medico-Psychological Association
of Cheat Britain and Ireland).
EDITED BT
H. RAYNER, M.D. A. R. URQUHART, M.D.
CONOLLY NORMAN, F.R.C.P.I. EDWIN GOODALL, M.D.
** Not toto intellectum longius a rebus non abstzahimus quam ut rerum imagine* et
radii (ut in sentu fit) eoire poesint.”
Francis Bacon, Frolcg. Instaurat. Mag. _
VOL. XLTV.
LONDON:
J. and A. CHURCHILL,
7, GREAT MARLBOROUGH STREET. W.
MDCCCZCTOL
Digitized by {jOOQle
“ In adopting our title of the Journal of Mental Science, published by authority
of the Medico-Psychological Association, we profess that we cultivate in our pages
mental science of a particular kind, namely, such mental science as appertains
to medical men who are engaged in the treatment of the insane. But it has
been objected that the term mental science is inapplicable, and that the terras
mental physiology, or mental pathology, or psychology, or psychiatry (a term
much affected by our German brethren), would have been more correct and ap¬
propriate; and that; moreover, we do not deal in mental science, which is pro¬
perly the sphere of the aspiring metaphysical intellect. If mental science is
strictly synonymous with metaphysics, these objections are certainly valid; for
although we do not eschew metaphysical discussion, the aim of this Journal is
certainly bent upon more attainable objects than the pursuit of those recondite
inquiries which have occupied the most ambitious intellects from the time of
Plato to the present, with so much labour and so little result. But while we ad¬
mit that metaphysics may be called one department of mental science, we main¬
tain that mental physiology and mental pathology are also mental science under
a different aspect. While metaphysics may be called speculative mental science,
mental physiology and pathology, with their vast range of inquiry into insanity,
education, crime, and all things which tend to preserve mental health, or to pro¬
duce mental disease, are not less questions of mental science in its practical, that
is in its sociological point of view. If it were not unjust to high mathematics
to compare it in any way with abstruse metaphysics, it would illustrate our
meaning to say that our practical mental science would fairly bear the same rela¬
tion to the mental science of the metaphysicians as applied mathematics bears to
the pure science. In both instances the aim of the pure science is the attainment
of abstract truth; its utility, however, frequently going no further than to serve
as a gymnasium for the intellect. In both instances the mixed science aims at,
and,taa certain extent, attains immediate practical results of the greatest utility
to the welfare of mankind; we therefore maintain that our Journal is not in¬
aptly ealled the Journal of Mental Science , although the science may only at-
tempfe-to deal with sociological and medical inquiries, relating either to the pre¬
servation of the health of the mind or to the amelioration or cure of its diseases;
and although not soaring to the height of abstruse metaphysics, we only aim at
such metaphysical knowledge as may be available to our purposes, as the mecha¬
nician uses the formularies of mathematics. This is our view of the kind of
mental science which physicians engaged in the grave responsibility of caring
for the mental health of their fellow-men may, in all modesty, pretend to culti¬
vate ; and while we cannot doubt that all additions to our certain knowledge in
the speculative department of the science will be great gain, the necessities of
duty and of danger must ever compel us to pursue that knowledge which is to
be obtained in the practical departments of science with the earnestness of real
workmen. The captain of a ship would be none the worse for being well ac¬
quainted with the higher branches of astronomical science, but it is the practical
part of that science as it is applicable to navigation which he is compelled to
study/*— Sir J. C. Buchnill , M.D., JP.R.S.
ft
Digitized by LjOOQle
MEDICO-PSYCHOLOGICAL ASSOCIATION OF GREAT
BRITAIN AND IRELAND.
LIST OF CHAIRMEN.
1841. Dr. Blake, Nottingham.
1842. Dr. de Vitr£, Lancaster.
1843. Dr. Conolly, Han well.
1844. Dr. Thurnbam, York Retreat.
1847. Dr. Wintle, Warneford House, Oxford.
1851. Dr. Conolly, Han well.
1852. Dr. Wintle, Warneford House.
LIST OF PRESIDENTS.
1854. A. J. Sutherland, M.D., St. Luke’s Hospital, London.
1855. J. Tburaam, M.D., Wilts County Asylum.
1856. J. Hitchman, M.D., Derby County Asylum.
1857. Forbes Winslow, M.D., Sussex House, Hammersmith.
1858. John Conolly, M.D., County Asylum, Hanwell.
1859. Sir Charles Hastings, D.C.L.
1860. J. C. Bucknill, M.D., Devon County Asylum.
1861. Joseph Lalor, M.D., Richmond Asylum, Dublin.
1862. John Kirkman, M.D., Suffolk County Asylum.
1863. David Skae, M.D., Royal Edinburgh Asylum.
1864. Henry Munro, M.D., Brook House, Clapton.
1865. Wm. Wood, M.D., Kensington House.
1866. W. A. F. Browne, M.D., Commissioner in Lunacy for Scotland.
1867. C. A. Lockhart Robertson, M.D., Haywards Heath Asylum.
1868. W. H. O. Sankey, M.D., Sandy well Park, Cheltenham.
1869. T. Lay cock, M.D., Edinburgh.
1870. Robert Boyd, M.D., County Asylum. Wells.
1871. Henry Maudsley, M.D., The Lawn, Hanwell.
1872. Sir James Coxe, M.D., Commissioner in Lunacy for Scotland.
1873. Harrington Tuke, M.D., Manor House, Chiswick.
1874. T. L. Rogers, M.D., County Asylum, Rainhill.
1875. J. F. Duncan, M.D., Dublin.
1876. W. H. Parsey, M.D., Warwick County Asylum.
1877. G. Fielding Blandford, M.D., London.
1878. J. Crichton-Browne, M.D., Lord Chancellor’s Visitor.
1879. J. A. Lush, M.D., Fisherton House, Salisbury.
1880. G. W. Mould, M.R.C.S., Royal Asylum, Cheadle.
1881. D. Hack Tuke, M.D., London.
1882. W. T. Gairdner, M.D., Glasgow.
1888. W. Orange, M.D., State Criminal Lunatic Asylum, Broadmoor.
1884. Henry Rayner, M.D., County Asylum, Hanwell.
1885. J. A. Eames, M.D., District Asylum, Cork.
1886. Geo. H. Savage, M.D., Bethlem Royal Hospital.
1887. Fred. Needham, M.D., Barn wood House, Gloucester.
1888. T. S. Clouston, M.D., Royal Edinburgh Asylum.
1889. H. Hayes Newington, M.R.C.P., Ticehurst, Sussex.
1890. David Yellowlees, M.D., Gartnavel Asylum, Glasgow.
1891. E. B. Whitoombe, M.R.C.S., City Asylum, Birmingham.
1892. Robert Baker, M.D., The Retreat, York.
1893. J. Murray Lindsay, M.D., County Asylum, Derby.
1894. Conolly Norman, F.R.C.P.I., Richmond Asylum, Dublin.
1895. David Nicolson, M.D., New Law Courts, Strand, W.C.
1896. William Julius Mickle, M.D., Grove Hall Asylum, Bow,
1897. Thomas W. McDowall, Morpeth, Northumberland.
a
o
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THE
MEDICO-PSYCHOLOGICAL ASSOCIATION
OF GREAT BRITAIN AND IRELAND.
THE COUNCIL, 1898-9.
president.— A. R. URQUHART, M.D.
PRESIDENT ELECT.— J. B. 8PENCE, M.D.
ex-president.— T. W. McDOWALL, M.D.
EMERITUS TREASURER.— JOHN H. PAUL, M.D.
treasurer.— H. HATES NEWINGTON, M.R.C.P.Ed.
/'HENRY RAYNER, M D.
\A. R. URQUHART, M.D.
JCONOLLY NORMAN, F.R.C.P.I.
'‘EDWIN GOODALL, M.D.
1Trntll(ADfl (T. SEYMOUR TUKE, M.B.
auditors. |OUTTERSON WOOD, M.D.
DIVISIONAL SECRETARY FOR BCOTLAND. —A. R. TURNBULL, M.B.
DIVISIONAL SECRETARY FOR IRELAND.— A. D. FINEGAN, L.R.C.P.I.
DIVISIONAL SECRETARY FOR NORTHERN AND MIDLAND DIVISION. —W. CROCHLEY
EDITORS OF JOURNAL.
CLAPHAM, M.D.
DIVISIONAL SECRETARY FOR SOUTH-EASTERN DIVISION.— E. W. WHITE, M.B.
DIVISIONAL SECRETARY FOR SOUTH-WE8TBRN DIVI8ION.— P. W. MACDONALD, M.D.
general secretary.— ROBERT JONES, M.D., B.S., F.R.C.S.
SECRETARY OF EDUCATIONAL COMMITTEE.— C. A. MERCIER, M.B.
registrar.— J. B. 8PENCE, M.D.
MEMBERS OF COUNCIL.
FLETCHER BEACH, M.B. 1896.
H. A. BENHAM, M.D.
E. C. HETHERINGTON, M.B. 1897.
JAMES M. MOODY, M.R.C.8.
G. RUTHERFORD MACPHAIL,
M.D.
WILLIAM R. WATSON,
L.R.C.8. and L.R.C.P.E.
A. LAW WADE 1898.
J. CARLYLE JOHNSTONE
A. W. CAMPBELL
T. S. SHELDON
JAMES CHAMBERS
OSCAR T. WOODS
C. T. EWART, M.B.
J. G. SOUTAR
R. D. HOTCHKISS, M.B.
R. PERCY SMITH
BXAMINBUS.
ENGLAND
(C. A. MERCIER, M.B.
t R- PERCY SMITH, M.D.
SCOTLAND J c^MPb'eLI^CLABK, M.D.
IRELAND
(OSCAR T. WOODS, M.D.
1CONOLLY NORMAN, F.R.C.P.I.
PARLIAMENTARY COMMITTEE.
Dr. FLETCHER BEACH.
Dr. BENHAM.
Dr. G. F. BLANDFORD.
Dr. D. M. CASSIDY.
Dr. CLOUSTON.
Dr. E. M. COOKE.
Dr. GARDINER HILL.
Dr. ROBERT JONES.
Mr. LEY.
Dr. J. G. McDOWALL.
Dr. MERCIER.
Dr. H. HAYES NEWINGTON.
Dr. CONOLLY NORMAN.
With power to
Dr. EVAN POWELL.
Dr. RAYNER.
Dr. SAVAGE.
Dr. PERCY SMITH.
Dr. J. B. SPENCE.
Dr. STOCKER.
Dr. G. THOMSON.
Dr. URQUHART.
Dk. WHITCOMBE.
Dr. WHITE.
Dr. WIGLESWORTH.
Dr. YELLOWLEES.
to their number.
1898.
»»
*>
Digitized by LjOOQle
HONORARY MEMBERS,
1896. Allbutt, T. Clifford, M.D., P.R.C.P., Regius Professor of Physic, Univ.
Camb., St. Radegunds, Cauibridge.
1881. Benedikt, Prof. M., Franciskaner Platz 6, Vienna.
1865. Biffi, M., M.D., Editor of the Italian Journal of Mental Science, 16,
Borgo di San Celso, Milan.
1881. Brosiuv, Dr., Bendorf-Sayn, near Coblenz, Germany.
1876. Browne, Sir J. Crichton, M.D.Edin., F.R.S.E., Lord Chancellor's Visitor,
New Law Courts, Strand, W.C. (President, 1878.)
1887. Chapin, John B., M.D., Pennsylvania Hospital for the Insane, Pliila-
delpliia, U.S.A.
1867.* Cleaton, John D. t M.R.C.S.Eng., late Commissioner in Lunacy, 19,
Whitehall Place, S.W.
1872. Courtena.v, E. Maziere, A.B., M.B., C.M.T.C.D., M.D., Inspector of
Lunatics in Ireland, Lunacy Office, Dublin Castle. (Son, Member ,
1891; Secretary for Ireland , 1876-87.)
1884. Curwen, J., M.D., Warren, Pennsylvania State Hospital for the Insane,
U.S.A.
1879. Echeverria, M. G., M.D.
1865. Falret, Jules, M.D., 114, Rue de Bac, Paris.
1892. F4r4, Dr. Charles, 37, Boulevard St. Michel, Paris.
1895. Ferrier, David, M.D., 34, Caveudish Square.
1872. Fraser, John, M.B., C.M., F.R.C.P.E., Commissioner in Lunacy, 19,
Strathearn Road, Edinburgh.
1868.1 Gairdner, W. T., M.D.Edin., F.R.S., Professor of Practice of Physic,
1888. j 225, St. Vincent Street, Glasgow. (President, 1882.)
1886. Godding, l)r.. Medical Superintendent, Government Hospital for Insane,
Washingtou, U.S.A.
1898. Hine, George T., 35, Parliament Street, London, S.W.
1881. Hughes, C. H., M.D., St. Louis, Missouri, United States.
1881. Krafft-Ebing, R. V., M.D., Vienna.
1866. Laehr, H., M.D., Schweizer Hof, bei Berlin, Editor of the Zeitschrift fur
Peyokiatrie.
1887. Lentz, Dr., Asile d’Alien£s, Tournai, Belgique.
1898. MacDonald, A. E., M.D., Manhattan Asylum, New York, U.S.A.
1898. Magnan, V., M.D., Asile de Ste. Anne, Paris.
1871.1 Manning, Frederick Norton, M.D.St. And., M.R.C.S. Eng., Inspector of
1884. J Asylums for New South Wales, c/o G. Grose, 10, Laurence
, Pouutney Lane, Cannon Street, London, E.C.
1867. Meyer, Ludwig, M.D., University of Gottingen.
1881. Mierzejewski, Prof. I., Medico-Chirurgical Academy, St. Petersburg.
1866. *1 Mitchell, Sir Arthur, M.D.Aberd., LL.D., K.C.B., late Commissioner in
1871. J Lunacy for Scotland; 34, Drummond Place, Edinburgh.
1897. Morel, M. Jules, M.D., States Lunatic Asylum, Mens, Belgium.
1880. Motet, M., 161, Rue de Charoune, Paris.
1859. Needham, Frederick, M.D.St. And., M.R.C.P.Edin., M.R.C.S.Eng.,
Commissioner in Lunacy, 19, Whitehall Place, S.W. (President,
1887.)
1891. O'Farrell, G. P., M.D., M.Ch.Univ. Dubl., Inspector of Lunatics in
Ireland, 19, Fitzwilliam Square, Dublin.
1881. Peeters, M., M.D., Gheel, Belgium.
Digitized by {jOOQle
iv Honorary Members.
1873. Pitman, Sir Henry A., M.D.Cantab., F.R.C.P.Lond., Registrar of the
Royal College of Physicians; Enfield, Middlesex.
1886. Roussel, M. Theophile, M.D., Senateur, Paris.
1887. Schule, Heinrich, M D„ lllenan, Baden, Germany.
1880. Sibbald, John, M.D.Edin., F.R.C.P.Edin., M.R.C.S.Eng., Commissioner
in Lunacy for Scotland; 18, Great King Street, Edinburgh.
(Editor of Journal , 1871-72.)
1888. Stearns, H. P., M.D., The Retreat, Hartford, Conn., U.S.A.
1881. Tamburiui, A., M.D., Reggio-Emilia, Italy.
1881. Virchow, Prof. R., University, Berlin.
CORRESPONDING MEMBERS.
1896. Bianchi, Prof. Leonardo, Manicomio, Provinciale di Napoli.
1896. Bresler, Johannes, M.D., Irrenanstalt, Freiburg in Silesia, Germany.
1897. Buschan, Dr. G., Stettin, Germany.
1896. Cowan, F. M., M.D., 107, Perponcher Street, The Hague, Holland.
1880. Komfeld, Dr. Herman, Grottkau, Silesia, Germany.
1889. Kowalowsky, Professor Paul, Kharkoff, Russia.
1896. Lindell, Emil Wilhelm, M.D., Gothenburg, Sweden.
1897. Nacke, Dr. P., Hubertusberg Asylum, Leipzig.
1886. Parant, M. Victor, M.D., Toulouse.
1890. R4gis, Dr. E., 54, Rue Huguerie, Bordeaux.
1890. Ritti, Dr. J. M., Maison Nationale de Charenton, St. Maurice, Seine,
France.
1893. Semelaigne, R6n6, Dr., Secretaire des Seances de la Soci6t6 Medico-
Psychologique de Paris, Avenue de Madrid, Neuilly, Seine, Paris.
Digitized by {jOOQle
Members of the Association .
Y
Alphabetical List of Members of the Association, with the pear in which they
joined. The Asterisk means Members who joined between 1841 and 1855.
1891. Adair, Thomas Stewart, M.B., C.M.Edin., Assistant Medical Officer
and Pathologist, Wadsley Asylum, near Sheffield.
1874. Adam, James, M.D.St. And., West Mailing, Kent.
1895. Adam, Walter, M.D.Edin., Graham’s Town Asylum, South Africa.
1868. Adams, Josiah O., M.D.Durh., F.R.C.S.Eng., Brooke House, Upper
Clapton, London.
1857. Adams, Richard, L.R.C.P.Edin., M.R.C.S.Eng., Bodmin, Cornwall.
1880. Agar, S. H., L.R.C.P.I., Glendossil, Hen ley-in-Arden.
1886. Agar, S. Hollingsworth, jun., B.A.Cantab., M.R.C.S., Glendossil, Henley-
in- Arden.
1890. Alexander, Robert Reid, M.D.Aber., Medical Superintendent, Hanwell
Lunatic Asylum.
1869. Aldridge, Chas., M.D.Aher., L.R.C.P., Plympton House, Plympton,
Devon.
1898. Allan, Thomas Sprot, L.R.C.P.Edin., and L.M., L.R.C.S.Edin., Ac.,
Fairfield House, Falkirk.
1882. Alliott, A. J., M.D., Rosendal, Sevenoaks.
1885. Amsden, G., M.B., Medical Supt, County Asylum, Brentwood, Essex.
1898. Anderson, John Sewell, M.R.C.S., L.R.C.P., Assistant Medical Officer,
Hull City Asylum, Willerby, near Hull.
1888. Anderson, W. A., M.B., 9, Devonshire Buildings, Barrow-in-Furness.
1894. Andriezen, W. Lloyd, M.D.Lond., Darenth Asylum, Dartford, Kent.
1894. Angus, Charles, M.B., C.M., Senior Assistant Physician, Royal Asylum,
Aberdeen.
1887. Aplin, A., M.R.C.S.E. and L.R.C.P.Loud., Medical Superintendent,
County Asylum, Snenton, Nottingham.
1898. Ashton, George, M.B., Ch.B., London County Asylum, Clayhury, Chig-
well, Essex.
1898. Asthury, Thomas, M.R.C.S., L.R.C.P., Wonford House, Exeter.
1892. Atherstone, Walter H., M.D., Surgeon-Superintendent, Port Alfred
Asylum, South Africa.
1891. Aveline, Henry T. S., M.R.C.S., L.R.C.P., M.P.C., Medical Superinten¬
dent, County Asylum, Cotford, near Taunton, Somerset.
1894. Roily, Percy J., M.B.Edin., Senior Assistant Medical Officer, London
County Asylum, Hanwell, W.
1878. Baker, H. Morton, M.B.Edin., Assistant Medical Officer, Leicester
Borough Asylum. Leicester.
1888. Baker, John, M.B., 471, Caledonian Road, London, N.
1876. Baker, Robert, M.D.Edin., Visiting Physician, The Retreat, York; 41,
The Mount, York. (President, 1892.)
1878. Barton, James Edward, L.R.C.P.Edin., L.M., M.R.C.S., Medical Superin¬
tendent, Surrey County Lunatic Asylum, Brookwood, Woking.
1895. Barraclough, Herbert, M.B., County Asylum, Devizes.
1864. Bayley, J., M.R.C.S., Medical Superintendent, St. Andrew’s Hospital,
Northampton.
1893. Bayley, Joseph Herbert, M.B., C.M.Edin., Assistant Medical Officer, St.
Andrew’s Hospital, Northampton.
1874. Beach, Fletcher, M.B., F.R.C.P.Lond., formerly Medical Superintendent*
Darenth Asylum, Dartford; Winchester House, Kingston Hill,
Surrey, and 64, Welbeck Street, W. (General Secretary , 1889—
1896.)
Digitized by
yi Members of the Association.
1897. Beadle, T. Alfred, L.R.C.P., L.R.C.S.Edin., Assistant Medical Officer,
District Asylum, Hartwood, Glasgow.
1892. Beadles* Cecil F., M.R.C.S., L.R.C.P., Assistant Medical Officer, Colney
Hatch Asylum.
1896. Beamish, George, L.R.C.S.I., L.R.C.P.E., L.M., Medical Officer’s House,
H.M. Prison, Wandsworth, London, S.W,
1872. Benham, H. A., M.D., Medical Superintendent, City and County Asylum,
Stapleton, near Bristol.
1894. Bernard, Dr. Walter, District Asylum, Londonderry.
1864. Bigland, Thomas, M.R.C.S.Etig., L.S.A.Lond., Bigland Hall, Backbarrow,
near Ulverston, Lancashire.
1894. Blackford, James Vincent, M.B., B.S.Durham, Assistant Medical Officer,
Bristol Asylum, Fishponds, near Bristol.
1897. Blackwood, John, B.A, M.R.C.S.Eng., L.R.C.P.Lond., Assistant Medical
Officer, Borough Asylum, Portsmouth.
1898. Blair, David, M.A., M.B., C.M., County Asylum, Lancaster.
1883. Blair, Robert, M.D., Medical Superintendent, Woodilee Asylum, Lenzie,
near Glasgow.
1879. Blanchard, E. S., M.D., Medical Superintendent, Hospital for Insane,
Charlotte Town, Prince Edward’s Island.
1857. Blandford, George Fielding, M.D.Oxon., F.R.C.P.Lond., 48, Wimpole
Street, W. (President, 1877.)
1897. Blandford, Joseph John Guthrie, B.A., D.P.H.Camb., M.R.C.S.Eng.,
L.R.C.P.Lond., Assistant Medical Officer, London County Asylum,
Banstead, Surrey.
1888. Blaxland, Herbert, M.R.C.S., Medical Superintendent, Callan Park
Asylum, New South Wales.
1890. Blumer, G. Alder, M.D., Medical Superintendent of the State Hospital
for the Insane, Utica, N.Y., U.S.A.
1895. Bodington, George Fowler, M.D.Durh., F.R.C.S.Eng., M.R.C.P.Lond.,
Medical Superintendent, Government Asylum for the Insane, Pro¬
vince of British Columbia, Canada.
1896. Boddie, William, M.B., C.M.Aber., Assistant Medical Officer, Fisherton
House, Salisbury.
1897. Bois, Charles A., L.R.C.S., L.R.C.P.Edin„ Senior Assistant Medical
Officer, Lanark County Asylum, Hartw'ood, N.B.
1892. Bond, Charles Hubert, D.Sc., M.D., Ch.M.Edin., Senior Assistant Medical
Officer, London County Asylum, The Heath, Bexley, Kent.
1877. Bower, David, M.D.Aberd., Springfield House, Bedford.
1877. Bowes, John Ireland, M.R.C.S.Kng., L.S.A., Medical Superintendent,
County Asylum, Devizes, Wilts.
1893. Bowes, William Henry, M.D.Lond., Assistant Medical Officer, Plymouth
Borough Asylum, Ivy bridge, Devon.
1896. Boycott, A. N., M.D.Lond., M.R.C.S.Eng., L.R.C.P.Lond., Assistant
Medical Officer, London County Asylum, Canehill, Purley, Surrey.
1898. Boyle, A. Helen A., M.D., 3, Palmeira Terrace, Hove, Brighton.
1883. Boys, A. H., L.R.C.P.Edin., Chequer Lawn, St. Albans.
1891. Braine-Hartnell, Georsre, L.R.C.P.Lond., M.R.C.S.Eng., Medical Super¬
intendent, County and City Asylum, Powick, Worcester.
1893. Bramwell, John Milne, M.B., C.M.Edin., 2, Henrietta Street, Cavendish
Square, London, W.
1881. Brayn, R., L.R.C.P.Lond., Medical Superintendent, Broadmoor Asylum,
Crowthorne, Berks.
1892. Bristowe, Hubert Carpenter, M.D.Lond., Wrington, R.S.O., Somerset.
1895. Briscoe, John Frederick, M.R.C.S.Eng., Resident Medical Superintendent,
Westbrooke House Asylum, Alton, Hants.
1864. Brodie, David, M.D.St. And., L.R.C.S.Edin., care of Bernard Holl&nder,
Esq., 61, Chancery Lane, London, W.C.
Digitized by
VI
Members of the Association.
1891. Brace, John, M.B., C.M.Edin., M.P.C., Laariston Town Hall Square,
Grimsby.
1898. Brace. Lewi* C., M.B.Edin., Assistant Medical Officer, Morningside
Asylum, Edinburgh.
1898. Branton, Walter Reyuer, M.B.Durh., 1, St. Stephen’s Gardens, East
Twickenham.
* Brnshfield. Dr., Budleigh Salterton, Devon.
1896. Bnbb, William, M.R,C.S. t L.R.C.P.Lond., Second Assistant Medical
Officer, Worcester County Asylum, Powick, near Worcester.
1894. Baggy, Louis, L.R.C.S.I, L.M., L.R.C.P.I., Assistant Medical Officer,
District Asylum, Kilkenny.
1892. Bnllen, Frederick St. John, M.R.C.S.Eng., 10, Pembroke Road, Clifton,
Bristol.
1869. Burman, Wilkie J., M.D.Edin., Ramsbury, Hungerford, Berks.
1891. Caldecott, Charles, M.B., B.S.Lond., M.R.C.S., Medical Superintendent,
Earlswood Asylum, Redhill, Surrey.
1889. Callcott, J. T., M.D., Medical Superintendent, Borough Asylum, New-
castle-on-Tyne.
1894. Campbell, Alfred Walter, M.D.Edin., Pathologist, County Asylum,
Rainhill, near Prescott, Lancashire.
1897. Campbell, Keith, M.B.Edin., Netherlea, Montrose, N.B.
1880. Campbell, P. E.. M.B., C.M., Senior Assistant Medical Officer, District
Asylum, Caterham.
1897. Campbell, Robert Brown, M.B., C.M.Edin., Assistant Medical Officer,
District Asylum, Inverness.
1890. Cameron, James, M.B., C.M.Edin., 13, Fettes Row, Edinburgh.
1874. Cameron, John, M.D.Edin., Medical Superintendent, Argyll and Bute
Asylum, Lochgilphead.
1897. Cappe, Herbert Nelson, M.R.C.S.Eng., L.R.C.P.Lond., Assistant Medical
Officer, Surrey County Asylum, Brook wood.
1896. Cardale, Henry Jasper, M.B., C.M.Ediu., Assistant Medical Officer,
Fisherton House, Salisbury.
1891. Carswell, John, L.R.C.P.Edin., L.F.P.S.Glasg., Certifying Medical Officer,
Barony Parish, 5, Royal Crescent, Glasgow.
1896. Cashman, James, M.B., B.Ch., B.A.O.Royal Univ. Ire., Assistant Medical
Officer, Cork District Asylum.
1896. Cassidy, Charles S., M.B.Edin., Assistant Medical Officer, Grahamstown,
South Africa.
1874. Cassidy, D. M., M.D., C.M.McGill Coll., Montreal, D.Sc. (Public Health)
Edin., F.R.C.S.Edin., Medical Superintendent, County Asylum,
Lancaster.
1888. Cham berg, James, M.D., M.P.C., The Priory, Roehampton.
1865. Chapman, Thomas Algernon, M.D.Glns., L.R.C.S.Edin., Betula, Reigate.
1880. Christie, J. W. Stirling, M.D., Medical Superintendent, County Asylum,
Stafford.
1878. Clapham, Wm. Crochley S., M.D., M.R.C.P., The Grange, Rotherham.
1863. Clapton, Edward, M.D.Lond., F.R.C.P.Lond., late Physician, St, Thomas’s
Hospital, late Visitor of Lunatics for Surrey; 22, St. Thomas’s
Street. Borough, S.E.
1879. Clark, Archibald C., M.D.Edin., Medical Superintendent, Lanarkshire
Asylum, Hart wood, Shotts, N.B.
1879. Clarke, Henry, L.R.C.P.Lond., H.M. Prison, Wakefield.
1898. Clinch, T. Aldous, M.D.Edin., Pathologist, County Asylum, Durham.
1862. Clouston, T. S., M.D.Edin., F.R.C.P.Edin., F.R.S.E., Physician Super¬
intendent, Royal Asylum, Morningside, Edinburgh. (Editor of
Journal, 1873-1881.) (Pbesident, 1888.)
Digitized by
viii Members of the Association .
1879. Cobbold, C. 8. W., M.D., Bailbrook House, Bath.
1892. Cole, Robert Henry, M.D.Lond., M.R.C.P.Lond., 53, Upper Berkeley
Street, W.
1896. Coles, Richard Ambrose, Barham, near Canterbury.
1896. Collins, George Fletcher, M.R.C.S.Eng., L.R.C.P.L., D.P.H.Cantab., 8,
Windsor Terrace, Penarth, near Cardiff.
1888. Cones, John A., M.R.C.S., Burgess Hill, Sussex.
1895. Conry, John, M.D.Aber., Fort Beaufort Asylum, South Africa.
1878. Cooke, Edward Marriott, M.B., M.R.C.S.Eng., Medical Superintendent,
County Asylum, Worcester.
1891. Comer, Harry, M.B.Lond., M.R.C.S., L.R.C.P., M.P.C., Brooke House,
Southgate, N.
1897. Cotton, William, M.A., M.D.Edin., D.P.H.Cantab., 281, Gloucester Road,
Bishopston, Bristol.
1891. Cowan, John J., M.B., C.M.Edin., Leigh Sinton, Malvern.
1893. Cowen, Thomas Phillips, M.B., B.S.Lond., Assistant Medical Officer,
County Asylum, Prestwich, Manchester.
1884. Cox, L. F., M.R.C.S., Medical Superintendent, County Asylum, Denbigh.
1878. Craddock, F. H., B.A.Oxon., M.R.C.S.Eng., L.S.A., Medical Superin¬
tendent, County Asylum, Gloucester.
1892. Craddock, Samuel, M.R.C.S.Eng., South Hill House, Bath.
1893. Craig, Maurice, M.A., M.B., B.C.Cautab., M.R.C.P.Lond., Assistant
Medical Officer, Bethlem Royal Hospital, Southwark.
1894. Crawford, Cyril R., M.R.C.S.Eng., L.R.C.P.Lond., Sussex County Hos¬
pital, Brighton.
1897. Cribb, Harry Gifford, M.R.C.S.Etig., L.R.C.P.Lond., Assistant Medical
Officer, London County Asylum, Canehill, Surrey.
1898. Crookshank, F. G., M.D.Lond., M.R.C.S., L.R.C.P., County Asylum,
Berrywood, Northampton.
1894. Cullinan, Henry M., L.R.C.P.I., L.R.C.S.I., Second Assistant Medical
Officer, Richmond District Asylum, Dublin.
1869. Daniel, W. C., M.D.Heidelb., M.R.C.S.Eng., Epsom, Surrey.
1896. Davidson, Andrew, M.B., C.M.Aber., Assistant Medical Officer, County
Asylum, Dorchester.
1868. Davidson, John H., M.D.Edin., Delamere House, Liverpool Road,
Chester.
1874. Davies, Francis P., M.D.Edin., M.R.C.S.Eng., Kent County Asylum,
Banning Heath, near Maidstone.
1891. Davis, Arthur N., L.R.C.P., L.R.C.S.Edin., Medical Superintendent,
Borough Asylum, Ivybridge, Devon.
1898* Davison, James. M.D., Streate Place, Bath Road, Bournemouth.
1894. Dawson, William R., B.Cli., B.A.O.Univ. Dub)., Assistant Medical Super¬
intendent, Farnham House Private Asylum, Finglas, Dublin.
1869. Deas, Peter Maury, M.B. and M.S.Lond., Medical Superintendent,
Wonford House, Exeter.
1896. Dewar, Margaret C., M.B., C.M.Univ. Glasg., Gartnavel Royal Asylum,
Glasgow.
1876. Dickson, F. K., F.R.C.P.Ediu., Wye House Lunatic Asylum, Buxton,
Derbyshire.
1898. Dobie, Stanley L., Surgeon Lieut.-Col., Dunain Park, near Inverness, N.B.
1879. Dodds, William J., M.D., D.Sc.Edin., Valkenberg, Mowbray, near Cape
Town, South Africa.
1886. Donaldson, Robert Lockhart, B.A., M.D., B.Ch.Univ. of Dubl., M.P.C.,
Senior Medical Officer, District Asylum, Monaghan.
1889. Donaldson, William Ireland, B.A., M.B., B.Ch.Univ. of Dubl., Assist¬
ant Medical Officer, London County Asylum, Canehill, Purley,
Surrey.
Digitized by ^ ooqLc
IX
Members of the Association .
1802. Don elan, J. O* C., L.R.C.P.I., L.R.C.8.I., M.P.C., First Assistant Medical
Officer, Richmond District Asylum, Dublin.
1898. Donnellan, Robert Vincent, L.R.C.P., L.R.C.S.Ed., Bam wood House,
Gloucester.
1881. Douglas, Archibald Robertson, L.R.C.S., L.R.C.P.Edin., the Grove,
Portland, Dorset.
1890. Douglas, William, M.D.Queen’s Univ. Irel., M.R.C.S.Eng.
1897. Dove, Emily Louisa, M.B.Loud., Assistant Medical Officer, London
County Asylnm, Claybury, Essex.
1884. Drapes, Thomas, M.B., Medical Superintendent, District Asylum, Ennis-
corthy, Ireland.
1898. Dyer, Sidney Reginald, M.D., Barrister-at-law, 18, Dovecot Road,
Wandsworth, S.W.
1874. Eager, Reginald, M.D.Lond., M.R.C.S.Eng., Northwoods, near Bristol.
1873. Eager, Wilson, L.R.C.P.Lond., M.R.C.S.Eng., Northwoods, Winter¬
bourne, Bristol.
1881. Earle, Leslie, M.D.Edin.. 21, Gloucester Place, Hyde Park, W.
1891. Earls, James Henry, M.D., M.Ch., Ac., 71, Brighton Square, Dublin.
1895. Easterbronk, Charles C., M.A., M.B., C.M., Assistant Medical Officer,
Royal Asylum, Morningside, Edinburgh.
1862. Eastwood, J. William, M.D.Edin., M.R.C.P.Lond., Dinsdale Park,
Darlington.
1895. Edgerly, Samuel, M.B., C.M.Edin., Assistant Medical Officer, West Riding
Asylum, Menston, nr. Leeds.
1897. Edwards, Francis Henry, M.D.Brux., L.R.C.P.Lond., M.R.C.S.Eng.,
Assistant Medical Officer, Camberwell House, S.E.
1889. Elkins, Frank A., M.B., C.M.Edin., M.P.C., Leavesden Asylum, King’s
Langley, Herts.
1898. Ellerton, H. B., M.R.C.S., L.R.C.P., County Asjlum, Nottingham.
1873. Elliot, G. Stanley, M.R.C.P.Edin., F.R.C.S.Edin., Medical Superintendent,
Caterham, Surrey.
1897. Elliot, John, L.R.C.S., L.R.C.P., Assistant Medical Officer, Borough
Asylum, Portsmouth.
1890. Ellis, William Gilmore, M.D.Brux., Superintendent, Government Asylum,
Singapore.
1898. Embleton, D. C., M.R.C.S., L.R.C.P., St. Wilfrid’s, St. Michael’s Road,
Bournemouth.
1898. English, Evelyn A. W., M.B., C.M.Edin., Resident Medical Officer,
Eastern Dispensary, Bath.
1895. Enrich, Frederick William, M.B., C.M.Edin., 65, Manniugham Lane,
Brad’ord.
1861. Eustace, J., M.D.Trin. Coll., Dub., L.R.C.S.I., Highfleld, Drumcondra,
Dublin.
1894. Eustace, Heury Marcus, M.B., B.Ch., B.A.Univ. Dublin, Assistant
Physician, Hampstead and Highfleld Private Asylum, Glasnevin,
Dublin.
1897. Everett, William, M.D., Assistant Medical Officer, County Asylum, Chart-
ham Downs, Kent.
1891. Ewan, John Alfred, M.A., M.B., C.M.Edin., M.P.C., Medical Superin¬
tendent, Kesteven and Grantham District Asylum.
1884. Ewart, C. T., M B., C.M.Aberd., Assistant Medical Officer, Claybury
Asylum, Woodford Bridge, Essex.
1896. Ewbank, Arthur George, M.R.C.S., L.R.C.P.Lond., Assistant Medical
Officer, Middlesex County Asylum, Tootiug, London, S.W.
1888. Ezard, E. H., M.D., D.Sc.Edin., M.P.C., 220, Lewisham High Road, St.
John’s, S.E.
Digitized by
x Members of the Association .
1894. Farquharson, William F., M.B.Edin., Assistant Medical Officer. Counties
Asylum, Garlands. Carlisle.
1897. Fieldiug-, James. M.D., Victoria Univ., Canada. M.R.C.S.Eng., L.R.C.P.
Edin., Medical Superintendent, Bethel Hospital, Norwich.
1867. Finch, W. Corbin, M.R.C.S.Eng., Fisherton House, Salisbury.
1873. Finch, John E. M., M.D., Medical Superintendent, Borough Asylum,
Leicester.
1889. Finch, Richard T., B.A., M.B.Cautab., Resident Medical Officer, Fisherton
House Asylum, Salisbury.
1890. Findlay, George, M.B., C.M.Aber., Brailes, nr. Banbury.
1882. Finegan, A. D. O’Connell, L.R.C.P.I., Medical Superintendent, District
Asylum, Mullingar. {Hon. Secretary for Ireland.)
1889. Finlay, Dr., County Asylum, Bridgend, Glamorgan.
1898. Finn, P. Taaffe, L.R.C.P., L.R.C.S.Ed., County Asylum, Newport, Isle of
Wight.
1891. Finny, W. E. St. Lawrence, M.B.Umv. Irel., Kenlis, Queen’s Road,
Kingston Hill, Surrey.
1888. Fitzgerald, G. C., M.B., B.C.Cantab., M.P.C., Medical Superintendent,
Kent County Asylum, Chartham, nr. Canterbury.
1894. Fitzgerald, Charles E., M.D., F.R.C.S.I., Surgeon Oculist to the Queen in
Ireland, 27, Upper Merriou Street, Dublin.
1872. Fletcher, Robert Vicars, Esq., F.R.C.S.I., L.R.C.P.I., L.R.C.P.
Edin., Medical Supt., District Asylum, Ballinasloe, Ireland.
1894. Fleury, Eleonora Lilian, M.D., B.Ch., R.U.I., Assistant Medical Officer,
Richmond Asylum, Dublin.
1880. Fox, Bouville Bradley, M.A.Oxon., M.D., M.R.C.S., Brislington House,
Bristol.
1861. Fox, Charles H., M.D.St. And., M.R.C.S.Eng., 36, Heriot Row,
Edinburgh.
1897. Fox, George Aubrey Townsend, M.R.C.S.Eng., L.R.C.P.Lond., Assis¬
tant Medical Officer, County Asylum, Chartham Downs, Kent.
1896. France, Eric, M.B., B.S.Durli., Assistant Medical Officer, North¬
umberland County Asylum, Morpeth.
1881. Fraser, Donald, M.D., 3, Orr Square, Paisley.
1873. Garner, W. H., Esq.. F.R.C.S.I., A.B.T.C.D., Medical Superintendent,
Clonmel District Asylum.
1893. Garth, H. C., M.B., C.M.Edin., 4, Harrington Street, Culcutta, India.
1867. Gasquet, J. R., M.H.Lond., St. George’s Retreat, Burgess Hill, and 1,
College Gate, Brighton.
1890. Gaudin, Francis Neel, M.R.C.S., L.S.A., M.P.C., Medical Superintendent,
The Grove, Jersey.
1885. Gay ton, F. C., M.D., Brook wood Asylum, Surrey.
‘1896. Geddes, John W., M.B., C.M.Edin., Assistant Medical Officer, Durham
County Asylum, Winterton, Ferryhill, Durham.
1871. Gelston, R. P., L.R.C.P.I., L.R.C.S.I., Medical Superintendent, District
Asylum, Eunis, Ireland.
1892. Gemmel, James Francis, M.B.Glasg., Assistant Medical Officer, County
Asylum, Lancaster.
1889. Gibbon, William, L.R.C.P.I., L.F.P.S.Glasg., Senior Assistant Medical
Officer, Joint Counties Asylum, Carmarthen.
1898. Gill, Frank A., M.D., Deputy Medical Officer, H.M.Prison, Manchester.
1889. Gill, Dr. Stanley, B.A., M.D., M.R.C.P.Lond., Shaftesbury House,
Formby, Lancashire.
1897. Gilmour, John Rutherford, M.B., C.M.Edin., Assistant Physician,
Crichton Royal Institution, Dumfries.
Digitized by ^ ooqLc
1878.
1898.
1897.
1889.
1898.
1888.
1894.
1887.
1890.
1897.
1886.
1896.
1898.
1894.
1896.
1886.
1879.
1894.
1866.
1894.
1896.
1895.
1897.
1898.
1886.
1892.
1892.
1891.
1890.
Members of the Association . xi
Glendinning, James, M.D.Glasg, L.R.C.S.Edin., L.M., Medical Super¬
intendent, Joint Counties Asylum, Abergavenny.
Goldie, Scot Thomas, M.B., C.M.Edin., M.R.C.S., L.R.C.P., Assistant
Medical Officer, Wameford Asylum, Oxford.
Good, Thomas Saxty, M.R.C.S.Eug., L.R.C.P.Lond., Assistant Medical
Officer, County Asylum, Littlemore, Oxford.
Goodall, Edwin, M.D., M.S.Lond., M.P.C., Medical Superintendent,
Joint Counties Asylum, Carmarthen. {Editor of Journal.)
Gordon, W. S., M.B., District Asylum, Mullingar.
Gordon-Munn, John Gordon, M.D., F.R.S.Edin., Resident Physician,
The Hall, Busbey, Herts.
Graham, T., M.D.Glasg., 3, Garthland Place, Paisley.
Graham, Samuel, L.R.C.P.Lond., Assistant Medical Officer, District
Asylum, Belfast.
Graham, W., M.D. (R.U.I.), Medical Superintendent, District Lunatic
Asylum, Belfast.
Gramshaw, Farbrace Sidney, M.D., L.R.C.P.Irel., L.R.C.S.Edin., L.M.,
L.A.H.Dubl., The Villa, Stillington, Yorkshire.
Grant-Wilson, Charles Westbrook, L.R.C.P.Lond., M.R.C.S.Eng.,
Heath field House, Streatham Common.
Greenlees, T. Duncan, M.B., Medical Superintendent to the Grahams-
town Asylum, Cape of Good Hi pe.
Greene, Thomas Adam, Assistant Medical Officer, District Asylum, Ennis,
Ireland.
Greenwood, Henry Harold, M.R.C.S.Eng.. L.R.C.P.Lond., Assistant
Medical Officer, County Asylum, Mickleover, Derby.
Griffin, Edward W., M.D., M.Ch., R.W.I., Assistant Medical Officer, The
Asylum, Killarney.
Griffiths, George Batho G., M.R.CtS., L.R.C.P.Lond., Assistant Surgeon,
H.M. Convict Prison, Parkhurst, Isle of Wight.
Grubb, J. Strangman, L.K.C.P.Edin., North Common, Ealing, W.
Gwynn, S. T., M.D., St. Mary’s House, Whitchurch, Salop.
Gwynn, Charles Henry, M.D.Ediu., co-licensee, St. Mary’s House,
Whitchurch, Salop.
Hall, Edward Thomas, M.R.C.S.Eng., Newlands House, Tooting Beck
Road, Tooting Common, Chelsea, S.W.
Halstead, Harold Cecil, M.D.Durh., Assistant Medical Officer, Peckham
House, Peckham.
Hanbury, William Reader, Assistant Medical Officer, County Asylum,
Dorchester, Dorset.
Harper, Thomas Edward, L.R.C.P.Lond., M.R.C.S.Eng., Assistant
Medical Officer, St. Ann’s Heath, Virginia Water.
Harris, William, M.D.St. And., F.R.C.S.Edin., M.R.C.P.Edin., Medical
Superintendent, City Asylum, Hellesdon, Norwich.
Harris-Liston, J., M.R.C.S., L.R.C.P.Lond., L.S.A., Auld Cathie, Sidcup,
Kent.
Harvey, Crosbie Bagenal, L.A.H., Assistant Medical Officer, District
Asylum, Clonmel.
Haslett, William John, M.R.C.S., L.R.C.P., Resident Medical Superin¬
tendent, Halliford House, Sunbury-on-Thames.
Hatched, J., F.R.C.P.I., District Asylum, Maryborough, Ireland.
Havelock, John G., M.B., C.M.Edin., Physician Superintendent, Montrose
Royal Asylum.
Hay, Frank, M.B., C.M., Assistant Medical Officer, Ashburn Hall Asylum,
Dunedin, New Zealand.
Digitized by
Google
xii Members of the Association .
1885. Henley, E. W., L.R.C.P., County Asylum, Gloucester.
1895. Hearder, Frederick P., M.B., C.M., Assistant Medical Officer, West
Riding Asylum, Wakefield.
1877. Hetherington, Charles, M.B., Medical Superintendent, District Asylum,
Londonderry, Ireland.
1877. Hewson, R. W., L.R.C.P.Edin., Medical Superintendent, Cotton Hill,
Stafford.
1891. Heygate, William Harris, M.R.C.S.Eng., L.S.A., Cranmere, Cosham,
Hants.
1879. Hicks, Henry, M.D.St. And., M.R.C.S.Eng., F.R.S., F.G.S., Hendon
Grove House, Hendon, Middlesex.
1882. Hill, Dr. H. Gardiner, Medical Superintendent, Middlesex County Asylum,'
Tooting.
1857. Hills, William Charles, M.D.Aber., M.R.C.S.Eug., Thorpe St. Andrew,
near Norwich.
1871. Hingston, J. Tregelles, M.R.C.S.Eng., Medical Superintendent, North
Riding Asylum, Clifton, Yorks.
1881. Hitchcock, Charles Knight, M. D., Bootham Asylum, York.
1892. Holmes, James, M.D.Edin., Overdale Asylum, Whitefield, Lancashire.
1896. Horton, James Henry, M.R.C.S.Eng., L.R.C.P.Lond., Assistant Medical
Officer, The Priory, Roehampton, London, S.W.
1896. Hossack, William Cardiff, M.B., C.M.Aberd., Assistant Physician, St.
Catherine’s, Banff.
1894. Hotchkiss, R. D.,M.B., C.M., M.P.C., Assistant Physician, Royal Asylum,
Glasgow.
1857. Humphry, J., M.R.C.S.Eng., Medical Superintendent, County Asylum,
Aylesbury, Bucks.
1897. Hunter, David, M.A., M.B., B.C.Cantab., County Asylum, Whittingbam.
1888. HyBlop, Theo. B., M.D., C.M.Edin., M.R.C.P.E., M.P.C., Assistant
Medical Officer, Bethlem Royal Hospital, S.E.
1882. Hyslop, James, M.D., Pietermaritzburg Asylum, Natal, South Africa.
1865. lies, Daniel, M.R.C.S.Eng., Resident Medical Officer, Fuirford House
Retreat. Gloucester.
1871. Ireland, W. W., M.D.Edin., Mavisbush, Polton, Midlothian.
1896. Isacke, Matthew W. S., M.R.C.S.Eng., L.R C P.Lond., Assistant Medical
Officer, West Riding Asylum, Wadsley, Sheffield.
1866. Jackson, J. Hughlings, M.D.St.And., F.R.C.P.Lond., Physician to the
Hospital for Epilepsy and Paralysis, Ac., 3, Manchester Square,
London, W.
1860. Jepson, Octavius, M.D.St.And., M.R.C.S.Eng., Elmfield, Newlands Park,
Sydenham, S.E.
1898. Jobson, Thomas Battersby, M.D.Dub., B.Ch., B.A.O.Dub., Somerset and
Bath Asylum, Well*.
1893. Johnston, Gerald Herbert, L.R.C.S. and L.R.C.P.Edin., Assistant Medical
Officer, North Riding Asylum, Clifton, Yorks.
1890. Johnston, John McCubbin, M.B., C.M., M.P.C., Town’s Hospital, Parlia¬
mentary Road, Glasgow.
1878. Johnstone, J. Carlyle, M.D., C.M., Medical Superintendent, Roxburgh
District Asylum, Melrose.
1866. Jones, Evan, M.R.C.S.Eng., Ty-mawr, Aberdare, Glamorganshire.
1880. Jones, D. Johnson, M.D.Edin., Senior Assistant Medical Officer, Banstead
Asylum, Surrey.
Digitized by LjOOQle
Members of the Association . xiii
1882. Jones, Robert, M.D.Lond., B.S., F.R.C.S., Medical Superintendent,
London County Asylum, Clay bury, Woodford, Essex. {Gen.
Secretary.)
1897. Jones, Samuel Lloyd, M.R.C.S.Eng., L.R.C.P.Lond., Assistant Medical
Officer, London County Asylum, Colney Hatch, N.
1897. Jones, William Edward, Assistant Medical Officer, Earlswood Asylum,.
Redhill.
1898. Jones, W. Ernest, M.R.C.S.Eng., L.R.C.P.Lond., Leicestershire and
Rutland Asylum, Leicester.
1879. Kay, Walter S., M.D., Medical Superintendent, South Yorkshire Asylum,
Wadslev, near Sheffield.
1886. Keay, John, M.B., Medical Superintendent, District Asylum, Inverness.
1898. Kemp, Norah, M.B., C.M.Glas., The Retreat, York.
1897. Kerr, Hugh, M.A., M.B., C.M., Assistant Medical Officer, Bucks County
Asylum, Stone, Bucks.
1893. Kershaw, Herbert Warren, M.R.C.S.Eng., L.R.C.P.Lond., Senior Assistant
Medical Officer, North Riding Asvhim, Clifton, Yorks.
1897. Kesteven, William Henry, M.R.C.S.Eng., L.S.A.Lond., Hill Wood,
Waverley Grove, Hendon.
1897. Kidd, Harold Andrew, M.R.C.S.Eng., L.R.C.P.Lond., Medical Superin¬
tendent, West Sussex Asylum, Chichester.
1897. Kingdon, Wilfred Robert, M.B., B.S.Durh., Resident Medical Officer,
Ticehurst House, Sussex.
1898. Labey, Julius, M.R.C.S., Medical Superintendent, Public Lunatic Asylum,
The Homestead, Gronville, Jersey.
1896. Langdon-Down, Reginald L., M.B., B.C.Cantab., M.R.C.P.Loud.,
Normansfleld, Hampton Wick.
1896. Laslett, Maurice H. t L.R.C.P., H.M.Dockyard, Chatham.
Lavers, Norman, M.R.C.S., Camberwell House Asylum, London, S.E.
1892. Lawless, Dr. George Robert, A.M.O., District Asylum, Armagh.
1870. Lawrence, A., M.D., County Asylum, Chester.
1883. Layton, Henry A., L.R.C.P.Edin., Cornwall County Asylum, Bodmin.
1883. Legge, R. J., M.D., Medical Superintendent, County Asylum, Derby.
1894. Lentagne, John, B.A., F.R.C.S.I., Medical Visitor of Lunatics to the
Court of Chancery, 29, Westland Row, Dublin.
1858. Lewis, Henry, M.D.Brux., M.R.C.S.Eng., L.S.A., late Assistant Medical
Officer, County Asylum, Chester ; West Terrace, Folkestone, Kent.
1879. Lewis, William Bevaif, Physician and Medical Director, West Riding
Asylum, Wakefield.
1863. Ley, H. Rooke, M.R.C.S.Eng., Medical Superintendent, County Asylum,
Prestwich, near Manchester.
1859. Lindsay, James Murray, M.D.St. And., F.R.C.S. and F.R.C.P.Edin.,
Brook side, Corston, Bristol. (President, 1893.)
1883. Lisle, S. Ernest de, L.R.C.P.I., Three Counties Asylum, Stotfold, Bal*
dock.
1898. Lord, John R., M.B., C.M., London County Asylum, Hanwell, W.
1872. Lyle, Thomas, M.D.Glasg., 34, Jesmond Road, Newcastle-on-Tyne.
1880. MacBryan, Henry C., Kingsdown House, Box.
1897. McCutchan, William Arthur, L.R.C.P.S.Edin., Assistant Medical Officer,
County and City Asylum, Hereford.
1884. Macdouald, P. W., M.D., C M., Medical Superintendent, County Asylum,
near Dorchester, Dorset. (J Ton. Sec. 8.W. Division.)
1893. Macevoy, Henry John, M.D., B.Sc.Lond., M.P.C., 41, Buckley Road,
Brondesbury, London, N.W. „ . . . _ LH3
1895. Macfarlane, Neil M., M.D.Aberd., Medical Superintendent, Government
Hospital, Thlotse Heights, Leribe, Basutoland, South Africa.
Digitized by
xiv Members of the Association .
1883. Macfarlane, W. H., M.B. and Ch.B.Univ. of Melbourne, Medical Super*
intendent, Hospital for the Insane, New Norfolk, Tasmania.
1891. Mackenzie, Henry J., M.B., C.M.Edin., M.P.C., Assistant Medical Officer,
The Retreat, York.
1886. Mackenzie, J. Camming, M.B., C.M., M.P.C., late Medical Superinten¬
dent, District Asylum, Inverness; care of Mr. Mackenzie, Enzie
Station, Buckie, N.B.
* Mackintosh, Donald, M.D.Dur. and Glasg., L.F.P.S.Glasg., 10, Lancaster
Road, Belsize Park, N.W.
1896. Maclaren, J., M.B., C.M.Edin., Assistant Medical Officer, Spring Villa,
Oughtybridge, Sheffield.
1886. Maclean, Allan, L.R.C.S.Edin., 10, Mitie Court Chambers, Temple,
E.C.
1873. Macleod, M. D., M.B., Medical Superintendent, East Riding Asylum,
Beverley, Yorks.
1898. Macnaughtou, George W. F., M.D., Warwick Lodge, 436, Fulham Road,
London, S.W.
1882. Macphail, Dr. S. Rutherford, Derby Borough Asylum, Rowditch,
Derby.
1896. Macpherson, Dr. Charles, Deputy Commissioner in Lunacy, 61, Queen
Street, Edinburgh.
1895. Madge, Arthur E., M.R.C.S.Eng., L.R.C.P.Lond., Priestwood, Bracknell,
Berks.
1896. Maguire, Charles Evan, M.B., C.M., Assistant Colonial Surgeon, Lagos,
West Africa.
1896. Mallanali/S., M.B.Edin., Medical School, Hyderabad, Deccan, India.
1865. Manning, Harry, B.A.Lond., M.R.C.S.. Laverstock House, Salisbury.
1896. Marr, Hamilton C., M.D.Glasg. Univ., Senior Assistant Physician,
Woodilee Asylum, Lenzie.
1897. Marshal], John, M.B., C.M.Glasg., Assistant Medical Officer, County
Asylum, Bridgend, Glamorgan.
1896. Martin, James Cbirke, L.R.C.S.I., L.M., L.R.C.P., Assistant Medical
Officer, District Asylum, Letterkenny.
1897. Mathieson, M.B., C.M.Glasg., Senior Assistant Medical Officer, County
Asylum, Stafford.
1888. McAlister, William, M.B., C.M., Struan Villas, Kilmarnock.
1894. McClaughry, Thomas, L.R.C.S.I. and L.A.H. Dnbl., Assistant Medical
Officer, District Asylum, Maryborough, Ireland.
1886. McCreery, James Vernon, L.R.C.S.I., Medical Superintendent, New
Lunatic Asylum, Melbourne, Australia.
1870. McDowall, T. W., M.D.Edin., L.R.C.S.E., Medical Superintendent,
Northumberland County Asylum, Morpeth. (Ex-Pbesidbnt.)
1876. McDowall, John Greig, M.B.Edin., Medical Superintendent, West
Riding Asylum, Menston, near Leeds.
1882. McNaughton, John, M.D., Medical Superintendent, Criminal Lunatic
Asylum, Perth.
1894. McWilliam, Alexander, M.B., C.M.Aberd., Medical Superintendent,
Heigham Hall, Norwich.
1886. Macpherson, John, M.B., M.P.C., Medical Superintendent, Stirling
Asylum, Larbert.
1890. Menzies, W. F., M.D., B.Sc.Edin., Senior Assistant Medical Officer,
County Asylum, Rainhill.
1891. Mercier, Charles A.. M.B.Lond., F.R.C.S.Eng., Lecturer on Insanity,
Westminster Hospital; Flower House, Catford, S.E.
1877. Merson, John, M.D.Aberd., Medical Superintendent, Borough Asylum,
Hull.
1871. Mickle, William Julius, M.D., F.R.C.P.Lond., Medical Superintendent.
Grove Hall Asylum, Bow, London. (Pbbbidbnt, 1896.)
Digitized by
XV
Members of the Association .
1867. Mickley, George, M.A., M.B.Cantab., Medical Superintendent, St. Lake's
Hospital, Old Street, London, E.C.
1893. Middlemass, James, M.B., C.M., B.Sc.Gdin., Borough Asylum, Ryhope,
Sanderland.
1898. Middlemist, George Edwyn, M.B., Assistant Medical Officer, County
Asylum, Dorchester.
1883. Miles, George E., M.R.C.P., &c., Medical Superintendent, Hospital for
the Insane (Idiots), Newcastle, N.S.W.
1897. Millard, Reginald J., M.B., Ch.M., Sydney, Assistant Medical Officer,
Callan Park, Sydney, N.S.W.
1893. Mills, John, M.B., B.Cn., and Diploma in Mental Diseases, Royal
University of Ireland, Assistant Medical Officer, District Asylum,
Ballinasloe.
1887. Miller, Alfred, M.B. and B.C.Dubl., Medical Superintendent, Hatton
Asylum, Warwick.
1881. Mitchell, R. B., M.D., Medical Supt., Midlothian District Asylum.
1895. Moffett, Elizabeth Jane, M.B., B.Sc.Loud., New Hospital for Women,
144, Euston Road, London, N.W.
1885. Molony, John, F.R.C.P.I., Med. Supt., St. Patrick's Hospital, Dublin.
1897. Montgomery, Sydney Hamilton Rowan, M.B., B.Ch., B.A.O.Royal
University, Ireland, Assistant Medical Officer, Borough Asylum,
Nottingham.
1878. Moody, James M., M.R.C.S.Eng., L.R.C.P. and L.M.Edin., Medical
Superintendent, County Asylum, Cane Hill, Surrey.
1885. Moore, E. E., M.B.Dubl., M.P.C., Medical Superintendent, District
Asylum, Letterkenuy, Ireland.
1891. Moore, George, J.P., M.D., M.R.C.S., Queen's Farm, St. Saviour’s,
Jersey.
1897. Mornement, Robert Harry, M.R.C.S.Eng., L.R.C.P.Lond., Assistant
Medical Officer, London County Asylum, Cane Hill, Purley,
Surrey.
1892. Morrison, Cuthbert S., L.R.C.P. and L.R.C.S.Edin., Medical Super¬
intendent, County and City Asylum, Burghill, Hereford.
1896. Morton, W. B., M.B., Assistant Medical Officer, Brislington House,
Bristol.
1896. Mott, F. W., M.D., B.S., F.R.C.P.Lond., F.R.S., 25, Nottingham
Place, W.; Pathologist, London County Asylum; Assistant
Physician, Charing Cross Hospital.
1896. Mould, G. E., M.R.C.S., L.R.C.P.Lond., Medical Superintendent,
Northumberland House, Finsbury Park, London, N.
1862. Mould, George W., M.R.C.S. hng.. Medical Superintendent, Royal
Lunatic Hospital, Cheadle, Manchester. (P&BSIDEXT, 1880.)
1897. Mould, Philip G., M.R.C.S.Eng., L.R.C.P.Lond., Assistant Medical
Officer, Royal Lunatic Hospital, Cheadle, Manchester.
1878. Muirhead, Claud, M.D., F.R.C.P.Edin., 30, Charlotte Square, Edin¬
burgh.
1897. Mumby, Bonner Harris, M.D.Aberd., D.P.H.Cantab., Medical Superin¬
tendent, Borough Asylum, Portsmouth.
1893. Murdoch, James William Aitken, M.B., C.M.Glasg., Medical Superinten¬
dent, Berks County Asylum, Wallingford.
1878. Murray, Henry G., L.R.C.P.Irel., L.M., L.R.C.S.I., Assistant Medical
Officer, Prestwich Asylum, Manchester.
1891. Musgrove, C. D., Dr., 8, Herbert Terrace, Penarth, S. Wales.
1890. Nash, Vincent, L.R.C.P.I., formerly Assistant Medical Officer, Richmond
District Asylum, Dublin; George's Street, Limerick.
1880. Neil, James, M.D., M.P.C., Assistant Medical Officer, Warneford Asylum,
Oxford.
Digitized by
Google
XVI
Members of the Association.
1875. Newington, Alexander, M.B.Camb., M.R.C.S.Eng., Woodlands, Tioe-
hurst.
1873. Newington, H. Hayes, M.R.C.P.Ediu., M.R.C.S.Eng., Ticehnrst, Sussex.
(President, 1889.) (Treasurer.)
1893. Newington, John, L.S.A., Tattlebury House, Goudhurst, Kent.
1881. Newth, A. H., M.D., Haywards Heath, Sussex.
1869. Nicolson, David, M.D, and C.M.Aberd., late Medical Officer, H.M. Convict
Prison, Portsmouth, and State Asylum, Broadmoor; Lord Chan¬
cellor^ Visitor, Elmhurst, Guildford. (President, 1895.)
1895. Nicolson, Robert Hendersou, M.B., C.M.Aberd., Senior Assistant Medical
Officer, County Asylum, Hatton, Warwick.
1893. Nobbs, Athelstane, M.B., C.M.Edin., 339, Queen’s Road, Battersea Park,
S.W.
1888. Nolan, Michael J., L.R.C.P.I., M.P.C., Medical Superintendent, District
Asylum, Downpatrick.
1892. Noott, Reginald Harry, M.B., C.M.Edin., Senior Assistant Medical
Officer, Broadmoor Criminal Lunatic Asylum, Crowthorne,
Wokingham.
1880. Norman, Conolly, F.R.C.P.I., Medical Superintendent, Richmond District
Asylum, Dublin, Ireland. (Hon. Secretary for Ireland , 1887*94.)
(President, 1895.) (Editor of Journal.)
1885. Oakshott, J. A., M.D., Medical Superintendent, District Asylum, Water¬
ford, Ireland.
1892. O’Mara, Dr., District Asylum, Limerick, Ireland.
1881. O’Meara, T. P., M.B., Medical Superintendent, District Asylum, Carlow,
Ireland.
1886. O’Neill, E. D., L.R.C.P.I., Medical Superintendent, The Asylum,
Limerick.
1897. Orange, Margaret, L.S.A.Lond., M.B.Brux., Assistant Medical Officer,
London County Council, Clayburv, Essex.
1868. Orange, William, M.D.Heidelb., F.R.C.P.Lond., C.B., The Bryn,
Godaiming, Surrey. ( President, 1883.)
1890. Oswald, Landel R., M.B., M.P.C., Medical Superintendent, City of Glas¬
gow District Asylum, Gartcosh, N.B.
1898. Parker, William Arnot, M.B., C.M., Gartlock Asylum, Gartcosh, N.B.
1898. Passmore, Edwin Stephen, M.D.Lond., M.R.C.P.Lond., London County
Asylum, Banstead, Sutton, Surrey.
1893. Paterson, Charles Edward, M.D.Edin., Arnold House, Famborough,
Hants.
1892. Patterson, Arthur Edward, M.B., C.M.Aberd., Senior Assistant Medical
Officer, City of London Asylum, Dartford.
1872. Patton, Alex., M.B., Resident Medical Superintendent, Farnham House,
Finglas, Co. Dublin.
* Paul, John Hayball, M.D.St. And,, M.R.C.P.Lond., F.R.C.P.Edin., Cam¬
berwell Terrace, London, S.E. (Emeritus Treasurer.)
1889. Peacock, H. G., L.R.C.P.Edin., M.R.C.S. and L.S.A.Lond., The Lawn,
Great Malvern; and Ash wood House Private Asylum, Kingswinford,
Staffs.
1873. Pedler, George H., L.R.C.P.Lond., M.R.C.S.Eng., 6, Trevor Terrace,
Knightsbridge, S.W.
1893. Perceval, Frank, M.R.C.S.Eng., L.R.C.P.Lond., Medical Superintendent,
County Asylum, Whittingham, Preston, Lancashire.
1874. Petit, Joseph, L.R.C.S.I., Medical Superintendent, District Asylum, Sligo.
1878. Philipps, Sutherland Rees, M.D., C.M.Queen*s Univ. Irel., F.R.G.S., St.
Anne's Heath, Chertsey.
Digitized by
Members of the Association . xvii
1875. Philipeon, George Hare, M.D. and M.A.Cantab., F.R.C.P.Lond., 7, Eldon
Square, Newcastle-on-Tyne.
1891. Pierce, Bedford, M.D.Lond., M.R.C.P., Medical Superintendent, The
Retreat, York.
1888. Pietersen, J. F. G., M.R.C.S., Ashwood House, Kingswinford, near
Dudley, Stafford.
1871. Pim, F., Esq., M.R.C.S.Eng., L.R.C.P.Irel., Medical Superintendent,
Palmerston, Cbapelizod, Co. Dublin, Ireland.
1898. Piper, Francis Pbrris, M.B.Lond., M.R.C.S., L.R.C.P., London County
Asylum, Claybury, Chigwell, Essex.
1890. Pitcairn, J. J., L.R.C.P., M.R.C.S., M.P.C., 1, Parkhurst Road, Hollo¬
way, N.
1896. Planck, Charles, M.R.C.S.Eng., L.R.C.P.Lond., M.A.Camb., Assistant
Medical Officer, East Sussex County Asylum, Haywards Heath.
1877. Plaxton, Joseph William, M.R.C.S., L.S.A.Eng., Lunatic Asylum,
Kingston, Jamaica.
1889. Pope, George Stevens, L.R.C.P. and L.R.C.S.Edin., L.F.P. and S.Glasg.,
Medical Superintendent, Middlesbrough Asylum, Cleveland, Yorks.
1876. Powell, Evan, M.R.C.S.Eng., L.S.A., Medical Superintendent, Borough
Lunatic Asylum, Nottingham.
1891. Price, Arthur, M.R.C.S., L.S.A., M.P.C.,Merriebank, Moss Lane, Aintree,
Liverpool.
1875. Pringle, H. T., M.D.Glasg., Medical Superintendent, Comity Asylum,
Bridgend, Glamorgan.
1894. Rambant, Daniel F., M.D.Univ. Dubl., Third Assistant Medical Officer
and Pathologist, Richmond District Asylum, Dublin.
1889. Raw, Nathan, M.D., M.P.C., Mill Road Infirmary, Liverpool.
1893. Rawes, William, M.B.Durh., F.R.C.S.Eng., Assistant Medical Officer, St.
Luke's Hospital, London.
1896. Ray, Matthew B., M.B., C.M.Edin., Admarsh, Park Avenue, Harrogate.
1870. Rayner, Henry, M.D.Aberd., M.R.C.P.Edin., 2, Harley Street, London,
W., and Upper Terrace House, Hampstead, London, N.W. (Presi¬
dent, 1884.) (Late General Secretary.) (Editor of Journal.)
1887. Reid, William, M.D., Physician Superintendent, Royal Asylum, Aberdeen.
1891. Renton, Robert, M.B., C.M.Edin., M.P.C., Montague Lawn, London
Road, Cheltenham.
1897. Renton, James Murray, M.A., M.B.Edin., Senior Assistant Medical
Officer, County Asylum, Chester.
1886. Revington, George, M.D, and Stewart Scholar Univ. Dubl., M.P.C.,
Medical Superintendent, Central Criminal Asylum, Dundrnm,
Ireland.
1897. Richard, William J., M.A., M.B., C.M.Glasg., Medical Officer, Govan
Parochial Asylum, Merryflats, Govan.
1889. Richards, Joseph Peeke, M.R.C.S., L.S.A., 6, Freeland Road, Ealing, W.
1893. Rivers, William H. Rivers, M.D.Lond., St. John's College, Cambridge.
1871. Robertson, Alexander, M.D.Edin., 11, Woodside Crescent, Glasgow.
1895. Robertson, William Ford, M.B., C.M., Scottish Asylums’ Laboratory,
12, Bristo Place, Edinburgh.
1887. Robertson, G. M., M.B., C.M., M.P.C., Medical Superintendent, Perth
District Asylum, Murthley.
1895. Robinson, George Burton, M.B., L.R.C.P., M.R.C.S., Spilsby, Lincoln¬
shire.
1876. Rogers, Edward Conlton, M.R.C.S.Eng., L.S.A., County Asylum, Ful-
bourn, Cambridge.
1859. Rogers, Thomas Lawes, M.D.St. And., M.R.C.P.Lond., M.R.C.S.Eng.,
Eastbank, Court Road, Eltham, Kent. (President, 1874.)
i
Digitized by {jOOQle
xviii Members of the Association .
1895. Rolleston, Lancelot W., M.B., B.S.Durh., Senior Assistant Medical
Officer, Middlesex County Asylum, Tooting, S.W.
1879. RonaldBon, J. B., L.R.C.P.Edin., Medical Officer, District Asylum, Had¬
dington.
1879. Roots, William H., M.R.C.S., Canbury House, Kingston-on-Thames.
1860. Rorie, James, M.D.Edin., L.R.C.S.Edin., Medical Superintendent, Royal
Asylum, Dundee. (Late Hon. Secretary for Scotland.)
1888. Ross, Chisholm, M.B.Edin., M.D.Sydney, Hospital for the Insane, Ken-
more, New South Wales.
1884. Rowe, E. L., L.R.C.P.Edin., Medical Superintendent, Borough Asylum,
Ipswich.
1883. Rowland, E. D., M.D., C.M.Edin., The Public Hospital, New Amsterdam,
British Guiana.
1877. Russell, A. P., M.B.Edin., The Lawn, Lincoln.
1883. Rnssell, F. J. R., L.R.C.P.Irel.
1892. Ruttledge, Victor, M.B., District Asylum, Londonderry, Ireland.
1866. Rutherford, James, M.D.Edin., F.R.C.P.Edin.,F.F.P.S.Glasgow, Physician
Superintendent, Crichton Royal Institution, Dumfries. (Hon. Secre-
tary for Scotland , 1876-86.)
1896. Rutherford, James M., M.B., C.M.Edin., Assistant Physician, Royal
Edinburgh Asylum, Morningside.
1887. Rutherford, W., M.D., Consulting Physician, Balliuasloe District Asylum,
Ireland.
1896. Rutherford, Robert Leonard, M.D., Medical Superintendent, Digby’s
Asylum, Exeter.
1889. Ruxton, William Leddington, M.D. and C.M., 8, Derwent Place, New-
castle-on-Tyne.
# Sankey, R. Heurtley H., M.R.C.S.Eng., Medical Superintendent, Oxford
County Asylum, Littlemore, Oxford.
1894. Sankey, Edward H. O., M.A., M.B., B.C.Cantab., Resident Medical
Licensee, Boreatton Park Licensed House, Baschurch, Salop.
1891. Saunders, Charles Edwards, M.D.Aberd., M.R.C.P.Lond., Medical Super¬
intendent, Haywards Heath Asylum, Sussex.
1873. Savage, G. H., M.D.Lond., 3, Henrietta Street, Cavendish Square, W.
(Late Editor of Journal.) (President, 1886.)
1894. Scanlan, William T. A., M.B., M.Ch., B.A.O.R.U.I., Assistant Medical
Officer, District Asylum, Cork.
1862. Schofield, Frank, M.D.St. And., M.R.C.S., Medical Superintendent, Cam¬
berwell House, Camberwell.
1896. Scott, James, M.B., C.M.Edin., Medical Officer, H.M. Prisons, Holloway
and Newgate ; 3, Parkhurst Road, Holloway, London, N.
1889. Scowcroft, Walter, M.R.C.S., Senior Assistant Medical Officer, Royal
Lunatic Hospital, Cheadle, near Manchester.
1880. Seccombe, George, L.R.C.P.L., The Colonial Lunatic Asylum, Port of
Spain, Trinidad, West Indies.
1879. Seed, William, M.B., C.M.Edin., The Poplars, 110, Waterloo Road,
Ashton-on-Ribble, Preston.
1889. Sells, Charles John, L.R.C.P., M.R.C.S., L.S.A., White Hall, Guildford.
1882. Seward, W. J., M.B.Lond., M.R.C.S., Medical Superintendent, Colney
Hatch, Middlesex.
1896. Shanahan, John Francis, L.R.C.P.I., L.R.C.S.I., 2, The Crescent,
Limerick.
1891. Shaw, John Custance, M.R.C.S.Eng., L.R.C.P.Lond., 233, Wightman
Road, Harringay, London, N.
1867. Shaw, Thomas C., M.D.Lond., F.U.C.P.Lond., Medical Superintendent,
London County Asylum, Banstead, Surrey.
Digitized by Google
Members of the Association. xix
1880. Shaw, James, M.D., 310, Kensington, Liverpool.
1881. Shaw, Harold B., B.A., M.B., B.B., D.P.H.Camb., Medical Superinten¬
dent, Isle of Wight County Asylum, Whitecroft, Newport, Isle of
Wight.
1882. Sheldon, T. S.» M.B., Medical Superintendent, Cheshire County Asylum.
Barkside, Macclesfield.
1898. Sherrard, David John, B.A., M.B., M.Ch.Dub., The Laurels, Hailsham,
Sussex.
1896. Sbortt, William Rushton, M.B., B.S.Durh., M.R.C.S., L.R.C.P.Lond.,
Assistant Medical Ofiicer, City Asylum, Gosforth, New castle-on -
Tyne.
1877. Shuttleworth, G. E., M.D.Heidelb., M.R.C.S. and L.S.A.Eng., B.A.Lond.,
late Medical Superintendent, Royal Albert Asylum, Lancaster;
Ancaster House, Richmond Hill, Surrey.
1895. Simpson, Francis Odell, M.R.C.S., L.R.C.P., Senior Assistant Medical
Officer, Hawk head Asylum, Crookston, N.B.
1889. Simpson, Samuel, M.B. and M.C.H.Dubl., M.P.C., St. Mark's Road,
Enfield.
1888. Sinclair, Eric, M.D., Medical Superintendent, Gladesville Asylum, New
South Wale*.
1870. Skae, C. H., M.D.Sfc. And., Medical Superintendent, Ayrshire District
Asylum, Glengal), Ayr.
1891. Skeen, James Humphrey, M.B., C.M.Aberd., Medical Superintendent,
Glasgow District Asylum, Bothwell.
1898. Skeen, William St. John, M.B., C.M., County Asylum, Winterton, Ferry-
hill, Durham.
1897. Smalley, Herbert, M.D.Dnrli., L.R.C.P., M.R.C.S., Prison Commission,
Home Office, Whitehall, S.W., and 1, Edinburgh Mansions, Victoria
Street, London, S.W.
1868. Smith, Robert, M.D.Aberd., L.R.C.S.Edin., Medical Superintendent,
County Asylum, Sedgefield, Durham.
1885. Smith, R. Percy, M.D., B.S., F.R.C.P., M.P.C., 36, Queen Anne Street,
Cavendish Square, W. ( General Secretary , 1896-7.)
1884. Smith, W. Beattie, F.R.C.S.Edin., L.R.C.P.Lond., Medical Superinten¬
dent, Hospital for the Insane, Ararat, Victoria.
1892. Smyth, W. Johnson, M.B.Edin., Durley Gardens, Bournemouth.
1881. Snell, George, M.D.Aberd., M.R.C.S.Eng., Medical Superintendent, Public
Lunatic Asylum, Berbice, British Guiana.
1885. Soutar, J. G., Barnwood House, Gloucester.
1875. Spence, J. Beveridge, M.D., M.C.Queen’s Univ., Medical Superintendent,
Burntwood Asylum, near Lichfield. (Registrar.)
1883. Spence, J. B., M.D., M.C., The Asylum, Colombo, Ceylon.
1898. Sproat, James Hugh, M.B.Lond., M.R.C.S., L.R.C.P., Somerset and Bath
Asylum, Wells.
1891. Stansfield, T. E. K., M.B., C.M.Edin., The Heath Asylum, Bexley, Kent.
1898. Steen, Robert H., M.D.Lond., West Sussex Asylum, near Chichester.
1868. Stewart, James, B.A.Queen’s Univ., F.R.C.P.Edin., L.R.C.S.Irel., late
Assistant Medical Officer, Kent County Asylum, Maidstone; Dun-
raurry, Sneyd Park, near Clifton, Gloucestershire.
1884. Stewart, Robert S., M.D., C.M., Assistant Medical Officer, County
Asylum, Glamorgan.
1887. Stewart, Rothsay C., M.R.C.S., Medical Superintendent, County Asylum,
Leicester.
1862. Stilwell, Henry, M.D.Edin., M.R.C.S.Eug., Moorcroft House, Hillingdon,
Middlesex.
1864. Stocker, Alonzo Henry, M.D.St. And., M.R.C.P.Lond., M.R.C.S.Eng.,
Medical Superintendent, Peckham House Asylum, Peckham.
Digitized by LjOOQle
xx Members of the Association .
1897. Stoddart, William Henry Batter, M.B., B.S.Lond., M.R.C.S.Eng.,
M.R.C.P.Lond., Pathologist, Lancaster County Asylum, Prestwich,
Manchester.
1881. Strahan, S. A. K., M.D., Assistant Medical Officer, County Asylum,
Berry wood, near Northampton.
1868. Strange, Arthur, M.D.Edin., Medical Superintendent, Salop and Mont¬
gomery Asylum, Bicton, near Shrewsbury.
1895. Strapp, Walter Russell, M.B., C.M., Avondlea, Aberfoyle, near Stir¬
ling, N.B.
1896. Straton, Charles Robert, F.R.C.S.Edin., Medical Visitor, Fisherton
House and Laverstock House, West Lodge, Wilton, Wilts.
1885. Street, C. T., M.R.C.S., L.R.C.P., Hay dock Lodge, Ashton, Newton-le-
Willows, Lancashire.
1897. Stuart, Robert, M.R.C.S., L.R.C.P.Lond., 20, New Elvet, Durham.
1886. SufferA, A. C., M.D., Medical Superintendent, Ruberry Hill Asylum,
near Bromsgrove, Worcestershire.
1894. Sullivan, W. C., M.D.R.U.I., Deputy Medical Officer, H.M. Prison,
Liverpool.
1898. Sutcliffe, John, M.R.C.S., L.R.C.P., Royal Asylum, Cheadle, near Man¬
chester.
1870. Sutherland, Henry, M.D.Oxon, M.R.C.P.Lond., 21, New Cavendish
Street, Portland Place, W.; Newlands House, Tooting Bee Road,
Tooting Common, S.W.; and Otto House, 47, Northeud Road,
West Kensington, W.
1895. Sutherland, John Francis, M.D.Edin., Deputy Commissioner in Lunacy,
4, Merchistou Bank Avenue, Edinburgh.
1868. Swain, Edward, M.R.C.S., Medical Superintendent, Three Counties’
Asylum, near Hitchin, Herts.
1877. Swanson, George J., M.D.Edin., Lawrence House, York.
1897. Tait, James Sinclair, M.D., L.R.C.P.Lond., L.R.C.S.Edin., Medical
Superintendent, Hospital for Insane, St. John’s, Newfoundland.
1857. Tate, William Barney, M.D.Aberd., M.R.C.P.Lond., M.R.C.S.Eng.,
Medical Superintendent of the Lunatic Hospital, The Coppice,
Nottingham.
1897. Taylor, Frederic Ryott Percival, M.D., B.S.Lond., M.R.C.S.Eng.,
L.R.C.P.Lond., Darenth Asylum, Dartford, Kent.
1890. Telford-Smith, Telford, M.A., M.D., Medical Superintendent, Royal
Albert Asylum, Lancaster.
1888. Thomas, E. G., Park House, Caterham, Surrey.
1880. Thomson, D. G., M.D., C.M., Medical Superintendent, County Asylum,
Thorpe, Norfolk.
1897. Thurman, William Rowland, M.B., B.S.Dunedin, Assistant Medical
Officer, City and County Asylum, Bristol.
1898. Todd, Percy Everald, M.B., Acting Medical Superintendent, Port Alfred
Asylum, Cape Colony, South Africa.
1896. Townsend, Arthur, M.R.C.S.Eng., L.R.C.P.Lond., Assistant Medical
Officer, Hospital for Insane, Barn wood House, Gloucester.
1888. Tuke, John Batty, junior, M.B., C.M., M.R.C.P.E., Resident Physician,
Saughton Hall, Edinburgh.
1881. Tuke, Charles Molesworth, M.R.C.S.E., Chiswick House, Chiswick.
1885. Tuke, T. Seymour, M.B., B.Ch.Oxford, M.R.C.S.E., Chiswick House,
Chiswick ; and 37, Albemarle Street, Piccadilly, W.
1877. Turnbull, Adam Robert, M.B., C.M.Edin., Medical Superintendent, Fife
and Kinross District Asylum, Cupar. (Hon. Secretary for Scotland.)
1896. Turner, Alan Charles, M.R.C.S.Eng., L.R.C.P.Loud., 79, Gordon Road,
Ealing.
Digitized by {jOOQle
Member* of the Associmtioiu xari
1889. Tamer, Alfred, M.D. and C.M., Assistant Medical Officer, West Riding
Asylum, Men*ton, Yorkshire.
1800. Turner, Jobn^M.H., C.M.Aberd., Senior Assistant Medical Officer, Essex
County Asylum.
1878. Urquhart, Alexr. Reid, M.D., F.R.C.P.E., Physician Superintendent*
James Murray's Royal Asylum, Perth. {Editor of Journal.) (Hon*
Secretary for Scotland t 1886-94.) (PRESIDENT.)
1894. Vincent, William James, M.B.Durh., Assistant Medical Officer, Borough
Asylum, Nottingham.
1876. Wade, Arthur Law, H.A., M.D.Dobl., Medical Superintendent, County
Asylum, Wells, Somerset.
1884. Walker, E. B. C., M.B., C.M.Edin., Assistant Medical Officer, Connty
Asylum, Haywards Heath.
1896. Walker, William F., L.R.C.S. and L.M.Edin., L.S.A.Lond., co-proprietor
and licensee. Home for Inebriates, Street Court, Kingsland, R.S.O.,
Herefordshire.
1898. Wall, Charles Percivale Bligh, M.B, Ch.B.Edin., District Asylum, Inver¬
ness. N.B.
1877. Wallace, James, M.D., Visiting Medical Officer, 16, Uniou Street,
Greenock.
1888. Walmsley, F. H., M.D., Medical Superintendent, Darenth Asylum, Dart-
ford, Kent.
1871. Ward, J. By water, B.A., M.D.Cuntab., M.R.C.S.Eng., 40, St. Giles's,
Oxford.
1880. Warnock, John, M.D., C.M., B.Sc., M.R.C.S., Sanitary Department,
Miuistry of Interior, Cairo, Egypt.
1897. Warren, Ernest Downing, L.R.C.P.Lond., M.R.C.S.Eng., Assistant
Medical Officer, Cumberland and Westmoreland Asylum, Garlands,
Carlisle.
1895. Waterson, Jane Elizabeth, M.D.Brussels, L.R.C.P.I., L.R.C.S.Edin.,
Official Visitor, Cape Town District Lunatic Asylums, Cape Town,
South Africa.
1801 Watson, George A., M.B., C.M.Ediu., M.P.C., Senior Assistant Medical
Officer, City Asylum, Birmingham.
1885 Watson, William Riddell, L.R.C.S. and L.R.C.P.Edin., Govan District
Asylum, Hawkhead, Paisley.
1898. Watson, William R. K., M.A., M.B., C.M., H.M. Prison, Holloway,
London, N.
1897. Watt, Neish Park, M.B., C.M.Edin., 1, Denham Green Terrace, Trinity
Road, Edinburgh.
1880. Weatherly, Lionel A., M.D., Bailbrook House, Bath.
1897. Welsh, Gilbert Aitken, M.B., C.M.Ediu., Assistant Physician, Crichton
Royal Institution, Dumfries.
1880. West, George Francis, L.R.C.P.Edin., Medical Superintendent, District
Asylum, Kilkenny, Ireland.
1872. Whitcorobe, Edmund Banks, M.R.C.S., Medical Superintendent, Winson
Green Asylum, Birmingham. (President, 1891.)
1897. White, A. T. O., M.R.C.S.Eng., L.R.C.P.Edin., Assistant Medical Officer,
Metropolitan Asylum, Darenth, Dartford, Kent.
1884. White, Ernest, M.B.Lond., M.R.C.P., City of London Asylum, Stone,
Dartford, Kent.
1889. Whitwell, James Richard, M.D. and C.M., Medical Superintendent,
Suffolk County Asylum, Melton Woodbridge.
1883. Wiggleswortli, J., M.D.Lond., Rainhill Asylum, Lancashire.
1895. Wilcox, Arthur William, M.B., C.M.Edin., Second Assistant Medical
Officer, County Asylum, Hatton, Warwick.
Digitized by LjOOQle
xxii
1887.
1862.
1890.
1896.
1895.
1897.
1875.
1897.
1869.
1894.
1878.
1885.
1877.
1898.
1862.
Members of the Association . .
Will, John Kennedy, M.B., C.M., M.P.C., Bethnal House, Cambridge
Hoad, E.
Williams, S. W. Duckworth, M.D.St. And., L.R.C.P.Lond., 76, Jermyn
Street, London, S.W.
Wilson, George R., M.B., C.M., M.P.C., Medical Superintendent, Mavis-
bank Asylum, Polton, Midlothian.
Wilson, Robert, M.B., C.M.Glasg., Nailsworth, Gloucestershire.
Wilson, James, M.A., M.B., C.M., Assistant Medical Officer, Wilts
County Asylum, Devizes.
Winder, W. H., M.R.C.S., L.R.C.P.Lond., D.P.H.Cantab., Deputy
Medical Officer, H.M. Convict Prison, Aylesbury.
Winslow, Henry Forbes, M.D.Lond., M.R.C.P.Lond., 14, York Place,
Portman Square, London.
Wiseman, David William, M.R.C.S.Eng., L.R.C.P.Lond., Assistant
Medical Officer, County Asylum, Melton, Suffolk.
Wood, T. Outterson, M.D., M.R.C.P.,Lond., F.R.C.P,, F.R.C.S.Edin.,
40, Margaret Street, Cavendish Square, W.
Wood, Guy Mills, M.B.Durh., Assistant Medical Officer, Couuty Asylum,
Barnhill, near Prescot, Lancashire.
Woods, Oscar T., M.B., M.D.Dubl., L.R.C.S.I., Medical Superintendent,
District Asylum, Cork. (Hon. Secretary for Ireland , 1897.)
Woods, J. F., M.R.C.S., Medical Superintendent, Hoxton House, N.
Worthington, Thomas Blair, M.A., M.B., and M.C.Trin. Coll., Dubl.,
Medical Supt., County Asylum, Knowle, Fareham, Hants.
Yeates, Thomas, M.B., C.M., Borough Asylum, Ryhope, Sunderland.
Yellow lees, David, M.D.Edin., F.F.P.S.Glasg., L.L.D., Physician
Superintendent, Royal Asylum, Gartnavel, Glasgow. (Presi¬
dent, 1890.)
Ordinary Members
Honorary Members
Corresponding Members
523
39
12
Total . 574
Members are particularly requested to send changes of address , etc., to Dr.
Robert Jones , the Honorary Secretary, 11, Chandos Street , Cavendish
Square , London , W. t and in duplicate to the Printers of the Journal ,
Messrs. Adlard and Son , 22J Bartholomew Close , London , M.C.
Digitized by
xxin
List of those who have passed the Examination for the Certificate of Efficiency
in Psychological Medicine, entitling them to append. M.P.C. (Med. Psych.
Certif.) to their names.
Adamson, .Robert 0.
Cooper, Alfred J. S.
Adkins, Percy.
Cope, George Patrick.
Ainley, Fred Shaw.
Conry, John.
Ainslie, William.
Corner, Harry.
Alexander, Edward H.
Cotton, William.
Anderson, John.
Couper, Sinclair.
Anderson, A. W.
Cowan, John J.
Anderson, Bruce Arnold.
Cowie, C. G.
Andrieson, W.
Cowie, George.
Armour, E. F.
Cowper, John.
Attegalle. J. W. S.
Cox, Walter H.
Aveline, H. T. S.
Craig, M.
Ballantyne, Harold S.
Cram, John.
Barbour, William.
Cross, Edward John.
Barker, Alfred James Glanville.
Cruickshank, George.
Bash ford, Ernest Francis.
Cullen, George M.
Begg, William.
Dalgetty, Arthur B.
Belben, F.
6 Dawson, W. R.
Bird, James Brown.
Davidson, William.
Blachford, J. Vincent.
DavidsoD, Andrew.
Black, Robert S.
De Silva, W. H.
Black, Victor.
Distin, Howard.
Blackwood, John.
Drummond, Russell J.
Blandford, Henry E.
Donald, Wm. D. D.
Bond, C. Hubert.
Donaldson, R. L. S.
Bond, R. St G. 8.
Donellan, James O’Conor.
Bowlan, Marcus M.
Douglas, A. R.
Boyd, James Paton.
Eames, Henry Martyn.
Bristowe, Hubert Carpenter.
Earls, James H.
Brodie, Robert C.
Easterbrook, Charles C.
Brough, C.
Eden, Richard A. S.
Bruce, John.
Edgerley, S.
Bruce, Lewis C.
Edwards, Alex. H.
Brush, S. C.
Elkins, Frank A.
Bullock, William.
Ellis, Clarence J.
Cameron, James.
English, Edgar.
Campbell, Allred W.
Eustace, J. N.
Campbell, Peter.
Eustace, Henry Marcus.
Calvert. William Dobree.
Evans,.P. C.
Carmichael, W. J.
Evan, John A.
Carrot her s, Samuel W.
Ezard, Ed. W.
Carter, Arthur W,
Farquharson, Wm. Fredk.
Chambers, James.
Fennings, A. A.
Chapman, H. C.
Ferguson, Robert.
Christie, William.
Findlay, G. Landsborougb,
Clarke, Robert H.
Fitzgerald, Gerald.
Clayton, Frank Herbert A.
Fraser, Thomas.
Clinch, Thomas Aldous.
Fraser, Donald Allan.
Coles, Richard A.
Frederick, Herbert John.
Collie, Frank Lang.
Fox, F. G. T.
Collier, Joseph Henry.
Gaudin, Francis Neel.
Conolly, Richard M.
Gawn, Ernest K.
Cook, William Stewart.
Gemmell, William.
Digitized by
xxiv
Genney, Fred. S.
Giles, A. B.
Gill, J. Macdonald.
Gilmonr, John R.
Goldie, E. M.
Goldschmidt, Oscar Bernard.
Goodall, Edwin.
Graham, F. B.
Graham, Dd. James.
Grainger, Thomas.
Grant, J. Wemyss.
Grant, Lacklan.
Gray, Alex. C. E.
Griffiths, Edward H.
Hall, Henry Baker.
Hoisted. H. C.
Hashtin, W. A.
Hassell, Gray.
Haslett, William John Handheld.
Hector, William.
Henderson, Jane B.
Henderson, 1*. J.
Hennan, George.
Hewat, Matthew L.
Hicks, John A., jun.
Hitching Robert.
Holmes, William.
Horton, James Henry.
Hotchkis, R. D.
How den, Robert.
Hughes, Robert.
Hutchinson, P. J.
2 Hyslop, Theo. B.
Ingram, Peter R.
Jagannadham, Annie W.
Johnston, John M.
Kelly, Francis.
Kelso, Alexander.
Kelson, W. H.
Ker, Claude B.
Kerr, Alexander L.
Keyt, Fred.
King, Frederick Truby.
King, David Barty.
Laing, J. H. W.
Laing, C. A. Barclay.
Law, Thomas Bryden.
Leeper, Richard R.
Leslie, R. Murray.
Livingstone, John.
Lloyd, R. H.
Low, Alexander.
Macdonald, David.
Macdonald, G. B. Douglas.
Macdonald, John.
McAllum, Stewart.
McGregor, George.
Macevoy, Henry John.
Mackenzie, Henry J.
Mackenzie, John Cumming.
Mackenzie, William L.
Mackenzie, William H.
Mackie, George.
Muclnnes, lan Lamont.
Macmillan, John.
Mocnaughton, Geo. W. F.
Macncece, J. G.
Macpherson, John.
Macvean, Donald H.
Mallannah, Sreenagula.
Marsh, Ernest L.
Martin, Wm. Lewis.
Masson, James.
Meikle, T. Gordon.
Melville, Henry B.
Middlemans, James.
Mitchell, Alexander.
Mitchell, Charles.
Moffett, Elizabeth J.
Monteith, Janies.
Moore, Edward Erskine.
1 Mortimer, John Desmond Ernest.
M orison, Cecil C.
Myers, J. W.
Nair, Charles R.
Nairn, Robert.
Neil, James.
Nixon, Johu Clarke.
Nolan, Michael James.
Norton, Everitt E.
Orr, David.
Orr, James.
Oswald, Laudtd R.
Paget, A. J. M.
Parker, William A.
Parry, Charles P.
Patterson, Arthur Edward.
Paul, William Moncrief.
Pearce, Walter.
Penfold, William James.
Philip, James Farquhar.
Philip, William Marshall.
Pieris, William C.
Pilkington, Frederick W.
Pitcairn, John James.
Porter, Charles.
Price, Arthur.
Pring, Horace Reginald.
Rainy, Harry, M.A.
Rannie, James.
4 Raw, Nathan.
Reid, Matthew A.
Renton, Robert.
Rice, P. J.
ltigden, Alan.
Ritchie, Thomas Morton.
Digitized by
XXV
Rivers, W. H. K.
3 Robertson, G. M.
Robson, Fredk. Wm. Hope.
Rose, Andrew.
Rowand, Andrew.
Rud&Ii, James Ferdinand.
Rust, James.
Rust, Montague.
Scott, George Brebner.
Scott, J. Walter.
Scott, William T.
Sheen, Alfred W.
Simpson, John.
Simpson, Samuel.
Skae, F. M. T.
Skeen, George.
Skeen, James H.
Slater, William Arnison.
Smith, Percy.
Smyth, William Johnson.
Snowball, Thomas.
Sou tar, James G.
Sproat, J. H.
Scanley, John Douglas.
Staveley, VVilliam Henry Charles.
Steel, John.
Stewart, William Day.
Stoddart, John.
Stoddart, William Hy. B.
Strangman, Lucia.
Strong, D. R. T.
Stunrt, William James.
Syraes, G. D.
Thompson. George Matthew.
Thomson, George Felix.
Thorpe, Arnold E.
Trotter, Robert Samuel.
Turner, W. A.
Umuey, W. F.
Walker, James.
Waterston, Jane Elizabeth.
Watson, George A.
Welsh, David A.
West, J. T.
Wickham, Gilbert Henry.
Whit well, Robert R. H.
Will, John Kennedy.
Williams, D. J.
Williamson, A. Maxwell.
Wilson, John T.
4 Wilson, G. R.
Wilson, James.
Wilson, Robert.
Wood, David James.
Yeoman, John B.
Yeates, Thomas.
Young, D. P.
Younger, Henry J.
Zimmer, Carlo Raymond.
1 To whom the Gaskell Prize (1887) was awarded.
2 To whom the Gaskell Prize (1889) was awarded.
3 To whom the Gaskell Prize 11890) was awarded.
4 To whom the Gaskell Prize (1892) was awarded.
5 To whom the Gaskell Prize (1895) was awarded.
6 To whom the Gaskell Prtze (1896) was awarded.
7 To whom the Gaskell Prize (1897) was awarded.
c
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Google
THE JOURNAL OP MENTAL SCIENCE.
[Published by Authority of the Medico-Psychological Association
of Great Britain and Ireland .]
No. 184. ^o 8 ^ 188 - JANUARY, 1898. Vol. XLIY.
PART I.—ORIGINAL ARTICLES.
Flechsig on the Localisation of Mental Processes in the Brain .
By W. W. Ireland, M.D.Edin.
Two Treatises* recently published contain the views of
Professor Flechsig, of Leipzig, upon the present state of onr
knowledge of brain function. The first is in the form of an
oration delivered in 1894 in the University Church of
Leipzig, of which a new edition appeared last year. The
second is a shorter pamphlet, which contains an account of
the most recent researches in the structure of the brain. In
the oration the notes occupy three times the space of the
text; in the other treatise the notes are not so long. In both
these notes are important, and form in some passages the
most interesting part of the work. He holds that the time
has now come when the old introspective psychology must
turn for guidance to anatomy and physiology. It is only
within the last few years that such claims could be enter¬
tained. The localisation of mental operations in the brain
was made by Hippocrates from observations of the loss of
function caused by diseases or wounds of the head. Polybos,
the son-in-law of the great Greek physician, held that the
brain was the centre of the nerves and the central organ of
the thinking soul; and Erasistratos, of Alexandria, first
taught that the superior intelligence of man depended upon
the greater size of the human brain, and the more compli¬
cated structure of the convolutions. A new era began with
the experiments of Fritsch and Hitzig in our own day.
Since then experimental physiology and clinical observations,
* Oehim end Seele , von Dr. Paul Flechsig, Professor der Psyohiatrie an der
Unlversitat, Leipzig. Verlag von Veit nnd Comp, 1896. Octavo, pp. 112.—
Die Localisation der Geistigen Vorgdnge insbesondere der Sinnesemp flndungen
des Mensehen, von Dr. Paul Flechsig. Leipzig, 1896. Post octavo, pp. 88.
XLIV. 1
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2
Flechsig on Localisation of Mental Processes , [Jan.,
going hand in hand together, have led to the accumulation
of a large fund of knowledge about the several functions of
the nervous centres. Another path of discovery was opened by
Golgi through his new method of differentiating the finer
structure of the grey masses of the brain by his silver colour¬
ings ; and also by Kolliker, who, working with low powers,
was able to demonstrate the course of the motor and sensory
nerve paths and of the association system in the brain.
Dr. Flechsig gives to Gall the credit of an incomparable
advance in brain physiology, as he showed that the convolu¬
tions of the brain formed the most important substratum of
mental activity. In my opinion this praise is little deserved.
What Gall did was to make a pretty comprehensive list of
the mental faculties and to locate them on all those portions
of the hemispheres under the outer surface of the skull,
wholly leaving out of consideration the gyri opposing one
another in the great longitudinal fissure, and also those
lying on the floor of the cranium. Gall, Spurzheim, the
Combes, and other preachers of phrenology kept up a noisy
and futile controversy which lasted for two generations, and
led many away from the truth. The only one of Gall’s
guesses which survived was the localisation of the orbital
part of the anterior lobe for the faculty of language, which
was put upon a scientific footing by Dax and Broca. Dr.
Flechsig observes that Goltz’s vivisection upon dogs went to
show that the extirpation of the cerebrum was followed by
the loss of all mental manifestations. The dogs which sur¬
vived removal of the hemispheres lost all memory and judg¬
ment, and were incapable of seeking out objects to gratify
their wants ; but they could still run about and hold them¬
selves upright. Under the stimulus of pressure, very bright
light, and loud noises, they executed movements which we
are accustomed to associate with discomfort and pain. A
dog thus mutilated bites and howls when lifted up in the
air, and when kept without food the whole body appears in
unmistakable disquiet. After being fed he falls into a state
of rest and apparent satisfaction, continuing in what appears
to be a dreamless sleep till aroused by new stimulation.
These observations show clearly the power and independence
of the bodily impulses; they teach us that many actions
have absolutely nothing to do with the mind. Many of such
observations hold good for the human species. Take the
case of the new-born child; he comes into the world with a
brain quite immature. The axis-cylinders of the nerve
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3
1898.] by W. W. Ireland, M.D.
fibres have scarcely formed, and the chemical structure ot
his brain is different from that of the adult, yet the animal
impulses show themselves with the first breath, and through
his cries he seeks the gratification of his wants which are
those needful to sustain life. When such wants are ap¬
peased, and he is left undisturbed, the outward manifesta¬
tions of consciousness are suspended. The feelings of
hunger and thirst in the infant do not appear to differ much
from the need of respiration excited by chemical alterations
in the blood acting upon the medulla oblongata. Dr. Flechsig
observes that only one-third of the human brain stands in
direct relation with the nerve-tracts which convey the
excitations of the periphery of the body to the grey matter,
the seat of consciousness, or which conducts the returning
impulses to the muscles, enabling the mind to direct volun¬
tary movements. The other portions of the brain have to
do with the operations of the intelligence and will. In the
study of the histological development of the infant’s brain
Dr. Flechsig find9 the key to the evolution of the mental
faculties. He assumes that the nerve-tracts do not exercise
their functions until the axis-bands are formed, and these
are developed independently in different parts of the nerve
centres. These tracts, known to be the paths of conduction
of the senses, first show the axis-band. To make this plain
we must translate several of Dr. Flechsig’s pages, principally
from the smaller and newer treatise upon cerebral localisa¬
tion. The author remarks that he is unable to make his
views clear without illustrations, of which there are several
beautiful coloured lithographs at the end of the Oration.
Of these the first three plates show sections of the brains
of new-born and young children. The next two plates
give a diagrammatic representation of the sensory and
motor areas of the brain, the paths of conduction and the
association centres. We reproduce all the engravings in
the smaller treatise, only altering the German names for
their Latin or English equivalents, and must refer our
readers to the original works for the coloured plates.
One of the chief achievements in workingout the anatomy of
localisation of the brain functions is the complete demonstra¬
tion of the paths of sensory conduction from their entry into
the eucephalon to their termination in the cortex. These paths
of sensory conduction of all the fibres in the white substance
of the brain are the first to appear in a matured condition,
that is showing axis-bands. In the brain of the foetus and
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4 Flechsig on Localisation of Mental Processes , [Jan.,
of the new-born child these tracts appear quite isolated.
One can easily distinguish their course and the areas of the
cortex with which they come into connection. These
observations derive confirmation from Turk’s methods of
observation, which consist in tracing downwards the
secondary degenerations following upon local inflammation
of the central area of the brain. We here give a sketch of
what is known of the spinal paths of sensory conduction.
1. The Posterior Roots of the Spinal Cord .—The first sen¬
sory paths of conduction appear in the posterior roots of the
spinal cords and the oblongata. In the white substance ot
the brain the first mature nerve fibres are exclusively pro¬
longations of these posterior roots.
The posterior roots are the conductors of those organic
sensations which do not depend upon the sympathetic, and
also of the impressions transmitted from the skin, those of
touch and temperature. For a long time clinical medicine
was not able to make out from the study of inflammations in
the cortex what areas were connected with sensory and
organic sensations. There is an important observation
mentioned in all the text-books of the connection of the
inner capsule with derangements of sensibility, which goes
by the title of Turk’s hemianaesthesia. This form of disease
occurs in two principal forms, a simple, and a complicated
one. In the simple form there is a suspension of the
sensibility and the organic feelings connected with the motor
approaches, the so-called muscular sense and the feeling of
pain in all outer parts of one half of the whole body,
including the cavity of the mouth and the sexual organs.
The sensibility of the abdominal viscera to pressure is
generally maintained, because these organs, reaching into
the middle line, have relations with both sides of the brain.
As Turk observed, and Charcot particularly investigated,
these symptoms are frequently accompanied by anaesthesias
of the higher senses, deafness or difficulty of hearing in one
ear, hemiopia, loss of taste and smell on one side. The
simple form of Turk’s hemianaesthesia, in which only the
functions of the posterior of the spinal cord are suspended,
is observed to follow lesions of the posterior portion of the
inner capsule, or the neighbouring foot of the corona
radiator. This forms a part of the carrefour sensitif of
Charcot. It is worthy of note that from injury to no other
region of the cortex does there follow so lasting and so deep
a hemianaesthesia of the posterior roots as from injury to
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1898 .]
by W. W. Ireland, M.D.
5
the said part of the inner capsnle. Well, in studying the
history of the development of the nervous system we find
that the inner capsnle is precisely the portion of the brain in
which we first recognise fibres with axis cylinders in the
foetal brain. This can be very clearly demonstrated. In the
course of development the strand of conduction separates
into three systems of fibres of the inner capsule. I have
named these No. 1, No. 2, and No. 3 (compare Figures
1 - 8 ).
A. The Sensory System , No. 1.—This occupies the upper half
of the inner capsule close behind the area of the pyramidal
path. It contains fibres with axis-cylinders developed about
the beginning of the ninth month of foetal life. Taking
with it the bulk of the fibres of the basal portions* of the
lateral nucleus of the thalamus as well as fibres from the
shell-like corpuscle, corpus testaceum, and from the fillet,
this sensory tract runs into the grey matter of the median
gyri which thus of all the cortex first receives excitations
from the periphery of the body. This tract forms a flat
strand of nerve fibres; its cross section through the medul¬
lary substance of the temporal lobe is indicated by a line
running from before backward (1 1' 1" Fig. 1.8). A small
bundle appears to go to the under part of the radiating
optic fibres (1 x ). Whether this offshoot of System No. 1
goes to the visual sphere cannot be certainly made out; in
any case we do not find fibres with the axis-band in any part
of the temporal lobe at this stage of development, whilst in
the optic tract single bundles containing axis-bands may be
found in the basal part of the posterior brain (externally to
and below the posterior cornu). These fibres may be fol¬
lowed nearly to the hinder portion of the lateral nucleus (L.
K. x Fig. 1).
B. System , No. 2.—About a month later than in No. 1
there is observed in the inner capsule a second tract of nerve
fibres which also grows out of the lateral nucleus of the
optic thalamus, but more behind (compare Fig. 2) than No.
1, which last issues out of the basal part of the optic
thalamus. This second tract of fibres passes into the
centrum ovale to the same regions of the cortex as No. 1.,
i.e. } the lobulus paracentralis and the foot of the first
frontal convolution; another portion of this tract takes a
sharp turn (2, 2, 2,) inwards and comes into connection with
nearly the whole length of the gyrus fornicatus. The
posterior bundles (2, Fig. 1) enter the cingulum and run
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6 Flechsig on Localisation of Mental Processes, [Jan.,
towards the hippocampus major. About the time of
maturity these said fibres, which issue from the upper and
anterior rim of the inner capsule, are accompanied by
another band which issues from the basal side, enters the
gyrus circinatus (2'") and finally reaches the pes hippocampi
so that the whole lobus limbicus is connected with the
lateral nucleus of the optic thalamus. The bundles of
fibres which pass to the first frontal gyrus seem to come
from the median centre (Luys) of the thalamus.
C. System , No. 3.—At a period varying from one to several
months after birth there is to be found in the inner capsule
a third system of fibres with axis-bands, which comes into
connection with the lateral nucleus of the thalamus. This
band of fibres passes from the anterior part of the lateral
nucleus in the middle of the capsule; one portion of it goes
directly to the foot of the third convolution ; another por¬
tion takes sharp curves to reach the cortex. JSome hundreds
of these last mentioned fibres run forward from the neigh¬
bourhood of the pyramidal path into the fasciculus sub-
callosus, and mount at the anterior rim of the corpus
striatum to the third frontal gyrus (3'); a second group
runs through the anterior part of the inner capsule into the
frontal lobe almost mounting to the vortex; it then wheels
round so that some of the fibres reach the middle of the
gyrus fornicatus (3); others reach the anterior half of the
first frontal (3"), and others reach the foot of the second
frontal gyrus.
All the ascending paths of nerve conduction which are
continuations of the posterior roots of the spinal cord pass
into the lateral nucleus of the optic thalamus, namely the
chief part of the fillet strand (compare Table 2), the upper
peduncle of the cerebellum (compare Table, Pig. 2 B), the
posterior and lateral columns, and the longitudinal bundle
of the formatio reticulares (compare Table, Pig. 2).
The fillet strand enters the ventral and posterior portion
of the lateral nucleus, especially the posterior half of the
ventral group of nuclei of Monakow; the basal bundles go
direct into the inner capsule. The lateral nucleus of the
thalamus, in my opinion, is also a gathering point in the
course of the posterior to the cortex cerebri. Here lies
everything together which goes from the thalamus to the
cortex as well as the strands which do not end here. What
remains over passes into the area which I have named the
corpus testaceum (Schalenformiger Korper), and the median
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7
1898,] by W. W. Ireland, M.D.
centre of Luys. The rest of the thalamas has nothing to do
with the sensory paths of the posterior roots.
These results, gained from a study of development, are
confirmed by pathological anatomy. In a case, which had
lasted fifty years, of softening of both central convolutions,
especially the posterior one, which had completely dis¬
appeared, there was found secondary degeneration of the
upper crus cerebelli, the fillet strand, and the formatio
reticularis. Besides the corpus, testaceum, the lateral
nucleus of the thalamus was visible, and especially at the
places from which the foetal System No. 1 arises. There
was degeneration of the whole ganglion cells, so that patho¬
logy and the history of development agree in showing that
the central gyri are related in part directly, but mainly
indirectly, with the sensory nuclei of the posterior and lateral
columns of the spinal cord. Destruction of the central gyri
is often accompanied by loss of the kinsesthetic perceptions,
so that the sense of situation and of the accomplished move¬
ments for the extremities and the mouth are deficient or
entirely wanting.
In the akin, especially after small localised inflammations,
there is a loss of the feeling of lighter contact and of the
knowledge of the locality touched. As a result of injury of
the arm region of the cortex, the middle of the central gyri,
there is an incapacity to recognise the form of outward
objects by touch.
Wernicke has shown that injury to the third frontal
gyrus is followed by an incapacity to execute, or rather to
recognise, the situation of the organs used in speech. The
System No. 3, already described as leading to the third, and
perhaps also to the first frontal gyrus, is distinguished from
the sensory paths of the median convolutions not by a con¬
nection with the cutaneous sensories, but with the deeper
{ >art8 of the body. The new-born child makes use of his
imbs, lips, and tongue before he can co-ordinate the
muscles of the trunk and the apparatus of voice. Accord¬
ingly we find that the sensory and motor nerve paths to the
extremities are more early developed than those for the
trunk and the special organs of speech.
The gyrus hippo-campi has been regarded as the terminal
station for the muscular sense; but a careful study of the
clinical cases has shown that this convolution has never
been affected without the inner capsule and thalamus also
showing lesions; besides Couty, an excellent observer, has
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8 Flechsig on Localisation oj Mental Processes , [Jan.,
shown that in lesions of the deeper part of the inner capsule
(in which System No. 1 comes in), disturbances of the
kinsesthetic feelings have been observed.
No pure case of disease of the whole gyrus limbicus (gyrus
fornicatus and hippo-campi) has been published. In a case
reported by Saville there was total loss of sensibility on the
opposite side, which soon passed away. Ferrier, Horsley,
and Schaffer are all agreed that destruction of the gyrus
limbicus in monkeys is followed by marked and persistent
anaesthesia to the stimuli of touch and pain; thus the gyrus
limbicus would be the terminal station of the conducting
path for the impression of touch and temperature and
common sensation, not for the whole conducting fibres, but
for a considerable part of them which end in the central and
frontal convolutions. To this region of the cortex, to which
we trace the termination of the posterior roots of the spinal
cord, Munk has given the name of sphere of bodily feeling
(Korpersfiihlsphare). This area, no doubt, contains a
number of sensory centres of different kinds, among which
the touch sphere is of special importance; but we must hold
in mind that the perception of touch demands the simul¬
taneous exercise of different qualities of sensations. This
sphere of bodily feeling is not exclusively connected with
sensory conducting tracts; it forms the starting-point of
numerous motor paths which lead in a centrifugal direction.
One group of these issues from the brain by the crus
cerebri; another is connected with the lower centres through
the thalamus and the tegmentum. The nerve tracts belong¬
ing to this sphere of bodily sensation form about four-fifths
of the diameter of the crus cerebri, including millions of
nerve fibres. In their development they show an arrange¬
ment similar to that of the sensory system in the inner
capsule. The pyramidal path in System No. 1 is the
only direct conducting tract from the cortex to the cells of
origin of the motor nerves coming from the bulb and
spinal cord.
Whether there is a motor tract corresponding with
System No. 2 our knowledge of anatomy and development
does not yet enable us to say.
Most of the paths which lead from the sphere of bodily
sensation pass into a region which cannot be shown to
stand in a relation to the posterior roots of the cord. These
are known in the older nomenclature as the inner nucleus
and the pulvinar. Dr. Flechsig, in conjunction with
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1898.] by W. W. Ireland, M.D.
Tschisch, named this the chief nucleus (Hauptkern ); he
now proposes as a more handy term the dorso-median
nuclear group (dorso-medial Kern-gruppe). This group
occupies the whole thalamus with the exception of the
lateral nucleus, the corpus testaceum, and the median centre,
as well as that structure which the learned professor has
designated as the ventro-lateral nucleus group. It seems
probable that cortico-petal fibres lead into this ventro-lateral
group while centrifugal fibres pass into the dorso-median
group; however, it is difficult to separate those two groups
of nuclei in dorsal and fore region of the thalamus. Each
part of the dorso-median groups of nuclei is connected with
one particular region of the cortex; the anterior nucleus
with the lobus limbicus with the cornu ammonis through
the fornix with the corpus mammilare and the bundle of
Yicq d*Azyr; the inner nucleus in its outer dorsal part is
connected with the median gyri, and on the inner part with
the foot of the collective frontal gyri and the corpus
striatum. The pulvinar has nothing to do with the
spheres of bodily sensation : it is exclusively connected with
the visual area and perhaps with the auditory one.
The significance of these anatomical details would be
clearer if we could fully demonstrate all the peripheral con¬
nections of the dorso-median nucleus group of the thalamus.
Within the sphere of bodily feeling are included the motor
regions of the cortex.
It would appear from the experiments of Horsley and
Beevor on the cortex and internal capsule of the orang¬
outang that only those tracts answer to electric stimulation
which lead to the crus cerebri, the paths of voluntary
motion. This sphere of bodily feeling has also relations
with the respiratory muscles, including those of the abdomen
and to the circulating system comprising the pulse beat, the
dilatation and contraction of the vessels, and the regulation
of the bodily temperature. It is to be presumed that in the
cortico-petal path of the sphere of sensation there are paths
of conduction which convey to the reach of consciousness
organic sensations from every part of the body, feelings of
thirst and of well-being, and changes in the respiration and
circulation as well as the state of contraction of all the
voluntary muscles. Dr. Flechsig considers it likely that
this sphere of sensation has to do with the increase or
diminution of muscular motions attending the expression of
the affections and passions, but he feels unable to indicate
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10 Flechsig on Localisation of Mental Processes , [Jan.,
by what paths these mnscnlar innervations are conveyed
from the cortex to the optic thalamus.
2. The Olfactory Nerve .—According to Edinger the sense
of smell is first manifested in the vertebrate animals. This
does not answer the expected correspondence between the
ontogeny and phylogeny of man, for in man the nerves of
common sensation become developed before the nerves of
smell, and the nerves of smell before those of vision. The
olfactory tract contains axis-bands about the end of the
ninth month. The frontal part is developed more easily
than the posterior part. The olfactory tract is directly con¬
nected from all parts with the cornu ammonis, which has,
no doubt, something to do with the perception of smell.
Besides this the olfactory sphere has connections with the
globus pallidus of the nucleus lenticularis, and with the
thalamus. Perhaps they furnish cortifugal reflex paths.
The author is unable to indicate the locality of the sphere
of taste; he thinks it should be sought for at the edge of
the sphere of bodily sensation or of the olfactory sphere.
8. The Optic Nerve shows fibres with the axis-cylinder in
the middle of the tenth month. At this period fibres may
be traced directly from the outer corpus geniculatum ex¬
ternum, and thence to the anterior corpus quadrigeminum.
Prom the corpus geniculatum externum a large bundle goes
to the pulvinar of the thalamus, which might appear to be a
direct continuation of the optic tract. This bundle reaches
the cortex of the calcarine fissure; it can be very easily
shown in the brain of the new-born child as a strand, with
axis-cylinders passing into the occipital lobe.
In the foetus the axis-bands are first developed in connec¬
tion with the macula lutea. In the child born at eight
months the axis-band fibres are not complete, but at nine
months the eye is mature for vision. Prom observations
upon a foetal brain the professor is inclined to think that it
is only the fibres of the macula Intea which are in direct
connection with the outer geniculate body, and that it is
the peripheral fibres of the retina which go directly to the
anterior corpus quadrigeminum and to the thalamus.
Gratiolet’s optic tract contains within its circuit many
fibres which have other functions than those of vision. Dr.
Flechsig holds that the visual sphere embraces the whole
inner mesial surface of the occipital lobe and a narrow zone
on its convex aspect in the region of the first occipital
gyrus up to the parieto-occipital fissure. It is even ques-
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11
1898.] by W. W. Ireland, M.D.
tionable whether all parts in this area subserve visual per¬
ception. These anatomical data, gained through the study
of development, are confirmed by the critical examination of
secondary degenerations. Softening which exclusively affects
the region of the calcarine fissure is followed by degenera¬
tion of the fibres of the occipital lobe and of the thalamus
to the anterior corpus quadrigeminum. The corpus genicu-
latum externum can be found degenerated in all its parts.
The pulvinar shows a partial degeneration. The degenera¬
tion is more extensive the more the primary lesion affects
the part of the visual sphere behind the calcarine fissure.
Dr. Flechsig holds that the gyrus angularis has nothing to
do with vision.
4. The Auditory Nerve .—The fibres of the auditory tract
are developed last of all the sensory nerves, though they
afterwards take the highest place in the intellectual and
emotional life of man. The nervus cochlearis through the
lateral fillet and a few fibres of the fomatio reticularis con¬
nects itself with the lower corpus quadrigeminum and the
inner corpus geniculatum to reach the temporal lobe. The
path of the auditory nerve from the cochlea to the cortex
has now been clearly made out. Clinical observation has
shown that a defined region of the temporal lobe is in
intimate relation with hearing. Sensory aphasia, or the
perceptive form of word deafness, is dependent upon the
lesions of the first temporal gyrus coming from before back¬
wards. Nannyn has more strictly defined this auditory
area as embracing the third and fourth fifth of the superior
temporal gyrus counting from before backwards. Monakow
has recently shown that destruction of this part is followed
by degeneration of the inner corpus geniculatum through
its whole extent. It has been found in the two months*
child that the fibres appear in the inner corpus geniculatum
sooner than in any other parts of the occipital lobe, from
which it is inferred that it is those two hitherto neglected
cross gyri of the temporal lobe which form the auditory
sphere, especially the anterior cross convolution (see Plate,
Fig. I.). Both these cross convolutions lie hid in the depth
of the Sylvian fossa, but they are connected with the first
temporo-sphenoidal, of which they indeed form the roots.
They lie between the posterior rim of the insula and the
free outward part of the first temporal. In all observed
cases of complete deafness following destruction of the
cortex in both sides, the area of these cross convolutions
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Google
12 Flechsig on Localisation of Mental Processes, [Jan.,
was found injured on both sides, and also iu cases of one¬
sided deafness or difficulty of hearing there were found
abscesses on one side or injury to the nerve fibres radiating
from the same region. Dr. Flechsig also describes a special
motor system of nerve fibres connected with the auditory
sphere which passes down to the outer bundle of the crus
cerebri.
The nervus vestibularis does not appear to be connected
with the auditory sphere of the temporal lobe. It can be
traced to the posterior roots of the oblongata, so that its
terminal station may be looked for in the sphere of bodily
sensation.
Feelings Not Localised.
Besides these definite sensory perceptions there are vague
feelings, such as general unrest, following on the over¬
charging of the blood with carbonic acid, changes in the
calibre of the vessels, the sexual impulses, and feelings of
tension, and general distress, which cannot be localised in
precise areas of the nervous centres. Dr. Flechsig observes
that the axis-bands are found developed in the motor
regions of the spinal cord, the antero-lateral columns, at a
period of foetal life when the posterior roots are still in an
embryonic condition. In this respect there is a remarkable
difference between the cortex cerebri and the medulla
oblongata. In the grey matter of the brain the motor areas
come to mature development, without exception, after the
sensory areas. But though the motor columns of the cord
are ready to take on their function, it does not appear what
function they could perform while beyond the reach of out¬
ward excitation and central impulse. From observation on
monstrosities, born without the higher portions of the
brain, and from extirpations in animals, we may infer that
some dull feelings are manifested in the lower ganglia and
bulb; but for the waking consciousness and the arrange¬
ment of our sensations in space and time we are dependent
upon the grey matter of the brain.
Dr. Flechsig holds that the exercise of the senses is abso¬
lutely dependent upon these defined areas of the cortex.
Patients in whom the visual areas are destroyed are abso¬
lutely blind; patients after destruction of the auditory
sphere on both sides are absolutely deaf. There is no
functional substitution of these sensory perceptions to any
other portion of the brain. The specific energies of the
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1898.] by W. W. Ibkland, M.D.
special senses are only realised through the centres in the
grey matter of the brain. Here it may be asked, with so
decided a difference of function, can there be recognised
any difference in structure? Dr. Flechsig replies that in
the sensory spheres there is a characteristic difference both
in the form and arrangement of the nervous elements. A
practised observer, he says, can distinguish between a
microscopic section, from the gyrus fornicatus from the
visual area, the visual auditory and other sensory spheres,
as well as between a piece of the liver and the kidney. In
the gyrus fornicatus there is a special form of cell (the large
spindle cell of Branca), which he has never found in any
other part of the cortex. The sensory spheres are also
distinguished by greater richness in the tangential cortical
associating fibres to such an extent that on the surface of
the gyrus circinatus in the sphere of bodily sensation the
tangential fibre layer, and deeper down, a layer of white
nervous fibres is observable to the naked eye. Dr. Flechsig
observes that the optic tract, in the outer geniculate body,
has a peculiar structure. It has granular layers, which are
similar to those of the retina. Indeed the layers of the
whole cortex have a resemblance to the structure of the
layers in the retina. This supports the view, which I have
suggested, that the retina is really a portion of the brain in
which visual images may be realised. This view is
strengthened by the history of its development. In the grey
matter of the brain the visual sphere is the most complicated
in structure; here Meynert counts eight layers, while the
olfactory area has the fewest layers.
In support of these striking statements Dr. Flechsig has
to combat the remark of Kolliker that the differences
observed in the size, number, and situation of the pyramidal
cells and the abundance and distribution of the nerve fibres
with and without axis bands, are of little significance. He
insists that this judgment is not borne out even by Kolliker’s
own book. He also blames Golgi for asserting that parts of
the cortex having different functions show throughout the
same structure. The Professor observes that the Italian his¬
tologist lays too much stress upon his method of staining
preparations, and that if he had used aniline dyes he would
not have denied the distinctive character of the giant cells of
the central convolutions. It may be here observed that Dr.
Flechsig uses his notes not only to explain his text by
farther details, but to keep up a fusillade of controversy
Digitized by L^ooQle
14 Flechsig on Localisation of Mental Processes , [Jan.,
against other neurologists. To reproduce these disputes
would take up too much space ou this occasion. Only about
a third of the human brain stands in direct relation to the
conducting paths which bring the impressions of the senses
within consciousness and carry motor impulses to the muscles.
Two-thirds of the brain hare nothing directly to do with
those operations; they have a higher office to perform. They
are the regions of intellectual activity, the Think-Organs
(Denkorgane). This region of the brain comprises the whole
frontal lobe except a part of the third gyrus, the insula, the
first and second parietal, the second and third temporal con¬
volutions, except the inner polus temporalis, the occipito¬
temporal gyri, the second or third occipital, and almost the
whole precuneus (see Plate, Fig. 1 and 2, the areas not
dotted). All these convolutions mature later than the sen¬
sory spheres. Amonth afterbirth the Think-organs are imma¬
ture, their fibres without the axis-cylinder, while the tissues
of the sensory areas have fully developed quite independently
of one another. Even in the third month these areas show
such a poverty in the axis-cylinders that they can be easily
distinguished from the other areas. Soon appear number¬
less associated fibres running from the other centres and con¬
necting all parts of the brain together. Dr. Flechsig thinks
that the ganglion cells of this mental region are the central
organs for the association of ideas. The sphere of bodily
sensation is much richer in association systems than the
other sensory regions. The auditory and visual areas are
only directly connected with the adjoining convolutions, but
do not send any association paths, at least these are few.
Thus each of these sensory spheres has a border zone of con¬
nection. In addition to this the sphere of bodily sensation
sends numerous long bands of nerve fibres into the middle of
the great association centres, especially a large one to the
posterior one (see Fig. 1), that is to the outer surface and
base of the temporal lobe. This band is distinguished from
all others by its late development. It has probably to do
with the voluntary or affective impulses of the mental con¬
ceptions. It is partly covered in by the fasciculus arcuatus,
as Meynert has represented. The central convolutions are
connected before with the frontal region, below with the
insula, and sends association fibres into the sensation sphere,
so that the central neurone of the association centres is closely
connected with the border zones of the sensory spheres (see
Plate, Fig. 1). The posterior and frontal mental centres
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15
1898.] by W. W. Ireland, M.D.
seem mainly to keep tip connection one with another through
the sensation sphere. Indeed, when we think of it, the rea¬
lisation of impressions from all parts of the body is of
supreme importance. It is the necessary prelude for the
formation of the conception of the Ego, and is the only
wholly indispensable condition for mental development, to
which the other senses contribute without being absolutely
requisite for the formation of a personality.
Man owes his mental superiority not only to the larger
mass and surface of his brain, but also to his great posterior
association centres, which enable him to associate all his
conceptions with words, and then to clothe them in words.
His capacity to utter these words rests upon the larger
development of his third temporal gyrus, and also of a part
of the sensation sphere, which last is not nearly so well
developed even in the highest apes. How far the strong
development of the frontal association centre contributes to
the mental superiority of man will be appreciated when we
better succeed in tracing the connections of this portion of
the brain. It is to be noted that the capacity to combine
the attention with personal motives for the regulation of
conduct is generally lost in double-sided disease of the frontal
lobes.* In disease of the association system lies the special
cause of insanity. We find the association fibres altered in
those mental derangements, the nature of which is clearest
to us because the microscope, cell by cell, fibre by fibre, dis¬
plays clearly the underlying alterations, and thus we can
show what are the consequences for mental life when these
tissues are more or less disorganised. The thoughts whirl
through one another, the mind fashions strange images when
stirred by the irritation of disease, and when morbid pro¬
cesses go farther the person loses the capacity to make use
of the past and to foresee the consequences of his actions.
These tissues are the chief bearers of what we call appre¬
hension, knowledge, and experience, of what we call prin¬
ciples and the higher feelings, and in part also of speech,
and all these capacities are swept away with one stroke, if
through some intoxicating agent, the mental centres are
deprived of their excitability.
* Ffochtig observes that the height of the forehead depends partly upon the
sise of the sensation sphere, and this in its turn upon the sise of the body.
Thus the height of the forehead is no direct measure of the mental powers.
The most important part of the brain for great mental performance seems to
lie in the posterior regions.
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16 Flechsig on Localisation of Mental Processes , [Jan.,
It was Tuczek who in his monograph on Dementia
Paralytica first showed the importance of the alterations in
the nerve fibres in this disease. Of all forms of mental
derangement general paralysis is the most instructive in
showing the dependence of morbid mental manifestations
upon brain lesions. In some cases the derangement is
purely intellectual; another patient has the most senseless
delusions of grandeur, with maniacal excitement; another is
troubled by deep melancholia or hypochondria; another is
the victim of fixed systematised delusions of persecution;
other patients are visited by hallucinations, or circular
insanity, or are simply affected by progressive indolence and
want of judgment. These varying symptoms are no doubt
partly dependent upon bom constitutional proclivities, and
also upon the exciting causes which have brought the
disease to a head, syphilis, or mental excitement, or drunken¬
ness; for the most part, however, these variations in the
clinical symptoms depend upon a lesser or greater power of
resistance in different parts of the brain, so that the dis¬
appearance or dissolution of numerous nerve fibres, and
occasionally, too, of nerve cells, is greater or less in different
regions of the brain. Sometimes the dissolution of the nerve
fibres affects the association centres of the fore brain, of the
insula, or of the hind brain. Professor Flechsig thinks
that the variations in the mental symptoms may thus be
explained. He regards the disappearance of the association
fibres as the essential lesion of general paralysis. Other
lesions, such as the inflammation of the membranes, the
extension of the inflammation of the substance of the brain
to the medulla and the hydrocephalus internus and externus
he regards as more or less incidental.
In some cases Professor Flechsig thinks that he has
succeeded in separating the simple affection of the associa¬
tion fibres from these complications, and has thus been able
to observe a group of symptoms which may be regarded as
the result of the deranged activity of the frontal lobes.
The patient loses a proper sense of his own personality;
confounds me and thee, mine and thine; cannot distinguish
the false from the true, and is prone to yield to his affections
and passions. In the end dementia supervenes, when he
loses the sense of what he has been, and of what he is.
The preceding resume does not exhaust the interesting
observations made by Professor Flechsig. With great
Digitized by
Google
JOURNAL OF MENTAL SCIENCE
JANUARY, 1898.
FIGURES ILLUSTRATING PROFESSOR FLECHSIG’S WORK.
Digitized by
JOURNAL OF MENTAL SCIENCE, JANUARY, 1898.
Fig. 1.—Sagittal Section op the Brain.
Here are delineated only the course of those fibres of the optic thalamus
which lead towards the cortex. The cortico-fugal conducting fibres of the
dorso-median group of the nuclei of the optic thalamus, the motor tracts,
&c.» of the cerebral cortex, are not given. The arrangement of the points
in the ventro-lateral region of the optic thalamus is purely diagrammatic.
To illustrate Professor Flechsig's work .
Digitized by LjOOQle
Explanation of Fig. 1.
Ne
LK
SK
c m
HK
V
ci
L
FI
Fill
G H
VC
HC
SR
S.op
Fi.ca
ventro lateral group x
of nuclei
dorso-median group
of nuclei
^db^jpallidus j o{ Qac ] eas lenticularis
Nucleus oaudatus.
Lateral nucleus
Shell-like corpuscle
Median centre
Inner nucleus and
pulvinar
Anterior nucleus
Inner capsule.
Corpus subthalmicum.
Gyrus frontalis superior.
Gyrus frontalis inferior.
Gyrus hippocampi.
*£terior } gyrus centralis.
Sulcus centralis (Rolandi).
Sulcus parieto-occipitalis.
Fissure calcarine.
of the optic
thalamus.
For Figs. 1, 2, and 8.
1
r
i x
r
8
x
X'
X”
8
x
r
The Sensory System Nr. 1.
The Sensory System Nr. 2.
The Sensory System Nr. 8.
Digitized by
JOURNAL OF MENTAL SCIENCE, JANUARY, 1896.
Fig. 2.—Transverse Section through the Brain.
To illustrate Professor Flechsig's work.
Digitized by
Explanation of Fig. 2.
III III First, seoond, and third limb of the nucleus lenticularis.
L K Lateral nucleus
) inner nucleus J of the °P tic thalamu8 -
N c Nucleus oaudatus.
L Corpus subthalmicum (Luys).
o K Upper crus cerebelli.
o Optic tract.
A m Amygdala.
F S Fossa sylvii.
H C Gyrus centralis posterior.
O sm Gyrus supra marginalia.
TI 1 )
TII 2 | Temporal gyri.
TUI 3 )
Q Anterior cross convolution of the temporal lobe,
o T Gyrus occipito temporalis.
L p Lobulus paraoentralis.
C C Corpus callosum.
a Auditory tract (Cochlearis).
Digitized by L^ooQLe
Explanation ov Fig. 3.
min
Nc
LK
%K
c m
P
M
hC
PG
P 1
A
T
a
8G
a
B
g Q .
FI
Fill
S°{
H
of the optio thalamus.
First, seoond, and third limb of the nucleus lentioularis.
Nucleus caudatus.
Lateral nucleus
Inner nucleus
Median centre
Pulvinar
Fascicle of Meynert (cross section).
Posterior commissure.
Pineal gland.
Pyramidal path.
Fascicle of Arnold.
Sensory.
Auditory path.
Course of optio fibres (Gratiolet’s).
Their cortioo-fugal path.
Cortico petal = corona radiata of the outer genu.
Anterior cross convolution passing into first temporal.
Gyrus subangularis.
gl Gyrus frontalis.
Gyrus fomicatus.
Subioulum oomu ammonis.
Posterior horn of latter ventricle.
Operculum.
(Dotted.) Cross seotion of the great association system
between the spheres of bodily sensibility (central gyri)
and the posterior great association system.
Island of Beil.
Explanation ov Figs. 4 and 5.
B Superior cerebellar peduncle '
(red nucleus)
l Fillet
r Formatio reticularis
c H Central tract of tegmentum
P Pyramidal tract
5 Temporal ) cortico-pontine )
6 Frontal f tract J
g Corpus genioulatum internum.
tegmentum I
of the I
pes of
crus cerebri.
The lines drawn in the brain convolutions indicate the association system.
Digitized by
Sphere of
Bodily Sensibility.
Frontal
Associations-Centre
Parietal
Associations-Centro
Olfactory Sphere
Gyrus hippocampi
Sphere of
Bodily Sensibility
Frontal
Associations-Gentre
Parietal
Assooiations-Centre
Island of Reil
Auditory Sphere
Occiplto-Temporal
Associations- Centre
To illustrate Professor Vlechsig's work .
juuxUNajli OF MENTAL SCIENCE, JANUARY, 1898.
Occipito-Temporal
/Google
17
1898.] by W. W. Ireland, M.D.
diligence and much ability he has sought to show how
recent researches in the structure and development of the
brain go to explain its high functions. In fact, after going
through his demonstrations we do see more clearly how the
mechanism of the brain renders it fit to be an instrument of
feeling and thought. Nevertheless, through the dead brain
we cannot understand the living mind in all its wonderful
powers, capacities, and receptivities. Of the internal vital
processes accompanying the working of the mind we know
scarcely anything. Professor Flechsig, indeed, remarks,
that as consciousness will not persist for a moment when
the supply of arterial blood-bearing oxygen to the brain
is interrupted, we may infer that a process of oxidation
goes on between the blood and the nerve cells.
The controversy which has already arisen in consequence
of the publication of these opinions is still in progress, and
Professor Flechsig has lately replied to his critics. Early
this year he intends to publish the further results of his
researches and reflections, and we await his communication
with great interest.
Atypical and unusual Brain-Forms , especially in relation to
Mental Status: A Study on Brain-Surface Morphology .
By W. Julius Mickle, M.D., F.R.C.P. (London).
(Concluded from page 80S , October, 1897.)
Chapter XIII.
Continuing the recapitulation , begun in the last chapter
(which dealt thus with the more general morphological states),
we next resume in brief the several Chapters, III to VIII,
on
UNUSUAL OR ABERRANT MORPHOLOGICAL CONDITIONS OF
INDIVIDUAL LOBES, GYRES, AND FURROWjft
Taking first the Mesial Surface,
Sub-frontal fissure. Superorbital, and mesial frontal intro -
gyral, sulci .
The sub-frontal fissure may present many deviations from
more usual form. It may end, behind, at different points of
the antero-posterior diameter in the two hemispheres.
Its posterior upturn may be further forward or further back¬
ward than usual, relatively to .the established landmarks ;
XLrv. 2
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18 Brain-Forms in Relation to Mental Status, [Jan.,
6r may fork; or the fissure may seemingly have several
separate upturns. The fissure may be more or less practi¬
cally doubled, and then also one or both furrows may exhibit
irregularity of conformation. It may be broken up into
several pieces. It may traverse the mesial surface at different
relative distances from upper and lower border, not only in
different brains, but in the hemispheres of the same brain.
It may join with the sub-parietal fissure. Its course may
be very oblique posteriorly. In such case, and in others, the
posterior upturn may fail to attain the upper surface or even
to attain the mantle border. The above variations necessi¬
tate corresponding differences in the relative size and form
of the gyres. Moreover, deviation of the sub-frontal fissure
from usual form is apt to be accompanied with other mesial
aberrant appearances.
An important effect is exerted by the annectant gyres, or
gyrels, crossing to or from the fornicatus, and usually
hidden in the depths of the furrow ; which, becoming super¬
ficial, may completely divide the sub-frontal fissure into
several separate arcs.
The attempt to appraise the significance and importance
of the several deviations from the typical described in the
third chapter may be recapitulated as follows:—
Superiority is indicated by shallow interrupted furrowing
of the anterior half of the mesial surface, above the fornicatus,
by a linear series of sagittally arranged sulci; thus dividing
that surface into two longitudinal superimposed tiers.
Other things equal, a mark of superiority is a well-developed
super-orbital sulcus, with two accessory super-orbital
incisionsand conversely, small size, imperfect development
and fewness of super-orbital furrows tell for inferiority.
Other things equal, the following would denote supe¬
riority :—
A single, or but once divided, sub-frontal fissure, well
provided avith deep or partly superficial annectant gyrels.
A sharply cut pre-oval sulcus, and defined oval lobule.
And the contrary conditions would denote relative in¬
feriority.
Failure of the posterior upturn of the sub-frontal fissure to
reach the upper hemispheral edge denotes defect and
aberrancy of conformation, as in lunatic or in microcephale.
Reduction of the normally sharp posterior upcurve to a slight
gradual flexure of the general line of the horizontal portion
of the sub-frontal, thus producing curtailment of the lower
Digitized by L^ooQle
1898.]
19
by W. Julius Mickle, M.D.
part of pre-oval lobule, brings about resemblance to the ape-
form of the fissure; marks inferiority ; may occur in small-
head idiots; in whom also the anterior portion of the fissure
may be irregularly developed or broken up, but seems to be
always represented more or less.
This posterior upturn of the fissure may be more or less
separated from its horizontal main stem by a gyrel, normally
deep-sunken, but now rising more or less to the surface and
crossing almost vertically from fornicatus to oval lobule.
And therewith, in some examples, the upturn, thus cut off
from its union with the main sub-frontal stem, makes more
or less complete union with the sub-parietal fissure. Such
condition, in man, points to a far-back-going phylogenetic
reversion. And in the third chapter I mentioned the view
that the posterior ascending terminal vertical piece of the
fissure represents, in the human brain, the sulcus cruciatus
of the carnivore brain; and that this posterior ascending
end-piece of the sub-frontal fissure is really a morphologically
independent furrow-element, which in the brains of primates
joins the sub-frontal fissure, this being, in them, predominant
and separate from the sub-parietal fissure; but in the case
of some other animals joins what is, in these, the much
more dominant sub-parietal fissure owing to relatively
defective influence of frontal brain. And I mentioned
examples of marked union of sub-frontal fissure, or of its
upturn, with sub-parietal furrow, in aberrant human brains*
Moreover, even when preserving free union with its horizon¬
tal stem the upturn sometimes unites nearly as much with
sub-parietal fissure as with sub-frontal.
PlLBCUNEUS : OB QUADRATE LOBULE.
Coming now to the quadrate, there is, in the first place,
the condition which I termed the formation of a pr&cun-
eolus (or anterior cuneolus); namely, the superficial insulation
or peninsulation (so far as concerns the mesial aspect) of the
upper and posterior area of the quadratic surface; triangular,
wedge-shaped, or squarish in outline; or of a narrow back¬
most zone bordering on the parieto-occipital fissure.
Tn some instances, this condition, or a foreshadowing of it,
may be seen in the foetus, the microcephale, and the ape. It
is an example of deviation and formative activity, rather
than of defect and formative inertia; in the human adult is
a somewhat unusual conformation, which, although in some
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20
Brain-Forms in Relation to Mental Status , [Jan.,
cases of developmental character, often indicates a reverting
tendency and possesses phylogenetic significance.
When a posterior marginal zone of the precuneus is cut
off by a duplication of the internal limb of the parieto¬
occipital fissure, the state is like the doubling of parieto¬
occipital fissure occasionally observed in anthropoid apes.
Passing by other deviations or anomalies of precuneus,
described in the third chapter, we consider the parieto¬
occipital frontier morphology .
Frontier Morphology: Parieto-Occipitax Fissure.
Whether strictly continuous, or discontinuous, with the
mesial part of the fissure, or of intermediate form in this
respect, the external part of the parieto-occipital fissure is
sometimes a deep irregular cleft, a bold dividing and bounding
furrow, nearly straight, or zigzag in course. Such highly
marked external limb of parieto-occipital fissure depressing
the first external gyre, and joining with interparietal sulcus
or a spur of it, or passing far out on the upper hemisphere!
surface ; is a mark of inferiority in type; and is also present
in some microcephales.
On the mesial aspect , also, there are a number of states of
parieto-occipital fissure indicating inferiority and atypy.
They indicate reversion as a rule: but as regards certain
examples of some of them, persistence of foetal character.
Each is present in certain ape-forms, in some microcephales,
and several of them are observed in some foetuses also. At
least, I take the following conditions as indicative of inferi¬
ority when present in adult Man, namely :—
An internal limb of parieto-occipital fissure interrupted
by a superficial gyrus cunei, or other annectant gyre (supe¬
rior internal) rising to the surface :—
Doubling of the internal limb of the fissure; shortness of
it; failure to reach the upper mantle-border; slightness of
its incision there:—
Its defective depth and boldness relatively to the cal¬
carine :—
Spurs running fore and aft from the internal parieto¬
occipital limb, furrowing and practically expending them¬
selves on precuneal and cuneal surfaces, or shallowly
touching the mantle-border, or joining the transverse occi¬
pital or transverse parietal or sub-frontal furrows. This fore
and aft forking of parieto-occipital fissure on mesial surface
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21
1898.] by W. Julius Mickle, M.D.
may occur in the foetus, and has been figured in the micro-
cephale:—
Confluence of the conjoint “stem” of calcarine and
parieto-occipital fissures with the collateral fissure.
Gyrus Cunei.
It was pointed out* that the gyrus cunei consists chiefly of
one-third round, or half-round, coils in relief, twisted around
each other, especially as regards two such, which seem to
enter aud distribute themselves, one on the lower zone, the
other on the anterior zone of the cuneus; a third one enter¬
ing the middle region of the cuneal substance: —
And that it is a departure from type aud sign of inferiority
when the gyrus cunei rises decidedly towards the surface and
still more so when it completely gains a superficial position.
Occipital Lobe ( including its Mesial Surface).
The Cuneus.
The cuneus may be unduly small, or irregular or twisted
in shape. Or it may evince the formation of a cuneolus;
namely, the insulation or peninsulation of a cuneiform por¬
tion of its surface by the posterior prong of a bifurcating or
trifurcating mesial limb of parieto-occipital fissure, which
thus nearly or quite cuts off a triangular portion forming the
anterior and upper part of the cuneal surface.
The formation of a cuneolus may appear in high ape or in
the full-time human foetus. Its significance is similar to
that of the formation of a preecuneolus {vide supra).
Another condition, occasionally observed, is the furrowing
off of an irregularly triangular upper and posterior, or upper,
part of the cuneal area, beside the mantle’s upper edge.
This cut-off is sometimes made by “ the stem,” extending
into the cuneus, forming a cuneolus, and then bifurcating
high up into branches set at nearly a right angle to its
main trunk. In the human foetus, as early as the sixth
month, a similar condition may be found.
Calcarine Fissure {not including “stem ”).f
In some low-type human brains the back end of the
(apparent) calcarine fissure is much further forward than
• Journal of Mental Science , July, 1896, p. 565.
f Journal of Mental Science , July, 1896, p. 569.
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22
Brain-Forms in Relation to Mental Status, [Jan.,
normal, but sometimes with a short curving sulcus behind
it; and there seems to be a reversion towards ape-type.
Among other states which seem to be more or less atypic,
and signs of inferiority iu Man, are those due to the calcarine
fissure being in small sections; or very jagged or zigzag.
A deep calcarine fissure, uncrossed by sunken annectant
gyrels, and preponderant relatively to the parieto-occipital
fissure, indicates a retrograde condition approximating
simian form; and is found in some microcephales.
An unusually far-back position of the anterior cuneo-
lingual annectant gyrel (and perhaps with downward incut
of the calcarine) shows inferiority and an approach to the
ape-form.
Likewise, a far back posterior cuneo-lingual gyrel, only
cutting off the posterior rami of the fissure, perhaps denotes
inferiority.
Inferiority may also be indicated by the termination of
the calcarine, behind, in a single simple unbranched end.
Confluence of the “ stem ” and collateral fissure on the
inferior cerebral surface, occasionally observed, is usually
slight. Especially when well-marked, it may represent
abnormal persistence of an inconstant and transitory foetal
state. For the collateral fissure begins in two or three
pieces; and in the human foetus in the sixth or seventh
month the middle piece is sometimes connected with “ the
stem,” and has then a more or less transverse direction.
This connection of “ stem” and collateral fissure,usually
at least, is an element in the formation of the girdle of fur¬
rows several times mentioned in preceding chapters.
In some brains of a low order, or aberrant type, one finds
two apparently contrasting states of the collateral fissure;
for in some it is defectively developed, broken up into
separate scattered representative fragments; whereas in others
it is long, bold, and coursing on the inferior occipital-tem¬
poral region almost from tip to tip of the two lobes. Of
these states of the fissure, the former seems to indicate
arrested development; the latter, reversion in form.
Transverse Occipital Sulcus (op Eckbr).
Unusual nearness of the transverse occipital sulcus to the
external limb of the parieto-occipital fissure, in their some¬
what parallel course, or separation by a narrow ridge only,
seems to mark a defect in idle advance, of the human on the
simiun brain. And its junction with the external limb, or
Digitized by {jOOQle
23
1898.] by W. Julius Mickle, M.D.
continuation, of the parieto-occipital fissure, occasionally
seen, appears to have,much the same significance. This
junction is also effected in some idiot brains.
The nature, homology, and formation of this sulcus are
discussed in the fourth chapter.*
Representation of Ape-chasm in Human Brain.
In relation to the question whether or not the ape-chasm
is represented in the brain of the human adult we touched
on the chief views as to the possible homologies here; enquir¬
ing whether the ape-chasm is represented in Man by the
transverse occipital sulcus, or by the external portion of
parieto-occipital fissure, or by the anterior occipital fissure,
or by the foetal and temporary sulcus of Bischoff. Enquir¬
ing, also, whether this last sulcus ever persists as an
abnormality in adult life; and, if so, in what form and
position.
In this relation, I describedf brains, of human adults,
which had possible representatives of the abnormal per¬
sistence of the external perpendicular occipital sulcus of
Bischoff; a sulcus which under normal conditions is only
foetal and temporary.
Occipital Operculum.
An appearance slightly resembling the simian occipital
operculum indicates a tendency to reversion towards that
form.
Posterior Parietal Operculum.
This may be taken as an unusual condition when it is ex¬
tremely marked, but in the direction of lack of balance, and
as the manifestation of over-activity on the more important
line of evolutionary advance, with some relative defect of
activity on the occipital line, which, normally, should offer
a due and appropriate measure of resistance to the (parietal)
one which has become predominant. The posterior parietal
operculum, so far as it goes, signifies a condition of high
type, yet, sometimes at least, associated with impaired
balance, with relatively defective occipital ontological forma¬
tion and phylogenetic endowment.
Occipital Gtres and Lobes generally.
In some brains the divergent occipital lobes leave the
# Journal of Mental Science, July, 1896, p. 673.
t Loe. eit., p. 676.
Digitized by LjOoq Le
24 Brain-Forms in Relation to Mental Status, [Jan.,
cerebellum very defectively covered behind. And, often
connected with this, relative smallness of occipital gyres
may be a markworthy feature; for in some inferior brains
one may observe a somewhat smaller relative size of the
occipital lobe, at least as gauged by antero-posterior mea¬
surement. This is not in harmony with widely accepted
views which implicitly teach that relative largeness of occi¬
pital lobes, and not relative smallness, indicates inferiority.
The teaching is true of one side of the shield. Bat if we
examine the brains of microcephales we find in some, even of
those who have survived to adult life, that the occipital
lobes are often decidedly shortened, relatively to the entire
hemispheral length, or even if of good relative antero¬
posterior length yet are curtailed in dimension and thin
from above downwards, fail to fully or normally cover the
cerebellum posteriorly, and look as if the lower part of the
occipital lobes is deficient or small, and these lobes thrust
upward by the cerebellum. And the relative size of some
occipital lobes, in what I term microcephaloid conditions, is
smaller than normal. One is reassured as to the accuracy of
this observation by the fact that the general trend of re¬
searches made of late years goes to confirm, as regards
certain points , the conclusions of Rudolf Wagner, who, a
third of a century ago, asserted that microcephaly pertains
partly to a developmental arrest of the posterior lobes of the
cerebrum, and seems to commence in the third and fourth
months of embryonic life.
Moreover, I insisted ( loc . cit.) upon the supreme value, in
these studies, of the microcephaloid type and condition ; and
that relative smallness of occipital lobes, defective develop¬
ment of them, undue retention of foetal character by them,
reversion to lower animal form manifest in their morpho¬
logy ; are—each and all—valid indications of deterioration
and inferiority.
Continuing the subject of occipital brain development in
relation to mental status; the first occipital gyre with its
annectant portion has been stated to be relatively much
developed in man; and to be smaller, more simple, and less
developed in negro than in white, in idiots than in normal
persons, and to be far less marked in higher apes than in
man; while for practical purposes it is slight or absent in
lower apes. In one quarter, the view as to the predominant
importance of the first external occipital annectant gyre was
carried to an extreme, in the statement that it increases in
Digitized by t^ooQle
25
1893.] by W. Julius Mickle, M.D.
size from lower apes to primates, and so on through females
to greatest fulness in males who are well-endowed mentally.
But these assertions have been much shaken and, at least in
part, successfully controverted. And I summed up this
part of the subject, as follows:—
“ Nevertheless, as regards its relative size, development,
form, position and relations, the possession of considerable
importance by the first external parieto-occipital annectant
gyre remains unshaken, its human characters mark a
triumph in the evolutionary struggle; a triumph which
probably was a necessary step in the attainment of Man’s
supremacy, and they remain as the stable fruit and posses¬
sion of victory. Yet . . . this gain may now yield in
immediate direct value to the evolutionary changes effected
in some other parts, and among these last, the developmental
and evolutionary advance of the representatives of the
second external parieto-occipital annectant gyre, and of the
inferior parietal lobule in Man, may mark an even greater
. . . triumph, and be now of more supreme importance.
... So that with regard to the upper occipital and the
lower parietal regions, the value of the advance in the one
is not contravened by the importance of the progression in
the other; nor should the lustre of the older triumph be
paled by the splendour of the newer.” (Chap. IV).
Temporal Lobe.
In the fifth chapter, after discussing the greater or less
fusion of the temporal lobe with the parietal and occipital
on the external and inferior cerebral surfaces, the indistinct¬
ness of the demarcation, the diversity of recognition and
identification of these parts, especially as illustrated by the
variance of anatomists’ views concerning the inferior parietal
lobule; we turned to the study of the first temporal sulcus
(<i). We described* the branches of this sulcus, pointed out
that, although some of them are absent or slight in most
brains, five branches of it may be mentioned. The forms,
relations, and positions of the second (f 2 ) and third (t 8 ) tem¬
poral sulci were also delineated. Next was pointed out
that, in different cases, the sulcus separating second and
third external parieto-occipital annectant gyres possesses
different apparent origins. It was also shown that what
some recognise as the anterior occipital furrow is, in certain
* Journal of Mental Science , Jan., 1897, p. 5. '
Digitized by L^ooQle
26 Brain-Forms in Relation to Mental Status , [Jan.,
cases, low down, usually joining the preoccipital incision or
the third temporal sulcus ; whereas what others identify as
the anterior occipital furrow is placed high up, and, as a
rule, not directly connected with the second temporal sulcus;
yet by some taken as a continuation or ascending ramus of
this sulcus (< 2 ), or a terminal piece in the flight of it.
Unusual, Aberrant Forms op Temporal Gyres and
Furrows, and their Signification.
A number of unusual or aberrant forms of the temporal
gyres and furrows were described, and among them that in
which the first temporal sulcus (^) joins the transverse
temporal sulcus, and much of the first temporal gyre (T 1 )
appears to sink into the Sylvian deeps.
This is a deviation which, other things equal, I was in¬
clined to take as a departure from the usual brain-pattern
in the direction of increased formative activity, and,
although a deviation from type, yet not a sign of inferiority.
Nevertheless there are some considerations which tend the
other way ; as when the condition is foreshadowed in some
foetal brains at the age of six or seven months.
A long course of the first temporal sulcus (fj, or of one or
more of its rami unusually far towards the upper or posterior
hemispheral border; unusual irregularity of the sulcus or
zig-zag course; unusual degree of forking and sub-forking
of it; islet formation in its channel; sharp upward and for¬
ward curve of the back end and anterior ascending ramus
thereof, as in some foetuses, insane persons, criminals and
negroes; an unusually vertical (transverse) position of the
sulcus, as in some idiots, including examples of micro¬
cephalous type:—all seem to be signs of inferiority, and
either mark inferior evolutionary status, or the uncommon
persistence of foetal characters owing to developmental
failure; as the case may be in the particular cerebral
hemisphere concerned.
Other aberrant states of temporal gyres and sulci are the
numerous confluences of the first temporal sulcus (f x ) with
other furrows, indicating defective development of the
anastomosing gyres. Or the presence of a very marked
temporal incision (of Schwalbe), as in some microcephali.
If the gyrels crossing temporal sulci are deeply sunken and
slight, or absent, the gyres are of simple type, present an
unusually sagittal aspect and connote inferiority. But with
Digitized by i^ooQle
27
1898.] by W. Julius Mickle, M.D.
gyrels, which are usually much submerged, rising to the sur¬
face the richness of folds and anfractuosities is enhanced,
and the aspect of the trend of gyres is more transverse.
The condition produced by breaking up of the first
temporal sulcus ( l J into fissurets ordinarily directed obliquely
upward and backward, in parallel overlapping series, and
not in rectilinear disposition, may be judged of by its
“ context.” 23.^., if this last indicates inferiority so may
the condition itself. Moreover, this fragmentary state of
the 8 ulcus may partly represent persistence of a foetal
character.
Very similar remarks apply to the partially-like uncommon
form of the second temporal gyre and sulcus when the latter
is represented only by a set of fissurets directed downward
and backward.
Marked non-symmetry of development of temporal gyres
in the two hemispheres of the same brain has been found in
some cases of deaf-mutism, and of moral imbecility.
Stunting of the temporal tip; shortening of its normal
forward bold projection ; dwarfing of its opercular formation
generally; tell of developmental hinderance, at least; and
perhaps of reverting tendencies as well, in some examples.
A highly marked so-called anterior occipital sulcus (o.a.)
may occasionally be seen in the eighth-month foetus ; exists
in some lunatics; is recorded in some insane delusional
criminals.
Other things equal, a well-developed third temporal sulcus
denotes superiority.
In a form of €t family disease ” I have observed of which
earl? blindness is one constituent symptom, both right and
left lingual lobules were relatively small, and only slightly
and irregularly furrowed.
Parietal Lobe.
Interparietal Sulcus .
When no incision downward from the interparietal sulcus
exists in Man the condition, so far, is like that of higher apes
(baboon, chimpanzee, orang).
In Man, resemblance to the form observed in some apes is
produced by two spurs issuing from the same point of the
interparietal sulcus, and diverging towards the upper border
of the mantle.
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28
Brain-Forms in Relation to Mental Status^ [Jan.,
In atypic brains the interparietal snlcos is frequently
confluent with various other sulci.
Anastomosing gyres of Interparietal Sulcus .
Absence of bridging gyres across the interparietal sulcus,
together with considerable depth, boldness and definition of
the latter, associated with a tc context ” of simplicity, is a
sign of inferiority. Indeed, a relatively bold, deep inter¬
parietal sulcus, uninterrupted, or nearly so, by deep or
superficial gyrels, reveals a simian character.
Superficial position of the usually deep anastomosing gyres,
in the interparietal sulcus proper, connecting the inferior
and superior parietal lobules, constitutes a bridging of the
sulcus which, I believe, marks superiority of brain-evolution.
And absence of any gyral interruption of this sulcus is com¬
paratively more frequent in the idiot’s brain than in that of
the ordinary person. Yet a view contrary to the one held
here has been maintained as to the superficial gyre some¬
times separating the two sagittal portions of the inter¬
parietal sulcus; and is to the effect that such surface-position
of the gyre denotes undue persistence of a foetal character,
and, therefore, untypic form.
In Man, an unusual depth of the interparietal sulcus
relatively to that of the central fissure marks inferiority due
to phylogenetic reversion.
In some human brains of inferior form the interparietal
sulcus mounts with bold sweep on the lateral and upper
cerebral aspects; and then, behind, curves sharply back¬
ward, outward and downward; much as in some ape-forms.
Angular disposition of sagittal parts of Interparietal Sulcus .
In some cases the sagittal part of the sulcus consists of
two pieces at a right, or only slightly obtuse, angle to each
other. This disposition reminds one strongly of the simian
appearance in some species in which the interparietal sulcus
incurves strongly towards the upper mantle-border.
Unusual furrow-appearance . Reduplication of Interparietal
Sulcus (i.p.)
Sometimes, apparently, there is more or less reduplication
of the interparietal sulcus. The lower furrow of the two
represents the anterior part of an anomalous interparietal
sulcus, unusual in position, direction and relations, and cut
Digitized by t^ooQle
29
1898.] by W. Julius Mickle, MvD.
off by a stretch of cortical surface from the upper farrow,
which latter has the aspect of an elongated posterior sagittal
portion of the interparietal.
But more pronounced partial reduplication of the inter r
parietal sulcus may occur. This occasionally brings about
more or less antero-posterior division of the superior parietal
lobule by a sulcus somewhat parallel to the upper border of
the mantle; a condition which marks irregular and inferior
conformation.
Superior Parietal Lobule.
This may not only evince the sagittal division just
described. For transverse, and more often oblique, sulci
may divide or partly divide it into several sub-gyres. An
unusual degree of division of the lobule by furrows running
thus obliquely backward and inward, is a deviation from
usual form due to increase of developmental activity on the
usual normal lines, which, more often at least, is in the
direction of superiority.
Inferior Parietal Lobule.
Tracing evolutionary advances of this part in the animal
scale, I stated ( loc . cit.) that “ in Man an enormous and rich
lower parietal development has occurred; in every quarter the
inferior parietal region has become strong and aggressive, it
has thrust aside opposition, and has swollen in an opercular
expansion as an emblem of domination over adjoining
cortical realms. ... A rich complexity of the cerebral
folds and furrows in the parietal lobes, if on fairly regular
lines and not too atypically irregular, indicates superiority
in form. But in many brains, otherwise, or in some other
respects, of inferior form, there is a richness of parietal
gyre-and-furrow-development, but it is irregular and ex¬
tremely atypical.” In the parietal area this irregularity
and bizarrerie of the outward architectural conformation are
of greater morphological importance as denoting aberration
from usual form or from type, than is an undue and atypic
simplicity, or defective complexity, of the same parts.
Obvious to the observer is the great contrast between the
brain of lower ape, with its occipital operculum overhanging
the angular gyre; and the human brain, with the several
bold superficial annectant gyres effecting the transition
between occipital gyres on the one hand and parietal and
temporal on the other, the lower-ape operculum having
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80 Brain-Forms in Relation to Mental Status, [Jan.,
totally disappeared. In the fourth chapter, and in the
sixth, we laid stress upon the relatively high development of
the lower parietal lobule in brains of superior type, as e.g .
in the lines:—“ Nor is the upward the only direction in
which the inferior parietal lobule tends to increase as we
ascend the evolutionary scale in its highest grades. For in
these the tendency is for the posterior part of the Sylvian
fissure to be ever more and more shortened by the successful
straggle for the surface waged by gyres which are sub¬
merged in animals lower in the scale of primates ; this rise
of gyres to the surface obliterating the back part of the
Sylvian fissure, and increasing the parietal territory. A
somewhat similar process shortens the first temporal sulcus
above and behind. The parietal lobe also tends to overhang
the occipital lobe, behind; and the frontal lobe in front; the
‘ inferior parietal lobule ’ tends to overhang and dominate
the ‘ superior * one. The angular and supra-marginal gyres
—or, better, the tri-partite divisions of the inferior parietal
lobule—in the course of this evolution attain to consider¬
able size and great complexity.”
A relatively small supra-marginal gyre is seen in some
brains otherwise, or in some respects, of inferior conforma¬
tion.
And general relative smallness of inferior parietal lobule,
and defective opercular character of it, denote both defec¬
tive development and reversion in type.
Post-Central Sulci.
A condition which, as far as it goes, seems to mark a
fairly good position, or even a decided tinge of superiority,
is that of a well-marked upper post-central sulcus, together
with its tendency to a comparative degree of union with
both the lower post-central sulcus and the interparietal proper.
In general terms, confluence of the several elements of the
“ intra-parietal ” sulcus group stamps the adult European
brain; and separateness the foetal.
Other things equal, disjunction of inferior and superior
post-central sulcus, as also of both from the interparietal
proper, tends to make for inferiority. And Cunningham
showed that in man “ there appears to be a general tendency
towards a union of the two originally distinct post-central
elements ” of the “ intraparietal ” sulcus.
In the seventh chapter, it was pointed out that the trans -
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1898.]
by W. Julius Mickle, ,M.D.
81
verse -precentral and transverse post-central sulci differ much
in different cases as to form, length, depth, direction ; as to
whether they boldly cleave the gyri and distinctly rise from
the Sylvian fissure; or only notch the opercular edge, or
fail to do so and repose on the external opercular and gyral
surface; and as to whether they assume the aspect of a
cleft, or of a furrow, or partly of both. The modifications
are numerous in the case of either: but difficulties meet
acceptance of the possible view that in the case of either
the thing itself may bo one.*
Concerning the deviation from usual form consisting of a
bold and unusually long furrowing of lower part of surface
of one, or other, or both, of the central gyres; and far more
frequently of the posterior one; by nearly vertical fissurets:
these last, in some examples at least, mark an unusual
extent and somewhat aberrant or less favourite position of
the transverse pre-central and post-central sulci; or, pos¬
sibly, duplication of a post-central or pre-central furrow-
element.
This form, and unusual degree, of furrowing of lower
portions of central gyres from the Sylvian, denote a develop¬
mental aberration. They are occasionally seen also in
microcephale8.
The Crotral Fissure. (F.of Vicqd’Azyr. F. of Rolando).
In brains of different grades some varieties exist as to the
position of this fissure, be it somewhat more forward or
backward than usual. As an unwonted condition, the
fissure may be confluent with other furrows. These con¬
fluences are comparatively frequent in inferior brains. Kg.,
confluence of central fissure and Sylvian is not infrequent in
idiots.
Or the central fissure may be bridged: or may fail to cross
or reach the upper mantle edge.
It has been asserted that in poorly developed brains the
central gyri are not sinuous or complicated or elaborated,
and that the central fissure, in inferior types, is less sinuous
and less likely to be fully separated from the great longitu¬
dinal fissure and from the Sylvian; confluence of it above
and below, with these, probably indicating low type. Yet
most of these conditions are not often a criterion of low
type or of inferiority. For in many cases the central fissure
* Journal of Mental Science , April, 1897, p. 219.
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82
Brain-Forms in Relation to Mental Status , [Jan.,
of low type is not unusually straight, devoid of zigzag
undulation or sinuous curve; on the contrary, some decidedly
inferior brains have sinuous or zigzag central fissures. And,
so far from indicating low type, the coming over of the
central fissure slightly on the mesial aspect is the typical
condition, usually occurs during the last month of foetal
life, and is normal in the adult. Indeed, its failure to occur
would, so far, denote an inferior brain.
Nevertheless, a short straight smooth-walled central fissure,
devoid of deep annectant gyrels, resembles that of lower
apes.
Bridging of the central fissure a little above, or about, its
middle, is a departure in the direction of inferiority, and is
equivalent to an unusual and abnormal retention of an
early foetal character; or, in cases, may indicate an atavism.
Abnormal, also, is the significance of a truly bridging
gyrel about, or below, the junction of middle and lower
thirds of the fissure, and possibly representing a surface
position of the deep gyrel which, in some cases, marks a
conjunction of the central fissure with transverse precentral
sulcus, and now seems to be placed higher up than usual
owing to the defective development of the central fissure in
a brain of low type.
Absence of forward projection of the posterior lip of the
central fissure in its lower half, tells for simplicity and in¬
feriority of brain form.
Forkings and unusual spurs of central fissure, and islets
of cortex in its channel, signify irregularity and deviation of
formative action.
In Man, a central fissure shallow relatively to the inter¬
parietal sulcus, betrays a tendency to simian character.
In brains of grossly defective and irregular form, the rela¬
tive position of the central and subfrontal fissures may be
strangely disturbed.
An unusually vertical position of central fissure in adult
human brain, if not explainable by brachycephaly, may some¬
times be an unusual preservation of its earlier foetal position.
Attempts have been made to establish human sexual
differences with regard to the dimensions of the frontal lobe as
measured up to the central fissure . But differences in the
average absolute length of the lobe in the two sexes are of
little value. The true problem is to find whether the
average relative length of the lobe differs in the sexes $ and
apparently it does not, in any noteworthy sense.
Digitized by LjOoq Le
33
1898.] by W. Julius Mickle, M.D.
On the absolute length of the central fissure itself human
sexual differences have been assigned. Yet the greater
absolute length in males is invalid to sustain the conclusion
built upon it. The relative length is required; and the rela¬
tive length of the fissure to total length of upper mantle
edge shows only slight differences in the sexes.
Also upon the direction or inclination of the central fissure
establishment of sexual difference has been attempted; but
is invalid, decided sexual differences not existing in this
respect.
False Appearance as of two ob three Central Fissures.
Specious appearance of two or of three central fissures may
arise from extremely bold definition and unusually great
development of the post-central sulcus group, or of the pre¬
central sulcus group, or of both.
The modes in which a continuous or nearly continuous
precentral furrow is formed were discussed.* The signifi¬
cance of this particular simulation of the formation of a
second central fissure is not very easy to appraise; different
points tell for and against it as an indication of either
advance or falling back. Yet it does not usually denote a
brain of high grade. A long, bold, precentral sulcus
representing, practically, the constituents of the whole pre¬
central sulcus-group—which usually are more or less separate
—is found in some brains of low or aberrant type, or even
microcephalic.
Insula.
Healthy adult human brains in the prime of life with the
Insula partly uncovered are defective in form, showing im¬
perfect opercular development, and to some extent repre¬
senting conditions found temporarily in the human foetus,
and tending to disappear in subsequent life; and found as a
permanent state in ape-brain. This partial uncovering of
the Insula is observed in some brains”of low form; as, for
example, in some idiots, imbeciles and criminals; and, it has
been said, in lower races of mankind.
The “ fronto-orbital ” sulcus of the anthropoid appears to
be the homologue chiefly of the anterior marginal sulcus of
the Insula; and probably to a slight extent of the anterior
horizontal Sylvian ramus, in normal adult human brain. In
man, a well-defined representative of the fronto-orbital
* Journal of Mental Science , April, 1897, p. 242.
IX.IT. S
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34
Brain-Forms in Relation to Mental Status , [Jan.,
sulcasof the anthropoid ape tells, as far as it goes, of revert¬
ing tendencies toward simian type. In some microcephales
its resemblance to the condition normal to certain apes is
very close.
Signifying inferiority, also, are relative marked smallness
of Insula, defective conformation of its gyres and furrows;
replacement of its usual folded state by a smooth layer of
grey matter, or by flattened and unusually radiating
volutions.
Frontal Lobes.
In the eighth chapter, we compared the several lobes of
the brain.
In lower-type brains the frontal lobes do not hold the
position of size, relatively to other lobes, that the length of
their upper border would speciously indicate; in many such
cases that length may be, relatively , good, even above normal
relative length; but the size of the lobe is not absolutely
good, nor its development even relatively so. The specious
appearance of being good or above normal in size is partly,
or sometimes, due to the arrested development of other parts
of the hemisphere, and partly to the fact that the frontal
lobes, although perhaps of good relative length , are often
narrow, or pointed, or shallow from above downwards, and,
as regards this last, especially does the frontal opercular
formation fail. It is in respect of this opercular formation,
perhaps more than of anything else in its larger morphology,
that the frontal lobe of the foetus and of the new-born is
surpassed by that of the human adult, the frontal lobe of
the ape by that of man. In microcephales, also, the frontal
lobe, although it may be of long or over-long upper frontal
relative index , is defective in its lower and opercular portion,
and may present that gradual slope of orbital over on to
external lateral frontal surface, and that partial exposure of
the Insula, which reproduce an image of the simian form in
this region.
Degree of convolutional elaboration of frontal lobes has
been held to indicate the most striking difference between
brains externally; and in the frontals of richly convoluted
brains attention has been drawn to the numerous divisions
by short secondary sulci, and the bridging of frontal furrows
by small secondary gyres.
In some defective brains, frontal gyres and sulci are very
irregular. Simple or boldly defined frontal gyres have been
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1898.]
by W. Julius Mickle, M.D.
35
found in delusional lunatics, idiots, negroes; and in imbeciles
numerous and unusually small gyri in flattened frontal
lobes. In some microcephales the whole frontal lobes are
small.
The third frontal gyres are small and ill-developed on one
side or on both in many microcephalous idiots, and in some
deaf-mutes.
On the external cerebral surface there may be only a single
anterior Sylvian ramus. Tet there are several conditions which
may modify our view on this part of the morphology in many
brains; e.g. 9 such as a partly orbital situation of the “ cap ”;
or, again, what I termed a “ double cap”; or such as a deep
cleft simulating an anterior Sylvian ramus. Smallness of
the frontal opercular region, including a dwarfish or rudi¬
mentary state of the cap, is a mark of inferiority. And the
third frontal gyre has much importance in the characterisa¬
tion of brains of high type. Indeed, comparison of the
normal adult human cerebrum of high type with (a) the
foetal human brain, and with (6) the brain either of anthro¬
poid, or of low, apes, seems to indicate that, among many of
importance, the most important factor of the difference
between the human and ape frontals is the great downward
growth of the lobe, especially in front, and complete oper¬
cular formation ; a condition which involves a better forma¬
tion of the third frontal gyre, also.
Coming to the sulci:—The first frontal furrow of adult
human brain may be represented by a series of overlapping,
obliquely-set fissurets, directed forward and inward; and
thus may have a disposition which resembles the usual
temporary one in the human foetus, and is fixed in per¬
manency in the brain of some apes, as the baboon. Or the
separate sulcus-elements may be set nearly in a straight line,
and may be shallow. These discontinuous states of the
sulcus are less apt to occur in the white than in the negro. In
fact, more or less decided continuity of these furrow-elements
distinguishes the white’s brain rather than the negro’s; the
adult brain rather than the foetal; the human brain rather
than the simian; and the sulcus only first appears in the
animal scale with the higher apes. In Man, its unusual
slightness or shallowness, or degree of interruption, betokens
inferiority ; other things being equal.
A short straight second frontal sulcus, devoid of anasto¬
mosing gyrels, shows resemblance to simian form. An
irregular sectional state of the sulcus may indicate undue
Digitized by t^ooQle
36 Brain-Forms in Relation to Mental Status, [Jan.,
persistence of foetal condition, is found in some microcephales
with a well-marked lower precentral sulcus, and shows
absence of high evolutional grade. The incision of the cap
develops comparatively late; it and its adjuncts are recent
Ceteris partmis, union of second frontal and inferior pre¬
central sulci marks a somewhat higher brain-form than their
discontinuity does. A more than usually evident and sagittal
upper ramus of inferior precentral sulcus , may indicate un¬
usual persistence of foetal character, in the adult. A some¬
what sickle-shaped inferior precentral sulcus seems like a
lower simian morphological reminiscence; or like retention
of a foetal character occasionally seen. Marked confluence
of precentral sulcus element with Sylvian fissure is apt to be
accompanied with absence of high developmental grade ; it
exists in some microcephales. And much the same is true
of its free confluence with the central fissure.
Defective formation of the superior precentral sulcus is fre¬
quent in brains of a lower order. Its shortness, or shallow¬
ness, or absence indicates developmental failure, or,
sometimes, reversion in type.
First and Second frontal intra-gyral furrows.
Of these, theirs* is ill-marked in many of the brains of
very defective morphology; but may be distinctly impressed
in insane persons who possess brains of comparatively high
evolution. In the insane, the second is much more often
clearly and boldly indenting than is the first, yet may be
feebly marked.
According to one view this second frontal intra-gyral
furrow possesses early phylogenetic formation ; but by the
opposing view only makes first appearance in higher anthro¬
poid apes.
The first frontal intra-gyral furrow is the very last of the
series of frontal sulci to become visible. It makes appear¬
ance near the very end of foetal life; or more often during
the first month of infancy. Phylogenetically, it is recent. It
first appears in Man, the summit of the evolutionary scale.
Even in the negro, it is only defectively stamped on the
brain.
Other things equal, a well-marked degree of the normal
state of these furrows denotes superiority; their absence, or
slightness, or irregularity of form, denotes inferiority.
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37
1898.] by W. Julius Mickle, M.D.
The developmental, and the inferred phylogenetic, history
of these two furrow-sets are made even more particularly in¬
teresting in virtue of their bearing on the significance of a
well-defined’arrangement of the sagittal frontal convolutions
in four or five tiers (instead of three); the next subject to
mention.
Incbbased Numb kb of Fbontal Convolutionaby Tiers.
The upper and lateral frontal convexity may be more or
less divided into four tiers of convolutions. And more or
less marked division of this frontal surface into five tiers of
convolutions may occur.
Most frequently the division is of the second frontal gyre . In
its front half, the convolution's own intra-gyral sulcus effects
the partition. 'While, behind, the upper or horizontal ramus
of the inferior precentral sulcus may intercalate itself
between the two roots of the gyre, and may be so directed
anteriorly as to join, or nearly so, with the intra-gyral sulcus,
and by its backward continuing branch may abut upon, or
even enter, a superior precentral element, thus, in one way
or the other, dividing much of the second frontal convolu¬
tion lengthwise. Other furrow elements may now and then
assist in this partition of the second frontal convolution.
The upper aspect of the first frontal gyre may be partly
divided by an unusual length depth and definition of its
intra-gyral furrow-system; or by great length of its external
(lateral) root, running far forward and lengthwise, before
it fuses with the gyre, and correspondingly dividing the
gyral area.
Thus, the exaggerated formation of intra-^vral furrows,
the length and separation of roots, and the aia of adjunct
furrow-elements, may lead to division of either the second or
first frontal gyre, or of both, in part or in whole, and sagit-
tally, into two superimposed tiers. Infrequent* and incon¬
siderable as a rule, is partial furrowing of the third frontal
gyre into two, horizontally.
Found in some brains of criminals, lunatics, and persons
mentally defective, this four-tier type has been stated to
indicate grave reversion and atypy. But against this view
I* argued that the frontal type of four (and five) gyral tiers
—especially when due to division of upper surface of first
frontal gyre—marks a higher than usual, and not a lower,
brain-formation ; and added that this “ is compatible with
* Journal of Mental Science, April, 1897, p. 244.
Digitized by Le
38 * Brain-Forms in Relation to Mental Status, [Jan.,
mental aberrancy, with unstable and labile mental activities,
lively and powerful but not well-directed—in a word a brain-
function lacking in balance." As bearing definitely on this
subject, reference was made to the contested homology of
the sulcus rectus of the ape. Thus the superiority (cet. par.)
of the frontal four-tier type was asserted.
Direction of Frontal Furrows and Gtres; real or
specious.
The frontal gyres and furrows have sometimes an appear¬
ance of being much twisted or deflected in their forward
course, so as to appear, in an unusual degree, as if trending
forward, upward, and inward, in a diagonal direction. It
is a too extreme degree of a normal appearance and con¬
dition.
It was then pointed out that in foetus and child a similar
direction is often taken by overlapping series of furrows
representing sulci in this region; that a like direction is
often assumed by certain furrow-elements in the adult; that
a similar disposition of some furrow-elements may be
observed in a few apes; and that, in adult brain, this
tendency for fissurets and gyres to run obliquely upward,
forward and inward towards the upper mantle-border, in
some cases apparently indicates persistence of foetal char¬
acter and a degree of developmental arrest; in some,
possibly, even indicates reversion.
Sylvian Fissure.
Unusual confluences of the Sylvian fissure mark, so far, a
deviation in form, and, often at least, mean defective forma¬
tion of opercula and of annectant gyres. Greater relative
length of horizontal posterior limb of Sylvian fissure seems
to denote inferiority. And a tendency towards unduly
vertical direction of the same has been noticed in brains of
some idiots and negroes. Indeed, in microcephales the
tendency to perpendicular trend may be very decided.
More recent researches have confirmed these views, by
showing that the average relative length of the posterior
horizontal Sylvian ramus is greater in human foetus and in
apes than in human adult. And that the average Sylvian
angle is greater in adult than in child, in the human, than
in the ape, brain; and on left side than on right. The
absolute length, and still more the relative length, of the
same, is greater, on the average, in females than in males.
Digitized by t^ooQle
89
1898.] by W. Julius Mickle, M.D.
Shortening of the Sylvian fissure, therefore, is a character
of the human, and especially of the male, brain. On the
contrary, a great relative length of the external Sylvian
fissure denotes a formative reversion.
In Man and orang the back part of the Sylvian and first
temporal sulcus are shortened, and the parietal lobe gains
surface-extension from before backward. As we ascend
the animal scale, the supra-marginal gyre, which in lower
apes is sunken in the Sylvian depth, is observed to gradually
attain the surface—at first op one side and inconstantly,
but in higher forms on both sides and constantly—to become
broader and broader; and, instead of forming a single loop,
to become doubled or complicately convolute.
In Man, the region of these recent gains is still very
variable, and the transverse temporo-parietal annectant
gyres, like fresh invaders, seem to struggle for the surface.
In the ninth Chapter was described
A Standard of Aberrant Conformations or Gtres and
Furrows, framed as a Test and constitutino a Stigma
of Hereditary Mental Degeneracy.
In the deviations from usual form or type already
described the material is provided for tests or criteria of
various forms of defective or aberrant brain development.
These peculiarities of brain-architecture are especially valid
and enlightening in relation to the great group of mental
diseases which are essentially based in hereditary mental
degeneracy, and in which there are, more or less, the recog¬
nised signs of degeneracy of mind and body in the individual
or the ancestry. Heredity and degeneracy, of course, do
not play an equally important part in all of such forms of
mental disease as are included here. For, throughout this
large group of mental affections the somatic and psychic
stigmata of degeneracy exist more or less, but their nature
and grade differ much in the several members of it. There¬
fore, I tried to frame a composite and sufficiently elastic
standard of abnormal superficial brain-architecture to use
as a test or criterion of the degenerate, defective and
aberrant developmental peculiarities found in the brain in
the several forms of predominantly hereditary mental
disease. Broadly and summarily viewed, it amounts to a
somatic indication of hereditary or of congenital mental
degeneracy.
Digitized by L^ooQle
40
Brain-Farms in "Relation to Mental Status , [Jan.,
This standard is taken from the brains of persons with
varieties and degrees of imbecility, or closely allied states
with mental peculiarities or perversions (congenital, and
chiefly developmental, imbecility; original paranoia;
analogous cases of similar mental status).
Summary of Brain Morphology in the Standard Group
of Deviations and Defects; Group I.
Group I. General.
Often :—Inequality in size and weight of the two cerebral
hemispheres.
Variations from usual limits of relative size of some of the
cerebral lobes.
Smallness of gyri in some.
• Irregularity of gyres and furrows ; partly from undue ex¬
tension or branching of sulci, or their duplication.
Simple bold gyres and furrows; partly from defective
development of annectant or anastomosing gyres and
gyrels.
Local. Frontal Lobe.
Often:—Differences in relative size and development of
the several frontal gyres, or of the gyres of same name in
the two cerebral hemispheres.
Often:—Simple and strongly defined are the frontal
gyres, or small; or irregular and odd in shape and outline.
They may look as if directed upward forward and inward;
or may be in four tiers.
The two upper frontal gyres may be cut across by unusual,
or unusually developed, sulci.
The third frontal gyre is often small, or irregular and ill-
defined. A dwarfish condition of frontal and parietal
opercula of the Sylvian region is apt to occur, and slight
sloping over of orbital surface on to external frontal aspect
may be seen. The central gyres may be deeply furrowed
from the Sylvian fissure. Only a single anterior Sylvian limb
may be apparent. Irregularities and defects of frontal
furrows are frequent, and precentral-sulcus elements may
enter central or Sylvian fissure.
On mesial surface, one or more of several conditions may
be found; such as small fomicatus; sub-frontal fissure
upturn opposite to central fissure, or bifurcate, or failing to
reach upper border, or reduced to a slight gradual flexure,
or its relative position different in the two hemispheres.
Or sub-frontal fissure joined with sub-parietal; or dupli-
Digitized by
41
1898.] by W. Julius Mickle, M.D.
cated; or in several scattered pieces. Some of superorbital
sulci; or the preoval farrow; may be defective or absent.
Sylvian. Posterior horizontal limb of Sylvian fissure may
run far back, or be sharply up-curved, behind ; or various
sulci may be confluent with Sylvian fissure. Occasionally,
is a possible representative of anthropoid fronto-orbital
sulcus.
Irregular states of central fissure may be seen.
Parietal . Relative smallness of supra-marginal gyre;
defective opercular development of inferior parietal lobule;
great and irregular division of parietals by branching of
sulci; are frequent. The interparietal sulcus may be a
relatively simple, deep, bold, unbridged furrow; it may be
cut into by various sulci, or may join the Sylvian; its
sagittal portions may be set at about a right angle to each
other. Occasionally a “ prsecuneolus ” is observed.
The Occipital Lobes may diverge behind and partly
uncover the cerebellum. The gyres may be small, ill-
marked, or few and simple; invaded by unusual sulci, their
furrows irregular. The external limb of the parieto-occi¬
pital fissure may be unusually long; it maj depress part of
first external annectant, and enter interparietal sulcus. On
the mesial aspect, the fissure may be interrupted by a
normally sunken gyre rising towards, or to the surface; or
may be bi- or tri-furcate, or throw off long spurs; or may
be short, perhaps failing to reach the upper mantle-border;
or may be unduly shallow relatively to the depth and bold¬
ness of the calcarine fissure.
The cuneus may be small or irregular; it may be deeply
ploughed up by a branch from the parieto-occipital fissure,
or from “ the stem ; 93 an appearance much as in some
microcephales and some apes. The back end of calcarine
may be unusually far forward, as in apes. The calcarine
may be very zigzag; or deep and bold relatively to the
parieto-occipital.
Temporal Lobes . In some examples, the first temporal
gyre seems to sink into the Sylvian fissure. Sometimes the
gyres are modified by ill-marked, sectional, states of the
first temporal sulcus; or by its sharp upward and forward
curve, behind; or by its unduly vertical trend ; or by con¬
siderable relative length of its trunk or rami; or their
irregularity. Defect of anastomosing gyres conduces to
simplicity and strong definition of the sulcus and bordering
gyres. The second temporal sulcus may be sectional, ana
Digitized by {jOOQle
42 Drain-Forms in Relation to Mental Status, [Jan.,
the pieces may be directed obliquely downward and back¬
ward. The temporal incision may be long and bold. The
temporal pole may be stunted; or the temporal operculum
defectively formed, in fact abortive.
Inferior Surface. The occipito-temporal gyres and
furrows may be very irregular, unusual in shape and rela¬
tions, very unsymmetrical on the two sides. The collateral
fissure may be only defectively formed; or, on the other
hand, may be very long and zigzag; or may slightly join the
“ stem” or the calcarine.
Summary of Comparisons detailed in Chapter XI.
Results of the Application of the Standard of Deviations and
Defects in Comparisons between the Gyres and Furrows in
several forms of Mental Disease, and those in the Standard
Group of Cases .
This is the subject of the eleventh Chapter, the external
cortical architecture being compared in several members of
the large group of mental diseases in which heredity and
degeneracy play so important a part.
Firstly, is compared the cerebral configuration of
THE STANDARD GROUP, OR i€ I.,” WITH THAT OF GROUP II., OT
paranoia of more or less psycho-neurosal type. A synopsis,
only, is stated here.
In “ II.,” as compared with the standard, “ I.,” are:—
Far less inequality of size and weight of the brain’s two
cerebral hemispheres:—
Less smallness of gyri; or irregularity of gyres and
furrows; or subdivision of gyres by furrows.
In the Frontal gyres of II., are:—
Less often differences in the relative development and size
of the several gyres; or smallness of them. And somewhat
less of extra, or unusually marked, furrows either ploughed
up from the Sylvian, or vertically-placed on the two upper
frontal gyres ; and of irregular division by furrows of various
kinds.
In Parietal gyres of II., are :—Somewhat less of irregular
sub-division of gyres by sulci; the post-central sulcus-group
less often bold and long:—the inter-parietal sulcus less cut
into by furrows.
In Occipital lobes of “ II.”:— Less often divergence of
occipital lobes behind, so as to partially uncover the cere-
Digitized by L^ooQle
48
1898.] by W. Julius Mickle, M.D.
bellum: Less gyral and fissnral irregularity: less invasion
by unusual furrows : less often smallness of occipital lobes
or aberrant conditions of cuneus. Also, differences on other
points.
In Temporal lobes of " II.”More departure from usual
relation of size between the several gyres:—
Less frequent forkings, irregularities, or long prongs of
first temporal sulcus :—
Second temporal sulcus more often highly marked or
extending far.
On Mesial Surface of “ II.” :—fewer examples of aberrant
form or position of sub-frontal fissure and its upturn.
On Inferior Surface of “ II.”:—the collateral fissure some¬
what less affected, on the average.
Comparison between the Standard group, or “ 1 . 99 ; and
Group “HI.” {paranoia of medium degenerate type).
In “ III.”; as compared with the Standard, " I.,” and
stated only in summary, here; are :—
The Frontal lobes, on the whole, affected similarly as, but
somewhat less than, in “ I.”
Precentral sulcus much less often abnormal:—
In Parietal lobes ; similar, but somewhat less, deviations
of gyral form (yet more, as regards one feature). The quad¬
rate lobule affected with considerable frequency.
The Occipital lobes in “ ni.” present, on the average, less
posterior divergence, slightly less furrowing, less affection of
calcarine fissure; but more gyral irregularity.
On the whole, the Temporal lobes are nearly but not quite
the same as in “ I.”
Some differences exist between “ IH.” and “ I.” as to the
aberrations from usual form of anterior Mesial surface and
Inferior surface of cerebrum.
Comparison between the Standard Group, “ I. ”; and
Group “ V.” {with chronic delusions of somenhat paranoiac -
type).
Ih “ V.”; the Frontal gyres nearly as much affected, on the
average, as in “ I.; ” and the precentral and postcentral
sulci considerably affected in like manner as in “ L”
The Parietal gyres less affected than in “ I.”: yet marked
examples of two individual deviations occur.
The Occipital and Temporal regions and the Mesial and
Inferior Cerebral Surfaces are less affected than in “ I.,” on
the average.
Digitized by
44 Brain-Forms in Relation to Mental Status, [Jati.,
Comparison between the Standard Group “I.”; and
Group “ VI.” {predominantly Impulsive).
In Group “ VI. ”:—The Frontal lobes, nearly as in I., on
some points:—
The Parietal lobes, somewhat less often affected than in
“I.,” but similarly in kind. Yet marked deviations from
usual form of quadrate lobule may occur.
Deviations of the Occipital gyres are less frequent than in
“ I.,” but in a few are extreme and very unusual.
Affection of Temporal lobes less frequent than in “ I.,”
yet occasionally highly marked.
Central, calcarine, parieto-occipital, interparietal and tem¬
poral furrows less affected, on the whole, than in “ I.”
Comparison between the Standard Group " I ;” and
Group VII. {Epileptic).
In “ VTI.” 2 —The brains larger on average than in “ I.”:—
Inequality in weight of the two cerebral hemispheres oc¬
curs but little:—
The Parietal and Temporal gyres are, on the whole, less
affected than in “ I.”
The external part of parieto-occipital fissure may be long;
and the pre-central and post-central sulci may be highly
marked.
Comparison between them showed that Group " VIII.,” or
Periodical Insanity , possessed a brain-surface morphology less
unusual and atypical than in the Standard Group “ I. ”;
and on the average much as in Group “ I/.,” (g.v., Chapter X.)
This last is an interesting confirmation of views expressed
i n pre ceding pages; inasmuch as Group “II.” ana Group
“ Vni.” according to my opinion, occupy, nosologically, a
similar position with regard to the degree in which they are
the outcome of heredity and degeneracy. In this respect
they are among the most mildly affected of the groups con¬
stituting the multitude essentially based in heredity and
degeneracy. Indeed, they are to some extent transition
groups.
In conclusion. Valuable as I believe the outcome of the
study of brain-surface morphology to be, it must not be re¬
garded as in any sense a substitute for the usual lines of
examination of brain and nervous system in the insane.
That study does not replace the methods hitherto in use;
but is auxiliary to them, and augments our knowledge of
the physical bases of mental defects and perversions. In the
Digitized by L^ooQle
45
1898.] by W. Julius Mickle, M.D.
study of psyohic status and condition, it gives us a wider
range of mental vision, and from a higher level; it promotes
that systematic arrangement, and that application, of know¬
ledge, which, respectively, constitute the very essence of
phUosophic, and of practical, science.
Visits to Danish Asylums for the Feeble-Minded, and other
Institutions . By William W. Ireland, M.D., Mavisbush
House, Polton, Midlothian.
The desire of visiting the institutions in Denmark for the
education of the defective classes was aroused in me by the
praises bestowed upon them by my friend Jakob Soethre
and Dr. Frederick Starr.* I knew that they were both men
well fitted to judge correctly, and not likely to be misled by
appearances, which are often deceptive and sometimes are
meant to be so. What indeed struck me was the statement
that there was no attempt at show in the Danish Asylums.
They must, therefore, I thought, depend upon their intrinsic
merits. I crossed the North Sea from Hull to Amsterdam
in the “ Professor Buys,” a route which I can recommend
for those who prefer a short sea passage. I travelled
through Northern Germany, stopping with some friends
at Bremen, where I visited several institutions. In the
beginning of July I reached Copenhagen, and soon got into
communication with my friend, A. Fnis, the Medical Super¬
intendent of the Custodial Asylum for Imbeciles at Ebberod-
gaard. Besides his eminent qualities as a physician and a
man of literary culture, Dr. Friis has the especial merit of
speaking English fluently, and, through his kind attentions,
I escaped the difficulties and perplexities to which I should
have been otherwise exposed.
GAMLE BAKKEHUS,
the oldest training school for imbeciles in Denmark,
opened in 1856, is situated in the western suburb of
Copenhagen, amongst pleasure gardens and divers places
of recreation, and not far from the fine park of Frederiks-
berg. The presence of a large city renders ground dear,
and this was no doubt the reason why the playgrounds
and gardens were somewhat small in proportion to the
• In “A Visit to the Keller Institutes in Denmark/' by Frederick Starr, in
the Charitable Observer , August, 1896. Lincoln, Illinois.
Digitized by L^OOQle
46 Visits to Danish Asylums, [Jan.,
number of inmates. I regret that I missed seeing the
Superintendent, Mr. E. Y. Rolsted, who was from home.
The holidays were commencing, and many of the pupils
were also absent. Dr. Friis and I were shown through the
place by a teacher, Mr. M. Damm, who spoke German. He
said there were about 200 children in the training school,
some of them not educable. For these there were four
male and sixteen female ■ teachers. Only one governess
lived in the house. No doubt a city like Copenhagen affords
facilities for skilful teachers amongst its residents, but I
always considered that the presence of the governesses was
of great advantage even beyond school hours. From the
Report for 1896 it appears that the whole staff comprises
thirty-one persons, including the visiting physician, Dr. J.
F. Nielsen. Amongst these are a singing master, a director
of work, a teacher of gymnastics, a gardener, a doorkeeper,
and a stoker. Ten of these employes were males and
twenty-one females. There were also two male servants
and twenty-four female domestics, nurses, chamber-maids,
sewing-maids, and cooks. Out of ninety-five pupils, twelve
adults were learning to work, and eighty-one were attending
school. The schoolhouse was a roomy building of three
stories, with wide passages; the schoolrooms were small,
but airy and light, and well furnished with objects of illus¬
tration. In my opinion small schoolrooms are much the
best, as several classes held together in one room distract
the attention, and with imbeciles the great difficulty is to
fix the attention. The dormitories for the boys and girls
were in separate blocks, and another building was used for
the cooking and stores. From the Annual Report of 1896
it appears that the average number of inmates during the
year was 196. Nineteen had been dismissed (12 males,
7 females) and 15 (7 males and 8 females) sent to Ebberod-
gaard, and 37 new pupils had been admitted—23 males and
14 females; 3 males and 1 female had died during the year.
Cooking for dinner was going on busily; the provisions
were good, and the children seemed well nourished. Each
child was supplied with fork and spoon, but, to judge from
what I saw, only about 10 per cent, used knives at table.
It was easy to see that education was the main object at
this institution, and that it was prosecuted in a diligent, and
intelligent manner without any attempts to make the results
showy or striking. The number of teachers allowed the
separation into many appropriate classes for the divers
Digitized by L^OOQle
47
1898.] by W. W. Ireland, M.D.
grades of intelligence. A young lady, who spoke good
English, showed me her stores of sewing, knitting, and
embroideiy, all neat and in good taste. The manufactures
done in the workshops consisted of common brushes of
various kinds, mats made of rushes, and some simple articles
in wood. There was shown a ship model constructed by
some expert pupil, and miniature Danish flags which could
be pulled up and down upon the staff. There was a separate
house for the infirmary—a wan looking building. At the
door, on a movable bed, lay a hydrocephalic boy, whose
huge head contrasted with his attenuated frame. The cir¬
cumference was 695 millimetres. He seemed intelligent,
and could speak and read. There were several children in
the infirmary going in consumption. In the rooms there
was a want of light, and I saw few objects of amusement;
but there was a kindly old nurse. Of the four deaths during
the year three were from phthisis and one from epilepsy.
As far as I could learn there were no sporadic cretins in the
institution. I noticed several microcephales and a con¬
siderable proportion of Mongolian idiots.
The dormitories were plain in their furnishings, though
clean and comfortable; there were iron beds of a dull colour,
without the brass ornaments or gay painting which make
iron beds look attractive in our country. I noticed this dull
pattern in almost all the dormitories which I inspected; the
prices mentioned seemed to me so high that I said they
could get better beds from Britain at a much less cost. One
Superintendent, however, assured me that this was not the
case.
It is noteworthy that in the Eeports the names of the
pupils are printed in full. This shows a decided difference
in national character between the Danes and the Scots,
for such a list in Scotland would cause great offence. From
the reserved and cautious nature of my countrymen they per¬
sistently avoid any information which might harm their
interests in any way.
THE CUSTODIAL ASYLUM OF EBBEBODGAARD.
After the institution at Bakkehus had gone on for thirty
years a Commission was formed in 1886 to consider the
results, and to take advantage of experience for further
arrangements. This Commission, which consisted of six
members, already acquainted with the subject, made a
careful and elaborate enquiry. They considered the uses
Digitized by
Google
48 Visits to Danish Asylums, [Jan.,
and functions of a Training School for Idiots, of a fostering
institution, and of a custodial asylum to which all might be
sent who could not be returned to their parents, or who had
no parents or guardians. It was determined to carry on the
work of teaching in the Bakkehus, and to build an asylum
in the country where adults could be received, where the
work of those who could be taught to work could be
utilised, and those who could not work should have proper
care, medical treatment, and protection. For this purpose a
piece of land was bought, a deserted farm at Ebberddgaard,
about two miles from the station of Birkerod, on the rail¬
way line between Copenhagen and Elsinore. This asylum
was opened in June, 1892, with 131 cases (80 males and 51
females). The plan from the beginning was complete and
comprehensive, information having been collected through
enquiries carried on in various countries. Through the kind¬
ness and hospitality of Dr. Friis I was enabled to take a pretty
complete survey of the buildings and inmates. Ebberodgaard
is situated in a beautiful undulating country finely wooded.
The asylum is made up of blocks of houses, generally of two
or, in the middle, of three stories, symmetrically arranged
with open spaces, lawns or playgrounds between. There are
separate houses for the helpless, for the workshops, for the
male and female dormitories, for the hospital, and a small
chapel for burial services. One group of the asylum buildings
is separated from the other group by a beautiful avenue of
tall lime trees, planted by a Lutheran Bishop, the proprietor
of the ground long ago. The grounds occupy 150 acres,
consisting of garden, arable, and meadow land. The water
supply of the establishment comes from two artesian wells
in the neighbouring woods. After being filtered the water
is pumped through iron pipes into the buildings. They have
in the farm 50 cows of the good Danish breed, three dairy¬
maids look after the cows ; milking is too nice an occupation
for imbeciles. Most of the milk is consumed on the establish¬
ment ; but a little butter is made. There were 10 horses and
120 pigs; the sewage is utilised for manuring. They make
their own gas, and bake their own bread. The buildings
are of brick, of plain architecture. The rooms, never very
large, are well lighted, and there is proper provision for
warming. Everything was new and bright; the furniture
had nothing of the superfluous, and nothing wasted in dis¬
play. Some of the inmates were very helpless, reminding
one of those in the Metropolitan Asylum at Darenth; others
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1898.]
49
by W. W. Ireland, M.D.
were robust and looked capable of work. Beyond what is
called habit-forming, the teaching at Ebberodgaard is
wholly industrial. The inmates had the good-humoured,
frank, and confiding character common with imbeciles who
are .well treated. There were all varieties of idiocy, and
some curious cases of deformity and nervous disorders.
They were stout, well nourished, decently clad, and evidently
well cared for. The breakfast consisted mainly of oellebroed,
rye bread, and beer boiled together. I tasted this brew and
found it better than I expected. In the course of my
travels I have fallen in with dishes which seemed to me
strange, though pleasing to the Scandinavian palate.
Custom from childhood has much to do with taste. A
French lady who had travelled through Scotland, once said
to me that she could not conceive how the people could
8wallow porridge, and she appeared to suspect my veracity
when I replied that I could sup porridge when I had lost an
appetite for everything else. In the same way the Ameri¬
cans relish hominy and other preparations of maize which are
not generally tasteful to us, and the whole of Northern Ger¬
many uses rye bread, which to most of us Britons tastes bitter.
The dinner consisted of beef and bread, potatoes, and
vegetables, with a milk pudding flavoured with a species of
rumex.
The staff consists of 17 officials besides the Superintendent
(10 males and 7 females). This comprises a gardener,
tailor, shoemaker, and baker, an engineer and assistant,
besides matrons and head attendants; there are also 70
servants (18 males and 52 females) engaged in keeping the
house clean, sewing and cooking.
In reply to what I said of the growing difficulty of
getting good servants in Britain Dr. Friis said that it was
the same in Denmark; some people in Copenhagen brought
servants from Sweden, and one gentleman, who had a large
household and a large number of domestics, imported
liussians, but had to keep an interpreter for them.
I saw through the workshops; the manufactures consist
of nail brushes, paint brushes, rush mats, simple chairs,
stools, and tables. Some furniture was made for the house.
Dr. Friis said that the ordinary charge for board was £30 for
those who could not work, and £21 for those who could. He
thought on an average that this £9 represented the value of
their work. The establishment is supported by private con¬
tributions, payments from the different Communes and from
XMV. 4
Digitized by LjOoq Le
50
Visit8 to Danish Asylums , [Jan,,
individuals. The Government gives a grant of one-half for
each case.* The asylum is not under Government control,
but is managed by a Committee of Direction. The accounts
of all the institutions are under the audit of the Government.
The chairman is Mr. A. Asmussen, Chief of the Educational
Department of Denmark, who has a villa near Ebberodgaard.
I had the pleasure of meeting this gentleman at Dr. Friis*
house, and retain a pleasing remembrance of his courtesy
and instructive conversation.
Owing to the greater age of the cases and the residual
condition of many of the patients the mortality is greater at
the custodial asylum than at Bakkehus, though the hospital
arrangements are superior. The daily average at Ebber¬
odgaard during the year 1895-6 seems about 400. In April,
1895, there were 884 inmates, and on 31st March, 423. The
admissions during the year were 71; the dismissals 14, the
deaths 18 (12 males and 6 females). Of these 9 were above
20 years of age, the oldest being 41 years ; one half of the
deaths were owing to tuberculosis, 3 to epilepsy, 3 to heart
disease, 2 to empyema, 1 to meningitis, and 1 to chronic
diarrhoea.
The mortality of Ebberodgaard has been from 1st June,
1892, to 31st March, 1893, 11 deaths amongst 243 patients,
4*52 per cent.
Deaths. Average No. Percent.
From 1st April, 1893, to end of March, 1894 ... 27 361 7*5
„ 1894 „ 1895 ... 24 384 6*25
1895 „ 1896 ... 18 423 4 25
„ 1896 „ 1897 ... 29 420 6*9
In the two first years they had several epidemics of scarlet
fever and diphtheria.
Dr. Friis, unwearied in his kind attention, introduced me
* The following note shows from what sources the Gamle Bakkehus and
Ebberodgaard derive their income. From 1st April, 1895, to 31st March, 1896,
they received:—
From voluntary contributions, c. 1,330 croners.. ... = £402
„ interests of legacies, c. 950 croners .= £52
„ payment for boarders, c. 296,070 croners.= £1,626
„ income from a lottery, c. 26,400 croners. .. = £145
£2,225
Of the payment for the boarders the Government had contributed 132,000
cr. = £7,252 15s. Formerly several of the charitable institutions in Denmark
each had permission to have a lottery; now there is a common lottery, in which
they partake. The Keller institutions have never had a lottery of their own,
but they began to get their part in the common one from the 1st April, 1897.
Digitized by L^ooQle
51
1898.] by W. W. Ireland, M.D.
to Professor Chr. Keller, who is at the head of the adminis¬
tration of De Kellerske Aandsvage-Anstalter, the different
institutions founded b j his father, Dr. Johan Keller, the first
of them in 1865. The situation and appearance of these
establishments showed their history; they had obviously been
set agoing one after another at different dates as funds came
in, and eligible feus or buildings came to be sold. They
were in different parts of the city; one of them, a large five¬
storied house, was in a thoroughfare called the Baggesens
Gade. Here the training schools are held, and the education
of the feeble-minded is perseveringly prosecuted through
methods which the experience gained by patient, thoughtful
effort and long use has shown to be the most serviceable.
In addition to the 164 boarders, 70 scholars from the city
take advantage of this school.
Another building, at Balderogade, also in the town, con¬
tained the trial or preparatory department, where the new
comers are received and their capacities fully tested by
lengthened observation and teaching. Here there were 90
boarders. Another building was reserved for idiots who
could learn nothing. One of the Keller’s institutions had
been lately destroyed by fire, but the Professor had succeeded
in hiring two houses next door to one another. Here I saw
two well pronounced cases of sporadic cretinism. When I
asked whether they had yet been given the thyroid gland or
extract, Professor Keller said that they were fearful of doing
so, having, I suppose, read of harm and death resulting in
cases of myxcedema. On this point I tried to reassure them,
and was enabled to tell them what success had attended Dr.
John Thomson’s treatment of such cases in Edinburgh.
Next day Inspector Johan Keller and Dr. Riis, one of the
visiting physicians to the Institutions, took me in a carriage
to the Home for Epileptics at Villa Poppina. It is situated
out of the town, near the arm of the sea called the Kalle-
bostrand. There were some children, but most of them were
big lads; I noticed several microcephales. One patient had
a glazed helmet; he used to strike himself on the face, and
then cry out as if hurt. The boys and girls are kept in
separate buildings. The rooms seemed somewhat crowded,
especially as they were not high in the roof. The beds were
of the same dull iron pattern, with grey bedcovers; but
everything was clean and neat. The food was good, the
milk excellent; this I found to be the case everywhere in
. Digitized by L^ooQle
52
Visits to Danish Asylums , [Jan.,
Denmark. The buildings had a newer, brighter look than
the Institutions in Copenhagen, and the country air, the
garden around, and the fine summer weather contributed to
give a more pleasing appearance to the establishment, in
spite of the hopeless character of many of the cases.
We then drove to the Asylum for Incurable Adult Idiots
at Karens Minde, which is about a mile and a quarter from
the city. Here we were kindly and hospitably received by
Inspector Graae. This asylum contained about 200 patients.
In spite of the unhappy name of incurable (Uhelbredelig)
the patients in general looked good-humoured, healthy, and
well-fed. The rooms were clean and light; it seemed
as if the dormitories were rather crowded. I thought that
in addition to grown-up idiots and imbeciles there were
some patients belonging to the class of “ harmless lunatics,”
and recognised several general paralytics. I saw three
caged beds which were carefully stuffed, big enough to
turn and sit up in. In Great Britain such an arrangement
would have entailed apologies; but the Inspector made none,
and pointed them out as something serviceable in treating
the particular cases for which they were used. He had two
large airing courts with wooden railings, and booths with
seats at one side where meals could be served in fine weather.
The asylum buildings are in a pleasing style of architecture,
with a considerable space of ground. For this building the
Rev. Johan Keller obtained a grant from the Government.
GAMMEL MOSBHU8.
The asylum for imbecile women whose training is over, and
who can do some work, is situated about five miles from
Copenhagen, in the midst of fields of rye, wheat, barley,
and sugar beet. It is a well-built house, with working rooms,
cowhouses, and a pleasant garden around, affording accom¬
modation for about forty imbeciles, besides five officials,
matrons, housekeepers, and teachers, and four women ser¬
vants. Most of the imbeciles are young, though one was
said to be sixty years old; she had no grey hairs. They
were seated at a long table at dinner, but rose respectfully
when we entered. There was a piano in the dining-room.
The women seemed in good health; some very stout. The
matron, an intelligent little woman, showed me the working
rooms. There were handlooms for weaving linen and
worsted cloth, which , is said to pay. I saw no sewing-
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1898.] by W. W. Ireland, M.D.
machines, bnt they sewed articles of clothing and knitted
stockings. Some women worked in the laundry. There
was scanttime to make notes of special cases, but I measured
the head of one microcephale : Antero-posterior, 24 c.; cir¬
cumference, 39 c.; transverse, 24 c. She looked strong
enough, but could not speak; another who had a larger head
spoke fluently. Everything seemed to go on in a quiet,
gentle, and orderly way.
At easy walking distance lies the workhouse for men,
LILLE MOSEOAARD,
a substantial three-storied building, with some pretensions
to architectural good looks. The staff comprises a superin¬
tendent and assistant, shoemaker, tailor, basket-maker, gar¬
dener and under-gardener, with two overseers or grieves,
and three male servants with a housekeeper, night watch,
and six servant girls. Here I saw a number of big stout
lads; five were working with the joiner, eight at basket¬
making, and seven at shoemaking. The baskets were made
from osiers grown on the farm. These were of the common
sort, somewhat loose in make. The joiner exhibited rude
chests of drawers, chairs, and tables. I saw one young im¬
becile sawing, another polishing wood. There were also
reed mats. Near the house there is a large garden in very
good order, with a variety of fruits and vegetables. The
strawberries were ripe, and were being sold in Copenhagen.
Tomatoes were in flower. There were ten cows and eight
horses. Amongst the outdoor work done by the inmates
are ditching and digging peat; every source of income is
carefully utilised. The island of Zaaland is quite flat and
difficult to keep drained, with many lakes and ponds and
morasses. Yet one comes across, here and there, scattered
over the fields and meadows, pebbles and boulder stones,
some of them of great size. As rock quarries are rare these
boulders are broken down to be used for road metal. Some
of the inmates who can only do the simplest are employed at
this work. From a stone heap near I picked up specimens
of granite basalt and quartz, which, no doubt, had been
carried in the uncounted geological periods from the moun¬
tains of old Norway. The house and grounds were sur¬
rounded by wooden palings. None of the Institutions which
I visited in Denmark were enclosed by walls. Their inmates
were all of a harmless character.
The total number of inmates cared for in the different
/
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54
Visits to Danish Asylums , [Jan.,
Keller’s Institutions amounts to about 600, who are thus
distributed:—
In School Departments.230
In Work Departments .150
In Karens Minde and other Asylums ... 220
The inconvenience of keeping these Institutions at irre¬
gular distances from one another under one central adminis¬
tration must be considerable, and I was told that Professor
Keller purposes shifting some of them to the neighbourhood
of others so that they should be less scattered, for which it is
to be hoped the needful funds will be forthcoming.
I purposed visiting the schools for the education of the
deaf and the blind in Copenhagen, but ere I could find time
to do so the vacation had begun and the teaching was
stopped.
At Bremen they were busy collecting money for an Insti¬
tution for the care and training of the idiots in the territory
of the old Hanseatic Republic. They already had a training
school for feeble-minded children (Schwachgegabte Kinder),
which I visited. It was in a house in a narrow street in the
middle of the town. There were 82 pupils, all children. The
head teacher is Herr A. Wintermann. I found him engaged
at the speaking lesson with about a dozen of the youngest
children; some of them were of low grades of idiocy; others
more intelligent. It is evident he reserves the most difficult
task for himself, and his methods showed that he understood
the business. Up stairs is the second class, which was
taught by a young man. There were 22 boys and girls who
could speak, and were learning to read. They sang a song
to the accompaniment of the violin. In the next room 12
girls were being taught needlework and knitting by a young
woman. In the workshop there were about the same number
of boys, who were taught to make baskets and to plait straw.
None of the children live in the place; they are sent every
day to the school by their parents. They all looked neat
and tolerably dressed. On the whole a school calculated to be
useful in which the best methods of teaching were diligently
employed.
We also pa,id a visit to the Deaf and Dumb Institution,
a pleasant house in a good street, with a nice garden.
The Director, Herr Marquardt, showed us three classes;
in general there were four, but one of the teachers was
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55
1898,] by W. W. Ireland, M.D.
absent. The schoolrooms, which were all separate, were
well supplied with engravings and materials for object
lessons. The first-class was for new pnpils, children from
seven to ten, nine in number. They were seated at desks in
a horse-shoe form, so as to be close to the teacher, who sat
in the middle. They were being taught primary sounds to
prepare them for learning to speak by the German method.
In the next class they had begun to practise speaking. There
were about a dozen pupils, boys and girls, from 10 to 14
years old. They related the story of Elijah being mocked
by the children. This was illustrated by an engraving repre¬
senting a crowd of young Israelites teasing the prophet
while two bears were biting and tearing the rear rank of
them. The children shouted out “ Kahlkopf heraus ” in a
drawling manner. In the next class, conducted by Herr
Marquardt himself, we witnessed the results of the long and
patient course of instruction. It was astonishing to note
the quickness of the young pupils, all quite deaf, in speak¬
ing, and especially in understanding speech. I marvelled
that they understood everything which I and my daughter
said to them, although my mouth was covered by a beard
and moustache. Herr Marquardt told them that we came
from America, when they asked by what steamer we crossed
the sea. We then explained that we came from Scotland,
by Amsterdam; they said that was in Holland. A girl
asked me if I were a doctor, and where I lived. I told her
the name of the street, “ Dobben,” and the name of the
friend with whom I was living, Herr Meyer-Bomers. One
pupil picked up and repeated the name, and said I could
walk there in ten minutes. To keep up the conversation I
asked if they could guess how I had lost my eye, when one
girl promptly said u Mit einem Kugel.” The teacher sug¬
gested that she made this successful hit from being the
daughter of a military officer. Altogether we were much
impressed by the patient diligence of the teachers and the
success of their labours. At the same time I am not yet a
complete convert to this teaching by the German method.
Herr Marquardt admitted that it would be more difficult to
teach our language in this way, as in English the vowels are
not pronounced so broadly, and some of the consonants are
glided over. My main objection, however, is that this
method is so extremely laborious that it leaves too little time
for other subjects, so, though it may do for some of the
smartest pupils, the less intelligent are apt to leave the
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56
Visits to Danish Asylums, [Jan.,
schools with little knowledge save this solitary accompUsh-
ment. I have a lingering conviction that figurative signs
are the most natural language of the deaf. I have been told
that pupils taught by the German method are forbidden to
converse by signs. Looking through the window at these
German children playing in the garden I saw some of them
conversing by signs. When they noticed me at the window
they at once stopped. It is somewhat amusing at large
classes for the deaf in our country to see the children busy
talking on their fingers to one another whenever the
teacher’s back is turned, of which, of course, he is quite
unaware.
Visitors to institutions maintained by charity are benevo¬
lently disposed to bestow praise in hackneyed adjectives
and adverbs, and to avoid critical remarks lest they might
injure the reputation and immediate prosperity of the
concern. Nevertheless, it does not seem to me or any ad¬
vantage in the long run that the merits of such establish¬
ments should be represented as greater than they really are,
and enduring harm has resulted from the managers escap¬
ing censure from a fear of depreciating the work which they
were supposed to direct. It seems proper to finish this
paper by considering how far the high claims put forth for
Danish institutions for the defective classes are justified by
what is done in other countries, for in this matter every*
thing is comparative. The population of Denmark is about
I, 967,932; the number of idiots and imbeciles was ascer¬
tained by an unusually careful enquiry in 1888-9 to be 8,857;
of these about 996 are accommodated in the institutions
just described, and we are informed that there are in Copen¬
hagen two private schools for about a hundred children.*
It thus appears that about 29 per cent, of the idiots in
Denmark are received into asylums especially adapted for
their wants. Carlsen tells us that the others are mostly
placed in workhouses, poorhouses, and similar places, and a
considerable number live with their relations, who receive
assistance from the parishes for their maintenance. He
only mentions 18 in infirmaries or madhouses. In England
about 6 per cent, are received into special institutions,
though idiots in the London district are well provided for.
In Scotland there is not up to 8 per cent, of the idiotic and
* Staiuke Underage l ser angaaende Aandssvage %, Danmark , 1888-1889, ved
J. Carlsen Dr. Med.
Digitized by t^ooQle
1898.] by W. W. Ireland, M.D. 57
imbecile in any institution specially designed for them.
Moreover, if we had correct returns of the number of idiots
in the population this percentage would, I believe, be much
less. When the children *in the charitable institutions
become older and their parents are dead, or too poor to sup¬
port them, they generally drift into asylums for the insane.*
In Ireland there is specific provision only for 60 idiots
and imbeciles, and in the United States, where such institu¬
tions are maintained by the States Governments, only 6 per
cent, find their way into them. In France the number of idiots
who received special care must be less than 4 per cent, of
the whole. Things seem to be better in Germany, but it is
somewhat humiliating to find that this unfortunate class is
better provided for in Denmark and Norway than in
countries so much wealthier.
As already noticed the staff of teachers and attendants in
these Danish Asylums is large, and they seem to be diligent
in their duties. There is much less attention paid to out¬
ward show, while everything necessary is provided. Never¬
theless, display is of importance in institutions supported by
charity where the visitors rarely go further than appearances.
In our own country, in asylums and hospitals mainly sup¬
ported by contributions, those concerned are sometimes
called upon to sacrifice the useful for the ornamental. I
doubt whether the asylums at Copenhagen are in all respects
under the best hygienic conditions, but it may be fairly
taken as a proof that good care is taken of them that the
average death-rate is low. The mortality during the past
year in the Gammle Bakkehus was a fraction above 2 per
cent., and as far as I can ascertain the mortality in 1896 in
all the Keller's institutions was no higher than this 2 per
cent. The death-rate at Ebberodgaard from the time of
opening till the 31st March, 1897, was about 6*26 per cent.
The reason of the higher mortality in the custodial asylum
is that the patients are much older. Of the 19 deaths
which Dr. Friis had last year 11 were patients above 21
years.
Dr. Shuttleworth estimates the average mortality of the
Boyal Albert Asylum during the time that he was Superin¬
tendent as 8*5 per cent.; Dr. Fletcher Beach returned the
death-rate of the Darenth Schools in 1889 as 3*07 on the
average number daily resident.
* See Mentally Deficient Children, by Dr. Q. E. Shuttleworth, London, 1895
p. 9.
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Visits to Danish Asylums, [Jan.,
The following are the death-rates of the Asylums for
Idiots in England for 1895-6 on the average number resi¬
dent :—
Western Counties Asylum ... . 1*3 per cent.
Eastern Counties Asylum ... ... ... 5*9 „
Royal Albert Asylum ... ... ... 2*8 ,,
Earlswood.3-5 „
Norman sfield... ... ... . 2*6 „
Midland Counties Asylum ... ... ... 1*9 „
Metropolitan Asylum, Darenth ... ... 3*77 „
In the Report of the Larbert Institution for the year
ending 31st January, 1897, the deaths are stated to amount
to 5*6 per cent, of the number of children under treatment
during the year. “ This,” the Report goes on, “ is a very
small number, if the physical condition of the children is
taken into consideration, and it is rather below the average
of previous years.” I have shown elsewhere* the average
death-rate of the institution during the years I was the
Resident Medical Superintendent ^1871-1881) was but 15 in
the thousand. For the next fourteen years the average
mortality was 50 in the thousand.
In the Report of the Baldovan Asylum for 1895 the visit¬
ing physician observes that “11 per cent, of deaths is not
excessive, considering the physical condition of many of the
patients.” Of ten children who died eight at least succumbed
to some form of tubercular disease. No doubt a bad physical
condition brings with it a high mortality. What should be
aimed at is to improve the physical condition of the children
by all available means. When at Larbert pauper boarders
used to be sent from the Glasgow parishes, but the Directors
of the Larbert institutions kept the applications so long
waiting for their consent that the Parochial Boards got
tired, and sent them to Baldovan. Thus I know something
of these cases. At any rate they cannot possibly be worse
patients than at Darenth, where the mortality is about one-
third of JBaldovan. I should be pleased to record a diminution
in the death-rate of the Scottish Asylum. It is stated as
6*12 per cent, in 1896, but this figure seems attained by
dividing the number resident at any part of the year by
the eight deaths, instead of taking the daily average of
inmates.
Reference to the industrial training recalls an old griev-
• Edinburgh Medical Journal for October, 1896, p. 329.
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5$
1808.] by W. W. Iriland, M.D.
ance. During the winter of 1881 Mr. John Miiller presented
himself at the Larbert Institution with a letter of introduc¬
tion, stating that he was one of the assistants in the
Pennsylvania School for Feeble-Minded Children, travelling
with a view of collecting information. We invited Mr.
Muller to stay with us, and he remained in our house in the
Larbert Institution from the 15th to the 18th of January,
1881. During this time I showed him through the build¬
ings, took him everywhere with me in my visits, and
answered his numerous questions to the best of my ability.
Some years after I received a copy of the Proceedings of the
Association of Medical Officers of American Institutions for
Idiotic and Feeble-Minded Persons . Sessions: — Glenwood t
Iowa , 1884, in which there was a paper by the said Miiller,
entitled “ Some Observations of the Scotch and Danish
Institutions for the Feeble-Minded.” These observations
contained a number of statements about the Larbert Insti¬
tution, scarcely any of which were entirely correct. Amongst
others :—“ There is no industrial department at Larbert,
and, like many others, this institution possesses no farm
land. A small garden adjoins the main building, but
otherwise there is no ground belonging to it.” And further
on :—“ The ability for handiwork, which proves so con¬
spicuous among even low Danish idiots, is strange compared
with the utter lack of it among the Scotch. I was assured
in Larbert, when I enquired about the industrial department,
that there was none, and, if one should be attempted, there
would not be more than two in the whole bouse who would be
able to use their hands for any kind of work.” “ Whether,”
went on Mr. Miiller, 41 the difference may be referred back
to national characteristics, I am unable to say; there is a
possibility in this, however.” This means, 1 suppose, that
the Danes are naturally very much more skilful with their
hands than the Scottish. Fortunately, Mr. Muller’s obser¬
vations were of a specific character, and free from that
ambiguity in which such critics often take the precaution
of wrapping their statements, for greater safety to them¬
selves, so reply was to me easy, only, as I could not allow
his assertions to pass without comment, I had to bear the
expense of getting my reply printed. I reproduce a part.
“ At this very time there was in the Larbert Institution a
roomy workshop in which brushes of various kinds and mats
of coir fibre were being made. In this workshop twenty-
five boys were employed at different stages of work, though
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60
Visits to Danish Asylums , [Jan.,
some of the worst cases could do very little. Prom the
Annual Report, which was dated 20th January, 1881, it
appears that there were made 641 brushes and 34 mats,
besides teasing and remaking mattresses. At the same
time the joiner had in his workshop (a separate building)
three pupils. He kept the house in repair, and made a
great deal of furniture. The gardener had nine boys under
his charge. The grounds comprised about nine acres, of
which four acres were cultivated by the spade, and supplied
the institution with vegetables during the whole year. The
rest of the grounds not occupied by buildings was in park
or playground; and the whole work of cultivating the
ground, keeping up the roads and fences, and caring for
the live stock, was done by the gardener and these ooys,
with a little assistance from the boiler-man during the
summer when the pipes which heated the house were not in
use. The girls were taught sewing and working in the
house, by the governesses and matron. It ought to be con¬
sidered that by the regulations of the Board of Lunacy I
was not allowed to keep pupils above eighteen years of age,
and therefore none of the boys could be said to have com¬
pleted an apprenticeship. The number of boys in the
institution was seventy-eight, but many of them were too
small and feeble to do any work.”
1 scarcely thought at that time that I was writing
history, for had Mr. Muller returned about six months after
he would have found his remarks justified. The manufac¬
ture of brushes and mats was introduced by my predecessor,
Mr. Addison, and we also taught shoemaking, carpentry,
and gardening, but shortly after I left these industrial
f mrsuits were abandoned, save the last, and, as far as I can
earn, have never been resumed. I gather from the Annual
Report that tailoring is now taught. This I never tried,
for 1 considered it an occupation unfavourable to the phy¬
sique, although, of course, sewing was taught to the girls.
At Baldovan, I have been told, no trades are taught save
gardening.
In all the best English training schools, such as Lan.
caster,* Earlswood, and Darenth, great attention is paid to
* On a recent visit to the Boyal Albert Asylum at Lancaster I found the
workshops carried on with much spirit under the direction of Dr. Telford-
Smith. The manufactures oarried on were carpentry, basket making, mat
making, plaiting, shoemaking, tailoring, gardening, ana field work.
Digitized by LjOoq Le
1898.]
by W. W. Ireland, M.D.
61
industrial training, and all these trades are taught. A
variety of occupation is of great importance in drawing out
their faculties. It is extremely difficu Itto fit imbecile lads
for occupation against the competition of the outer world,
but by keeping them in an asylum their labour could be so
utilised that they could defray the whole, or a considerable
portion, of their board. We had never any difficulty in
selling the mats and brushes manufactured at Larbert,
which were bought by the shopkeepers in the neighbour¬
hood. They were somewhat better finished than those I saw
in Denmark, but many of the articles made in that country
were of a too simple structure for our markets. On the
whole, I do not think that in manufactures the asylums in
Denmark can claim any superiority over the best asylums in
England, and they are much inferior in building and furni¬
ture. One point in which they excel is the subdivisions of
patients and pupils into different establishments. Instead of
being only designed for one class, young imbeciles as in Scot¬
land, or including in large buildings every grade and variety
of idiocy of both sexes as in some institutions in England,
idiots are in Denmark arranged according to their ages,
sexes, capacities, wants, and needs. It is easy to see that
want of funds very much hampers the benevolent exertions
of Danish philanthropists; without the assistance of the
State they could never have been able to do so much, and it
is to be hoped that the State will give them further aid and
enable them to complete their work. As regards Great
Britain, we have long been convinced that private charity
will never overtake the task which it has in part attempted,
of affording proper care and education to the idiot and
imbecile who are in need of help. We see with sympathy
the efforts of “ The English National Association for Pro¬
moting the Welfare of the Feeble-Minded,” who are trying
to found custodial homes for grown-up imbeciles; nor do
we undervalue the efforts of those who aim at the establish¬
ment of schools for children who, from mental dulness, are
incapable of deriving benefit from the teaching in the Board
Schools. The Birmingham Workhouse Committee are
making enquiries about the training of imbeciles, and have
issued a Report. There is no movement about such work
in Scotland; but the Poor Board of the Barony Parish of
Glasgow have begun to pay attention to the question of
training feeble-minded children, and we hope that their
Digitized by L^ooQle
62 Visits to Danish Asylums . [Jan.,
deliberations will end in establishing a training school and
asylum for the feeble-minded amongst the poor of that great
and wealthy city, which would be an example and a model
for the rest of Scotland.
Lavage in Refusal of Food by the Insane . By H. Harold
Greenwood, M.E.C.S., Assistant Medical Officer, Derby
County Asylum.
The refusal of food by an insane patient is a troublesome
and frequently a serious matter, partly because, from the
absence of symptoms in most cases, it is difficult to arrive at
a diagnosis of its cause. In many instances it may reason¬
ably be supposed that subjective feelings of pain or dis¬
comfort in the stomach, leading to the refusal of food, arise
from organic disease or functional disorder of that organ.
That there is a centre in the brain, disorder of which causes
a distaste for food, has been suggested, but is scarcely worthy
of serious consideration. The cause is more likely to be some
local affection, such as malignant disease, gastric ulcer, or
simple gastritis, giving rise to pain on the ingestion of food;
the refusal of food is then the translation of a protest from
a stomach in an unfit state to receive any but the lightest
food.
Malignant disease is a well recognised cause, but less
attention appears to have been given to gastritis, a common
disorder amongst the sane, and assuredly more so amongst
patients whose secretions are so notably disordered and who
are indifferent as to how and what they eat, bolting their
food half-chewed or even swallowing paper and other rub¬
bish. From the imperfect action of the skin, of the genera¬
tive organs, of the intestines, in fact, of all thq, secreting
organs, so frequent in the insane, we should infer that the
mucous membrane of the stomach likewise performs its
functions imperfectly in many cases, and is therefore very
prone to become inflamed. In the following case gastritis
appears to be the most probable cause of food being re¬
fused :—
W.C., aged 31, a case of melancholia, refused food entirely
on March 19th, 1897. For a week previously he had missed
occasional meals, and had appeared out of sorts. He grew
taciturn, maintaining a gloomy silence, his face wearing a
look of profound misery and depression. During this time.
Digitized by LjOOQle
63
1898,] Lavage in Refusal of Food by the Insane .
too, he had some diarrhoea, the stools being very foul, his
breath became offensive; he grew wet and dirty in his
habits and tossed restlessly about at night, groaning and
perspiring. All the information he gave was by laying his
hand over the epigastrium or holding his head as if he had
headache.
After two days* complete fast he was fed with the stomach
tube, receiving milk, arrowroot, eggs, and 2 ozs. port wine
this was continued twice daily for a month.
Despite this ample food, which apparently was not
properly digested, his weight fell from lOst. to 6st. 131bs.,
and he was now, at the end of the month, so weak that
his life was despaired of.
On April 19th the stomach was washed out twice with
warm water. The first washings resembled beef tea, mixed
with white ropy mucus ; the second were almost clear. He
was then fed with milk, arrowroot, and an egg. The
following day lavage was again employed, followed by the
usual feed.
Improvement followed at once. The next morning he
took milk spontaneously. Continuing to improve he was
a month later stronger, taking food well, occasionally
speaking and not complaining of any pain. An immediate
result of the treatment was diminished foulness of breath,
cessation of the diarrhoea, and then gradual regain of
control over the bladder and rectum. His weight had
only increased to 7st. 31bs., but his strength had increased
in much greater proportion. The next month he weighed
8st. 81b8., at the end of the sixth month list., and was on
the high road to recovery from his mental disorder. He
remembers refusing food, and gives as his reason for doing
so, severe gnawing pain in the abdomen, intensified by the
ingestion of food. During the last week of November he has
had dyspeptic symptoms, and coincidently with this his
mental symptoms have, in slight degree, returned.
Whilst W. C. was under treatment, an essentially similar
case occurred here in a female, M. R., another case of
melancholia. After lavage she began to take food of her
own accord and quickly grew stronger.
In both cases the first washings were thick and discoloured
from the presence of altered blood and mucus. Microscopic
examination revealed the presence of red blood-corpuscles,
abundant granular nucleated cells, with here and there a
larger, clearer, less deeply-stained cell. There appeared to
Digitized by L^OOQle
04
Lavage in Refusal of Food by the Insane. [Jan.,
be cells shed from the peptic glands. By cleansing
the stomach from this foul coating, in which ferment^
five processes would readily occur, the food subsequently
introduced was, probably on that account, more thoroughly
digested. Possibly a weak solution of some antiseptic such
as boracic acid would have acted better.
Many cases such as this, no doubt, recover by simple
feeding, but even in these lavage would, I believe, hasten
recover; others, however, die, as this man would have
done; in these cases lavage would give a better chance of
recovery. In all cases of refusal of food by the insane
this treatment is worth a trial, for whilst iu many cases
of simple gastritis it helps to cure the affection, in cases
of malignant disease it might enable a diagnosis to be
made by microscopic examination of the washings, and in
no case can it do any harm. The principle on which it is
based, namely, that of removing the unhealthy discharge
from an inflamed surface, is one of the axioms of surgery.
An Analysis of 131 Male Criminal Lunatics admitted to
the West Riding Asylum , Wakefield , during the years
1884-1896, inclusive. Being a Graduation Thesis pre¬
sented to the University of Edinburgh .* By Frederic P.
Hearder, M.D.Edin., Assistant Medical Officer, West
Biding Asylum, Wakefield.
The period chosen is from the introduction of “The
Criminal Lunatics Act, 1884,” to the end of the year
1896, and male cases only are considered.
Criminal lunatics are divided into two classes :—
“ (a) Any person for whose safe custody during her
Majesty’s pleasure her Majesty or the Admiralty is
authorised to give order; and
“ (6) Any prisoner whom a Secretary of State or the
Admiralty has in pursuance of any Act of Parliament
directed to be removed to an asylum, or other place, for the
reception of insane persons : ” + or, shortly, Queen’s Pleasure
Lunatics and Secretary of State’s Lunatics; the former,
seven in number, having an indefinite, the latter, 124, a
definite period to serve, viz., to the determination of the
sentence of the court.
* Bead at the first meeting of the Northern and Midland Division of the
Medico-Psychological Association, October. 1897.
f Archbold’s Lunacy , 4th Edition, p. 800.
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65
1898.] An Analysis of 131 Male Criminal Lunatics.
Daring the same period 29 cases were received from
prison, as pauper lunatics, at the expiration of their
sentences; six military cases; nine cases transferred from
the Criminal Lunatic Asylum, Broadmoor; and one ticket-
of-leave man from Portland Convict Prison. These cases
are sometimes, but erroneously, termed Criminal Lunatics,
and are not further considered.
The cases were received from Her Majesty’s Prisons at
Wakefield, Leeds, and Armley, the prisons of the We 9 t
Riding of Yorkshire, and were largely composed of the
lowest grade of the mining and manufacturing population
of that district. The degree of education of the majority
was very low, many, indeed, being unable to read and write.
Of the total 53 were labourers; 16, ironworkers; 11, trades¬
men ; six, miners; four, engine-drivers; three, clerks ; three,
hawkers; two, tramps; and one of each of the following :—
Journalist, printer, schoolmaster, farmer, leather-currier,
the remainder being made up of mill-hands, etc.
Their ages were as follows :—
17-19 20-29 30-39 40-49 60-59 60-66
2 34 42 31 17 5
The average age was 37 years. The oldest case, aged 66
years, was sentenced to one month imprisonment for break¬
ing windows. He remains in the asylum, after more than
three and a half years, hopelessly insane and deluded. He
frequently threatens to kill some mysterious “ Smith,” and
on one occasion stole and secreted a knife. The youngest,
aged 17 years, was sentenced to one month imprisonment as
a “ vagrant, sleeping out.” He was a congenital imbecile,
with hallucinations of a persecutory character, was im¬
pulsive, quarrelsome, and violent. He was discharged
“ relieved ” mentally, in six months.
Seventy of the cases were single; 49 were married; and 12
widowed; 102 belonged to various Protestant denomina¬
tions ; 28 were Roman Catholics, and the religious views of
one case were unknown.
The offences for which they were convicted were as
follows, in order of frequency:—Larceny, 45; rogue and
vagabond, 13; drunk and disorderly, 11; assault, eight;
indecent assault, seven; brawling, six; housebreaking, six;
attempted suicide, six; begging, five; horsestealing, three;
threatening, three; murderous assault, three ; shooting, two;
breaking glass, two; embezzlement, two; neglecting the
xliv. 5
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66 An Analysis of 131 Male Criminal Lunatics, [Jan.,
family, two; with one case of each of the following :—
Manslaughter, interfering with railway points, libel, travel¬
ling without a ticket, army deserter, cruelty to a horse, and
bestiality. Included in the above are the Queen’s Pleasure
Lunatics, two of whom were sentenced for attempted
suioide, and one for each of the following offences :—Shoot¬
ing, manslaughter, wounding, indecent assault, and larceny.
The sentences varied from five years to 10 days; two cases
for five years; one for three ; three for two; 11 for H; one
for 1£; and seven for one year, the remainder being for
lesser terms of imprisonment.
Two of the number only showed no symptoms of insanity
after admission, and were discharged after a few days as
“ not insane," considered to have been malingering; 19
cases were congenitally defective, without epilepsy; eight
were cases of epileptic insanity; 36 suffered from general
paralysis; 31 from mania; 26 from melancholia; and nine
from dementia.
The number of “ congenital cases, without epilepsy," 19,
calls for remark, being more than 14 per cent, of the total
criminal cases, while for the same period, taking all the
similar male admissions to the asylum, the percentage to
the total male admission rate was under seven. The number
of “ general paralytics," 36, is also very large, being 28 per
cent, of the total criminal admissions.
During the same period the percentage of all the male
general paralytics to the total male admissions was 18, this,
of course, including the criminal cases under consideration.
Of the general paralytics 24 were maniacal, and 12 demented
on admission. Many ran an exceedingly rapid course. One
of these cases in a fall stained a fracture of the femur, which
made a good union.
Twenty of the maniacal cases were fairly acute, but none
suffered from typical €t acute mania;" six were chronic, one
recurrent, and four were cases of “ mania a potu." Of
the melancholiacs 24 were acute, one chronic, and one
recurrent.
More than one half of the maniacal and melancholic
cases might well be termed cases of “ delusional insanity ”
since their delusions and hallucinations formed the most
prominent phase of their alienation.
In considering the form of insanity of the cases, one is
at once struck by the large number of hopeless cases, from
a recoverable point of view, and this is fully borne out by
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by Frederic P. Hearder, M.D.
67
1898.]
statistics, for of the discharges 23, or nearly 18 per cent.,
were recoveries, as against 36 per cent, male recoveries on
the total male admissions for the same period, leaving the
large number of 106, or 82 percent., as incurable. One case
having recovered some time previous to the expiration of
his sentence was returned to prison. (The two cases dis¬
charged as “ not insane ” are excluded from these
statistics.)
Of these 106 cases, 28 were discharged “ relieved ” to
their relations or to the guardians, any acute symptoms
they may have exhibited having subsided. Twenty-three
were, after the expiration of their sentence, transferred to
other asylums as pauper patients, their unions of settlement
not being of the districts sending their patients to the
West Riding Asylum, Wakefield; the procedure adopted
being, on the approach of the expiration of the sentence on
a case, to obtain a magistrate's order for the further
detention of the case, being still insane, making him charge¬
able prima fade to the union in which the offence was
committed, leaving the burden of finding his correct
settlement to that union’s authorities.
Thirty-one cases died, or 25-5 per cent, the average death-
rate for ail males for the same period being nearly 24 per
cent, calculated on all the male admissions. The death-rate
for males calculated on the average of numbers resident for
the same period was 15 per cent.
The death-rate in the criminal cases is really much higher
than the figure 25*5 per cent, represents, since many cases
were transferred to other asylums after but short residence
in this asylum.
This high rate is brought about by the large numbers of
general paralytics. Of the 31 deaths one was a congenital
case, 25 were general paralytics, one maniacal, one melan¬
cholic, and three were demented.
But for the general paralytics the death-rate would be
very low, as one would expect from the class of admissions,
there being an almost complete absence of acute or senile
cases.
In the case of a criminal lunatic dying before the ex¬
piration of his sentence, it is the duty of the coroner to hold
an inquest on the body. This point is not mentioned in
“ The Criminal Lunatics Act, 1884.”
Their health and condition on admission was described as
good in 50 cases, fair in 64, and poor in 17 ; prison regimen,
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An Analysis of 181 Male Criminal Lunatics , [Jan.,
especially in short sentence cases, undoubtedly reducing
the bodily condition.
At the end of the year 1896 there remained in the asylum
24 cases who had been admitted as criminal lunatics,
the period of their residence varying from twelve years to
three months, the average period being four years. The
number of cases whose sentences had not expired was five.
In studying the etiology of these cases even greater
difficulties were met with than in the case of ordinary
pauper lunatics in obtaining reliable information as to the
history of the cases, and especially so as regards their family
history. In several cases it was impossible, as no relations
were known.
The probable causes and combinations of causes of insanity
in these cases are as follows:—
Worry, 5; intemperance in drink, 86; sexual excess, 8;
venereal disease, 23; masturbation, 4; sunstroke, 4; injury,
8; privation, 1; previous attacks, 21; heredity, 20; con¬
genital defect, 19; laudanum habit, 1; nostalgia, 1; and in
12 cases no cause could be ascertained.
The cranium was malformed in 22 cases: —asymmetry,
microcephalus, hydrocephalus, low receding foreheads, and
narrow highly arched palates were noted.
Twenty-two cases showed other stigmata of degeneracy:
—Prominent or malformed ears, strabismus, corneal
opacities, old iritis, large hernise, extensive psoriasis,
small-pox marks, bodily deformity, degraded facial expres¬
sion, and tattooing were found.
The cases in which malformed heads were noted include
a few of the cases in which other stigmata were present.
Four cases had previously been drummed out of the army
and one was an array deserter.
Sixteen cases were ascertained to have been previously
convicted. Others probably had, but this is not certainly
known. One case, having 11 previous convictions against
him,- was sentenced to 5 years* penal servitude with 5 years*
police supervision for stealing; he is a chronic maniac, is
noisy, abusive, and has hallucinations of sight and hearing.
In no case could prison life be definitely given as a cause
of the insanity, but it undoubtedly had great effect in
moulding its form in many cases, there being a remarkable
similarity in the delusions and hallucinations expressed by
these cases. The probable explanation of this similarity is
to be found in the prison regime. In the long hours of soli-
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1898.]
by Fbedbrio P. Heardeb, M.D. 69
tary confinement cases on the borderlands of insanity, or
already insane, are all subjected to the same sounds and
other influences from without which they are unable to in¬
terpret correctly; this, combined with the prohibition from
conversation with their fellows during exercise, would
naturally tend to the fostering of wrong impressions and
the gradual evolution of systematized delusions.
The number of cases in which alcoholism was ascertained
is largely in excess of the general lunatic population; the same
remark applies to the cases which showed evidence of venereal
disease, but in a much greater degree. Indeed, this is to be
expected when we consider that the majority were drawn
from the lowest grade of society. The actual percentages,
comparing the criminal cases with all the male admissions
for the same period, are:—Alcoholism in 66*6 criminal to
31*2 general; venereal diseases in 17 f 8 criminal to 2*2 general.
The most prominent symptom of insanity displayed was
delusion, no less than 47 cases expressing delusions persecu¬
tory in character, e.g ., false imprisonment, conspiracy against
them; that they were going to be poisoned was frequently
expressed, to be burned, that cancer was put in the food,
that filth was put in the food, that they were damned spiri¬
tually; two cases who claimed to be Christ were noisy,
abusive, and foul-mouthed, against the fidelity of the wife,
witchcraft, etc.
Religiose, sexual, and persecutory delusions were fre¬
quently found together in the same case.
Twelve cases, not included in the above 47, expressed
delusions of grandeur. These were, in tbe main, general
paralytics in the early stage, one of whom was sentenced for
travelling without a ticket, another for stealing a chemise,
at a time when both considered themselves worth millions of
pounds.
Forty-two cases had hallucinations of one or more of the
special senses, the most frequently found being " the hearing
of voices;” visual hallucinations were fairly common, olfac¬
tory less so, of taste were rare; various parsesthesim were
common in the alcoholic cases. In the majority of cases the
hallucinations were painful and persecutory in character,
those of a pleasing nature being almost absent. Some of
the hallucinations were that chloroform was administered,
chemical vapours in the air, odours or dust thrown into the
air of the room, phonographs applied, and in several cases
that telephone wires were attached to the bedsteads, etc., to
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An Analysis of 131 Male Criminal Lunatic^, [Jan.,
learn what they were thinking about and to worry them
in other ways.
In two cases, both of whom had double aortic murmurs
with hypertrophied hearts, these electrical delusions and
hallucinations were very persistent. The one case died in
this asylum, having never lost them. The other, a fairly
educated man, a journalist, at the expiration of his sentence
was transferred to another asylum, and there being a tech¬
nical error in the magistrates’ order for his further detention
as a pauper, was discharged. He then published a pamphlet
describing his experiences in the asylum, and brought
numerous charges against the administration of the institu¬
tion and the medical staff for their electrical ill-treatment of
him, amongst other things saying that one of the airing
grounds was heated to an unbearable pitch by electricity.
Since his discharge, about nine months ago, he has on
several occasions attempted, and is still attempting, to obtain
summonses against members of the staff and others. From
letters which he writes he still believes himself to be acted
upon by electricity from this asylum, although lie lives in
another county.
A very small number refused food to the extent of needing
to be fed by the tube.
The criminal cases are, as a class, refractory. Forty-two
cases exhibited violence to a marked degree towards their
fellow patients and members of the staff. One case, who re¬
mains in the asylum after more than 11 years, exhibit*post¬
epileptic automatism, in which state he is at times very
dangerous. Eleven cases attempted escape, using violence
in the attempt or at their recapture.
Thirty cases were restless and noisy, a large proportion of
these, but by no means all, being general paralytics.
Twenty-one were very destructive of bedding, clothes,
books, plants, etc.
Four cases had a predilection for breaking glass on every
opportunity. One of these cases suffered from petit mal.
He could converse rationally, but was of a rather sulky
disposition. He had been turned out of the army for strik¬
ing, and had been very violent and destructive of glass in
the prison. In the asylum he was impulsive, and would
suddenly turn and strike anyone near him without the
smallest provocation, or, if near glass, would strike at it,
and on several occasions he cut himself severely. He
attempted escape, and fractured his os calcis in dropping
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1898.]
71
by Frederic P. Hearder, M.D.
from the top of a high wall. He frequently stated that he
tried, but was unable to control these actions, and that he
always felt great satisfaction after having given way to the
impulse.
Thirteen cases were exceedingly dirty in their habits,
throwing their urine and faeces about, and at times painting
the walls with excrement. A case, who still remains in the
asylum after three years, has needed special supervision to
prevent his practising sodomy. He has been found teach¬
ing imbecile lads to masturbate, and has incited them to
commit sodomy in order to blackmail them afterwards. He
practises masturbation to au excessive degree; this, how¬
ever, is a very common habit.
A large number of the cases had marked thieving pro¬
clivities, but it was very often impossible to bring the theft
home to them, they, as a rule, being sufficiently cunning to
steal from cases who could not bring charges from their
demented or imbecile condition, the theft only being dis¬
covered during surprise inspection of their pockets and
clothing, when money, etc., which they could not have come
by honestly was found. One was detected rifling the pockets
of an epileptic, who was on his knees at bed time, having
noticed that his victim was usually long at his nightly
devotions.
A few have stolen and secreted knives for future use,
whilst others have improvised weapons or tools by sharpen¬
ing bits of iron they have picked up, and fitting them into
handles made from wood, or by binding rags around one
end.
From the character of their delusions and hallucinations,
with their other proclivities, it will be readily seen that a
large number of these cases were very prone to take and
give offence on the slightest, or, indeed, often for no pro¬
vocation. They were frequently involved in broils, and a
large proportion of the cases resident was always to be
found in the refractory wards.
The mental symptoms, as a rule, abated considerably
after a short residence in the asylum, but few made an
absolute recovery, the improvement being due to the
removal of the strict prison regime for the far greater
freedom of asylum life, with the improvement of dietary,
and the privileges of conversation, writing to, or receiving
visits from their friends, etc.
Many had no known relatives, and on going through the
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72
An Analysis of 131 Male Criminal Lunatics , [Jan.,
visiting books for the period under consideration it was
found that 38 cases, or 29 per cent., had been visited by
relatives. But few were visited regularly, many receiving
only one or two visits in a long period of years.
Prom the foregoing it will be seen that these cases are by
no means a desirable class for reception into an ordinary
pauper lunatic asylum, where they must mingle with the
other patients, there being no provision made for treating
them in special wards such as were arranged for by the
Government to be attached to Bethlehem Hospital in 1814,
and again to Pisherton House, Salisbury, in 1835.
The experience of this asylum agrees with one of the
findings of a Select Committee appointed by the House of
Commons in 1859 to enquire into the care of the criminal
insane, as quoted in Archbold’s Lunacy :—
“To mix such persons with other patients is a serious
evil; it is detrimental to the other patients as well as to
themselves; but to liberate them on recovery, as a matter
of course, is a still greater evil, and could not be sanctioned,
for the danger to society would be extreme and imminent.”
(Parliamentary Paper , No, 495, I860.)*
One of the results of this Committee’s Report was the
building of the Criminal Lunatic Asylum at Broadmoor,
which was opened in 1863, under what is known as the
“ Broadmoor Act, 1860.” This is the only asylum that has
hitherto been built under the Act, a Departmental Commis¬
sion, appointed in 1880 to enquire into criminal lunacy,
finding amongst other conclusions :—
“ 3. That if it is necessary to make special provision for
specially dangerous pauper lunatics, the proper course is
for the local authorities of counties and boroughs, by united
action, to build one or more asylums designed to receive
such specially dangerous lunatics. (Parliamentary Paper 9
C—3,418, 1882).” f An excellent suggestion, which has
not been acted upon.
Discuttion.
The President said—In Northumberland I have had, with very few excep¬
tions, only ordinary cases. I remember a patient, who, like some of those
mentioned by Dr. Hearder, was of an abominable disposition. He appeared to
have been at Wadsley Asylum previously, and I have every reason to suspect
that he was a rogue, many of his symptoms having been feigned. He feigned
melancholia with stupor so well that to this day I hardly know whether he was
a scoundrel, a lunatic, or perhaps both together. He refused to be fed for three
months, but would behave excellently for months together. What became of
him I do not know. In his previous history there were many charges against
* Op. tit ., p. 726.
t Op. cit., p. 728.
Digitized by LjOoqIc
78
1898.] by Frederic P. Heaedeb, M.D.
him for fraud, and his offences generally took the form of representing that
he was So-and-so, getting money from the persons upon whom he imposed. When
sent to prison he would lapse into the “ insane ” condition and be sent to an
asylum, where he would remain for several months. On getting out he would
recommence his fraudulent practices, and so do the round over again.
Dr. Percival —I understand that if a criminal lunatic dies before his sen¬
tence expires the coroner should hold an inquest ?
Dr. ELkabdeb— On every convicted person. I believe also that it is the
coroner’s duty to hold an inquest on any person who has recently been a
prisoner, whether in an asylum or whether he is one of the general population.
Major Taylor, coroner for the .West Biding, informed me of this. It may be in
the Coroners’ Acts, but the point is not mentioned in the Lunacy Acts.
Dr. Bay referred to an interesting case of a man who was transferred from
the West Biding Asylum, Wakefield. After having been in the asylum two
months he was discharged, his friends undertaking to look after him. Only
two days afterwards, however, he was found in a house into which he had
broken; he had made himself comfortable with whisky and cigars, and had
filled his pockets with all the attractive articles he could find. He had been
sitting there for an hour or so. The police took him to prison again, but he
was discharged on trial. In spite of that he was brought up at the Police Court
later, and committed for trial at the West Biding Assizes, which are at present
proceeding. He had another very quiet case from Broadmoor, who had been
there for five years. After having been at Broadmoor he still seemed to be
chargeable to the Union.
Dr. Nicolson— This particular case, which occurred five or six years ago, is
a man named Lyons, who, at Broadmoor, took the opportunity of splitting my
head with a stone. On the expiration of his sentence I wrote to the authorities
at Sheffield, and said that I had recommended his being detained in Broadmoor
as a pauper lunatic on account of his violence. They wrote back with refer¬
ence to 17s. 6d. per week being charged for him. 1 replied, “You are by all
means welcome to him. We do not want him here, he is much trouble to us.”
We could not get him from his room, and it took three or four warders to look
after him. He would not take exercise, and suffered from “ telephonic com¬
munications.” * When I wrote and told the doctors my reasons for his being
detained they were pleased to have him kept at Broadmoor. There was further
correspondence, and the matter almost became a scandal. In the end the whole
matter was referred to the Law Officers of the Crown, who said that the man
had been illegally detained, and that the only way out of the difficulty was to
send him to a lunatic asylum, which was done. It was a mere accident his
having hit me. Lyons, with others, wanted to speak to me. It was not then
convenient, so I told him I would come back later and he could then speak to
me. He was crying out about being detained, and worked himself into a
white heat. I saw that he would make for me. I said, “I’ll come and see you
again,” and had got a little way, when hearing him behind I turned round,
and was struck on the head. The general question of the paper is one of
great interest, and the conclusion arrived at commends itself to us. It is very
undesirable to introduce one of these criminal lunatics into an ordinary insane
population, it is most disastrous to discipline and management. The diffi¬
culty might be overcome by separation—not allowing them to keep up turmoil,
insubordination, and encouragement to escape. At Broadmoor this system was
adopted, and these cases were kept in a special block by themselves. There is a
certain hardship in removingsuch lunatics from asylums to Broadmoor, because
of the inconvenience to the friends of the patients. It is surprising how faithful
these friends are, and they cannot easily or often undertake a long journey.
The short sentence men are most troublesome cases. I know one who stole a
duck, and was imprisoned for a few months. He went out and stole again,and
was certified to be insane. At last he was sent to Broadmoor, where be behaved
himself, and was recommended for discharge. He committed himself again,
and is now in Broadmoor. He will be kept there for life. Such a course is a
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An Analysis of 131 Male Criminal Lunatics. [Jan.,
great pity. The Home Office do not understand such oases, and I think we
ought to work so that these men would not be thus bandied about. It is most
important that young workers should take up these matters and induce whole¬
some changes. The amount stolen by that type of criminal was trifling, and it
is hardly fair to them to depict them in terrible colours. In one sense many of
them are taught to be criminals and are therefore to be sympathised with. I thank
you for the opportunity of being here. It is a great privilege, for I like to
identify myself with the work going on in our various asylums.
Statistics Relating to the Disappearance of Rigor Mortis .
By J. V. Blachford, M.B., C.M., Assistant Medical
Officer, Bristol Asylum.
Of 220 cases in which post-mortem examinations were
held the following were the conditions as to rigor mortis.
It will be seen that in only 11 cases does the condition
recorded militate in any way against the statement that
“ far from commencing in the jaw, then attacking the arms
and lastly the legs, and disappearing in the inverse order,”
as was at one time taught, and as is stated at the present
time in some of our text-books, in whatever order it may
commence, it almost invariably disappears first from the
jaw, afterwards from the arms and legs; in fact probably in
the order of its appearance.
Absent in all extremities ... ... ... 33
Present in all extremities ... ... ... 65
Absent jaw, disappears arras, present legs ... 25
Absent jaw, present arms and legs ... 12
Absent jaw, disappears arms and legs ... ... 3
Absent jaw and arms, present legs . 2
Absent jaw and arms, disappears legs ... ... 4
Absent arms, present legs ... ... ... 26
Absent arms, disappears legs ... ... ... 7
Disappears arms, present legs. 15
192
Present arms, disappears legs. 1
Slightly present arms, absent legs . 1
Present jaw and arms, absent legs . 1
Present jaw, disappears arms and legs. 3
Present jaw and legs, disappears arms. 2
Present jaw and legs ... ... ... ... 1
Disappears arms, absent jaw and legs. 1
Absent jaw and legs . 1
11
Not noted ••• ... ••• ... ••• ... 17
Digitized by
1898.] The Disappearance of Rigor Mortis . 75
If we analyse the 11 cases in which the order of dis¬
appearance is at variance with that occurring in the far
larger number, we find that they are not to be regarded as
reliable, either from the absence of negative as well as
positive evidence, the possible careless handling of the
cadaver previous to examination, or indefinitely expressed
statements.
With regard to the time of total disappearance of the
rigor, the following facts were elicited from the same
cases:—
In 33 it was absent altogether, the earliest recorded time
after death being 174 hours, but as this happened in a case
of advanced heart disease, with very extensive oedema of all
parts, the rigor was probably never perceptible at all, owing
to the sodden condition of the tissues.
The next was in one 20 hours after death, the patient
having died of general paralysis.
Then in one 24 hours after death from phthisis.
Of all 33 cases in which it was absent 15 had died from
phthisis, four of general paralysis, the remaining cases
being spread amongst various diseases, from which it would
appear that in those dying of phthisis, post-mortem rigor is
peculiarly prone to disappear early, probably owing to the
exhausting nature of the disease.
Twenty-one of the cases were examined 50 or more hours
after death. Of these rigor mortis was present in some part
in 11. The longest time after death at which it was pre¬
sent was 60 hours, death being due to nephritis ; and there
were several in which it occurred 66, 57, and 58 hours after
death.
From the above facts it appears that although in excep¬
tional cases the death rigor may disappear as early as the
twentieth hour, it may be, and probably often is present 60
hours after death.
Discussion.
Dr. Macdonald referred to a case in general hospital practice where, nine
hours after death, there was no rigor mortis. He asked Dr. Blachford what
was the earliest time he had observed rigor mortis to disappear ?
In reply. Dr. Blackford said that his records showed 174 hours and 21 hours
in two cases.
Digitized by L^ooQle
76
[Jan.,
Carlyle—His Wife and Critics .* By Sir James Crichton-
Browne, M.D., LL.D., F.R.S.
Gentlemen,—I am not going to weary you with a cata¬
logue—it would be a long oue—of the distinguished sons
that Dumfriesshire and Galloway have sent forth ; I ask
you to bear with me for a little while I appeal for your
generous admiration of the most illustrious of all of them
—I mean Thomas Carlyle. And such an appeal is not
unnecessary, for this illustrious man—glorified by genius—
has more than any great man of modern times been subjected
since his death to detraction and disparagement. Late in
securing the recognition of his claims as a writer, for it was
not until he was in his forty-second year that the British
public really took note of him, he rose rapidly thereafter in
fame and popularity, and after his rectorial address in this
University, in 1866, was the object of enthusiastic national
regard. He died in universal honour, the ablest and highest
of his literary contemporaries vying with each other in
sounding his praises, extolling his heroic and unsullied
life, and describing him as sovereign by divine right
amongst the British men of letters of his generation. But
a change speedily came over the spirit of the scene. Carlyle
had not been a week in his grave when the Reminiscences ,
edited by Froude, appeared; these were followed within
a year by the Letters and Reminiscences of Jane Welch
Carlyle; and after these came rapidly The Early Life and
The Life in London , for which also Froude was responsible.
“ It was these nine volumes,” says Masson, “ that did all the
mischief.” Full, at least as regards the earlier volumes, of
slovenly press errors, and obviously very hurriedly prepared,
they depicted Carlyle in his darkest and gloomiest moods,
almost ignoring the bright and genial side of his nature, and
gave prominence not merely to the biting judgments he had
passed on public men, but also to his pungent comments on
private individuals then still living. Froude was Carlyle’s
most intimate friend in his latter days; he was his chosen
literary executor; he was his faithful disciple in doctrine;
he has, with lofty eloquence, described his extraordinary
personality and gifts, and put on record his conviction that,
with all his faults of manner and temper, he was the greatest
* Part of the Inaugural Address, delivered to the Edinburgh University,
Dumfriesshire, and Galloway Literary Society, 6th November, 1897.
Digitized by LjOoq Le
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1898.] Carlyle—His Wife and Critics.
and best man he had ever known. And jet, for all that,
it has been his part to open the flood-gates of adverse
criticism, and to supply all the quacks, and idiots, and
sects, and coteries whom Carlyle had scourged, in his
day, with nasty missiles with which to pelt his memory.
Even Fronde’s warmest defenders are constrained to
admit that he showed defective reticence and bad taste,
and every impartial reader of the Reminiscences must, I
think, perceive that in his vivid sympathy with that bril¬
liant woman, Mrs. Carlyle, Froude has many times been
betrayed into references to her husband that are unjust and
almost vindictive. When Carlyle was working at the French
Revolution “ his nervous system,” says Mr. Froude, “ was
aflame. At such times,” these are Mr. Froude’s words, “ he
could think of nothing but the matter which he had in
hand, and a sick wife was a bad companion for him. She
escaped to Scotland to her mother.” The plain inference
from this is that Mrs. Carlyle, when an invalid, was driven
away from home by Carlyle’s neglect and irritability. The
fact is, that it was solely the state of her own health that
sent her to the north, and that she had no peace or comfort
till she got home again. She writes, on returning on this
occasion: “The feeling of calm and safety and liberty
which came over me on re-entering my own house was
really the most blessed I had] felt for a great while.” Does
this sound like coming back to a self-absorbed bear of a
husband ? “ The house in Cheyne Kow,” says Mr. Froude,
“requiring paint and other readjustments, Carlyle had gone
to Wales, leaving his wife to endure the confusion and
superintend the workmen alone with her maid.” Thus
Froude insinuates that Carlyle selfishly went off to enjoy
himself, leaving his wife to drudgery and discomfort. But
the facts are that Mr&. Carlyle was a house-proud woman,
and took delight in her domestic lustrations, and that while
Carlyle was.in Wales at this time, on one of those excursions
which were*essential to the maintenance of his health and
of his bread-winning labours, Mrs. Carlyle went off on a
holiday on her own account to the Isle of Wight, from which
she was very glad to return to her dismantled home. I
could quote a dozen paragraphs like these in which Froude
seems to seek, by innuendo or elision, to convey the im¬
pression that Carlyle was systematically hard and heartless
in his relations with his wife, whereas the truth is that,
with failings of temper and thoughtlessness—from which
Digitized by LjOOQle
78 Carlyle—His Wife and Critics , [Jan.,
few are exempted—he was a tender and affectionate
spouse.
But if Carlyle’s reputation has suffered at the hands of his
own familiar friend, it is a nearer one still and a dearer one
far than all other who has inflicted on it the deepest injury.
It is Mrs. Carlyle’s Letters , and still more the fragments of
her Journal , that have created the strongest and most widely
diffused prejudice against Carlyle, for when, in general
society to-day, you press for an explanation of the aversion
with which the mention of his name is received by some
fashionable dames, who know absolutely nothing of him or
his works, you are invariably told that he was cruel to his
wife, and obliged her to go in an omnibus, while he himself
was riding an expensive horse. For the publication of her
Letters and Journal Mrs. Carlyle was not to blame; that was
owing to the indiscretion of another. She never intended
them to see the light, and if permitted still to keep an eye on
current literature, caustic and damnatory must have been
her observations on the day they issued from the press. But
still the fact remains that this devoted wife, whose pride in
her husband was the mainstay of her existence, has done
more than anyone else to besmirch his memory and to dero¬
gate from his fair fame.
Now, let us examine for a moment Mrs. Carlyle’s one
great grievance against her husband which gave rise to
most of her depreciatory and reproachful remarks—
his friendship with Lady Harriet Baring, afterwards
Lady Ashburton, a subject which many of his critics
evade as delicate or obscure. There is, I think, no
delicacy or obscurity about it. Leave out of account Mrs.
Carlyle’s feelings on the subject, and there is nothing
in that friendship from first to last—from 1844 till 1857—
that is not to Carlyle’s credit. Lady Harriet was one of the
most brilliant women of her day, and Mrs. Carlyle herself
wrote of her on their first introduction—“The cleverest
woman out of sight that I ever saw in my life; moreover,
she is full of energy and sincerity, and has, I am sure, an
excellent heart.” Was it a sin that Carlyle admired this
fascinating woman, and took pleasure in her society and in
that of her noble and accomplished husband, and of the men
of wit and genius whom she gathered round her? She
opened bountifully to this reserved, fastidious man and to
his wife the highest literary circle, where he could meet on
equal terms those most distinguished in rank and learning.
Digitized by Le
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1898.] by Sib James Cbichton-Brownb, M.D.
Was it flagitious in him to avail himself of the opportunities
thus offered to him—opportunities almost essential to his
advancement in his career P She and her husband lavished
on him and his wife innumerable kindnesses and atten¬
tions. He would have been worse than ungrateful had he, at a
woman’s caprice, thrown over such generous benefactors.
Mrs. Carlyle’s bosom female friends allow that she never
had an iota of a ground for jealousy ordinarily so-called,and on
sach a question such testimony from such witnesses is, 1 take
it, irrefragable. But, say they, Mrs. Carlyle was sensitive and
exacting beyond other women, and the consciousness that
she who had clung to her hero through the long days of
obscurity was now, when the sun of prosperity shone upon
him, to be superseded in his supreme regard by any other
woman, was gall and wormwood to her soul. That she was
so superseded even for an instant there is not a tittle of
evidence; indeed, all the documents go to prove not only
that she never had a rival in her husband’s heart, but that
his fealty to “ that most queen-like woman,” as he called
Lady Ashburton on her death, was not incompatible with a
far deeper devotion to the intellectual sovereignty of his
wife. “ Any other wife,” says Miss Jewsbury, “ would have
laughed at Carlyle’s bewitchment with Lady Ashburton;
but her it made more intensely and abidingly miserable than
words can utter.”
Well, it seems to me that the true key to Mrs. Carlyle’s
frame of mind at the time of the Ashburton episode is to be
found in her state of health. I have no doubt myself, and I
have bestowed some attention on the facts of the case, that
she then passed through a mild but distinct and protracted
attack of climacteric melancholia, and that all her accusa¬
tions against her husband were but expressions of morbid
feelings.
Mrs. Carlyle was hereditarily predisposed to nervous dis¬
ease. Her mother died of an apoplectic brain seizure and a
maternal uncle was paralysed. She boasted of a strain of
untamable “ gipsy blood ” in her veins, derived from one
Baillie, who suffered at Lanark, and was, according to Foster,
“ a cross between John Knox and a gipsy,” and she was,
moreover, of intensely nervous temperament, keen to feel
and quick to react to feeling. Although a doctor’s child,
she was brought up under hot-bed conditions; her naturally
active brain being stimulated by ambition. She learnt Latin
like a boy, and read Virgil at nine years of age; would sit
Digitized by ^ ooqLc
80 Carlyle—Hie Wife and Critics, [Jan.,
up half the night over a mathematical problem when a girl
of twelve, and wrote a tragedy when fourteen ; and as the
consequence of all this she grew up into a highly neurotic
woman. Throughout her married life she was subject to
frequently recurring and severe sick headaches, lasting for
days together, brought on by worry and excitement, and
even by the effort of talking and being witty, and sometimes
instantly dissipated by a strong mental impression. She
had several pronounced attacks of influenza, which we now
know has oiten a far-reaching and deleterious effect on the
nervous system. She was as hyperaesthetic to noise as her
husband, and like him a victim to persistent insomnia. For
several years before the date at which I would fix the
climax of her mental trouble, she had been occasionally
taking morphia, which is apt to induce depression and
suspicion in those who indulge in it, and besides being
addicted, like her husband, to excessive tea-bibing, she
unoked cigarettes at a time when that practice was less
common amongst English ladies than it is to-day. She was,
in short, the very woman in whom the physician would
?xpect a mental breakdown at a critical epoch in life.
As early as 1841 Mrs. Carlyle complains of low spirits, due,
as she then correctly surmised, to some sort of nervous ail¬
ment, and from that time onwards she had periods of gloom,
such as all nervous people are liable to, attributable for the
most part to external events ; but it was not until 1846,
when she forty-five years old, that her despondency assumed
a morbid complexion. Then, however, there enveloped
her a cloud of wretchedness, an emanation of her own brain,
which deepened and darkened until 1855, when that excru¬
ciating Journal was begun; which lightened up in 1856, and
was almost completely dispelled in 1857, leaving behind it,
however, shattered bodily health and the seeds of serious
evils in the nervous system, which afterwards developed and
brought renewed depression, but of a very different nature
from that previously experienced.
Did time permit, I could trace out step by step from her
own writings the progress of Mrs. Carlyle’s mental malady,
which, be it observed, was emotional throughout, and never
in the slightest degree involved her intellectual faculties.
Her marvellous will power enabled her to a great extent to
suppress the outward manifestations of it, but not altogether,
for some of her friends remarked on her haggard and care¬
worn look 5 but what she could conceal when abroad flowed
Digitized by t^ooQle
81
1898.] by Sib James Criohton-Browne, M.D.
forth freely when in the privacy of her own room, and the
Journal bears the unmistakable marks of cerebral disorder.
“ My constant and pressing anxiety,” she says, “ is to keep
ont of Bedlam.” “ That eternal Bath House 1 ” she exclaims.
“ I wonder how many thousand miles Mr. 0. has walked
between there and here, putting it altogether, setting up
always another milestone and another between him and me.”
“ Dear, dear I ” she goes on, “ what a sick day this has been.
Oh, my mother, nobody sees what I am suffering now.”
“ It was with a feeling like the ghost of a dead dog that I
rose and dressed and drank my coffee.” “ To-day has been
like other days ontwardly. I have done this and that, and
people have come and gone, but all in a bad dream.” “ How
I keep on my legs and in my senses with such little snatches
of sleep is a wonder to myself.” “ I was no more responsible
for what I wrote than a person in a brain fever would have
been.” “ To-day I walked with effort one little mile and
thought it a great feat.” " I am weaklier every day and my
soul is sore vexed. Oh, how long ? ”
In these and many passages to a like effect the medical
psychologist will recognise the cerebral neurasthenia which
is so often accompanied by profound dejection and delusional
beliefs. And that Mrs. Carlyle really suffered from cerebral
neurasthenia her subsequent history makes abundantly
apparent. In 1863 she suffered from violent neuralgia,
which deprived her of the use of her left hand and arm, and
two years later the same malady, after internal manifes¬
tations rendered her right hand and arm powerless, at the
same time partially paralysing the muscles of the jaw and
causing difficulty in speech. Along with this neuralgia there
was acute mental distress, which did not, however, assume
any delusional phase, and there were frequent temptations
to suicide. Mrs. Carlyle died in 1866 from failure of the
heart's action, caused by the shock of seeing her little dog
run over and injured by a carriage in Hyde Park.
Up till the date which Lhave fixed for the incursion of her
illness, Mrs. Carlyle's letters to her husband are like those of
a belated lover, overflowing with ardent affection. “ God
keep you, my own dear husband, and bring you safe back.
The house looks very empty without you, and I feel empty
too.” “ She (your wife) loves you, and is ready to do any¬
thing on earth that you wish, to fly over the moon if you
bade her.” And so on, and on until 1843, when we read—
“ Oh, my darling, I want to give you an emphatic kiss rather
XL tv. 6
Digitized by LjOoq Le
82
[Jan.,
Carlyle—His Wife and Critics ,
than to write. But yon are at Chelsea and I at Seaforth, so
the thing is clearly impossible for the moment. But I mast
keep it for yon till I come, for it is not with words that I
can thank you adequately for that kindest of birthday letters
and its small enclosure—the touching little key.” And so
on, indeed, until 1846, when the glimmerings of distrust
first appear. “ Yes,” she then writes, “ I have kissed the
dear little card case, and now I will lie down a while
and try to get to sleep. At least to quiet myself I will try
to believe, oh, why cannot I believe once for all ? that with
all my faults and follies I am still dearer to you than any
other creature.” But after this the correspondence cools.
The letters have no amatory introduction, are subscribed
“ faithfully yours ” or u yours ever,” and contain sometimes
sharp taunts and cruel reproaches, sometimes acknowledg¬
ments of her own infirmity. “ God knows,” she tells him in
1850, “ how gladly I would be sweet tempered and cheerful
hearted and all that sort of thing for your single sake if my
temper were not soured and my heart saddened beyond my
power to mend them I ” It was not until the lapse of years had
brought healing and soothing, and convinced her that his
strange humours had never arisen from real indifference
towards her, that the old tenderness returned; but it is
pleasant to know that it did return, for in 1864 we find her
beginning her letters to him with all a girl’s fondness—
“ Oh, my own darling husband ! ”
Throughout the whole duration of Mrs. Carlyle’s illness—
covering the Ashburton jealousy—Carlyle’s attitude towards
his wife was singularly noble. Those slighter forms of
mental alienation such as I maintain Mrs. Carlyle suffered
from are really much more trying to those who have to deal
with them than downright madness, and few positions more
painful and difficult can be conceived than that of Carlyle,
who, while struggling with a herculean task, his Frederick
the Great, and himself harassed by hypochondria, had to
live with an ailing woman, possessed by groundless jealousy
and with the wit to give poignant expression to her supposed
wrongs. But whatever he may have had to endure, no angry
retort or impatient protest ever escaped his pen. We have
no record of his personal intercourse with his wife at this
time ; perhaps he gave way to gusts of anger, but his letters
are uniformly gentle and affectionate, full of encouragement
and good cheer. And this, indeed, is characteristic of all his
communications to and about his wife—not only at this
Digitized by
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1898.] by Sib Jambs Cbichton-Brownb, M.D.
period, but during their whole married life. The portrait
he has painted of her is a masterpiece of its kind, abound¬
ing in bold and harmonious colour, pre-Raphaelite in the
truthfulness of its minute details, and so suffused by tender¬
ness that all harsh features are lost sight of. No Madonna
was ever painted with more reverent touch or genuine
inspiration. It speaks volumes, I think, for Carlyle’s
magnanimity and whole-heartedness that there is not to
be ferreted out of his most private lucubrations one word
or phrase reflecting unfavourably on his wife. From first
to last he has nothing but praise and blessing to bestow on
her. Testy and arbitrary in his personal communication
with her he no doubt often was ; stinging words sometimes
darted from his tongue, or overwhelming objurgations rolled
from it, but the moment he took pen in hand he did her more
than justice. Unsparing in his own self-reproaches for his
irritability and unreasonableness, he was indulgent to her
beyond measure, and never set down aught in accusatory
condemnation of the trials and vexations which she caused
him. His gratitude was unbounded for the protection and
help she rendered him, and during the fifteen years for
which he survived her, his main occupation was to arrange
the material for the most impressive and sorrowful cenotaph
that has ever been erected to mortal woman.
Apart from the Ashburton misunderstanding, which was,
as I have endeavoured to show, a mere figment of a perverted
imagination, the offspring of an excited brain, Carlyle’s
critics and Mrs. Carlyle’s lady friends have still grave fault
to find with him for his treatment of her. According to
them, she was incessantly craving for little marks of tender¬
ness, for caresses and loving words, which were denied her by
the cold, hard man she had married. I do not believe a word
of it, and I think that those who advance such a theory have
strangely misconceived Mrs. Carlyle’s character and our
Scottish customs. She was the last woman in the world to
desire or tolerate public exhibitions of uxoriousness, or to
measure the depth of a husband’s love by the froth on the
surface, and she was reared in a school in which effusiveness
is not approved. We Scotchmen are a somewhat dour and
gruff race, and do dissemble our love without actually kick¬
ing our relatives downstairs—but sometimes with gestures
which a stranger might mistake for an intention to do so.
With us the family affections, as I have already insisted,
and conjugal fidelity are at their highest. But the temper
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84
Carlyle—Bis Wife and Critics , [Jan.,
of our people, saturated with Calvinism, is severe and self-
restraining, and they rarely indulge in those terms of endear¬
ment that are so constantly bubbling from southern lips.
The head of a Scotch household is rarely heard addressing
his wife as “ love” or “ darling.” “ Gude wife ” he calls
her, or “ mither,” or " Maggie,” “ Jeanie,” or “ Elsie,”
as the case may be. To the children he speaks
in tender diminutives, but to his wife his address
might sound to the uninitiated somewhat harsh, while her
replies might savour of snappishness. And yet are they
united in life-lasting and storm-defying love—love too well
assured to need declaration, at least in company, in which
indeed they have a secret satisfaction in demeaning them¬
selves in a circumspect, distant, and almost austere fashion.
A Scotchman would immediately suspect there was some¬
thing wrong if he saw a husband and wife fondling or heard
them “ joeing ” and “ dearieing ” each other. Mrs. Carlyle
was too sensible a woman, and knew her husband's up¬
bringing and severe turn of mind too well, to expect or
desire of him blandishments or pettings. She must have
remembered that his intercourse with his mother, for whom
his love was profound, consisted mainly in sitting with her
silently by the fireside in the evening and enjoying a tran-
quillising pipe of tobacco; and curiously enough she has
anticipated and disallowed the plea of her apologists that he
gave her cause of offence by his negligence in small matters.
“In great matters,” she wrote of him, “ he is always kind
and considerate, and now the desire to replace to me the ir¬
replaceable (her mother, who had recently died) makes him
as good in little things as he used to be in great.”
But whatever his lip service, Mrs. Carlyle had overwhelm¬
ing epistolary evidence of her husband's attachment. “ Oh,
my love, my dearest, always love me. I am richer with thee
than the whole world could make me otherwise ! ” “ The
Herzen Goody must not fret herself and torment her poor
sick head. 1 will be back to her, not an hour will I lose.
Heaven knows the sun shines not on the spot that could be
pleasant to me were she not there. So be of comfort, my
Jeannie!” “Adieu, dearest, for that is, and, if madness
prevail not, may for ever be your authentic title.” This is
the strain that with marvellous and beautiful modulations
runs through his letters to her for forty years of their
wedded life, and with it echoing in her heart she could
scarcely hanker after loud-mouthed endearments or punctili-
Digitized by le
85
1898.] by Sib James Crichton-Bbowne, M.D.
oiis attentions. She rejoiced rather in their wit combats
and the banter and bickerings they exchanged in the
presence of their guests in the little drawing-room in Cheyne
Row. There the shuttle of persiflage sped freely to and
fro. Dull guests with no sense of humour may have seen
animosity in these encounters, but they were simply trials
of intellectual fence, in which a clever thrust or parry gave
equal pleasure to both combatants. The wounds inflicted
in them, like those in a recent well-advertised duel, did not
penetrate beyond the subcutaneous cellular tissue and did
not take long to heal. Tennyson, with his poet’s insight,
discerned better than others their true relations, for he said,
as reported in his recently published biography, that “ Mr.
and Mrs. Carlyle on the whole enjoyed life together, else
they would not have chaffed one another so heartily.”
Browning, too, saw beneath the surface, and while express¬
ing his affectionate reverence for Carlyle, never ceased to
defend him against the charge of unkindness to his wife.
He went too far in describing her as a hard, unlovable
woman, but he was right in holding that for any domestic
unhappiness that they experienced she was the more to
blame of the two. Mrs. Carlyle, no less than her husband,
was “gie ill to deal wi\” The letters written in her girl¬
hood to Ellen Stoddart display a somewhat headstrong
disposition, and caustic wit and biting sarcasm, remarkable
in one still in the bright morning of youth, and who had
suffered no hardships or disappointments, and are couched
in language so frank and strong as to make it certain that
she did not derive the expletives she used in later life from
Carlyle. Then her relations with her mother reveal heat of
temper and self-assertion. These two women loved each
other dearly, but they were both too excitable to jog along
together smoothly, and so they quarrelled daily. After
Mrs. Welch’s death Mrs. Carlyle suffered bitter remorse for
what she regarded as her shortcomings as a daughter. She
pleads guilty to “shrewing” her husband from time to
time, and she certainly rejoiced in taking snap-shot portraits
of him in his least happy and amiable moments, portraits
which she confided to her correspondents, and which Fronde
diligently collected for public exhibition.
Mrs. Carlyle had boundless respect and love for her hus¬
band, but still there was a void in her existence. The child¬
less woman poured forth her pent-up affections on many
pets—dogs, cats, canaries, hedgehogs, and even a leech—
Digitized by CjOoqL e
86
[Jan.,
Carlyle—His Wife and Critics ,
but unsatisfied longings still perturbed her, and, combining
with her keen sagacity, made her cynical beyond the common
measure of her sex. “ An infant crying in the night ” at
Cheyne Eow might have vexed Carlyle's soul worse than his
neighbour’s cocks and hens, and would not have been so
easily got rid of, but it would in all likelihood, paradoxical
though it may sound to say so, have* brought peace, hope,
and felicity to the household. To say that Carlyle neglected
his wife is to libel him. He had his work to do, laborious
work, which he could only carry on in solitude, and so he had
to separate himself from her during his wording hours, but
surely most working men, whether of professions or trades,
have to do the same. On the whole, he spent much
more time with her than the average husband is wont
to spend with his wife. He did not dine at his club
on dainty dishes and leave her to fare on cold mutton
at home. He had no amusements or pursuits apart from
her, and only left her for those visits to the Ashbur-
tons, in which it was generally her own fault that she did
not participate; or for those visits to his kindred in Scot¬
land, which were at once a duty and a necessity of health.
He never forgot some little offering for her birthday, and was
ever ready to assist in her charities. In his poverty he did his
best to provide her with small pleasures, and when he grew
comparatively rich he pressed upon her luxuries which she
was reluctant to accept. How monstrously he has been mis¬
represented in these respects I may illustrate by one example
adduced out of many. Miss Gully writes : “ In his richest
days he would never have more than one servant. ... I
don’t myself see that he had any right to indulge in a witty
wife and yet indulge in his idiosyncrasy of only having one
cheap servant.” Will it be believed that it was by Mrs.
Carlyle’s express wish that only one servant was kept, and
that after two had been employed in deference to her hus¬
band’s earnest representations, she lay awake at night re¬
gretting the time when she had had but one little maid?
Such matters are trivial enough, but they merit notice, for a
multiplicity of them have been piled up as if of malice pre¬
pense to damage Carlyle’s good name.
And yet this man who has been held up to obloquy as a
misanthrope, as a raging, snarling egotist, as a miserable
dyspeptic, as a restless Annan dale eccentric, as a venomous
iconoclast of other men’s reputations, as “a boor and a
brute ”—these words have been actually applied to him—
Digitized by t^ooQle
87
1898.] by Sib James Crichton-Bbowne, M.D.
almost as a wife-beater, was full of magnanimity and human
kindness. Look at his conduct in great affairs. Mill came
to announce that crushing catastrophe, the burning of the
manuscript of the first volume of the French Revolution . He
sat for three hours, and when he went the first words that
Carlyle spoke were: “ Well, Mill, poor fellow, is very
miserable. We must try to keep from him how serious the
loss is to us.” Note his self-sacrifice. On the death of
Mrs. Carlyle's mother he had a strong desire to retain the
house and garden at Templand as an autumn retreat for
himself—“ no prettier place or refuge could be in the
world,” but Mrs. Carlyle shrank from going there, so he at
once abandoned the project, cancelled the lease, and sold off
everything. Mark his patience and consideration for others.
He arrived in Liverpool from Ireland between five and six
o’clock in the morning, and was found an hour later seated
on his luggage at the door of Mr. Welch’s house in
Maryland Street, placidly smoking a cigar, not having
cared to disturb the household so early. Notwith¬
standing his stern maxims he was the softest hearted
of men. Thrifty and frugal in his personal habits, he
was prodigal in his benevolence. Depths of tenderness
lay in this rugged man. Miss Martineau said he was dis¬
tinguished by his enormous force of sympathy. “ No one
who knew him,” says Masson, “ but must have noted how
instantaneously he was affected or even agitated by any case
of difficulty or distress in which he was consulted; and with
what restless curiosity and exactitude he would enquire into
all the particulars till he had conceived the case thoroughly
and as it were taken all the pain to himself. The practical
procedure, if it was possible, was sure to follow.” If he
could do a friendly act to any human being he did it, and
care and personal exertion, if needed, were not wanting.
Intolerant of sentimentality, he was himself a deep well of
sentiment from which clear and refreshing pailfuls were
drawn daily by passing events. It was really dirty surface
water sentiment that stirred his ire, not the pellucid
draughts that come from its hidden springs. To the
strangers who pestered him with their curiosity, and to
the literary aspirants who sought his aid—and few men
have suffered more persecution of this kind than he did—he
was as a rule not only bluntly honest, but courteously kind;
and if a hard word did escape him it was not long before he
made what amends were in his power. In extreme old age
Digitized by t^ooQle
88 Carlyle — His Wife and Critics, [Jan.,
his testiness was evanescent, and followed by prompt con¬
trition.
“ I shall never forget,” Mrs. Allingham writes to me,
“ the alarm I felt the first morning when, by Mary Aitken's
kind invitation, I made the drawings of him in 1878. I had
settled myself with paper and colours ready on the old sofa
in the drawing-room in Cheyne Row. Carlyle came in and
eyed me suspiciously (no wonder, he had not been told I was
coming); when Mary quietly remarked that I was just
going to make a little sketch of him while he sat and read
before he went out for his drive. He became restive, and
said, ‘ She tried me before, and made me look like a fool/
* The very reason/ Mary said, ‘ that she wants to draw you
again/ Then he got up and marched to the door, saying,
*1 have had enough of sketching/ I longed to fly, but
Mary only laughed, and signed to me to be quiet and wait.
She brought him to his arm-chair and settled him there,
with his book close in front of the fire; and I with fear and
trembling began to sketch him. When he shifted his
position I began a new drawing; this for about an hour,
when the carriage was announced. Mary had been quite
right; as soon as he became interested in his book he
forgot all about me, and when the time came to go all his
natural kindness of heart and courtesy to a guest were pre¬
sent again, and, finding that I had not finished my drawing,
he invited me to come again. It was the same on the sub¬
sequent visits—as to his kindness—and he complimented
me on the likeness of several of my drawings. One day
Browning called, and they had a brilliant talk about
Michelet. Browning curbed his natural energy to listen
with great deference to Carlyle till the moment came for
him to reply, when he did in his usual vivid manner.”
I have dwelt at this length on Carlyle's conjugal relations
and on his character as disclosed in private life, because it
is in connection with these, as I have said, that popular
feeling was stirred up against him. No sooner had Froude
spoken than, as Mr. Lilly has pointed out, gigmanity was
up in arms, and was speedily joined by the brougham and
tandem people. All the interests that Carlyle had offended
by his outspoken judgments took vengeance on his memory
when he was safe in his grave. There was “ an explosion
of the doggerries,” and an insensate yelping has been kept
up ever since. But the attacks on Carlyle have not been
confined to his domestic history or personal traits. The
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work of traduction has been greatly extended, and now
there is nothing that he said or did that has not been
ridiculed or belittled. I cannot attempt to challenge here
or even to enumerate the adverse criticisms that have been
pronounced on Carlyle and his writings of late years; but
about the very last of them I would say a few words, and
that is to be found in the biography of the late Professor
Jowett, published in the spring of this year. In a letter
written in 1866 Jowett says of Carlyle that he is a man
“ totally regardless of truth, totally without admiration of
any active goodness—a self-contradictory man, who investi¬
gates facts with the most extraordinary care in order to
prove his own preconceived notions.” And in a letter to
Lady Abercromby, dated March, 1881, he remarks that “all
London is talking about the Reminiscences with well-
deserved reprobation.” “ It contains,” however, he goes
on, “ a true picture of the man himself, with his independ¬
ence, ruggedness and egotism, and the absolute disregard
and indifference about everybody but himself. He was not
a philosopher at all to my mind, for I do not think that he
ever clearly thought out a subject for himself. His power
of expression outran his real intelligence, and constantly
determined his opinion ; while talking about shams, he was
himself the greatest of shams.”
Now the witticism attempted at the close of this tirade,
that the denouncer of shams was himself a sham, is not
original but a variant of the old story of Thackeray, who
once, when congratulated on his Book of Snobs , replied with
an air of confidential confession, “Ah, madam, I could not
have written that book had I not been myself a snob.” But
the witticism, if not original in form, certainly contains a
statement that is strikingly original, and even grotesque in
its absurdity and inappropriateness; for if there is one fact
about Carlyle more certain than another it is this, that he
was in deadly earnest. No one can dip into his writings
without being convinced of this, and no one who has written
about him save Jowett, has ever accused him of affectation
or pretence. Jeffrey’s complaint about him was that he
was “ so dreadfully in earnest.” Goethe recognised in him
“ a new moral force, the extent and effect of which it is
impossible to foretell.” Froude declared that he left the
world “having never spoken, never written a sentence which
he did not believe with his whole heart, never stained his
conscience by & single deliberate act which he could regret
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Carlyle—His Wife and Critics ,
[Jan.,
to remember.” The late Professor Nichol, a favourite pupil
of Jowett, for whose opinion he expressed much respect,
said—“ Carlyle has no tinge of insincerity ; his writings, his
conversation, his life are absolutely, dangerously transparent.
His utter genuineness was in the long run one of the secrets
of his success.” And let Carlyle speak for himself. On
finishing the French Revolution , he said to his wife—“ I know
not whether this book is worth anything, nor what the world
will do with it, or undo, or entirely forbear to do (as is like¬
liest) ; but this I would tell the world : you have not had for
a hundred years a book that came more direct and flamingly
sincere from the heart of a man: do with it what you like,
you-.”
Jowett offers no evidence in support of his accusation ot
shammery against Carlyle. The Master of Balliol has spoken,
and Carlyle is gated for evermore. He says, indeed, that
Carlyle, while exhorting to serious work, would be the first
to laugh at anyone who tried to embark in it. “ If I were
engaged,” he writes, “ in any work more than usually good
(which I never shall be) I know that he would be the first
person to utter a powerful sneer, and if I were seeking to
know the truth he would ridicule the very notion of an
homunculus discovering the truth.” But this would not be
a sham but sardonic derision, and the allegation is unwarrant¬
able, for no one reverenced the truth-seeker more than he, who
had fought his way from the “ Everlasting No ” through
the “Centre of Indifference” to the “Everlasting Yea.”
It was not the honest truth-seeker, however humble, but the
man who, while feigning to seek truth, had all the time a
furtive eye to his own advantage, that earned Carlyle’s con¬
tempt. He could be unstinted in his appreciation of good
work. No doubt he was too prone to ascribe unworthy
motives; but that is not characteristic of the sham, whose
best weapon is wholesale and servile flattery. No doubt he
was severe and hasty in his strictures on his contemporaries—
an unpardonable offence in these mutual admiration and log¬
rolling days—but many of his proleptic remarks upon them
have been justified by events ; and it is rank falsehood to
assert that he had never a good word to say of anyone. He
has spoken with liberal approbation and esteem of scores of
men, public characters and private friends, of Lockhart,
Sterling, Shaftesbury, Milnes, Landor, Cavaignac, Mitchell,
Graham, Redwood, Baring, Erskine, Pusey, Clough, Cock-
burn, Thirlwall, Poster, Tyndale, and so on.
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91
Granted, as Jowett suggests, that Carlyle might scoff at
some of those who were striving to give effect to his teach¬
ings, there was not necessarily any insincerity in that,for one
may lay down general principles without committing one¬
self to approval of every well-meaning essay at their prac¬
tical application. It is permissible to advocate the building
of breakwaters and still to smile at Mrs. Partington's mop.
The over emphasis and exaggeration of which Carlyle was
unquestionably guilty were, one phrase makes me think,
relied on by Jowett as indicating that he was a sham ; but
this is strangely to misinterpret them, for they were in his
case not the trumpetings of the quack, but the wrathful
denunciations of a righteous man, who sees wrong prevailing
around him and can be angry and sin not. It was impossible
for him to be so sluggish, indifferent, or cool. He thought
deeply and felt strongly, and was by organic necessity im¬
perative and aggressive in urging his conclusions. He had
abounding humour, too, and this often led him into ex¬
aggeration, and often pulled him up in it. A friend tells us
that he has seen him many times check himself in a tumult
of indignation with some ludicrous touch of self-irony,
wander into some absurd phantasy, and end in a burst of
uproarious laughter. Carlyle gave up his best prospects in
life for conscience sake—he chose toil and poverty, he was
just and generous to all who had claims on him, he trampled
on the idols of the market place, he never budged an inch to
threat or cajolery, or fawned on the rich and powerful. He
declined the Grand Cross of the Bath and a civil pension,
and he is represented by Jowett as having been a sham and
not in earnest. Carlyle a sham! Carlyle not in earnest!
Is the lightning in earnest ? Is the umbrous torrent that
rushes through Crichope Lynn in earnest in its search for
the sea ? No more fervid and sincere man ever breathed the
breath of life. And I suspect that those who charge him
with lack of earnestness are not in earnest themselves, and
cannot understand him.
That Jowett had a grudge against Carlyle is tolerably
clear. He never forgave him the epigrammatic flash with
reference to the Essays and Reviews . “The sentinel who
deserts should be shot/' and he never lost an opportunity of
a thrust at him who had inflicted this sore hurt. Soon after
Carlyle's death reference was made in Jowett’s presence to
Proctor’s speculation that it was not impossible that about the
year 1897 a comet might strike the sun and raise its tem-
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Carlyle—His Wife and Critics , [Jan.,
perature just so much as to cause the destruction of all ani¬
mal life on the earth. Upon which Jowett remarked: “ How
pleased Mr. Carlyle would have been to hear this if he had
been alive.” Towards the end perhaps there was some
mitigation of his rancour, for in 1891 he delivered himself
of a more favourable opinion of Carlyle, which does not,
however, enhance one’s estimation of his critical acumen.
He had been reading Obiter Dicta . I daresay some of you
recollect the reception of In Memoriam by one critic, who
committed himself to the opinion that it was obviously the
work of a widow, written in memory of her late husband,
who was a military man. Well, Jowett fell into a similar
error with reference to Obiter Dicta , informing Mr. J. A..
Symonds that it was written by a lady at Clifton. What
does the member for West Fifeshire say to that ? “ It con¬
tains,” he continues, “ an excellent favourable criticism of
Carlyle, and many new and well-expressed thoughts. I find
that my old feeling about Carlyle comes back again, and
when a man has written so extremely well you don’t care
to ask whether he was a good husband or a good friend.”
It is not for me in defending Carlyle to assail Jowett. I
admire, as all must do, the simplicity of his character, his
aversion to what was unreal, his power of imagination, his
industry, his generous patronage of youthful talent; but at
the same time I cannot shut my eyes to the fact that he was
intellectually and morally immeasurably inferior to Carlyle
in every respect, and had a lower and narrower range of
vision. He was a gentleman who was very much at ease in
Zion. He knew few or no privations, and had the finest
educational advantages ; while Carlyle had to wrestle with
difficulties for a great part of his life, felt the pinch of
poverty, and had really to educate himself. Jowett identified
himself with the interests of his college, which became, it
was said, an embodiment of selfishness and greed; while
Carlyle embraced the universe in the magnificent sweep of
conceptions, and had a passionate sympathy with human
helplessness. Jowett entertained the great of the land
sumptuously at the Master’s Lodge; while Carlyle gave a
dish of tea to a few choice spirits in the dingy little
drawing-room in Cheyne Row. Jowett’s name is known to
a few scholars—he can never touch the masses; Carlyle’s to
multitudes wherever our language is spoken.
Jowett has freely recorded his opinion of Carlyle. Carlyle,
as far as I am aware, never said anything about Jowett. He
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93
received from him, I know, a copy of his Plato , five bright-
looking volumes, but he only cut a few leaves of it. I can
well conceive, however, with what scathing scorn he would
have disposed of Jowett’s comfortable philosophy and of his
views upon many subjects. Jowett held that civilisation
owed more to Voltaire than to all the fathers of the Church,
that Louis Napoleon was a genius worthy of admiration,
that the Commune in Paris included a number of fine
fellows, that Governor Eyre ought to have been hanged,
that increased facilities should be given for divorce, that
when there were various readings of the New Testament the
least orthodox should be preferred, that a gentleman’s
motto ought to be “ regardlessness of money, except in great
things and as a matter of duty,” and the tradesman’s
“ take care of the pence and the pounds will look after them¬
selves.”
It is to be borne in mind, too, that Jowett himself, with
his u cherubic chirp, commanding forehead, and infantile
smile,” for thus does an enthusiastic admirer describe him,
was not free from suspicions of insincerity. He was ever
undecided, sitting on the rail, and sent away his hearer
puzzled not only as to what his opinions were, but as to
whether he had any opinions at all. No wonder that the
parodist summed up his teaching in the jest which will still
bear repetition : “ Some men will say that this day is hot,
and some, on the other hand, that it is cold; but the truth is
it is neither, or rather both, for like the Church of Laodicea,
it is lukewarm.” And this is the teacher who said Carlyle
was regardless of truth and called him a sham !
Let me tell you an anecdote illustrative of Carlyle’s
abiding hatred of shams in small matters as well as great.
I had an opportunity lately of asking the Duke of Rutland
whether there was any truth in the story which I have
heard many times repeated, that in 1851 he (then Lord
John Manners), Mr. Disraeli, and other members of the
Young England party, deeply impressed by the Latter Day
Pamphlets, waited on Carlyle to invite from him some
practical hints for legislation, only to be met by vague but
tremendous exhortations to get things mended on pain of
eternal perdition. “ There is no truth in the story,” said
the Duke. “No doubt we of the Young England party
were ail much struck by Latter Day Pamphlets , but we
never supposed that Carlyle was the man to draft a Bill. It
was general inspiration, not detailed instructions, that we
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Carlyle—His Wife and Critics , [Jan.,
expected from him. I only met Carlyle once,” the Duke
added, “ and that was in the house of Sir William Stirling
Maxwell. Thinking to interest him, I told him that I had
just returned from Dumfries, and was sorry to notice that
the stones in the Burns Mausoleum there were crumbling
away from exposure to the weather. ‘ Sorry ! 9 exclaimed
Carlyle, ‘ I am very glad to hear it. I hope they will go
on crumbling till there is not one stone left upon another.
To think of it, that a man whose name was Turner, and who
called himself Turnerelli, should have been employed to make
a monument to the greatest genius that ever lived! ’ ”
I have bestowed some attention on the unkind things
Jowett said of Carlyle, because his eminence and the de¬
ference paid to him by a select group of old pupils and
admirers, some of them writers of high attainments, is not
unlikely to secure to them wide currency and some accept¬
ance. They were at once quoted in the Times . But Carlyle
has foes fiercer and more implacable than Jowett. Some
superior literary persons in London refer to him with un¬
disguised contempt; and a distinguished member of the
literary fraternity, a friend of my own, in conversation with
me not long ago, utterly denied him any claim to greatness.
He was, he declared, a commonplace man, who raved
portentously with nothing to say, whose scholarship was
meagre and inexact, whose history was untrustworthy,
whose style was detestable, whose knowledge of French and
German was very limited, and who twisted and distorted
the English language. We must go back, my friend con¬
cluded, from the vehemence of Carlyle to the clearness and
serenity of the eighteenth century.
If I might keep you till midnight, I should have something
to say under each count of this indictment, but in view of
the clock I must leave it as a horrid example of the lengths
to which the vilification of Carlyle may go. Fortunately,
those holding such extreme views are few in number,
and there is reason to believe that the calumniators of
Carlyle of all shades are a diminishing body. The slump
is over, and a steady appreciation, if not a boom, has set
in. Mr. H. D. Trail, who takes as comprehensive
and trigonometrical a survey of the field of literature as
anyone now living, has written this very year: “ Time has
been swift of despatch in the case of Thomas Carlyle. His
award has been delivered within fifteen years of Carlyle’s
death, and it confirms the judgment of his contemporaries as
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1898.] by Sib James Crichton-Brownb, M.D.
to his literary greatness. The appeal of his posthumous
detractors is dismissed with costs/’ Mr. Augustine Birrell,
too, who is quick to read the signs of the times, has written
within the last two months— u Oh, young man, do not be in
too great a hurry to leave your Carlyle unread.” Naming the
greatest historians of the day, Mr. Birrell adds: “ But no
one of them is fit to hold a candle to Carlyle. . . Excellent
Thomas.”
“ Come back in sleep, for in the life
When thou are not
We find none like thee. Time and strife
And the worlds lot
Move thee no more, but love at least.
And reverent heart,
May move thee, royal and released
Soul as thou art”
Mr. Arthur Balfour, speaking at Dumfries in August, while
confessing that he was not of the “straitest sect” of Carlyle’s
admirers, was obliged to admit that he was a great genius,
and had in him a force and originality which enabled him to
speak to two generations of his countrymen with a power and
force on some of the deepest and most important subjects
which can interest us, as no other man has perhaps been
able to do.
CLINICAL NOTES AND CASES.
A Case of Concussion of the Brain simulating Delirium
Tremens. By J. R. Ambler, M.R.C.S., L.R.C.P.,
Assistant Medical Officer, County Asylum, Chester.
A man, aged 50, was admitted on 4th October and died 15th
October, 1897. The medical certificate stated that he was suffer¬
ing from delirium tremens.
On admission .—The left side of his face was much bruised, both
eyes blackened, and there was a wound on the nose; coagulated
blood was formed in the left ear. Mentally he was dazed and
stupid, restless, muttering and incoherent in conversation.
Past history .—While on a voyage from London to Belfast some
days previous to admission he had a serious fall which rendered
him unconscious for a time. He, however, recovered sufficiently
to be able to attempt the journey from Belfast via Dublin and
Holyhead to London. He was found wandering about Crewe, and
was ultimately taken in charge by] the police and sent to this
asylum.
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Clinical Notes and Cases .
[Jan.,
For three days after admission he improved, became more
coherent and rational, and was able to answer questions. Three
days later he relapsed into the former rambling, restless and
incoherent state, and gradually sank. Throughout the day of his
death he was unconscious, with stertorous breathing, and died
somewhat suddenly at 9.15 p.m.
Post-mortem examination .—Thirteen hours after death. Cal¬
varium normal. A large quantity of serous fluid escaped on
opening the dura mater, which was firmly adherent along the sides
of the superior longitudinal sinus. Arachnoid and pia mater
normal.
There was an effusion of blood on surface of brain in the
Sylvian fissure and adjoining sulci on both sides, also on surface
of left frontal lobe. The left cerebral hemisphere was congested,
the right pale. There was also a small effusion of blood in the
floor of the fourth ventricle on the left side.
The left lung contained a small calcareous tubercle. The aorta
was atheromatous ; calcareous nodules were noted on an attached
border of the semi-lunar valves; slight incompetency in conse¬
quence. Liver large, fatty and friable. Spleen normal. Small
cysts in right kidney.
Remarks by Dr. Lawrence. —The large quantity of serum
underneath the membranes had probably been accumulating
for some time before the accident, and was coincident with,
and the cause of certain mental symptoms which had been
observed for a few months previously. At the time of the
accident rupture of capillaries had taken place; there had
been a gradual oozing of blood, which, mixing with the
serous fluid already in the Sylvian fissure and adjoining
sulci, retained its fluid condition and ultimately produced
the symptoms of compression which ushered in death. No
symptoms directly traceable to the small clot in the floor of
the fourth ventricle were observed.
The degree to which recovery of consciousness was mani¬
fested for three days is noteworthy.
Notes of a Case Introducing a Discussion on the Making of
Wills by Certified Patients , and the Duties of Medical
Men in regard to this. By W. B. Morton, M.D., Resi¬
dent Medical Officer, Brislington House, Bristol.*
The subject of these notes was a gentleman who was
admitted under the care of Dr. Deas, at Wonford House, in
# Bead at the Autumn Meeting of the South-Western Division, 1897.
Digitized by LjOoq Le
97
1898.] Clinical Notes and Cases.
June, 1895, and remained there until his death in July,
1896.
I do not propose to give a minute description of his
symptoms, which were those of a typical case of mental
stupor, but to note chiefly those which were of medico-legal
interest.
He was a gentleman of private means and no occupation. He
was 50 years of age, and had a marked history of insanity in his
family, both his mother and maternal grandfather having been
insane. There was no history of any exciting or other predis¬
posing cause.
For several months previous to his admission his manner had
been peculiar and his conduct eccentric, so much so that in
January, 1895, a petition for an enquiry was presented.
At this time his mental condition varied much. At times he
was morose, preoccupied, and almost taciturn; at others excitable
and confused, without apparently knowing what he was doing.
He wrote many extraordinary and unintelligible letters, incurred
liabilities greatly exceeding his income, burnt newspapers in an
hotel, threw the bedding out of the window, and wandered about
at night time. Some days he ate little, but at times had as many
as three dozen raw eggs in twenty-four hours.
Shortly after the presentation of the petition, improvement in
his mental condition occurred, and he quickly became apparently
quite himself again, so that no further steps were taken. How¬
ever, in June a relapse occurred, and he was certified on the 15th
and admitted into Wonford House.
His mental condition then was one of melancholia, with a
tendency to stupor.
After his admission the stupor rapidly increased and became
the most marked feature, and this was essentially his condition
until June, 1896, the exceptions being :—
(1) For a few days in August he began to eat his food, and
seemed brighter and apparently intelligent, hut still taciturn.
(2) In December he spoke once or twice voluntarily, but
quickly relapsed.
(3) In February he whispered a few sentences intelligibly, but
apparently with difficulty, and occasionally when pressed to
answer he would whisper, chiefly in monosyllables.
In May and June his health began to fail, and he was confined
to bed with recurring attacks of pleurisy and basic pneumonia,
probably of a tubercular origin, and at the height of one of these
attacks he was said to have conversed quite intelligently for an
hour with his night attendant.
Quite suddenly on June 29th the stupor passed off, and having
been sent for I found him dressed and eating his breakfast. He
said he was quite himself again, and I satisfied myself that this
XLIV. . 7
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Clinical Notes and Cases .
[Jan.,
really was bo, for, during an hour’s conversation, he spoke clearly
and intelligently, and gave me details of his property, and com¬
mented on events which had occurred both in and out of the house
during the time when he was apparently unconscious of his sur¬
roundings. He could give no explanation of his long silence,
except that he felt that it was impossible for him to speak, and I
could get no suggestion that it had been due to delusion, nor was
there any evidence of the existence of delusion at any time during
his illness. *
During the afternoon of the same day he relapsed into his
former condition of stupor. It took place quite suddenly whilst
he was talking with his attendant.
This was clearly a genuine lucid interval, and it appeared to
me that he was for the time “ of sound mind, memory, and under¬
standing.”
Two days later he had another interval, which lasted several
hours, and which was quite as lucid. He was very weak and ill,
and said he knew he would not live long, and would like to make
his will. This was drawn out two days later, but whilst it was
being read over to him by his solicitor he again relapsed into
stupor, and could not sign it. Four days later another interval
occurred, and he sent for his solicitor and signed his will.
From then to the time of his death, which occurred after ten
days, he had periods of stupor separated by distinct lucid intervals
during one of which he made a codicil to his will.
His death was due to disease of the lungs, as is said to occur
so often in cases of stupor. No post-mortem examination was
made.
The will was contested by two relatives who had not been
so well provided for as they would have been had the will
been upset, but, unfortunately for present purposes, after a
short hearing the case was settled out of court, and what
promised to be an interesting trial was cut short.
The chief feature in the case is the lucid intervals, which
were so distinctly separated and sharply marked off from
the states of stupor. During the former he was seen by
four medical men, who were all agreed as to the lucidity,
and in the latter there was no doubt as to his complete
incapacity, whilst the transition from the one state to the
other occupied but a few minutes.
The question of will making by certified patients is always
an interesting one. In this case the duties of the medical
attendant were easy, but I have no doubt we shall hear of
cases where the course was not quite so clear, and for this
purpose these notes have been read as a means of intro¬
duction.
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1898.]
Clinical Notes and Cases.
99
Discussion,
Dr. Dba§ said, taking the case now reported as their text, it was a question
that perhaps might be regarded as somewhat narrow and limited. That was so
no doubt, but at the same time very difficult questions might arise in connection
with such oases, and he thought it was a class of patients in regard to which it
would be well for all of them to have, if possible, some definite ideas as to how
they would deal with such cases when they arose. The first point that suggested
itself was as to the legal question. Was there any legal reason, he asked, why
persons in asylums should not make their wills? He thought the general
public, and even some of themselves, had ideas which were not quite in accord¬
ance with the law in regard to these matters. There was a general feeling that
as soon as a person was certified and entered an asylum he was, practically and
legally speaking, dead, and had no further civil rights. That, he thought, was
certainly a mistake. They knew very well that one important legal right was
reserved to those who were inmates of asylums—the right of being tried for
any crime which they might have committed in the same way as the members
of the outer world. One might go a little further, and say that if the present
legal version of the criminal responsibility of the insane were pushed to its
logical limit there was no reason why an inmate of an asylum should not have
the further advantage of being hanged for a crime which he might have com¬
mitted, and thereby be on an exactly similar footing with those who had not
the great advantage of being placed for protection within the walls of an
asylum. There was no reason in law why any patient in an asylum could not
make a will. The whole point was a question of fitness, and his own opinion
was that in this respect a person within the walls of an asylum was in
exactly the same position as a person outside. A man might make a will if
he had the requisite amount of intelligence to properly express his desire to
do so, and to give instructions for it to be drawn up, recording those instruc¬
tions or communicating them to a solicitor. Everyone who made a will was
liable to have it disputed, and to have his mental condition taken into considera¬
tion. The next question was as regards medical officers of asylums. What were
their duties in connection with this matter ? Supposing a patient communi¬
cated to the medical officer a desire to make a will. Was the medical offioer to
place himself in the position of opposing the patient's wish, or was he to place
nimself in the position of trying to comply with it ? Personally he was rather
in favour of the medical officer stretching a point in favour of the patient
making a will. Of course a great deal depended on the individual ciroumstanoes
of the case, but he thought they might perhaps formulate one or two proposi¬
tions which would help them. He himself should say that if a patient in an
asylum had sufficient mental capacity to say in a reasonable way that he wished
to make a will he should be allowed to see a solicitor if he so requested. Of
course one would naturally communicate with the relatives of the patient in
the first instance, but he did not think that the medical officers of an asylum
should put themselves in the position of opposing or interfering with the legal
right of an asylum patient, subject to the opinion tha,t might be formed as to
his mental condition. Very often cases arose when a patient was dangerously
ill. Now it might so happen that the relatives of the patient could not readily
be communicated with. The patient’s condition might be very critical. If a
person in that state communicated to the medical officer the desire to make a
will and asked that a solicitor should be sent for, would the medical offioer be
going beyond his functions by complying with the wishes of the patient at
once? He thought they should reserve to themselves a wide liberty of action,
and if they thought a patient was in a state of mind to be able to give
intelligent instructions for the drawing up of a will, and was evidently
labouring under mental anxiety to settle his affairs, surely it was their
duty to such steps as to enable the patient to carry out his wishes.
Digitized by {jOOQle
100
Clinical Notes and Cases.
He knew that a great many people would say they would be taking a good
deal too much on themselves by doing this, and interfering in matters
that might lead them into great trouble afterwards. His own opinion was, how¬
ever, that in such cases the medical officer would be not only justified in taking
action, but that it was laid upon him to do so in the sense of a moral duty.
Another point to which he would like to refer was as to the particular kind of
patients who might be considered mentally capable of making a will. The oase
brought before their notice by Hr. Morton was, he thought, a typical oase in
which lucid intervals might occur, and might be looked for. They all knew
how a person might remain for months in a state of intense stupor and then
the whole condition was changed, and the person was practically and to all
intents and purposes in the same condition as before the cloud descended. It was
surprising the amount of knowledge and consciousness which patients of this
kind had of what had passed in the stuporose interval. These were typical cases
in which, if this clearing up took place, patients were quite capable of exhibiting
testamentary powers. Then as to the number of cases one might have in the
course of his experience. It would not be very large certainly, but he had three
oases of the kind within the space of some seven-and-twenty-years. In all these
three cases the wills were held to be good, and two of the three cases were those
in which the patients were in the condition alluded to by Hr. Morton—in
imminent danger. In one of the cases he wrote out the will at the patient’s
dictation, and signed it as a witness. ' One of the wills was upheld on trial in
spite of the fact that he gave evidence that he thought that it was tinctured
by the delusions from which the patient suffered. He mentioned this as show¬
ing the wide view the law took of such matters—that there was nothing in the
administration of the law to put any impediment in the way of patients in
asylums making wills. In the case to which he was alluding the patient was
undoubtedly suffering from insane delusions, and he gave it as his opinion that
the will was, as he had said, tinctured by these delusions. Still the jury upheld
the will. r
Hr. Bower considered that what they had to consider were the conditions
they might be placed in at any time, and the course they would take in the
event of having to come to a hasty decision as to whether they should grant
these facilities or not. Thrashing out such subjects at a meeting like 8 that
naturally placed them in a better position to come to a right conclusion as to
what to do when these emergencies arose. He thought the cases mentioned
were just those where one would be inclined to seud for a solicitor and allow the
patient to make a will. There were no doubt difficulties in the way, and the
last case mentioned by Hr. Heas rather weakened his propositions, by showing
that sometimes they might do mischief, and be the means of an injustice being
done. The more they saw of the views of lawyers about lunatics the less one
wanted to have lawyers coming to see their patients. As a rule a lawyer never
could understand that a lunatic asylum was a place for treating disease. His only
idea was that it was a place of confinement, and what he wanted to know was
merely whether a patient was dangerous to himself or others; otherwise he was
sure to do all he could to get him out. From their point of view an asylum was
a place for the treatment of disease, and the treatment of a disease such as
insanity was very much hindered if there were all sorts of arguments going on
as to the necessity for a person being kept in an asylum or not. Where there
was a case of serious illness probably then there would be no difficulty in having
a solicitor present, but it might result in many persons who wauted to agitate
for a patient’s discharge having solicitors brought up on these pretexts.
Personally he had had no experience of any patient making a will, except very
informal wills with regard to directing the disposal of very small property in
which no legal questions were ever involved. J
The Chairman instanced the case of a patient under his care who made a
codicil to a will at the suggestion of his brother, a medical man, who urged that
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Clinical Notes and Cases.
101
the will the patient had made was defective, in that it did not provide for his
sisters. The old gentleman had sisters dependent upon him, and the brother
suggested that a codicil might be made to provide for these sisters. He sup¬
ported his wish by the fact that the Court had in apportioning the patient's
income apportioned £100 a year to be divided among the sisters. He pointed
out that the effect of the death of his brother under this old will would be that
these sisters would be left practically destitute, and the patient’s assets would go
to his nieces—daughters of married sisters. The old gentleman was a simple
dement, but he had remarkable intelligence when one could awaken it. The
avenues of his senses were practically closed, he was nearly blind and nearly
deaf, but he seemed to thoroughly understand what was said to him, and the
circumstances under which he made this will, and other points which were to
them and the solicitor unintelligible, he explained. Be explained why certain
conditions had been inserted in the will, and they were of a decidedly intricate
nature, but he was perfectly clear, and they had interviews with him on the
subject of the will, he believed on three occasions, the patient always manifest¬
ing the same intelligence. He grasped the situation with regard to the sisters,
and said it was an omission, and that he would like to make a fresh will and
correct it. His memory, however, was quite defective, and between the inter¬
views he never once referred to the subject again. A codicil was drawn up, and
he signed it, and the lawyer felt perfectly convinced that the patient thoroughly
understood what he was doing, and considered the thing safe, in view of the
fact that the Court of Chancery had already during his lifetime disposed of a
portion of his income in the way he would be disposing of it in the codicil. He
had no doubt if this old gentleman were not in an asylum, and he was one of
those who at the present time might be out if his friends would look after him,
there would be no likelihood of dispute. The case was a different one to that
Dr. Morton had instanced. In this case they had, as it were, to open the man's
senses; it was very seldom he made a remark unless he was spoken to, but he
was tolerably intelligent when approached.
Dr. Fox remarked that he had had wills made at that asylum, hut none
that had been contested, all being on the face of them perfectly reasonable.
Notes on a Case of Fracture of the Fibula in a Melancholic
Patient, with Remarks on Treatment in Fractures Gener¬
ally* By J. F. Briscoe, M.E.C.S., Westbrook© House,
Alton, Hants.
The object of this communication is to draw from the
members of the Association the modern treatment of
fractures as adopted in institutions for the insane. It is
obvious that the various plans, as practised in hospitals,
must be considerably modified in asylums. For instance,
to strap and bandage a case of fractured ribs, secundum
artem , taxes any medical officer, unless the patient is
quietly disposed and clean in his habits. However, with skill
and a fairly docile patient, there should be little difficulty in
the management of ordinary fractures of the bones below
the elbows and the knees. From time to time one reads of
* Bead for the author by Dr. Macdonald, at the Autumn Meeting of the
South-Western Division.
Digitized by L^OOQle
102
Clinical Notes and Cases .
[Jan.,
cases of fractures of the ribs occurring in asylums, remark¬
able autopsies being recorded. It is difficult sometimes to
give a correct history of their causation, and, in conse¬
quence, much opprobrium has been unjustly cast on asylum
officials. It is believed by not a few that there is a
peculiar affection of the ribs in the insane causing them
to fracture readily. It is said, too, that it is common in
general paralysis. Dr. Christian has stated in the Journal
of Mental Science , January, 1886, that he is decidedly
opposed to the idea that general paralytics are more liable to
fracture of the bones. He gives 250 cases, and says, “ I can
assure you, gentlemen, I have not come across a single
case of fracture among them.” But no figures of the
kind can be relied upon unless verified by post-mortem
examination. It is not uncommon to find in the mortuaries
ordinary hospitals and asylums, and in the dissecting-
room, specimens of fractured ribs, the causation of which
is unaccounted for. With our present pathological know¬
ledge of the osseous system we must withhold our verdict.
I will narrate the case of J. C., set. 68, a patient in Westbrooke
House, suffering from chronic melancholia. She arose from her
chair one morning, stumbled, and broke her left fibula in the
usual place above the ankle-joint. At first I was inclined to
believe it was a simple sprain, for no displacement or crepitus was
elicited when handling the foot. To seek for grating is bad surgery,
as we know, and gives rise to unnecessary pain. Two days after the
accident, and when the swelling had subsided, a careful comparison
of the two ankles was made. There was no doubt as to the solution
of continuity, the patient complaining of local pain, over the seat of
which was an oblique depression. Accordingly, the foot was put
at right angles, and a plaster-of-Paris crinoline bandage applied.
The patient rested her leg, ringing the changes, first on a chair, then
on a hassock. On or about the seventh day she was allowed to take
the nurse’s arm, and also bath-chair exercise in the grounds. She
made an uninterrupted recovery, and the “ Sayre ” was removed at
the end of a month, being substituted by a soft-webbing figure-of-
eight bandage. Although the patient is a feeble lady, with a
cyanotic condition of the extremities, yet this fracture appears to
have done well. Her mental state is benefited. She seems to have
quite forgotten about an imaginary tumour in her abdomen, and has
been much more sensible since the accident.
To be diffuse on the treatment of fracture in the insane is
not the object of the writer of this paper. Personally, I am
inclined towards immovable supports, such as gum and chalk,
and, above all, the plaster-of-Paris bandage of Dr. Sayre, of
Digitized by L^ooQle
Clinical Notes and Cases .
103
1898.]
New York. I should only adopt wooden splints in a quiet
case; but in an extensive fracture of the thoracic walls I should
sling my patient, all other things being equal, affixing a
plaster jacket. In less extensive solution of continuity of the
ribs I would favour a broad flannel bandage, with suitable
braces to hold up the whole. In fracture of the thigh, below
the neck, I can think of nothing better than a Sayre bandage
to be extended figure-of-eight-fashion around the hips. To
strengthen this support a convenient piece of metal or
wood can be inserted between the layers of the plastered
bandage. If there should be any doubt as to sores or
abrasions arising from the use of plaster-of-Paris, hose
should be worn next the skin, suitable cotton-wool pads
being arranged over prominences; failing this, the splint
must be eye-letted and laced.*
Discussion.
The Chaibman said fortunately he had not had much experience in the treat¬
ment of fractures, but he had always used the ordinary means of a surgeon with
the usual success. He believed his last case was a fracture of the forearm and
he had considerable difficulty in keeping the patient still. He required
special and constant attendance day and night, but he made a very good recovery
indeed. He thought movable splints were really necessary in this case, for the
patient very frequently got his splints loose and they had to be readjusted.
It was rather new to him to hear—if he heard correctly—that there was any
dispute about the liability of general paralytics to fracture of the ribs. He had
personally seen many cases w;here ribs, not previously damaged, were most easily
fractured at the post-mortem examination, and found to be mere shells con¬
taining an oily substance, rather than marrow, ribs that must necessarily have
been exceedingly easily fractured if they had been subjected to violence.
Hr. Benham referred to a case of fractured leg which occurred under his
care lately. The patient was of such a restless character that it was necessary to
restrain him in bed, and two carefully padded leather bands were put round the
wrists, with a ring at the end and tied at some distance so that the patient’s
hands could not be used to tear the dressings from the limb. He had a com¬
munication from the Commissioners in Lunacy, that having used leather bands
of that nature he was quite going beyond their orders, and that only a bandage
should be applied. What he did certainly gave the patient a very much easier
time. The Commissioners in Lunacy had not visited them since that communi¬
cation, and he was keeping the means of torture which he applied with a view
of asking if they could suggest anything more suitable. With regard to the
liability of fracture in cases of general paralytics, he had seen more than one
instance where the ribs, crumbled in the fingers. Very early in his asylum
experience he had a case where nine ribs were found to be fractured on the
post-mortem examination. As the question arose as to whether these ribs were
fractured previous to admission it had to be thrashed out before a coroner and his
jury. By referring to the many cases quoted in the past, it was shown clearly
and convincingly that the ribs of the insane were liable to degenerate and frac¬
ture very easily. He pointed out how a fracture might easily be caused on the
removal of the body from the place of death and could speak of one case where
* Paraffin wax bandages have been found very suitable in asylum practice.
—Ed.
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104
Clinical Notes and Cases .
[Jan.,
he was confident the fracture occurred after death. He thought a fact of
this nature should not be overlooked. With regard to putting cases up in plaster-
of-Pari8, he might say that as soon as convenient he thought it was desirable to
do so, but at the very first in fractures of the insane he would not advocate it.
Dr. Macdonald said that, in the face of a most able contribution to a meeting
in London, not two years ago, from the Pathological Laboratory at Barnhill
Asylum, he should have thought Mr. Briscoe would have hesitated to quote
Dr. Christian’s older paper, especially after what was shown on the blackboard,
under the microscope, and by the aid of the limelight by Dr. Campbell, all going
to show and prove the degeneration of the bones of general paralytics.
OCCASIONAL NOTES OF THE QUARTER.
Sir John C . Bucknill.
The portrait of the late Sir John Bucknill, which forms the
frontispiece of the present number, will forcibly recall to a
large proportion of the members of this Association the
personality of one who for many years held so prominent a
place in their ranks.
The obituary notice of Sir John Bucknill in our last issue
has fully recorded the eminent services which he performed
in his various official and social relations, but we seize this
opportunity of specially reminding the Association of the
great work that he did for it when it was still a struggling
organisation of doubtful vitality.
Such a record as this frontispiece is the very smallest
expression of esteem and gratitude which we can yield his
memory, and we must hope that the time may yet arrive
when the Association’s local habitation may admit of its
gathering together, in the more artistic form of oil paintings
or busts, the memories of those who, like Sir John Bucknill,
have not only served it, but have added honour and dignity
to its history.
Pathology in the London County Asylums.
The London Asylums Report of this year gives evidence
that the Pathological Laboratory established at Claybury
has borne good fruit, and gives promise of an even larger
yield in the future.
The Medico-Psychological Association has already bene¬
fited from this new departure by the able demonstrations
which its director, Dr. Mott, has given at two meetings in
the past year; and we are glad to learn that full reports of
Digitized by L^OOQle
1898.] Occasional Notes of the Quarter . 105
the work of the laboratory, in the form of Archives , will be
edited by him.
Dr. Mott during the past year has especially devoted
himself to the study of general paralysis, with the relation
of syphilis to this disease, and be could not have attacked a
subject of more interest and importance. Some of the
results of his observations and his views of their patho¬
logical significance have already appeared in this Journal,
and we shall await with interest their further development in
the Archives .
Dr. Mott has already succeeded in one great object of
such a laboratory, viz., the attracting to it of young and
energetic workers; this we hope will be even more success¬
ful in the future, and lead ultimately to the establishment of
a school of neuro-pathology worthy of the most wealthy and
populous city in the world.
The London County Council and its Asylums Committee
are to be congratulated on having made so important an
advance, and on having placed their laboratory under such
able management.
The Laboratory of the Scottish Asylums .
The conjoint Laboratory of the Scottish Asylums is now
open and fully equipped for work. Already the pathologist.
Dr. Ford Robertson, has made reports upon cases of special
interest submitted to him for expert opinion, and on the
11th November the Scottish Division held their Autumn
Meeting in the large room of the laboratory. Much care and
thought have been bestowed upon the arrangements and
fittings, with a view to thoroughly practical work, and all
the necessary apparatus for histological research has been
procured. The Scottish Division is to be congratulated
upon having secured central and convenient premises in
immediate contact with the Laboratory of the Royal College
of Physicians at 12, Brisco Place, Edinburgh. This is bene¬
ficial to the College as well as to the asylums, since the
close association of workers in science is both stimulating
and helpful.
The duties of the pathologist are stated briefly, as
follows :—To carry on original researches upon the
pathology of insanity ; to examine pathological material
sent from the asylums and to furnish reports ; to teach
and give assistance to members of the medical staff of the
Digitized by L^ooQle
106
Occasional Notes of the Quarter . [Jan.,
associated asylums in regard to research work upon the
pathology of insanity; to make one visit annually to the
associated asylums at the expense of the laboratory funds,
and to make additional visits as required. This is a very
generous scheme, and it is to be hoped that it will not un¬
duly tax the energies of Dr. Ford Robertson and his assistant,
Dr. David Orr.
It will be gathered from the foregoing that the aim of the
Board has been to retain the services of a consulting
specialist in pathology in the widest interests of psychiatry,
and thereby to assist and develop similar work in the
associated asylums. In short, the object of the scheme is to
further our knowledge of the pathological processes of
mental disease by instruction, advice, and encouragement.
There is, unfortunately, an inevitable aloofness in asylum
life. Medical observation and research is frequently pursued
in uncongenial and remote surroundings ; enthusiasm, too,
often wanes in presence of dull routine and mechanical
duties. Our Association has done much to bring its members
together for the discussion of difficulties and the promulga¬
tion of ideas ; and in a similar, helpful manner the Patho¬
logical Laboratory will keep alive that glow of intellectual
vitality which medical education inspires, and will constitute
a centre to irradiate the remoter hospitals for the insane in
Scotland. It augurs well for the future of this scheme that
fourteen institutions have already joined to set it upon a
sound financial basis, and it is confidently expected that
others yet undeclared will aid in developing the laboratory
so that its operations may proceed with every encourage¬
ment. Under these favourable auspices, with the cordial
support of the college, which was well represented upon the
opening day, we may expect great results in the course of
time. We venture to predict that the Scottish Laboratory
will prove worthy of imitation by the other Divisions of the
Association, and heartily wish success to the South-Western
Division in their similar undertaking.
Irish Pauper Lunatics .
The absence of a law of settlement in Ireland is beginning
to be acutely felt in connection with the cbargeability of
lunatics. The insane who are sent to public asylums in
Ireland are not paupers in the same sense as in England, for
they do not necessarily come first within the purview of the
Digitized by L^ooQle
107
J898.] Occasional Notes of the Quarter.
Poor Law. A considerable number of broken-down people
of Irish birth, however, who become insane in England and
Scotland are deported by the Poor Law Authorities in the
latter countries to Ireland, and are then transferred to
District Asylums.
This is regarded as a grievance, inasmuch as the richer
island has had these poor people’s services perhaps for many
years and sends them home to die when their work is done.
Within the island itself the law which ordains that a
lunatic shall be sent to the asylum for the district in which
he may chance to be arrested, weighs unfairly upon the
districts which happen to have a large floating population.
Thus the Metropolitan area, which contains numerous
hospitals andjprisons and several very large workhouses, and
which naturally attracts a steady stream of vagabonds as
well as of the unemployed from all parts of the country, pays
a heavy tax for its “ advantages ” in the shape of a very
undue proportion of rate-supported lunatics. The same
state of things appears to exist, though in a less degree, in
Belfast and Cork.
We learn from the Dublin newspapers that the Guardians
of the Dublin Workhouses are co-operating with the Gover¬
nors of the Richmond Asylum in an endeavour to bring the
matter under the notice of Government with a view to its
being dealt with in the forthcoming Irish Local Government
Bill.
We hope this is not the only branch of Irish Lunacy
Administration which Government will then take up. We
observe that a member of the Board of the Metropolitan
Asylum is anxious to press forward the question of the
boarding-out of lunatics, and proposes to call upon Govern¬
ment to take it up. Why this has never been done before
we cannot imagine. The same desperation which, accord¬
ing to Sam Weller, prompts a man when he has no money
for anything else to plunge in oysters must surely actuate
the Irish neglect of a cheap method of dealing with a cer¬
tain section of the insane. If boarding-out is ever tolerable
anywhere it surely ought to be worth attempting in Ireland,
where it is so hard to get money for asylum purposes and
where there is no other alternative than the asylum or the
workhouses. The revelations of the last few years with
regard to the condition of the sane sick, and of the insane
in Irish Workhouses have sufficed, we hope, to put an end
to any of the projects, once freely canvassed, for the cheaper
Digitized by CjOoqL e
108 Occasional Notes of the Quarter . [Jan.,
treatment of lunatics by transferring them to such institu¬
tions from asylums. Even the Poor Law Guardians them¬
selves, not generally very humane or very advanced in their
views about such matters, are beginning to feel that work-
houses are hardly suitable places for the insane on the lines
of management which have hitherto characterised those
unhappy establishments. In discussing this subject more
than a year ago our contemporary, the British Medical
Journal , pointed out that “ to feed an Irish convict for one
week costs 3s. lid.; to feed a healthy Irish lunatic costs
3s. 5d.; to feed a healthy Irish pauper for the same period
costs Is. 5d.; and an aged and infirm pauper Is. 4d.” To
which of the two last enviable classes the workhouse lunatic
is supposed officially to belong we are not informed.
The Temporary Treatment of Incipient Insanity .
The sudden collapse of the Lunacy Bill last year brought
to a standstill the work of the conjoint Committee of the
British Medical Association and our own on this subject.
This Committee, it is to be hoped, will still continue its
labours, and be prepared, before the next Session of Parlia¬
ment, with a workable adaptation to the English law of the
Scottish clause dealing with the same stage of mental
disease.
The Lord Chancellor will almost certainly introduce a
"Lunacy Acts Amendment Bill” in the coming Session,
and it would be a reflection on the business capacity of the
profession if this found us unprepared with a practical pro¬
position, on a point regarding which there had been such an
emphatic expression of professional opinion.
The profession at large is too apt to undervalue the power
it possesses of influencing legislation, but in the passing of
the recent Lunacy Acts we had many opportunities of
proving how great this power really is, a fact which should
be remembered as an encouragement to future efforts in the
same direction.
Provision for the Poor Private Insane .
The last Report of the General Board of Lunacy for Scot¬
land contains a most important and urgent appeal for legis¬
lative measures in relief of the poorer classes of the insane
Digitized by L^OOQle
1898.] Occasional Notes oj the Quarter. 109
in Scotland. It is a closely reasoned declaration of the
opinion of the Commissioners in view of the fact that the
Royal Asylums are no longer adequate to meet the require*
ments of those who are but little removed from the " pauper 99
class. This has been apparent for some time, and the con¬
viction, which has grown in strength, has found utterance in
the suggestion now made, viz., that the powers conferred
upon the County Lunacy Authorities of England should be
extended to the District Lunacy Boards of Scotland. The
existence of tracts of country where no provision has been
made for those in narrow circumstances, the want of suffi¬
cient accommodation in existing institutions, the unfortunate
results of the present condition of affairs have weighed with
the Commissioners in urging that a measure of relief should
be granted bv Parliament.
We note, however, that an important restriction is to be
laid upon the District Boards of Lunacy in respect of the rates
to be charged. It is evident that the position of the Royal
Asylums and their beneficent work should not be endangered.
There is no intention to provide accommodation at the cost
of the ratepayers for those otherwise able to command it.
On the contrary, the Commissioners attach great importance
to the limit of the rates of board to the sum charged for
pauper lunatics, with the addition of a sum in name of rent
to be levied as the District Boards may see fit. And,
further, this sum in name of rent is to be calculated on the
net cost of what may be required to provide the buildings.
The Commissioners point out that higher rates than those
indicated would defeat the very object for which this
measure has been proposed. There is no intention to lessen
the burden of the ratepayers by profits from keeping private
E atients, but rather to prevent burdens falling on the rates
y offering no excuse for the acceptance of parochial aid.
We trust that the temperate, judicious, and benevolent
scheme thus propounded may be carried into effect in the
near future.
Straits Settlements Asylum .
Those of our members who listened to Dr. Ellis’ interest¬
ing paper on Latah will be interested to read his report on
the lunatic asylum over which lie presides.
Dr. Ellis has a nearly complete pathological and bacterio¬
logical laboratory, and his remarks on the special causes of
Digitized by t^ooQle
110
Occasional Notes of the Quarter. [Jan.,
insanity (malaria, etc.), on the forms it assumes, and on the
endemic diseases with which he has to contend, are of the
utmost interest. Chief among these is beri-beri, to the con¬
sideration of which affection he devotes a large portion of
his report.
The pioneers of science and civilisation, scattered over our
colonies and possessions, can send us not only much that is
new, but also much that is instructive, and we should do
our utmost to keep them in touch with us, not for their
advantage only, but for our own.
Lunatics at Large and the Public Press.
The daily Press, or at least a certain section of it,
oscillates between two extremes in its views of the treatment
of lunatics.
If some half-cured lunatic succeeds in attracting popular
attention, the Press loudly advocates legislation that will
prevent t€ incarceration ” in an asylum, or, if a discharged
patient commits a crime, it is equally forcible about
“ lunatics at large/’ and the wrongfulness of letting insane
persons out of asylums.
The “ lunatics at large ” of which complaint is thus made,
it should be remembered, are largely the outcome of the
recent legislation, which was mainly based on these illogical
outbursts of the Press.
The difficulties in placing a sick person with mental dis¬
order under treatment resulting from the recent Lunacy Act,
leads to many of these becoming “ lunatics at large,” until
their lunacy is placed beyond all dispute. This is often
arrived at by the uncertified lunatic committing some overt
act, such as assault, homicide, suicide, or homicide followed
by suicide, and thus proving that he needs or has needed
treatment.
The number of “ lunatics at large ” thus created is probably
considerably increased by the periodical recertification of
lunatics under the recent Act, which may lead to the dis¬
charge of patients, who although manifesting no certifiable
symptoms while under detention, develop their lunacy very
shortly after discharge. Many of these “ lunatics at large,”
therefore, are not under control, not from want of evidence of
their insanity, but because this evidence is not within the per¬
sonal observation of a medical man at the time when he is
called on to certify.
Digitized by {jOOQle
1898.] Occasional Notes of the Quarter . Ill
The Medical Certificate evidently does not cover the
ground, and it is obviously desirable that there should
Be some other procedure whereby a known lunatic could be
placed or detained under care, when from any reason the
written evidence of a medical man is not available.
The crimes which result from this defect of the law appeal
by their striking character to the popular mind. They are,
however, of little importance in comparison with the mass
of mental suffering, prolonged even to lifelong lunacy, pro¬
duced by the hindrances to treatment which the law entails
in demanding written evidence (as on oath), from a medical
man, as the only means whereby a sick person can be appro¬
priately treated.
The " liberty of the subject ” has been the popular cry on
which this lunacy legislation has been based, with the object
of preventing the most improbable possibility of a sane
person being sent to an asylum. In this zeal for liberty
many hundreds of sick persons are annually deprived of the
liberty of obtaining the medical treatment they require,
obtaining in exchange only the liberty to commit suicide or
homicide.
The public should be clearly instructed that the annually
recurring and possibly increasing horrors from the crimes of
u lunatics at large 99 are the price it pays, under the existing
lunacy law, for protection from an illusory danger to the
“ liberty of the subject.” u Oh, liberty ! liberty ! how many
crimes are committed in thy name.”
The Evil of Irresponsible Criticism.
Perusing certain remarks made recently by a Mr. Berdoe
in a lay paper, anent a therapeutic enquiry by Dr. Berkley
at the City Asylum, Baltimore, and weighing these after a
consideration of criticisms to be found in the British Medical
Journal of September 18th and September 25th last, the
thoughtful ratepayer—especially of the Metropolis, where
Mr. Berdoe's superfluous energies, find a vent—may well
pray to be saved from his friends. Everywhere, and
especially, probably, in the Metropolis, any painstaking in¬
vestigation having for its object the determination of means
whereby mental disorders may be arrested before they pass
into the interminable night of chronic dementia, would be
cordially approved of by those who contribute to the main¬
tenance of county asylums, which look to become vast
Digitized by CjOoqL e
112 Occasional Notes of the Quarter. [Jan.,
hostelries for the incurable in mind. Dr. Berkley records
in the Bulletin of the Johns Hopkins Hospital for July,
1897, the results of the administration of thyroid extract in
cases that “ had either passed, or were about to pass, the
limit of time in which recovery could be confidently ex¬
pected.” We need not here describe Dr. Berkley’s work, of
which our readers can judge in the original. We content
ourselves with the observation that it is the record of the
trial of a medicinal agent, carried out scientifically, and for
the benefit of the patient. To Mr. Berdoe, however, it
appears that Dr. Berkley’s work was “ a study of poisoning,
as a poison might be tested on an animal.” Viewing the
matter in this lurid light, Mr. Berdoe felt forcibly that the
interests of the public were in jeopardy, and, thus agitated
in mind, was constrained to seek out a sympathetic con*
fidant, whom he found in the Daily Chronicle . The u up-
to-date ” and democratic organ upon which Mr. Berdoe’s
choice fell was far too astute to miss the opportunity of
heading a letter (i Experiments on Lunatics; ” and con¬
sequently we find his feelings concentrated under that
harrowing title in an issue of the above newspaper. Those
members of the profession who may have seen his letter,
though it may be denied them to gauge the intensity of Mr.
Berdoe’s feelings, will not fail correctly to estimate his
action in this matter. They cannot but regret that he
should have condescended, not merely to have addressed his
strictures upon a medical colleague to a lay organ, but
further—to quote from our medical contemporary above-
mentioned—to have made statements which u are not
accurate,” and to have given “a very unfair version of the
facts.”
The Evil of Unrestricted Zeal .
But, while we condemn libel on a professional brother,
while we protest, alike in the interests of humanity and of
our profession, against any stupid effort to excite prejudice
against the proper use of new methods, we would denounce
any real “ experiment ” upon lunatics unhesitatingly. It
is not too much to say that such a procedure would be
cowardly, immoral and infamous. On similar grounds we are
inclined to condemn the practice of pressing into the service
of science criminals under sentence of death. This has, how¬
ever, been occasionally carried out. Thus Kiichenmeister
Digitized by LjOOQle
1898.] Occasional Notes of the Quarter. 113
gave twenty cysticerci celluloses , on two occasions, to a criminal;
and it is recorded that “ afterwards 99 nineteen tapeworms
were found in his intestines; and thus the converse of feeding
pigs with the proglottides of the taenia was experimentally
manifest. It appears to have been reserved for a Viennese
specialist to make what is probably the first experiment upon
an insane person, and we record the fact with regret and re¬
probation. Those members of the Association who attended
the Moscow Congress, and who heard the discourse of
Krafft-Ebing on general paralysis, may be already aware of
the circumstances; for we gather from an account of the
proceedings of the Congress (as they related to Psychiatry)
which appears in our French contemporary, Annales Medico -
Psycholog iques (Nov.-Dee., 1897), that this address made
mention of the experiment alluded to. The announcement,
it is stated, caused considerable surprise and emotion, as we
can readily believe. It would appear that a certain
specialist in Vienna, whose name is not disclosed, being
desirous of throwing light upon the question of the relation¬
ship between syphilis and general paralysis, conceived the
idea of inoculating with the former disease nine general
paralytics taken at random from his clinique. Of these six
remained free from syphilis, but three contracted it, the
conclusion being that syphilis was not the cause of the
general paralysis in these latter cases. The moral laxity
which permitted this shameful indulgence of scientific
curiosity was justly censured by the public Press. The
Deutsches Volksblatt of August last has an article upon the
subject entitled t€ Human beings in place of rabbits for ex¬
perimental purposes.” The enemy have indeed had occasion
to blaspheme.
PART II.—REVIEWS.
The Fifty-first Report of the Commissioners in Lunacy ,
England , July 5th, 1897.
Notwithstanding their special supplement issued earlier in
the year, dealing with the alleged increase of insanity, the
Commissioners in Lunacy most unwisely open their Annual
Report to the Lord Chancellor for 1896 with an expression of
“ regret 99 at the very large increase in the number of lunatics
in England and Wales on January 1st, 1897. This indiscre-
xliv. 8
Digitized by L^OOQle
114 Reviews. [Jap.,
tion, for such alone it can be called, after their very deliberate
conclusion that insanity is not greatly increasing out of
proportion to the increase of population, has naturally been
followed by a buzz of excitement in the lay Press, which at
this season of the year is but too keenly anxious to grasp at
any sensational item from which to elaborate highly specu¬
lative articles and alarmist leaders. Following the line of
argument we have all along adopted, the Commissioners in
their supplementary publication accepted certain influencing
factors as undoubtedly operative in minimising, to a great
extent, the apparent pro rata increase of the insane in our
midst, and, making a slight bid for consistency, they add a
weak explanatory paragraph further on in this Report
accounting for the apparent increase during the past year.
Why, then, if this increase can so logically be explained,
should they express regret ? Is it, perhaps, that their
onerous duties, which are steadily increasing year by year,
are so heavily weighing on them that the expression is
fathered by a hope that additional Commissioners may ere
long be appointed to aid them in their inspections, their
visitations, and their criticisms ? If so we are entirely at
one with them, for we are certain that the number of active
Commissioners is far too small efficiently to cope with the
enormous amount of work that has annually to be done; but
could a veiled official desire, if such it be, not have been less
ambiguously worded ? The ordinary reader of this Report,
and the lay Press critic when trenching on matters dealing
with lunacy statistics is very ordinary indeed naturally
accepts their expression of regret as an authoritative
acknowledgment that insanity in its more active phases is
a rapidly progressive malady in the community, likely ere
long to encompass its ruin. The result of this is that we
have, as in previous years, to clear the way by combating
these erroneous conclusions with a wearisome reiteration of
all our old arguments. Shortly to summarise the factors
we deem of sufficient importance to affect this question, and
which we have for some years past insisted upon as quite
impossible to disregard, we may mention: 1. The increase
of population. 2. A gradually diminishing death-rate in
asylums. 3. A gradual prolongation of age-periods in
asylums above the middle age-periods. 4. The improved
facilities for location in asylums of paupers and the in¬
creased popularity of asylum care, etc. 5. The more ready
transference of pauper insane from workhouses to asylums
Digitized by LjOoq le
1898.]
Reviews.
115
for the sake of the 4s. grant. These and certain other
minor influences are effectual in swelling the aggregate
without in the least, as we have so often shown, increasing
the true ratio of occurring insanity to population. From
the Report we learn that the total number of patients under
the supervision of the Commissioners on January 1st, 1897,
amounted to 99,365, an increase on the number on the same
date in the previous year of 2,919, and this increase is the
cause of the Commissioners ’ t€ regret/’ We endeavoured last
year to show that to adopt a date-estimation as a basis of
calculation in taking an asylum census thus is an error, and
that a far more reliable comparison of yearly work is the
difference between the average number resident in all in¬
stitutions, for the occurrence of insanity is, as we main¬
tained last year and as the Commissioners themselves show
elsewhere in this Report, liable to periodic quantitative
fluctuations, so that an enormous number of admissions at
one period may be followed by another of comparative in¬
activity and vice-versa. Whether our criticisms of their
Report are ever to have weight with the Commissioners we
cannot say, but we can only express the hope that ere long
many of their statistical tables will be subjected to a
thorough revision, so that information more precise and
valuable, which might certainly be collected from the
numerous returns and reports supplied by institutions to
their office, may be granted us. Many of these tabular
summaries have in their present form been served up
annually for half a century, and it is high time they were
regarded as trite and out of date.
The increase in the reported number of insane on the
date chosen by the Commissioners is the largest on record,
and assuming the numbers for a moment truly to represent
the increase of insane in asylums, etc., the average annual
increase for the decade has thereby been raised from 1,437
last year to 1,847. The ratio of reported insane to the
population, according to the Commissioners’ calculation,
rose on January 1st, 1897, from 31*40 to 32*00, a differentia,
increase of *60 on last year’s ratio, making an average
annual ratio for the decade of 30*38 per 10,000. This, and
the preceding table (Nos. I. and II.) are especially note¬
worthy as monuments of inaccuracy, for reasons we gave
last year, and their continuance in their present form in
an official publication is certainly deplorable. The same
remark applies, but perhaps with not such force, to
Digitized by L^OOQle
116
Reviews .
[Jan.,
Table III., that dealing with the ratio per 10,000 of the
number of patients admitted into various institutions during
the year. Did the Commissioners but content themselves
with merely a tabular statement of the actual numbers,
discarding all ratios to population (save those ratios dealing
with insane to sane paupers) as untrustworthy, their totals
would then be of importance and interest, but where all
sorts and conditions of admissions, which at the same time
happen to be those insane only who come under the
Commissioners 9 cognisance (first admissions, recurrences,
relapses, transfers and recertifications), are heaped together
and then made to bear comparison with an estimated whole
population value, we are merely obtaining a little elemen¬
tary arithmetic of no particular value to anyone who has
ever given lunacy statistics a thought. The Commissioners
evidently accept their own calculations as quite unimpeach¬
able, for they freely comment on their value to two places of
decimals, speaking of the slight decrease of # 01 per 10,000 in
the ratio of private patients to population. The results to
be gathered from Table II. are exactly not what the Com¬
missioners would have us believe; we are asked to accept as
a conclusion, from the absurd miscalculation in this table,
the absolute (not the approximate) deduction that one
person in 313 is insane, and that this ratio is a progressively
diminishing one, from which an indiscreet statistician has
quite recently in a popular publication computed the startling
result that in a.d. 2301 we shall all be mad ! Such is one
of the simple results of the Commissioners 9 arithmetical
fallacies.
The ratio per cent, of pauper insane to paupers of all
classes (Table IV.) is one of the few sound numerical
summaries in the Report. We have here the actual number
of pauper insane on a given date compared with the actual
number of sane paupers on the same date, and as the pauper
insane with but very few exceptions come under the review
of the Commissioners 9 office, we may, knowing that the
ratio of sane paupers to the population is almost constant,
make a fairly approximate estimation of the prevalence of
insanity in England and Wales. The table is, therefore,
one of some value. We shall find on examining it that the
ratio per cent, of insane to sane paupers is almost a fixed
quantity, the average for the decade being 10 per cent., a
value differing not materially from that of previous decades.
Fluctuations above that percentage can reasonably be put
Digitized by LjOOQle
Reviews .
117
1898.]
down to a greater readiness to resort to asylum treatment
and care. The steady rise in the actual number of pauper
insane during the last five years (the average per annum
increase being 2,287), while the ratio shows no greater
variation above 10 per cent, than *71 per cent, at any time
during that period, is perhaps the most convincing numerical
proof of the stationary condition of insanity; every other
computation bristles with inaccuracies.
While the total number of patients under detention on
January 1st, 1896, amounted to 73,580, or an increase on
the number on the same date in the previous year of 2,265,
the total number of admissions during 1896 was 18,854, a
number only 60 in excess of the previous year’s admissions.
The following table shows the variations as to increase
and decrease in admissions during the year in the various
institutions and modes of care:—
1
County and
Borough
Asylums.
Registered
Hospitals.
Metropolitan
Licensed
Houses.
Provincial
Licensed
Houses.
Naval and
Military
Hospitals.
Criminal
Asylum,
Broadmoor.
3
to .
55
CD 3
3 *
i&
&
u
"a
S=3
Total.
Increase.
266
—
3
—
n
—
—
376
Decrease.
1 “
68
-
77
H
3
9
59
316
Total increase . 60
As compared with last year’s admissions we once more
have to note the remarkable fluctuations presented by these
figures in occurring insanity so far as can be gauged by
admissions into asylums; then there was a marked increase
both among the pauper and private insane, and it merely
shows how utterly useless it is to attempt any dogmatic
inferences from figures which deal with but a section of the
insane population. The remarkable diminution in the num¬
ber of certified private patients, however, calls for remark,
and we shall briefly deal with this subject later on.
The table dealing with transfers is inserted merely in
support of the adjacent tables; nothing of practical interest
can be gathered from it.
The re&dmissions on fresh reception orders due to the
expiry of previous reception orders remains in total nearly
the same as that of last year.
Recoveries during 1896 numbered 7,178, an increase on
Digitized by L^ooQle
118
Reviews .
[Jan.,
the previous year’s total of 105, the increase occurring
mainly in County and Borough Asylums, where the greater
number of patients renders the range of fluctuation
greater.
The percentage of recoveries to the total number of
admissions rose from 38*18 to 38*53, an increase of *35 per
cent., but still below the percentage average of recoveries
for the five preceding years by *85 per cent. The Commis¬
sioners are careful to regard these merely as “ stated
recoveries,” and the table must therefore be looked upon
as only approximately trustworthy. The proportion of
recoveries to the average number resident (which, as we
shewed last year, it would be perfectly fair to tabulate,
seeing that the only possible objection to such a calculation,
viz., that for comparison of recovery-rates the computation
would be a fallacious one, as the average number resident
depends on varying causes in different asylums, here falls to
the ground in a general survey of all classes of asylums)
shows diminution in the recovery-rate by *24 per cent, on
the previous year’s ratio. We are inclined to regard such a
calculation as more reliable than the usual rational estima¬
tion of recoveries to admissions, for admissions can bear but
a subordinate relation to recoveries which on the other
hand are closely bound up with the average number resident
in all institutions. For the sake of comparison of recovery-
rates of different asylums, however, the ratio of recoveries
to admissions is the only correct method of estimate. On
examining the tables given below, showing recoveries to
admissions and recoveries to average number resident, we
may observe the steady declination in the average recovery
rate for each successive quinquennial period during the last
twenty years, a possible numerical illustration of how
asylums have of late become crowded with non-recoverable
cases.
The actual total number of deaths during 1896 amounted
to 6,806, a decrease of 429 on the previous year’s number,
diminishing the asylum death-rate (properly calculated here
to the average number resident) from 10*01 per cent, to
9*05 per cent., a remarkable diminution, and the lowest
recorded during the last twenty years. We give as usual a
table of comparative death-rates (per 1,000) taken from the
Commissioners’ tables, and the Registrar-General's ratio
(per 1,000) of deaths in the whole population to the
estimated whole population for 1895. Comparing the
Digitized by LjOOQle
Reviews .
119
1898.]
insane to sane death-rates at various age-periods for the
three years 1893-1895, it may be noted (discarding the
extreme age-limits) that the main variations in death-rate
occur at age-periods in which it may be presumed acute
manifestations of mental disease are more common, while in
the age-periods 45 and upwards, the rate remains fairly
constant This will serve also to show that in asylums the
death-rate of cases over the middle age-period not only
tends to approximate more closely to the sane death-rate as
age advances, but also remains very nearly constant.
Hence it is that we have so great an accumulation of senile
cases, especially females, in all asylums.
Tear.
Percentage Ratio of
Recoveries to Admissions.
Percentage Ratio of
Recoveries to Average
Number Resident.
1877
37-30
10-71
1878
39 94
11-31
1879
40*50
Average
’ 39-65
10-96
Average
' 10-85
1880
40-29
10-77
j
1881
39*72
10-61 ;
1832
39*41
10*22 ’
1883
38-50
10-28
1884
40*33
Average
‘ 40-27
1030
Average
r io-o8
1885
41*99
9*89
i
1886
41*16 j
9 73 ,
1887
38-66
9*41
1888
38*71
9‘54
i
1889
38-81
Average
* 3914
9*44
Average J
‘ 8-76
1890
38*69
9-87
i
189!
41*04 ;
10-68 ,
I
1892
38-94
•
10-06
•f
1893
38-46
9-95
1
1«94
40*31
Average
' 38*88
10-13
Average
' 989
1895
38*18
9-78
|
1896
3V53 ,
9*54 ,
The Commissioners make a passing comment on the
i ncrease in the percentage of paupers treated in asylums,
and the diminution (amounting to exactly the same total)
of the proportion of paupers treated with relatives, etc., and
Digitized by LjOoq Le
120 Reviews. [Jan.,
in workhouses. “ This tendency,” they say, “ has an im¬
portant bearing on the amount of asylum accommodation
which it becomes necessary to provide. In the last 10 years
there has been an advance of 6*6 per cent, in the proportion
of pauper lunatics treated in asylums, hospitals, and licensed
houses. The effect of this advance has been that 7,938 more
pauper lunatics are now maintained in these institutions
than would have been so maintained under the proportion
existing at the commencement of the period.”
Penodi.
Death-rate per 1,000
Reported Insane, ’895.
Death-rate per 1,000
whole population, 1895.
|2|
5 9 -
ill
|S|
is"
1*1
Death-rate,
Insane to
Sane, 1893.
Under 5
}
—
ft:
64-4
53-7
\
58-5
—
—
—
5-9
CM. 42*9
IP. 941
}
68’5
if:
3-9
40
}
3*9
17-5 to 1
25*5 to 1
8-5 to 1
10—14
CM. 60*1
IF. 74-8
I
67-4
{¥:
2‘4
2’5
}
2‘4
28 0 to 1
22*9 to 1
25 0 to 1
15—18
(M. 781
\F. 06*8
}
72-4
{¥:
3-7
37
\
3-7
11*4 to 1
11*1 to 1
14’6 to 1
20—24
jM. 47*8
1P. 38*9
\
43-3
{?:
6-1
4-6
}
4*8
9 0 to 1
11*7 to 1
12*1 to 1
25-34
CM. 81*7
IF. 719
}
76-8
m
6-8
6-3
}
6-5
11*8 to 1
10-4 to 1
8 9 to 1
35-44
CM. 113*7
IP. 57*5
}
80*1
is-
11*4
98
}
10-6
7 4 to 1
7 *5 to 1
7*9 to 1
45-54
CM. 106-3
IF. 65-5
\
85*9
18*9
150
}
16-9
5 0 to 1
51 to 1
s-7 to 1
55-64
(H. 1321
IF. 82*4
\
107'2
35*7
30-2
\
32-9
3 2 to 1
3-7 to 1
3*3 to 1
65-74
CM. 224*6
tF. 144-9
184*7
\f:
70*2
621
}
661
2 7 to 1
3 0 to 1
2*5 to 1
75-84
CM. 383-3
(.F. 265-4
}
321*3
{*■
155-3
144*3
}
149-8
21 to 1
2-7 to 1
2-3 to 1
85 and
upwards
CM. 379*3
IF. 522*4
}
450*8
if:
305-2
275-6
f
290*4
1-5 t > 1
1-3 to 1
—
The causes of death are again tabulated, and there is a
notable increase in the number of deaths from general
paralysis (28*6 per cent, in 1896, as compared with 16 per
cent, in 1895 of the total number of deaths), but the other
main causes, pulmonary phthisis (14*03 per cent, in 1896,
14*7 per cent, in 1895), senile decay (8*69 per cent, in 1896,
7*5 per cent, in 1895), pneumonia (6*37 per cent, in 1896,
7 per cent, in 1895), cardiac valvular disease (5*73 per cent.
Digitized by LjOoq Le
Reviews .
121
1898.]
in 1896, 4*7 per cent, in 1895), exhaustion from mania and
melancholia (8 # 62 per cent, in 1896, 3*8 per cent, in 1895),
apoplexy (3*21 per cent, in 1896, 3*1 per cent, in 1895),
chronic Bright’s disease (2.56 per cent, in 1896, 2*9 per
cent, in 1895), and bronchitis (2*46 per cent, in 1896 and 2 # 8
per cent, in 1895) appear to maintain a fairly constant pro¬
portion to the total number of deaths, the remaining ratios
being distributed over a large number of diseases. Of the
total number of deaths, accident, suicide and violence are
represented by only *85 per cent.
Table XV. is new. It gives the actual number of patients
admitted into various institutions during each month of the
year 1895, classified into the principal forms of mental
disorder, as well as the daily average for each month of
these disorders. “In calculating these averages,” say the
Commissioners, “ Sunday has been omitted, as few if any
admissions take place on that day.” The table of total
numbers for each month, if continued for some years, may
possibly be of some use in giving us an idea from year to year
of the fluctuations of occurring insanity, so far as this can
be estimated from certified cases only, though it is falsified
in a degree by the inclusion of recurrences, relapses, fresh
reception orders through inaccuracy, lapse, etc., but the
daily average table is, so far as we are able to judge, useless.
Such a tabulation is but of small value when limited to
a single year and made exclusive of Sundays, an absurdly
fanciful method of calculating a daily average. The table
of totals for each month is an eloquent condemnation of the
Commissioners’method of taking asylumstatistics from which
to draw conclusions, for if their total number of patients
in asylums had been taken at the end of May, for instance,
with its 1,707 admissions, there would have been a surprising
difference between their sum total and the one taken at the
end of the year, with but 1,357 admissions in December.
We maintain, therefore, that no possible judgment approach¬
ing accuracy can be formed of the numerical increase of
even officially recorded cases of insanity by the present
system of enumeration on a particular date, to compare this
with a like enumeration on the same date in the previous
year. An ordinary censal estimation cannot be applied to
asylums for the purpose of determining the increase or
diminution of insanity under various forms of care when
such wide departures from the monthly average, as in one
case 252 above and in another 303 below, can be observed
Digitized by LjOoqIc
122
Reviews.
[Jan.,
to occur. The method of estimation, however, is a depart¬
mental one which custom has hallowed, notwithstanding its
glaring errors, and we must fain be content.
The remark the Commissioners make on Table XV. is so
very characteristic of the manner in which in all depart¬
ments of their work they draw arbitrary inferences from
wholly insufficient premises, that we cannot refrain from
quoting it in full. Speaking of this tabular arrangement of
the numerical incidence of insanity during the one year
1895, they say : “ It would thus appear that insanity in a
form requiring treatment away from home is more fre¬
quently developed in the spring and summer months than in
the autumn and winter.” Parchappe’s study of the sea¬
sonal incidence of insanity is certainly in accord with this
conclusion, but he was not so illogical as to draw his valuable
deductions from one year’s observation.
With regard to Table XVI. we can but repeat what we
said last year, that as an official summary of the occurrence
of insanity in various professions and callings it is abso¬
lutely untrustworthy. The yearly average of the total
number of lunatics under the Commissioners’ cognisance for
the five years 1891-1895 is compared with the actual census
enumeration in 1871 in some cases and in 1891 mothers.
The ratios thus calculated are erroneous and misleading.
The table giving the yearly average occurrence of the
principal forms of mental affection for the five years
1891-1895, so far as is known officially, shows that 48*8 per
cent, were the subjects of mania, 27*3 per cent, of melan¬
cholia, and that 4*8 per cent, were the subjects of senile
dementia. The antiquated classification here adopted of
“ mania; melancholia; dementia, ordinary and senile; con¬
genital insanity; and other fortns” shows either a weak
official clinging to routine or a lack of faith in more recent
scientific classification. Maniacal and melancholic con¬
ditions alone are expressive of such varied types of mental
aberration that the massing together of these under two
common headings minimises the value of this table to a
great degree. Of the yearly average, 70*5 per cent, were
first attacks, 8*1 per cent, epileptics, 8*4 per cent, general
paralytics, and 25*1 per cent, suicidal cases.
The causes of insanity are dealt with in Tables XXIV.-
XXVII. This official classification of causes is almost
universally accepted as satisfactory, but we are inclined to
the opinion that it might greatly be improved upon; to
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1898.]
Reviews.
123
take one objection only, it is almost impossible clinically to
discard the influence of physical causes when mental causes
apparently are prime factors, and vice-versa, and this is just
what the Commissioners from the foot-note to Table XX1Y.
attempt to do. It is however recorded that 20*9 per cent,
of the yearly average of admissions of males, and 8*5 per
cent, of females, are insane through alcoholic intemperauce,
a disproportion between the sexes we are somewhat inclined
to question, that 20*8 per cent, of males and 25*9 per cent,
of females are hereditarily predisposed, and that 16*4 per
cent, of males and 22*0 per cent, of females have had
previous attacks. As might be expected, mental anxiety,
worry, and overwork is nearly twice as fruitful a cause
among private as among pauper patients, and alcoholism,
though not differing so markedly in the two grades, is a
greater causative influence among paupers. On comparing
this table with that for the quinquennial period 1888-1892
we find but little difference between the percentage propor¬
tions. There is no appreciable distinction between the
ratios of the causes of general paralysis and the causes of
all other forms of insanity, and this in the light of recent
scientific elucidation of the true origin of the malady is
somewhat absurd.
The number of voluntary boarders remaining in Registered
Hospitals on January 1st, 1897, was 92, iu Metropolitan
Licensed Houses 18, and in Provincial Licensed Houses
82. Of the 326 admitted during the year only 87, or 26*7
per cent., were certified. We could, did space allow, say
much on this matter of the admission of boarders, but the
Commissioners should surely know by this how frequently
the privilege has been abused merely to save the publicity
and trouble certification before admission would entail.
The admissions into the seventy County and Borough
Asylums during 1896 amounted to 16,164, or 2,513 in excess
of the decennial average. The recoveries came to 6,188 and
the deaths to 6,123, in 4,893 of which (or 79*9 per cent., a
proportion exactly the same as last year) post-mortem
examinations were made. The Commissioners shortly
enumerate the changes among the Medical Superintendents
of Asylums during the year, but they make no special
comment on the much discussed appointment to Ports¬
mouth Borough Asylum. Particular mention is made of
the enquiries at Norfolk County Asylum, the second of
which certainly reveals a lamentable want of care and good
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124
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management. The insufficiency of asylum accommodation
for paupers is as usual the subject of remark. It will be
many years before local authorities can be brought to see
the necessity of early and prompt provision for the ever
growing insane population. As it is not only in well-to-do
counties and boroughs, but also, and mainly, in the more
needy that asylum care is called for, it naturally follows
that there will always in the latter class be an insufficiency
of accommodation, and it may ere long become needful for
the Legislature either to make the matter of asylum provision
a national one or so to reorganise county boundaries as to
help poorer districts out of the difficulties in which they
will sooner or later be struggling. The insanitary condition
of certain asylums (seven of these were mentioned in last
year’s Report, one has been in the insanitary list for three
years, and another for four years in succession) is detailed
in a special section of the Report. There were twenty-two
deaths from suicide, but only fourteen of these can properly
be considered as having occurred while under treatment;
ten of these were males and four females. Of the males
three committed suicide by drowning, two by hanging, one
by cutting his throat, one by poison, one by throwing him¬
self under a train, one by precipitation from a height, and
one by strangulation. Of the females two committed suicide
by hanging, one by drowning, and one by setting herself on
fire. We observe that the Commissioners are anxious to
impress on the Lord Chancellor how vigilant they have been
in urging the removal so far as possible of all conditions
which may rank as adventitious aids to suicide. We are
not so sure that the safety so acquired is not counter¬
balanced by a resultant lack of watchfulness on the part of
attendants; besides, is it not one of the first principles of
medical treatment of the insane to render their surround¬
ings as much as possible perfectly normal and ordinary? An
obtrusive withdrawal of ;all possible means to do harm to
himself is frequently as suggestive to a suicidal patient as a
careless non-observance of ordinary precaution. The deaths
by misadventure numbered but six, two of which were from
epileptic suffocation. The cost of maintenance in County
and Borough Asylums per week per head shows a slight
diminution on the amounts given last year.
In a short paragraph dealing with Registered Hospitals
as a whole the Commissioners allude to certain of these “in
which the income is large ” and “ in which a small pro-
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1898.]
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125
portion of it only is devoted to charitable purposes.” It is
perfectly well known to which institutions allusion is here
made, and we may well ask why is this permitted?
Registered Hospitals are placed on the same footing as
regards privileges with licensed houses, but their conduct
and control is absolutely autocratic, and they may if they
please, armed with their bye-laws from the Secretary of
State, snap their fingers at the Commissioners. They
contain, as pointed out by the Commissioners in their
Report for 1894, more than a third of the private patients
under the review of the Commissioners' Office, and were one
half of the irregularities which are constantly occurring in
some of them perpetrated in licensed houses these latter
would suffer a serious annual diminution in their number
through revocation of their licenses. That Registered
Hospitals are devoted to charity and Licensed Houses to
venality is a false conception which for many years has
dimmed the Commissioners' mental vision; can it be that
the official eye is beginning to see more clearly? It is
apparently a matter of congratulation that “ the reports upon
the Holloway Sanatorium have recently been of a favourable
character."
The Commissioners very properly draw attention to the
fact that the Legislature has largely neglected the care and
management of idiots, and their suggestion that institutions
for such should be put on a line with asylums for the insane
will probably bear fruit in the near future. There is, how¬
ever, a serious lack of special accommodation throughout
the country for the large number of idiots and imbeciles who
are at the present moment most improperly being treated in
county asylums, private asylums and workhouses.
The Commissioners pertinaciously adhere to the state¬
ment we corrected last year that there are seventy-five
licensed houses. We have again gone through their list
—Appendix L—and again can find only seventy-two.
Two suicides, both males, occurred in Metropolitan Licensed
Houses, and one suicide and one death through misadventure
in Provincial Licensed Houses. Copies of the entries made
by the Commissioners at their last visit in the year are
again furnished, and from these we gather that on the whole
the management of licensed houses is generally satisfactory.
The number of single patients shows a further diminution,
and the Commissioners remark that they are “ unable to
avoid the conclusion that while this form of treatment has
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£ J 8iD«y
not diminished, the tendency has increased to apply it with¬
out resort to certification and its concomitant notification,”
and they are perfectly right, only the matter is not one
of speculative opinion, but a glaring fact. The undisguised
way in which patients are received uncertified into the
houses of medical men, “ nursing homes,” “ sanatoriums,”
etc., etc., conducted by medical men and others, is un¬
doubtedly scandalous, and so great has the abuse grown that
it is beginning seriously to diminish the number of certified
insane of the private class. The open way in which the law
is being evaded certainly does not redound to the credit of
the Commissioners* Office. This and the gradual steady in¬
crease in the number of boarders can he due only to the
publicity and difficulties with which certification nowadays
is hedged around.
The Commissioners have, we all know, much to do, but were
they to adopt a more scientific elaboration of the material
supplied to them we should all benefit more largely; as it is,
we can be but thankful for the crumbs of useful information
with which they supply us in their Annual Report to the
Lord Chancellor.
Thirty-Ninth Annual Report of the General Board of Commis¬
sioners in Lunacy for Scotland . Edinburgh. 1897,
The changes which have occurred in the registered
lunatic population of Scotland during 1896 have resulted
in the addition to the total number of 383, a considerable
increase over that of the preceding year. This represents a
percentage increase during the twelve months of 2*8, the
estimated annual percentage increase of population being
only 0*75; and the ratio to population has risen from 330
to 336 per 100,000. Taking Table V., of Appendix A, as an
index of the occurring insanity of the country, the record of
1896, too, compares unfavourably with that of 1895, for,
while in the latter there was an actual decrease of 4*6 per
cent., in the former there is an increase of 2*9 per cent., the
ratio per 100,000 of population rising from 56 to 57'2. But
in making these comparisons it is only right to bear in mind
that 1895 was, as regards lunacy in Scotland, a distinctly
favourable year, and one cannot but regret that the good
record of that year has not been maintained.
The table on p. 2 shows the manner of distribution of the
total number of lunatics on 1st January, 1897, and the
Digitized by
Number of Lunatics at January, 1897.
1898.]
Reviews,
127
Digitized by {jOOQle
Totals. 6,766 I 7,734 1 11,600 1,031 1,156 2,217 5,662 6,529 j 12,221
128
Reviews.
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changes that have taken place daring the year have resalted
in the following differences:—In Royal and District Asylums
there is an increase of 17 private and 502 pauper patients;
in private asylums a decrease of 7; in parochial asylums a
decrease of 109; in lunatic wards of poorhouses an
increase of 11; and in private dwellings an increase of 2
private and a decrease of 33 pauper patients. The total
increase of 383 registered lunatics is made up of 12 private
and 371 pauper patients. The number accommodated in
establishments has increased by 414, while in private dwell¬
ings there is a decrease amounting to 31.
The private patients admitted to establishments during
the year were 33 less than in 1895, and the number of
paupers was 111 more than in 1895, and 217 more than the
average for the five years 1890-94. In Scotland, as in Eng¬
land, there appears to be a greater liability to insanity on
the part of the male population, for, while in every 1,000 of
the population there are 35 more females than males, in
every 1,000 admissions there were in 1896 only 28 more
females, and in the five years 1890-94 33 more females than
males.
As will be seen from the following table the recovery-rate
in establishments, with the exception of parochial asylums,
shows no falling off on that of the preceding year.
Classes of Establishments.
Recoveries pec oent. of Admissions.
1890-94.
1895.
1898.
In Boyal and District Asylums
..
39
35
34
M Private Asylums .
...
38
28
40
„ Parochial Asylums .
...
43
46
41
„ Lunatic Wards of Poorhouses ...
...
7
6
6
The recovery-rate for all classes of establishments has
been for the past 25 years a steadily diminishing one. In
the 15 years ending 1884 it was (Tables VII. and VIII. of
Appendix A) 46*1 per cent, of admissions, excluding
transfers; in the succeeding 10 years it had fallen to 43*5,
and in the year under review there was a still further fall to
42*8. The explanation of this fact is, no doubt to a great
extent, due to the greater number of old and broken-down
cases which are now sent to asylums. Still, it is not a
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1898.]
satisfactory feature, and it will be interesting to note in the
{ rears to come whether the recent appointment of the patho-
ogist to the Scottish Asylums will effect any increase in the
proportion of cures in these institutions. That is what
one naturally looks for, and it will be disappointing if it
eventuates otherwise.
The death-rate in establishments during 1896 is 1 per
cent, lower than in the previous year, and, as the following
tables show, the lowering takes place entirely among pauper
patients, though it applies to all classes of establishments.
Classes of Patients.
Proportion of Deaths per cent, on Number
Resident in Establishments.
1890-04.
1896.
1896.
Private Patient*.
7*6
6*5
6*8
Pauper Patient*.
8-7
0*3
7*0
Both Classes.
8*5
8*7
77
Cleat** of Establishment*.
Proportion of Deaths per cent, on Number
Resident.
1800-94.
1805.
1896.
Royal and District Asylums...
8*8
8*4
7*6
Private Asylums .
6*3
10*8
64
Parochial Asylums .
9*6
10*8
10*1
Lunatic Wards of Poorhouses .
4*6
57
| 3*7
It is noteworthy that the year under review is characterised
by a still increasing proportion of general paralysis as a
cause of death. In 1895 21 per cent, of male and 3*5 per
cent, of female deaths were due to this affection, and in this
year the proportions have risen to 26*2 and 5*8 respectively.
The total number of deaths in establishments is 87 less than
in 1895, and this represents a percentage diminution of 9*2
—10*6 for males and 7*8 for females; while the deaths from
general paralysis have increased by 20, representing a per¬
centage increase of 16*8—11*6 for males and no less than 50
for females. This question of the increase of general
paralysis was very fully gone into by the Commissioners
xliv. 9
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in their Report for 1895, and the farther experience of
another year has certainly thrown more light on it and of a
quite unmistakable sort. It is a curious fact that this
considerable increase in general paralysis in Scotland should
be coincident with a diminished proportion of these cases in
the admissions into asylums in England.
In their comments upon changes among attendants and
servants in asylums there is one recommendation of the
Commissioners which we feel sure will meet with the
approval of all who have the interest of the insane at heart,
and that is the provision of comfortable separate cottages
for married attendants. Something has, no doubt, been
done in this matter, but that its extension would in the end
be a real economy hardly admits of doubt, and such an
official recommendation as is given in this Report will un¬
doubtedly encourage asylum authorities in their efforts to
improve the service of the institutions entrusted to their
care.
Twelve suicides occurred during the year, which is double
the number recorded in 1895, and on the whole the record of
this year is not a favourable one. In the five years 1890-94
the percentage of deaths from suicides and accidents was
1*5, while in 1896 it was 2*3. Patients in Scottish Asylums
are allowed a comparatively large amount of liberty, and
this may in some measure explain the greater frequency of
these causes of death, which in England amounted to only
0 # 8 per cent, of the total number of deaths in 1895.
While pauper patients have increased in establishments
during the year by 404, representing a percentage increase
of 4*5, there has been a diminution in the numbers of those
accommodated in private dwellings by 33, a percentage
decrease of 1*3. The proportion of patients in private
dwellings on 1st January, 1896, was 23*2 per cent., and the
changes during the year have reduced this to 22-2 per cent.
The Commissioners “ attach no special significance to the
decrease,” but that it is due to certain restrictions—re¬
strictions made entirely in the interests of the patients—
placed upon the increase of licences for more than two
patients and upon the tendency to too great aggregations
of patients is, we think, more than probable, for it has only
been during the past two years, during which these re¬
strictions have been in force, that any decrease has taken
place. These restrictions must too have the further effect
of increasing the expense of accommodation in private
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181
1898.]
dwellings, with the result of further approximating the cost
of this mode of provision and that in asylums, and thus
indirectly tending to the reduction of the proportion of
patients outside asylums. The average daily cost per
patient has increased by ^d., and the increase is the same
for establishments other than poorhouses and for private
dwellings, whilst in lunatic wards of poorhouses there is a
decrease of $d. The general result of which is that, taking
the average cost as 100, that for lunatic wards of poor¬
houses is reduced from 80*3 to 75*8, and that for other
establishments remains unaltered, while that for private
dwellings has risen from 70*5 to 71.
The position of affairs in regard to lunacy administration
in Scotland has changed greatly since the General Board
was constituted. The Commissioners, impressed by the fact
that legal provision for the poor private insane is now
inadequate, have made a strenuous appeal in their interests.
It is stated that the only institutions now available for the
care and treatment of the poorest class of private insane are
Royal Asylums and District Asylums. The means possessed
by the District Asylums for receiving this class of patient
have, however, always been very limited, and are yearly
becoming more so. District Lunacy Boards have power to
provide accommodation for pauper patients alone; they can
only receive private patients when accommodation provided
for panper patients happens to be vacant.
The Report goes on to show how it has proved impossible
to meet the wants of this class of patients, although new
asylums have been built. The Commissioners.freely acknow¬
ledge the beneficent work done by existing institutions,
and explain how it has been limited. They say :—“ The
Royal Asylums provide admirable accommodation for the
more affluent class; but the increasing demands for the re¬
ception of this class . . • continue to limit more and more
their power to receive private patients at unremunerative
rates. It must not be understood that they do not provide
for a large number of private patients at very low and some¬
times at merely nominal rates. On the contrary, most of
them maintain many such patients. Still their action is
mainly confined to special cases, and to the counties and
localities in which the asylums are situated. . . . But there
are large areas of Scotland, such as those of Inverness, Fife,
and Ayr • . . which contain no District Asylum possessing
accommodation for private patients, and which have no
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132
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special claim on any Royal Asylum for the accommodation
of their insane; and in the case of some Royal Asylums,
where such claims may be said to exist, the pressure on
their accommodation and resources is such that . . . only a
very few of the demands for accommodation of patients at
low rates of board can be met. The doors of some of the
Royal Asylums are, indeed, practically closed to all but two
classes—the comparatively rich and the pauper patients of
certain districts or parishes for whose reception contracts
have been entered into. The poorest class of private patients,
pressed between the growing demands of these two classes,
are being thus gradually placed in a position of increasing
difficulty. . • •
“ The [impossibility of finding accommodation at a low
rate of board for such patients results in some of them, for
whom asylum care is urgently needed, being kept at home,
and in others, being placed in Royal Asylums at rates much
beyond what their relatives can really afford, in the heme
that recovery may be rapid, or, if the hope should not be
fulfilled, that a reduction may be made in the rate of board.
But the great majority have no course available but to apply
for assistance from the parish council. ... As soon, how¬
ever, as the relatives realise that the patient is by this pro¬
cedure completely pauperised, and no longer therefore in a
position in which he can derive any benefit from their con¬
tributions, they not unnaturally endeavour to escape wholly,
or as far as possible, from the burden of maintaining him.
It must be a matter of great difficulty for parish authorities
to control this, in the absence of any certain knowledge of
the capacity of the relatives to pay, especially where there
is no legal obligation to do so. . . .
“We have therefore, in consideration of all the facts
before us, come to the conclusion that fresh legislation on
the subject is desirable, both in the interests of private
patients of the poorer class, and of the ratepayer. In the
report of 1891 of the Committee on Lunacy Administration
in Ireland, of which Sir Arthur Mitchell . . . was chairman,
it is recommended that District Boards should be empowered
to provide accommodation for private patients, and a like
permissive power, which is being largely taken advantage of,
is conferred upon county lunacy authorities in England under
the Act of 1890. We think that the time has now come for
conferring a similar permissive power upon District Lunacy
Boards in Scotland. ...
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1898 .]
“ In the framing of a measure empowering District Lunacy
Boards to provide accommodation for private patients in
District Asylums, we think it would be desirable that the
following principles should be kept in view :
<r l. District Lunacy Boards should be authorised to
receive private patients, and also to provide accommodation
for such patients, if they should see fit, by erecting separate
buildings or by setting apart for the purpose sections of
existing building*.
“ 2. Private patients being once received should be re¬
garded as having a right of accommodation, and should not
be liable to be removed to make room for pauper patients.
“ 3. The rate of Board chargeable for maintenance should
not be higher than the maintenance rate charged for pauper
lunatics, with the addition, if the District Board should see
fit, of a sum in name of rent for the accommodation
afforded.
“ 4. This sum in name of rent should not exceed a charge
calculated on the net cost of what may be required to pro¬
vide the buildings, and we believe it would be an eventual
saving to the ratepayers if the District Board were em¬
powered to charge the maintenance rate only in cases where
they are satisfied that a higher rate cannot be afforded.
“ We attach great importance to the limit of the rates of
board indicated in heads 3 and 4. Permission to District
Lunacy Boards to charge higher rates than those indicated
would not only bring District Asylums into undesirable com¬
petition with Royal Asylums which have sunk large sums in
providing for private patients, but would defeat the very
objects for which the measure is proposed. It would not be
one of its objects to lessen the burden on the ratepayers by
the profits from keeping private patients, but to prevent
burdens falling on the rates by offering no excuse for the
acceptance of parochial aid. Anything in excess of the
lowest charge in repayment of expenditure would both
nullify the encouragement intended to be held out to
relatives to support their insane, and would tend to replace
the class of the insane for whose benefit the proposed legis¬
lation is specially intended, in the position in which they
are at present. It is believed that the class of private
patients referred to would not, as a rule, differ greatly from
the class from which many of the pauper patients are drawn.
Pauper lunatics are not drawn wholly from the classes of the
community which produce ordinary pauperism; they include
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134
Reviews.
[Jan.,
all, from the poorer or less successful professional man or
man engaged in commerce downwards. Private patients in
District Asylums may be therefore expected to be drawn
chiefly from those occupying much the same social status as
many of the pauper patients. They might be engaged in
useful healthy work, such as the present pauper inmates of
asylums engage in, and they would not require a better
dietary or more expensive accommodation than that provided
for pauper patients/’
It will be* observed that the Commissioners ask for ex¬
tension to Scotland of the powers granted to County Lunacy
Authorities in England, and that they safeguard the position
of the Royal Asylums, the welfare of the insane, and the
interests of the ratepayers, by proposing very definite re¬
strictions on the rates to be charged by District Lunacy
Boards. Such a scheme deserves well of all classes. It
would constitute a measure of relief to the ratepayers, it
would conserve Scottish independence, it would benefit
large numbers of the deserving poor. We therefore
commend it to the active support of our Association.
There is ample evidence in this Report that, as regards its
lunacy administration, Scotland continues to maintain the
high position it has hitherto held. We do think, however,
that there is a still higher duty than that of making
adequate provision at a reasonable cost for the existing
lunacy of the country. The never-failing stream of lunacy
goes on year by year in undiminished, if not increasing,
force; and we trust that it is not an impossible task to
devise some means of stemming it and thereby adding not
a little to the happiness of the people and easing the burden
which becomes ever more onerous.
Forty-Sixth Report of the Inspectors of Lunatics , Ireland, for
the year 1896.
The tide of lunacy seems ever flowing. We wait in
patience, as those who have gone before us have waited, for
the turn, but it does not come. Each year we scan the high-
water mark, and hope, but with only a half-hearted
expectancy, that the maximum limit has at last been reached,
but the flood still creeps upward with a wearisome, irritating
persistence, and we look in vain for the ebbing* And yet it
must come. On a priori reasoning, if there were no other
grounds for the conviction, it must come. In Ireland we
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1898.]
have the phenomenon of a fast-waning sane population,
reduced to one-half within the last fifty years, and at the
same time a rapidly increasing insane population—more
correctly speaking, an increasing population of registered
lunatics. If this process were to go on indefinitely the
insane must eventually out-number the sane. Such a
contingency is so utterly outside the bounds of probability as
to rank with the impossible. Sooner or later finality must
be reached. The tide must turn. But when ?
The latest Eeport of the Inspectors (for 1896) has nothing
in it to indicate that the wished-for change is at hand. It
has to chronicle the same monotonous fact which has
appeared with such unbroken regularity in its predecessors,
that there has been a substantial increase in the number of
insane under care. The following is the Inspectors’ summary
of the numbers and distribution of insane in establishments
in 1896 and 1897 respectively:—
On 1st January, 1896.
On 1st January,
, 1897.
Males.
Females.
Total.
Males.
Females.
Total.
In District Asylums .
7,287
6,045
13,332
7,680
6,361
14,041
„ Central Asylum, Dundrum ...
140
23
163
145
20
165
„ Private Asylums.
806
358
663
318
358
676
„ Workhouses .
1,724
2,388
4,113
1,686
2,356
3,992
„ Prisons .
1
-
1
-
-
-
Single Chancery Patients
47
39
86
45
47
92
Total.
9,504
8,853
18,357
9,824
9,142
18,966
The total increase for the year was 609, a figure largely
above the average of the past ten years, 405. One grain of
comfort appears; the number of insane in workhouses has
decreased by 120. That the population of the District
Asylums has been increased very considerably by the trans¬
ference to them of workhouse patients is an admitted fact.
But the data for estimating the actual amount of increase
traceable to this particular source are not forthcoming.
And they ought to be. What would be easier than to have
a return included in the annual statistics of each asylum of
the number of patients transferred thither from the various
unions ? It would not be a very difficult task to compute
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136
Reviews.
[Jan.,
the number of admissions from workhouses for the past ten
or fifteen years. Such a table would serve a useful purpose,
and place us in a position to estimate with tolerable accuracy
the part these transfersplay in the “ increase of insanity.” As
regards workhouse patients, however, even the meagre
amount of material at our disposal enables us to make more
than a mere conjecture as to what is taking place. A
reference to the Census Table quoted on page 3 of the
Inspectors’ Report shows that the insane in workhouses
numbered 1,511 in 1861, 2,457 in 1871, 8,479 in 1881, and
3,957 in 1891. That is to say there was an increase of 946 in
the first decade, of 1,022 in the second, and of 478 in the
third. It is a matter of grave doubt whether these census
figures are at all correct. As the table has appeared with
unfailing regularity in no fewer than six successive Reports,
it is to be assumed that the Inspectors themselves have
confidence in its accuracy. To the ordinary mind, however,
the fact that it makes the total number of idiots increase by
1,897 during the ten years 1871-1881, and decrease by 2,896
in the succeeding decade seems inexplicable. What possible
cause could bring about such a result P There is also a
serious discrepancy between the numbers given in the Census
Table and those given in Table L on page 44, presumably on
the Inspectors’ authority. In the Census Table the number
of lunatics (7,547) and idiots (1,896) stated to be in asylums
make a total of 9,443, whereas the numbers stated in the
Inspectors* own table to be in District Asylums (8,978),
Central Asylum (173), and Private Asylums (635) total up to
9,786, a difference of 343. This seems a greater difference
than may be accounted for by the fact that the numbers were
computed at different times during the same year. The
difference between similar returns for 1891 amounts to 247.
In the late Inspectors’ Reports the numbers of insane in
workhouses for 1871 and 1881 are given as 2,914 and 3,640,
showing a difference from those of the Census Returns of 457
and 161 respectively. Whichever figures we take, however,
it is evident that there was an increase of about 1,000
patients in workhouses during each of the decades between
1861 and 1881. In the following decade (1881-1891) there
was also an increase, but it had fallen to in or about 500.
(It is only possible to be roughly accurate.) But in the last
half-decade, 1891-1896, if we take the figures in the In¬
spectors’ table as correct, there has been an actual, though
slight, decrease. This is a significant fact taken in connec-
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tion with the circumstance that in latter years the transfers
from workhouses to asylums hare been much more
numerous than formerly* If all the patients in workhouses
were once safely housed in asylums one source of the
apparent “increase of insanity” would be cut off. And
if all the “ insane at large ” (also a diminishing quantity)
could be similarly dealt with we should probably hear but
little of this increase. The effect of the workhouse element
may to a certain extent be gauged by the fact mentioned in
the Report that the ratio of insane in District Asylums to the
total number under care in 1880 was 67 per cent., and in
workhouses 27 per cent.; whereas in 1896 the ratio in
asylums had risen to 74 per cent., while in workhouses it
had fallen to 21 per cent.
The following table, compiled from various tables in the
Report, gives a bird’s-eye view of the changes in respect of
increase or decrease which have occurred during the past
ten years in District Asylums:—
No. of Patients*in
District Asylums
on 31st December
in each year.
Daily
Average.
First
Admissions.
Readmissions.
Total
Admissions.
Inc.
Inc.
Inc.
Dec. (
Iuc.
Dec.
Inc.
Dec.
18*6
1
10077
205
9998
217
2140
-
_
606
_
2“46
_
1887
10499
422
10263
265
2243
103
-
620
M
-
28 4 3
117
—
1888
10825
326
10691
428
2190
53
631
11
—
2821
-
42
1889
11180
355
11019
328
2329
139
-
627
-
4
3956
135
—
1890
11488
308
11297
278
2451
644
17
-
3095
139
—
1891
11733
245
1164*
S47
230
101
660
16
-
3010
-
85
1892
12183
399
11958
314
2116
65
-
766
106
-
3181
171
—
1893
12431
801
1230!
349
2458
43
-
749
-
17
3207
26
—
1894
12771
337
12605
298
2448
-
10
: 781
32
-
3229
22
—
1895
13332
581
13082
477
2458
10
-
758
-
23
3216
-
13
1896
14041
709
13735
653
2564
106
-
765
7
-
3329
113
-
From this it will be seen that in 1896 the increment in the
number of patients under care at the close of the year (709)
is much latter than any noted during the past ten years; in
fact it is more than double the average annual increase (348)
of that period. The daily average shows a similar advance,
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the increase in it over that of 1895 being 653, and the aver¬
age increase of the previous ten years 330. The total
number under care on 31st December, 1896, was 14,041; and
the daily average 13,735. The total admissions were 3,329,
first admissions numbering 2,564 and readmissions 765, or
an increase ander each head of 113, 106, and 7 respectively.
It is not possible to make any reliable deduction from these
figures. The increase in 1896, especially of first admissions,
is unusually large, but the numbers vary so irregularly from
year to year that they baffle any attempt to frame conclusions
upon them. If we take first admissions, for instance, for the
past six years, what can explain the fact that in 1891 there
was a decrease of 101, in 1892 an increase of 65, and in 1893
of 43 ; in 1894 a decrease of 10, in 1895 an increase of 10,
and in 1896 an increase of 106 ? If we were furnished with
a list of the transfers from workhouses it might help to a
solution of the problem, but these we do not possess. The
Inspectors comment much to this effect. If they were to
issue a return of the workhouse transfers for each year this
particular point—an important one—would no longer be left
to surmise.
It is to be regretted that many of the more useful tables
which are issued with the English Blue Book are con¬
spicuous by their absence from the Irish one. Statistics for
any single year give a certain amount of bald information ;
but they are useless for purposes of comparison. For this
they should be extended over a series of years. This is done
in Table I. (giving the number and distribution of lunatics
from 1880 to 1896) at the end of the general Report, between
it and the statistical tables of the first “ Appendix.” But
why should this table not take its proper place at the head of
the series as in the English Blue Book ? And why should it
not be followed by a table somewhat similar to the Eng¬
lish Table II., giving the ratio per 10,000 of the
various classes of the insane ? A partial table of this kind
is inserted in the body of the Report on page 4, but it loses
half its value by the distribution being omitted, as the
relative ratios of the various classes of lunatics through
successive years constitute one of the most material points
to ascertain in the study of lunacy. There is nothing m the
Irish Blue Book corresponding to Tables III. to VIII. of the
English one, in all of which the statistics of a number of
consecutive years or periods are given, so that a comparison
of figures can be made at a glance; whereas, in order to
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obtain similar information, the unfortunate reviewer of Irish
lunacy statistics is forced to wade with slow and painful
steps through a mass of individual Blue Books. This work
should not be shirked in the Irish Lunacy Office. If the
clerical staff there is undermanned, then its strength should
be forthwith increased, so as to give a greater element of
completeness—now sadly wanting—to returns published for
the information of Parliament and of the country. The
Inspectors have from time to time commented upon the
desirability of having Irish lunacy administration assimilated
as far as possible to that of England and Scotland. Example
is better than precept, and as regards statistical tables, if
they were (literally) to take a leaf, or rather several leave?,
out of the Bine Books of those countries the value of their
own would be greatly enhanced.
One observation in the Report we totally dissent from.
On page 3 the Inspectors say:—“We must repeat that,
having regard to the fact that the male population in
asylums in Ireland so greatly preponderates over the female,
whilst insanity is at least as prevalent amongst women as amongst
men here as elsewhere , it is to be expected that the
admission of female patients will increase from year to year
until the ratios of the sexes are more nearly equalised.”
This is an admirable instance of “ begging the question.”
What has never been proved, or rather what statistics, if any¬
thing, disprove, is assumed as a fact, and an argument of
prophetic character founded thereon. The writers speak
without book. The proportion of females to males in Irish
Asylums, calculated on their own Table I. of Appendix A.,
has remained absolutely unaltered for the past 17 years. In
the first three years of this period the ratio of females in
asylums to the total number of patients was 45*9, 45*8, and
45*8 respectively. In 1889 and 1890 it just touched 46*0;
and in 1894, *95 and *96 it was 45*1, 45 # 1, and 45*2. In the
face of these figures the surmise of the Inspectors must be
held to be as yet unsupported by facts. In lunacy matters,
as in many others, Ireland may have to be regarded as a
“ separate entity.” Irish lunacy is said to differ from
English and Scotch in one remarkable particular—the lesser
frequency of general paralysis. Why should it not differ in
another, viz., that the male insane should preponderate over
the females ? We should, it is true, expect the contrary to
occur, even more than in England, emigration, presumably,
having much more effect in Ireland, being on a larger scale
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in proportion to population, and removing so many of the
healthy male adults, leaving the more weakly ones behind.
Why this should be so is another question to which we are
not likely to find an answer, except such as was the unfailing
resort of a once well-known grinder in Trinity College,
Dublin, when he had to face an inconvenient poser from
some student thirsting for knowledge, which he was not pre¬
pared to give him :—" I can’t tell you, sir; it’s the will o’ God.”
The recovery-rate in 1896 was 37*2 per cent, on admissions,
that of the previous year being 39*3. The death-rate also was
lower, being 6*7 per cent, on the daily average as compared
with 7*1 in 1895. This lower recovery and death-rate com¬
bined must, of course, have increased the amount of
accumulation at the end of the year. The highest proportion
of recoveries recorded is at Omagh, which was 49’4, and
following it in order came Belfast, Ennis, Enniscorthy, and
Ballinasloe, all these being 48 per cent., or over. Those
with lowest rate are Letterkenny, Richmond, Sligo, and
Kilkenny, descending in order from 25‘2 to 21-3. Thedietaiy
in use in Kilkenny Asylum, which was commented on in last
year’s Report, does not seem to have been improved. It has
the advantage of extreme simplicity. Every morning, except
Sunday, the patients, male and female, get 6£ oz. of oatmeal
and 1 oz. of rice in porridge, with two-thirds of a pint of
milk. On Sundays bread is substituted for porridge. Eveiy
evening the same allowance of milk with 8 oz. of bread for
males and 6 oz. for females. For dinner on two days of the
week 40 lbs. of meat are allowed for 100 patients, with bread
and vegetables ; on one day Irish stew ; and on the remain¬
ing four days bread and butter and cocoa. The meagreness
and monotony of this diet would hardly be conducive to re¬
covery. Possibly extras are given freely to patients who
need them, otherwise the wonder would be if any recoveries
should take place. Strange to say, the recovery-rate in this
asylum ran up as high as 64 per cent, in 1885. But the
vagaries of asylum recovery-rates are inscrutable, Clonmel
presenting a remarkable record in this respect, a recovery-
rate of 81 per cent, having been chronicled in 1885, while in
1893 it sank to 17! The term “recovery” has no doubt
greater elasticity of meaning in the case of insane patients
than it usually has. And the fact of a patient’s recovery
being a matter of mere opinion, it is obvious that the
number of recoveries in any asylum will depend, to a great
extent at least, upon the optimistic views or otherwise of
the recorder.
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The average percentage of deaths on daily average was
6*7, ranging from a maximum in Omagh and Letterkenny,
where conditions more or less insanitary appear to exist, of
10*4 and 10*3 respectively, to a minimum in Enniscorthy
(4*5) and Armagh and Kilkenny (4*7). The mortality in
Castlebar has decreased from 11*1 per cent, in 1895 to 8*4 in
1896, the reduction being, no doubt, in great measure due
to the discontinuance of the use of an impure water supply,
condemned iu severe terms in the Inspector’s Report of
June, 1895. The value of this object-lesson is apparent.
The relative mortality from phthisis is an interesting but
perplexing study. Two hundred and fifty-five deaths out of
a total of 926 were due to this cause, representing a per¬
centage of 27*5, which is precisely the same as in 1895.
Now, the puzzling thing is this. Armagh and Belfast are
both overcrowded. Of the former the Inspector in his
Report says :—“ The one blot is the overcrowding of the
wards;”and of Belfast:— 1 “It is quite useless to refer at
any length to the great overcrowding of the parent asylum
at Belfast.” And yet these two asylums, each suffering
from a congested population, can show the lowest mortality
from phthisis, the ratio being only 6*4 and 6*8 respectively.
Whereas Mullingar, deservedly regarded as one of the best
managed of Irish Asylums, with an able Superintendent and
a liberal Board of Governors, who seem only anxious to be
up-to-date in all their arrangements—having, in addition to
numerous other improvements, provided within a recent
period a splendid and inexhaustible water supply, au
entirely new drainage system “on the most modern prin¬
ciples of sanitation,” the “ Plenum ” system of heating and
ventilation, and a magnificent electric installation—this
model asylum, in every way, notwithstanding its superb
advantages, and as if in mockery of all our theories, has one
unenviable pre-eminence—it exhibits by far the highest
relative mortality from consumption, viz., 44*4 per cent.
And, as a still further illustration of the irony of facts, the
mortality among the females, 47*6, is considerably higher
than at the male side, 40*0, the latter being overcrowded,
while there has been abundance of space at the female side.
It should be mentioned that the general death-rate is much
the same in all these asylums, Belfast and Mullingar being
almost identical (5*3 and 5*2), while Armagh is somewhat
lower (4*7). Why half the females who die at Mullingar
should die of consumption is an enigma which still awaits
solution. The asylum has been described by the Inspector
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as “ a.busy hive of industry ” Can it be that there is too
much indoor employment for a class the majority of whom
are accustomed to spend most of their time in the open air ?
Desirable as employment is in the treatment of the insane,
it is just possible that with the very best intentions this
might be carried to an extreme. It would not be desirable
to assimilate the life and surroundings of asylum patients
to those of factory operatives.
Three deaths resulted from suicide—two by strangulation,
in the third case the patient placed himself in front of a
railway train, and was killed instantly. Only three deaths
were due to accidents. The rarity of such occurrences is
again a matter for congratulation, and is highly creditable
to the various staffs who perhaps, on this head, hardly
receive from the public the appreciation they deserve. As
a writer in a lay journal has recently remarked :—“ The fact
that the public only become aware of what happens, and
never of what is prevented in asylums should always be borne
in mind in commenting upon these accidents.” A graceful
tribute to a class of persons whose difficulties and hourly
anxieties are all but unknown to any but those who have
lived in asylums themselves.
The deaths from general paralysis were 84, being five less
than in 1895. The large majority of these were in the
Richmond Asylum. The disease does not appear to be
making great progress even in Dublin. In most of the
country asylums it is said to be non-existent.
In 220 cases post-mortem examinations were held, or 23*7
per cent.; a lower proportion than last year. It is to be
feared that a very long time must elapse before the
prejudices of the Irish in this respect will be so far over¬
come that permission will be universally accorded for
autopsies. It is to be regretted that the Inspectors have
not the courage of their convictions in this matter, and do
not adopt regulations making these examinations manda¬
tory, in accordance with the suggestion made by the Super¬
intendent of the Limerick Asylum in his evidence before
the Trench Commission many years ago. The same reasons
connected with the protection of the patients and of their
attendants which have caused such a regulation to be the
law in the prison service apply equally to asylums. At
present the difficulty of dealing with the reluctance of
patients’ friends, and the risk of violating the existing rules,
form a barrier to advance, and to this rather than to any
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unwillingness on the part of the medical staffs must the
scantiness of pathological work in Irish Asylums be mainly
attributed.
Seventy-two per cent, of the admissions were on warrant,
as compared with 76 in 1895. The Inspectors again express
regret at the so frequent use of this method, which they
stigmatise as “cumbrous and objectionable.” They ought to
be weary of pronouncements of this sort. What is wanted
is energetic action. The Lord Chancellor is the nominal
head of the Lunacy Department. The Inspectors, however,
are the working heads, supposed to be fully conversant with
the points of lunacy law in which reform is needed. They
have the ear of the Privy Council, which has framed the
“ Rules and Regulations ” for the management of lunatic
asylums. Have they pressed upon that body the urgent
necessity there is for certain changes in the law ? If they
fail there, why should not the Lord Chancellor be called on
to intervene? A Bill for consolidating and amending the
provisions for lunacy administration scattered through
various Acts of Parliament should be drafted, and is just
one of those measures which would be most suitably
initiated and discussed in the House of Lords. In 1890-91
an important Commission on Lunacy Administration in
Ireland was held. Its views and recommendations were
embodied in a report, which was, of course, “ presented to
both Houses of Parliament by command of her Majesty.”
In this report the Committee dealt at some length with the
question of dangerous lunatics. They say :—“ It is clearly
undesirable that so many lunatics, who cannot be properly
described as dangerous, should be committed to asylums as
dangerous, and in this matter it appears to us that the law
requires change.” And, after describing the provisions of
the English and Scotch laws bearing on the subject, they
add“ We recommend that similar provisions should form
a part of fresh lunacy legislation for Ireland. We think it
would be possible to combine in a new Irish Law the
distinctive characters of the English and Scotch Laws on
this subject, modifying them to suit the circumstances of
Ireland.” Over six years have elapsed since this report was
issued. Has a single step been taken to give effect to this
or any other of the recommendations of the Committee?
Is the report to be allowed to remain a dead letter ? Was
the whole proceeding, like many another Parliamentary
Commission, a mere farce ?
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The total cost of maintenance in 1896 was
£321,914 12s. 6d., of which £176,585 7s. Id. was paid out of
County Cess; £130,653 17s. 7d. was received as Government
Grant; and £6,075 Is. 7d. contributed by relatives. The
amount from the latter source might be considerably
augmented but for the inane restriction of Privy Council
Rule XXIX., which limits the amount to be contributed by
a paying patient to the average cost of maintenance of a
pauper patient. A different plan is found to work well in
Scotch Asylums, and it would probably be to the advantage
both of patients and of ratepayers if a change in this direc¬
tion were to be made in the Irish regulations.
The present Irish rule taken in conjunction with the
regulation which is interpreted to mean that no difference is
to be made between the treatment of public and private
patients, seems to have been framed for the purpose of
keeping the latter class out of District Asylums, and this is
hard, because there are in Ireland virtually no other places
for insane persons of small means to go to.
The average capitation cost was £28 8s. 9d., or 3s. over
that of 1895. As usual the various asylums differ widely in
this respect, Mullingar heading the list with £29 Os. 5d.,
closely followed by the Richmond, where the cost is
£28 13s. lid. At the bottom of the scale are Ballinasloe,
£18 16s. 6d.; Kilkenny, £18 9s. 8d.; and Castlebar,
£18 68. 3d. There must be some very radical difference in
the treatment of patients in these last three asylums from
what they receive in Mullingar to account for the cost of a
patient in the latter institution being once and a half as
great.
In their remarks on the subject of Private Asylums, the
Inspectors allude to the inadequate provision for the care of
the insane of limited means, who are not paupers, but
whose means do not admit of their being sent to a
Private Asylum. They recommend that in any future
legislation the local authorities should have power to provide
accommodation for the insane paying low rates of board,
“but entirely separate from District Asylums/* In the
marginal note this accommodation is said to be recommended
“ in connection with Public Asylums/* We presume what
is meant is that such accommodation should be provided in
a separate building from a District Asylum, but connected
with it by being under the same administration; such an
arrangement, in fact, as obtains in Morningside and other
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1898.] Reviews . 145
Scottish Asylums. In this recommendation we heartily
concur.
In reviewing the forty-fourth Report of the Inspectors,
and commenting on the unlacky conjunction of these gentle¬
men with the Board of Control, we observed, €t The Board
of Control, unlike other great spending departments,
publishes no report of its transactions.” We are glad to
find that our hint seems to have produced an indirect effect.
At page 15 of the forty-sixth Report, the Inspectors say :—
“ Inasmuch as the responsibility for structural works is
made by statute to rest exclusively on the Board of Control,
of which we are members, we deem it advisable to submit in
full a very interesting and valuable memorandum as to all
that has been done under this head, during the decade 1886
to 1896, just furnished to us by Mr. S. Ussher Roberts, C.B.,
the Consulting Architect to the Board.”
Mr. Roberts, to whose ability and tact the Board of
Control owe an immense debt, has prepared a most in¬
structive report. It is quite true that a report dealing with
expenditure of public money running to such figures as
those here dealt with, should not appear as a mere
parenthesis in the Reports of the Inspectors, and it is also
unfortunate that we are deprived of the valuable criticisms
of the Inspectors, who of course cannot assume a judicial
position with regard to executive work, the responsibility of
which by statute rests upon them m conjunction with others.
In asylums built before 1895 the estimated cost of works
already executed and those in progress is £727,189; and
that of asylums which have commenced to be built since
1895 £631,600. The latter include new asylums for London¬
derry, Antrim, and Belfast, as well as an additional asylum
for the Dublin District at Portrane. The old asylums of
Londonderry and Belfast being situated within their re¬
spective cities are about to be relinquished, and the old
district of Belfast, which consisted of the County of Antrim
and City of Belfast, is being divided. Apparently all the
District Asylums stood in need of extension, and extensions
are being carried out everywhere. The Board of Governors
of the various asylums seem to have assented in a very
liberal spirit to the claims made upon the local purse, and
though, here and there, a pretty loud clangour has arisen,
as the rusty wheels of the rickety bureau were being
got into work, there prevails in most places a wonderful
harmony which may be put to the credit of Irish patience or
xliv. 10
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to the discredit of Irish indifference. Neither of these
qualities is likely to be much longer subjected to the severe
strain which the relations of the Board of Control and the
Boards of Governors to each other involved.
The memoranda of inspection made at the various district
asylums contain much that is interesting and that seems to
show much activity on the part of medical officers. We
note a strongly persoual tone in these memoranda. Eighteen
years ago or so we noted, in dealing with the Inspectors*
Reports of inspection, that those gentlemen always spoke
in the first person singular, and we then commended the
Scotch Commissioners for eschewing this practice even
though they do not hunt in couples after the English
fashion. Though the 'personnel of the Irish Commission
has changed, the custom we refer to remains. Even where
the matter of these memoranda is not, as in some cases,
distinctly suggestive of controversy, the manner is personal
to a degree that is unusual in official reports, and is perhaps
calculated to deprive of their due weight the carefully
considered utterances of the Inspectors. At the same time
it is right to say that the reports on individual asylums and
their officers are frequently kindly and appreciative.
L’Annee Psycholog ique, Publi6e par M. Alfred Binet.
Paris : Schleicher Frferes, 1897. Pp. 825. Price 15 fr.
The title-page of the third issue of this valuable year-book
shows that various alterations have taken place since the
previous issue. Prof. Binet is now nominally, as he has
been virtually throughout, at the head of the undertaking;
M. Victor Henri, as his chief assistant, is editorial secretary,
and the publisher has been changed. There are also certain
alterations in the work itself. The volume is smaller by 200
pages than the previous volume, the diminution being
entirely accounted for by the decreased space given to
original memoirs, a section of the work to which we alluded
last year as the least essential to such a year-book. The
other change is less satisfactory; morbid and abnormal
psychology receive far less attention in this than in the
second volume ; there may be adequate reason for this
discrepancy, but it certainly seems to render the work less
valuable, not only to the medical, but also to the purely psycho¬
logical student, both of whom need to recognise the intimate
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relationship between the normal and the abnormal in
psychology. At the same time, however, abnormal psycho¬
logy is by no means wholly banished from the volume. On
the whole the work is carried out with all the care and
thoroughness which we hare now learnt to expect from its
accomplished editors, and Mr. Parrand and Mr. Warren are
again responsible for the admirable bibliography of 120 pages.
The first of the original memoirs is a short paper
by Prof. Ribot, on the Abstraction of Emotions; it is
the complement to the chapter in Psychology of the
Emotions on the Emotional Memory which the author
regards as the first stage in the abstraction of emotions, and
incidentally there is an interesting analysis of the method of
procedure of the symbolist school of poets. This is followed
by an experimental study by Binet and Courtier, on the
diurnal changes in the form of the capillary pulse, in which
it is shown that without exception the influence of meals is
translated into an augmentation of the capillary pulse or an
accentuation of dicrotism, independently of temperature, and
that whatever accidental variations may be due to exercise,
emotion, intellectual work, fatigue, etc., a regular rhythm
still persists. This study is the first of a series by the same
authors, on the psychological aspects of the circulation; in
the next and following memoirs the influence of muscular
and intellectual work on the capillary pulse is investigated.
The idea of an antagonism between the circulation in the
brain and that in the limbs is rejected (as it is also by Mosso,
who formerly propounded it), and it is concluded that a short
and energetic intellectual effort produces functional excita¬
tion, vaso-constriction, acceleration of heart and respiration,
followed by slight slackening of these functions, and in some
subjects diminished dicrotism; while intellectual effort, pro¬
longed for several hours with relative immobility of the body,
produces slowing of the heart and diminished circulation in
the peripheral capillaries. The last and longest of this
series of studies is on the influence of the emotional life on
the heart, respiration, and capillary circulation. It is not
easy to summarise briefly the conclusions of this interesting
senes of experiments; it is shown that all the emotions are
really stimulants (though pain to a much less extent than, for
instance, fear), producing an acceleration of respiration and
of the heart, and provoking vaso-constriction, the effects in¬
creasing with the intensity of the emotion. In a few rare cases
emotions of pain and sadness have produced slight slowing
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148
Jteviews .
[Jan.,
of the heart (it must be remembered that we are dealing only
with short, sudden emotions in healthy persons); and there
is some reason to believe that the form of the capillary pulse
changes with the quality of the emotion, “ which may some
day permit a classification of the emotions according to their
physiological effects on the form of the pulse.” A detailed
investigation into the physiological effects of music on a
single subject is embodied in this study. The following
study, by Binet and Vaschide, deals with the influence of
intellectual work, emotion, and physical work upon the blood
pressure, investigated by means of Mosso’s sphygmomano¬
meter, which the writer considers of great value; it is shown
that all these influences are stimulants of the nervous
system, physical work being the most intense, and
intellectual work the least intense stimulant. In a sub¬
sequent memoir, V. and C. Henri, working on the answers to
a questionnaire concerning the earliest recollections of child¬
hood, find that the third year is the chief epoch for such recol¬
lections, that they are far more often visual than auditory,
and that when they are very trivial it has often happened that
the really serious emotions, associated with the visual
reminiscence, have been forgotten. The following memoirs
are by Vaschide, on the Localisation of Memories; by V.
Henri, on the Localisation of Tactile Sensations and
Aristotle’s Experiment; by the same writer, on Psychic and
Physical Work and the Factors Involved, with special
reference to the labours of Kraepelin and his school; and by
Binet, on the “ Paradox of Diderot,” in which he shows
by investigating the experiences of the leading actors at the
Com^die Francaise, that emotion plays a real part in the
actor’s work; and, finally, a study by Binet, founded on the
descriptions of the same photograph, furnished by a number
of children and noting the various psychological types
revealed by such descriptions.
L'Evolution des Idees Generates. Par Th. Ribot. Paris:
Alcan. 1897. Pp. 260. Price 5 fr.
The present volume follows closely after the same author’s
Psychology of the Emotions, and while it shows Prof. Ribot’s
customary ability and erudition in expounding and simplify¬
ing psychological problems, it is much less interesting than
that volume. The psychology of the emotions opens up so
many difficult and fascinating problems, affecting every part
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of life and many fields of science, that any fairly adequate
discussion of the matter must needs prove generally attractive.
The evolution of abstract ideas is a much less impassioning
subject, and, moreover, the author has much less new light
to throw on it. He mostly contents himself throughout with
a methodical summary and lucid presentation of those views
of the question with which he is in sympathy, confining
himself so far as possible to the evolution of general ideas
and ignoring the quarrels of nativists and empiricists as to
their essential nature. “ This is,” he writes, “ a study of
pure psychology from which everything relating to logic,
the theory of knowledge, and philosophy has been strictly
eliminated ; we are here only concerned with genesis,
embryology, evolution. We must therefore rely on observa^
tion, and on the facts in which mental work is incarnated
and revealed.” In pursuance of this evolutional idea, Prof.
Ribot seeks his documents among animals, children, unedu¬
cated deaf-mutes, primitive and half civilised races, and in
the development of scientific notions, theories, and classifica¬
tions.
Starting from the statement that intellectual activity may
always be reduced to one of two types, either associa¬
tion and verification, or dissociation and separation, Ribot
finds that abstraction belongs to the second type and is “ a
natural and necessary process of the mind dependent on at¬
tention, that is to say the spontaneous or voluntary limita¬
tion of the field of consciousness,” and, so far from being
rare, is one of the commonest of mental acts. He finds the
simplest type of generalisation in the formation of a
“generic image,” using a simile derived from Galton’s
composite photographs* and first applied to psychology by
Huxley. This generic image results from a spontaneous
fusion of images, and is produced by the repetition of more
orless similar events. It consists in an almost passive pro¬
cess of assimilation, is not intentional, and only deals with
the grossest resemblances, of which it is the accumulation
and summation, moulded at last into a solid kernel, from
which minor differences have fallen away, and which be¬
comes capable of further development. This early evolution
is studied through three chapters, in animals, in children,
and in deaf-mutes, in regard to whom much material is found
in the early work of Gerardo, dating from a period when
deaf-mutes were less frequently subjected to education than
at present.
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After a fairly fall and interesting discussion of speech, in
the course of which regret is expressed that linguistics has
yet received so little attention from psychologists, Ribot
passes on to deal with the superior forms of abstraction
generally, and then to the evolution of the principal concepts
—number, space, time, cause, law and species—to each of
which a chapter is devoted. With regard to the conception
of number, Ribot appears to be in essential agreement with
James that it is primarily the stroke of our attention in the
discrimination of things, being thus directly reducible to
what the author regards as the essential and fundamental
condition of abstraction. Space is traced from its first
concrete form in the intuition of definite extension. Time is
considered to be a complex state or, rather, process; the
vital rhythmic sensations, like respiration, constitute its
kernel—“ it is an internal chronometer fixed in the depths of
our organism ”■—and to this subjective element are added
and co-ordinated other objective elements, the regular
successions arising from external sensations, and forming
the envelope of the kernel. The conception of cause is
briefly developed from its primitive form in experience as a
force, a power which acts and produces, to its final develop¬
ment in the law of universal causality.
In the concluding chapter the author points out that the
progressive march of abstraction and generalisation depends
on two principal causes, the first (of general character) being
its utility, the second (more accidental and sporadic) the
appearance of discoveries, corresponding to spontaneous
variations in evolutionary biology. The development of
abstraction is thus due to social causes—to utility and to
imitation. If the progress of abstraction, from its lowest to
its highest stages, is considered from another point of view
in relation to its aims, it is found to have followed three
main directions in its historical course : practical, specula¬
tive, scientific. It is to a considerable degree an uncon¬
scious process, and the author concludes that the psychology
of abstraction and generalisation is in large part the
psychology of the unconscious.
It may be added that this volume is a summary of lectures
delivered at the College of France during 1895, and that it is
the first of a series which Prof. Ribot hopes to publish,
dealing with the whole range of psychology: the unconscious,
perception, images, will, movement, etc.
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Psychologic als Erfahrungswissenschaft. Yon Hans Cornelius.
Leipzig: Teubner. 1897. Pp. 445.
This work is an attempt to give on an empirical basis a
descriptive account of psychology which shall be scientific
and, one might add; philosophic. It is in striking contrast
to many recent works which are crowded with facts and
details of individual psychology. The author seeks to
ignore individual psychology altogether, and only to present
the broad aspects of psychic life in their most abstract and
generalised forms. His relationships may perhaps be most
clearly realised by his sympathetic and admiring references
throughout to Kant, James, Helmholtz, Avenarius, and
Mach, while to T7V undt and his school very little reference
is made. He is opposed to “ atomistic ” psychology, which
seeks to account for mental processes by a synthesis of
hypothetical elements; he is opposed to a merely associa-
tional psychology; he is still more opposed to a psycho¬
logy founded on brain physiology (“ the psychic phenomena
are certainly in some degree dependent on the physiological
processes in the nerve substance, but they are not identical
with them, and the description of one is not the description
of the other.”) Nor will he found psychology on any
metaphysical hypothesis. It must, like every other science,
be a description of facts. He lays great stress on the asser¬
tion (made by Kirchhoff in relation to physics) that all
explanation is a simplification of description, and he desires
to describe psychic facts as completely and as simply as
possible; a mere reckoning up of isolated observations he
regards as the least simple method of explanation, not
worthy to be called science at all. Like James (whom he
couples with Hume) the author regards consciousness as a
stream, and sometimes also (as James would not) as a chain.
His most fundamental idea is what he calls “ the principle
of unity” ( Einheitsprincip ). This law is described as “the
endeavour manifested throughout our psychic life to bring
together various parts, according to their resemblances,
under common symbols.” In other words it is the tendency
€t everywhere so far as possible to indicate by a comprehen¬
sive symbol the common element in varying phenomena.”
Psychology for the author may thus be said to deal very
largely with the formation of abstract ideas. He finds his
principle of unity already indicated by Berkeley, but more
especially developed by Mach and Avenarius. It is the
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.former’* '-principle of economy in thinking, the latter’s
principle of thinking with the least expenditure of energy.
(Herbart and Beneke have set forth somewhat similar prin¬
ciples). We seek, so far as pdssible, to range all our experi¬
ences under already known ideas, to bring them under the
same symbols as previous experiences, and in so doing we
are seeking to classify them with greatest economy, least
expenditure of energy or most simplicity. Scientific
endeavour is thus the continuation of a really primitive
mode of thinking, which may be traced throughout, and
which has as its object the abbreviation of our experi¬
ences; suck abbreviation is, in science, a theory of these
experiences.
It is scarcely necessary to follow the author through his
broad and comprehensive, but very bald and colourless, dis¬
cussion of psychic phenomena. The author throughout
deliberately avoids definite illustrations or detailed facts.
This seems to be a mistake, for, as Ribot has shown, even
the most abstract conceptions may thus be to a large extent
illuminated. One may again compare this book with Pro¬
fessor James’s great work, The Principles of Psychology ,
which also deals with psychology on a broadly descriptive
and noil-metaphysical basis. James’s work is full of
r instructive and interesting detail, which certainly enriches
rather than impedes the argument. The present work,
notwithstanding its ability, is scarcely adapted for a text¬
book, or for other practical purposes, while its baldness
renders it somewhat unprofitable to read.
Legofos de Clinique M£dicale. Par le Dr. Pierre Marie.
Paris : Masson et Cie, Editeurs. 1896. Pp. 296; figs.
57. Price 6 fr.
These 16 lectures were delivered by Marie at the H6tel-
Dieu Hospital, and include quite a variety of subjects—no
doubt largely determined by the kind of case which hap¬
pened to present itself at the Clinique, so that the volume
before us may best be described as a collection of monographs
on interesting medical diseases, and as a rule illustrated by
more or less typical cases. It is a curious fact that the pub¬
lication of books of this kind (collections of clinical lectures)
is very much more frequent in France than in our own
country, probably for reasons.of a complex kind; but it
seems to us thait medical science benefits by the practice.
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especially when the pen is wielded by the skilful hand of
such a good clinical observer as Dr. Marie.
Rheumatoid arthritis is the subject of the introductory
lecture, and Marie draws special attention to the form of
this disease, which is distinctly of infectious origin, and
which presents certain marked characteristics; it readily
affects the serous membranes in connection with joints, and
is especially obstinate. Salol appears to be the only drug
which may influence it.
Lect. ii. and iii. deal with the important subject of
thoracic deformities and their relations with certain visceral
affections. In these days of refined diagnosis, where bac¬
teriology and the phonendoscope are expected to solve all
chest-problems, it is well to be reminded that it may be
useful to carefully inspect the thorax of a patient. Con¬
genital influence often plays an important part in the pro¬
duction of these deformities, and the author remarks on the
frequent presence of the funnel-shaped thorax in the
degenerate. The association of a thorax flattened laterally
and bulging forward just above the xiphoid, with congenital
heart-disease is, as Marie points out, a strong argument
against the view that congenital cardiac malformations
generally arise from endocarditis during foetal life. In con¬
nection with the chest deformities associated with various
nervous diseases (progressive myopathy, Friedreich’s disease,
acromegaly, etc.), Marie hazards the opinion that our friend
Punch is a type of acromegaly, and supports his thesis by re¬
ference to certain historical documents obtained from his
friend Dr. Toso, of Turin.
In the next three lectures, devoted to glycosuria, we find
a number of interesting points discussed—the question of
surgical interference in cases of diabetes, the explanation of
conjugal diabetes (Marie inclines to the theory of true con¬
tagion), the pathology of pancreatic diabetes, the special
characters of hemiplegia in diabetics, the causation of the
angina pectoris which is not unfrequently observed in these
cases, etc. The importance of remembering that diabetes is
only a syndroma, like jaundice, and not a disease strictly
speaking, is wisely emphasised.
The record of a case of “ diab&te bronz6,” a disease first
described by Hanot and Chauffard in 1882, is given in Lect.
vii. Only 11 cases have so far been recorded, and apparently
all in France. The disease, which is usually met with in
adult males who drink, begins more or less suddenly. With
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[Jatf.,
the ordinary symptoms of diabetes we find distension of the
abdomen, enlargement of the liver and spleen, marked weak¬
ness and emaciation, and a characteristic uniform pigmenta¬
tion of the skin. It is rapidly fatal—generally within a
year.
Marie inclines to the view that the hsemoglobin of the
blood plays the principal part in the pathogeny of bronzed
diabetes, and that it is a morbid entity and not an epiphe*
nomenon of ordinary diabetes.
Cyclical albuminuria is discussed in Lect. ix. and x. in
connection with an interesting case observed on and off for
six years by the author. Various circumstances in this case,
and the examination of certain conditions recorded in other
cases, lead him to look upon the condition as a sympathetic
affection. Antipyrin he has found useful in the treatment
of certain symptoms in his case.
Cyanosis in congenital heart-disease, and the subject of
congenital malformations of the heart generally, are ably
treated in Lectures xi., xii., and xiii., including among other
interesting questions a discussion of the mode of origin of
these malformations, and of the mode of production of
cyanosis, the causation of increase in the number of red
corpuscles, etc.
Finally, we are given a good account of that cnrious con¬
dition in which neurofibromata are found scattered all over
the body (except the hands and feet), either as molluscum
nodules or as nsevi. Certain psychical symptoms, such as
depression, torpor, with marasmus, are usually associated
with the disease, but beyond congenital influence we are
ignorant of its causes, nature, and mode of production.
Legons de Clinique Medicals—Psychoses et. affections nerveuses.
Par Gilbert Ballrt. Pp. 451 ; Figs. 52. Price 9 fr.
Paris: Octave Doin, Editeur. 1897.
This is a collection of 24 lectures, for the most part given
by the author at the Hopital Saint-Antoine during the
winter session of 1895-1896, but including a few previously
given at the same hospital and elsewhere in former years.
They are clinical lectures in the best sense of the term, and
while they must have been fascinating to listen to, they prove
most interesting to read, and deal incidentally with many
questions recently solved, or being solved, in the pathology
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1898.]
of nervous diseases. Clearness of diction and an endeavour
to make the descriptions of cases as objective as possible
are, the author informs us, his great aims; that he has suc¬
ceeded we feel sure will be the verdict of his readers. We
will consider more especially in this review the lectures
dealing with mental diseases.
The first lecture deals in a general way with mental
pathology and is a plea for the caref al analysis of symptoms,
not forgetting physical signs, in the study of mental cases ;
the futility, in the present state of knowledge, of taking
normal psychology as a basis of classifications or researches
in mental diseases is wisely emphasised; and great stress is
laid on the importance of the evolution of mental troubles
as an element of differentiation in diseases.
Chronic delusional insanity is the subject of Lecture ii., and
while Ballet accepts Magnan’s classification of these cases
into two marked groups—delusional insanity of persecution
with systematic evolution, and the delusional insanity of the
degenerate, he is fully convinced that there are a number of
intermediary types. In cases of the former group we may
certainly find stigmata of degeneration ; we may find certain
morbid mental symptoms years before the onset of the
delusional insanity; on the other hand the unmistakably
degenerate may become affected with typical chronic systema¬
tised delusional insanity. The onset of the latter disease
may be comparatively early in some cases.
Lect. iii. deals with a group of persecuted insane who are
“ self-accusing ” instead of innocent victims, and in whom
very often the origin of the disease appears to be some hypo¬
chondriacal preoccupation. They may not be as passively
resigned as the average melancholiac, but they do not evince
the anger and the hatred of the ordinary persecuted patient.
In this connection the case of a patient possessed with a
tendency to indecently expose himself—an “ exhibitionist ”
to borrow the denomination suggested by Lasagne—is
recorded as a type of the self-accusing persecuted, who
always present stigmata of degeneration. Closely related to
these, and belonging to the large class of degenerates, are
what Ballet calls the u persScuteurs familiaux” (Lect. v.),
whose delusions are related to their family identity;
such patients believe that they are sons or fathers
of personages (generally distinguished) in reality quite
unrelated to them, and not unfrequently exhibit few or no
abnormal ideas beyond these leading delusions; i.e., typical
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monomaniacs according to Esquirol and other writers. A-
more careful examination, however, shows that, as a rule,
these patients are intellectually weak or morally oblique 5
in some, other delusions crop up after a time; so that the
leading false conception is but the revelation of a more
general and deeper mental trouble.
Lect. vi. and Lect. vii. deal with the important question
of puerperal psychoses, and Ballet discusses the relations
between the various aspects of insanity observed in
connection with the puerperal state and the physical con*
dition of the patient. While, on the one hand, as in the
case of such neuroses as chorea, hysteria, Graves’s disease,
pregnancy may be one of the occasional causes of a psychosis,
so, on the other hand, certain psychoses may be purely toxic
(perhaps on occasions uraemic). But, independently of these
two groups, there are intermediary cases in which auto*
intoxication intervenes and awakens a latent psychosis; so
that between the two extreme views as to the causation of
the puerperal insanities, truth would lie in a wise eclecticism*
Onp. 124 the author suggests a classification into five groups
of the various mental troubles which appear during preg¬
nancy or the puerperium—a classification taking into account
their physiognomy, their evolution, their probable or certain
pathogeny, and their relations with eclampsia or infection.
With the progress of our knowledge, hypochondriasis
(Lect. viii.) as an entity appears to us less common than
formerly; for many cases so labelled prima facie , are now
classified as cases of melancholia, of recurring insanity, of
general paralysis, etc,; nevertheless Ballet recognises that
a certain number of cases remain which are not easily
relegated to any definite variety of insanity, and he does not
favour the tendency of certain authorities to classify them
all as cases of mental degeneration.
Lect. ix. deals with an interesting case of hypermnesia
with exaggerated vividness of cerebral images, and in¬
cidentally lays stress on the importance of being watchful
in presence of individuals who exhibit a markedly abnormal
development of certain faculties, especially that of mental
representation.
In Lect. x. some very important remarks are made on the
question of the long prodromal period which may be noticed
in some cases of general paralysis of the insane; especially
with prodromata assuming a neurasthenic form, which may
extend over months and even years (v. page 173-174, case
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1898.]
1, three years; case 2,seven years). Comparatively recently,
one of the most brilliant French novelists of the last quarter
of this century was energetically treated for several months
with douches, as a neurasthenic, before the obvious signs
of general paralysis were observed. On p. 178, Ballet
mentions a few characteristics which may help in diagnosing
preparalytic neurasthenia from simple neurasthenia.
In Lect. xi. a consideration of the eye troubles in general
paralysis (so important in diagnosis) is undertaken, the
author drawing attention to the excellent work done by
Sevan Lewis on this subject. He shares the views of the
latter as regards the u paradoxical” reaction of the pupil
in early general paralysis, and its sluggish dilatation or the
absence of dilatation after irritating the skin of the body,
etc., under the same circumstances. As regards changes in
the optic papilla, Ballet's observations confirm those of
Gowers; in 37 cases of general paralysis examined With
the ophthalmoscope in conjunction with M. Jocqs, no
particular lesion of the fundus was detected.
Iu connection with a case affected with neurasthenia,
Graves's disease and hysteria, some interesting facts
are recorded in Lect. xii. concerning the nature of the
artificial sleep induced by simply closing the patient's eyes
and ears (there is in the case complete anaesthesia, loss
of muscular sense, loss of smell and taste). Various ex¬
periments made on this patient confirm the conclusions of
Janet and others that the anaesthesia in hysterical patients
is only apparent; the tactile impressions are not perceived,
owing to narrowing of the field of consciousness, but they
are conducted to the brain and stored, as may be shown by
experiment. The remaining lectures are devoted to purely
nervous diseases.
In Lect. xiv. Ballet considers and discusses an interesting
case of pseudo-bulbar paralysis in a syphilitic man, aged 34
years, due probably to a specific double lesion in the right
and left cerebral hemispheres (usually involving the central
grey nuclei). The close resemblance to Charcot's disease
(amyotrophic lateral sclerosis) in the symptoms: glosso*
labial paralysis, spasmodic paralysis of the limbs with
amyotrophy, absence of sensory and sphincter troubles, is
worthy of notice. Spasmodic laughing and crying, ably
described by Brissaud in Rev . Scientif, 1894, was present
in Ballet's case.
Acroparesthesia is the subject of Lect. xv., three cases
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of which are described, and the final lectures deal with the
subjects of multiple neuritis and infectious myelitis, in
which are embodied the most recent researches in the
pathology of these diseases. While we do not dwell more
fully here on the subject of these concluding lectures, they
are certainly most attractive to all students of nervous
pathology. After perusal of Dr. Pallet's volume one cannot
resist feeling that one more name should be added to the
already long list of French medical writers who excel in the
art of clinical exposition.
Results of Thyroid Feeding in Insanity . By Robert Cross,
M.B., C.M., Assistant Medical Officer, Midlothian and
Peebles Asylum. (Reprinted from the Edinburgh
Medical Journal , Nov., 1897.)
The literature on thyroid feeding in the insane seems to
increase pari passu with the growing scepticism as to its
efficacy. Although the method was initiated on very loose
empirical grounds, it was so well written up that many
thought that in it we had a panacea for all diseases the
mind was heir to. Experience has shown otherwise; and
while in no hands has it had the same measure of success as
in those of its originator, in most instances its results have
been practically nil . Usually one finds much useless repeti¬
tion in these communications upon thyroid treatment, and
this suggested the scheme for collective investigation pub¬
lished in a previous number.
These reflections are suggested by a perusal of a reprint
we have before us on the “ Results of Thyroid Feeding in
Insanity/ 5 by Dr. Robert Cross. It is a record of 20 cases
of various types of insanity, in which thyroid extract was
exhibited. The cases seem carefully recorded, and show
evidence of painstaking enquiry. On applying these cases
to Dr. Lord’s scheme* we find that out of the 20 cases, one
recovered, one was improved, seven were affected prejudi¬
cially, and 11 showed no improvement. These figures fully
bear out the statistics already published, and the addition
of these cases to the latter yields the following figures:—
Out of 78 cases of various forms of insanity 18 recovered,
of which 15 were permanent; 14 improved, of which four
♦ “A Scheme for the Registration of the Results of Thyroid Treatment
Mental Disorders,” by John R. Lord, M.B., C.M., Journal of Mental Science,
July, 1897.
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were permanent; 34 did not improve; 12 were affected
prejudicially.
Dr. Cross is of the opinion that this method of treatment
should receive a fair trial before any patient is considered as
hopelessly incurable. Unfortunately, the available experience
does not justify the hope that an unfavourable prognosis is
likelv to be modified by the use of thyroid; on the other
hand, one need not abandon hope because of comparative
failure in these results.
La Confusion Mentals Primitive: Stupidity Demence Aigue ,
Stupeur Primitive . Par le Dr. Ph. Chaslain, etc. Paris :
Asselin et Houzeau, 1895. 16mo, pp. 264. (Primary
Mental Confusion : Stupidity, Acute Dementia, Primary
Stupor, etc.)
The second title of this work shows to some degree the
position in which the author would place the form of mental
disease with which he deals. Before laying forth his own
views, however, he deals at some length with the contri¬
butions of previous authors. Two incidental remarks will be
sympathetically received by English readers. Chaslain ob¬
serves that though MoreFs conception of degeneration
was an advance, it has done harm by the exaggeration with
which it has been pressed in France. On the other hand,
in Germany, a language which is not very clear, a terminology
too profuse and often contradictory, and a profusion of
anatomical and psychological hypotheses have contributed
to confuse our subject not a little, so that it is frequently not
easy to understand precisely what thought the authors wish
to express. But our satisfaction is dashed by the remark
that on this particular topic Italy and England but reflect
the views of Germany !
Not to delay over scattered and fragmentary observations
of earlier writers, it seems clear, as Dr. Chaslain points out,
that Delasiauve was the first author who recognised fully
the existence of this form of mental disease : “ it is to him
that we owe the first good description of mental conf asion,
to which but little has since been added. It was he who
grouped under this name facts which were scanty up to his
time and which we shall find scanty after his time.”
Delasiauve recognised that hallucinations and delusions
occurred, but pointed out that confusion was the basis of all.
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“ The predominant fact which results from the cerebral con-
dition is the impairment of the exercise of the intellect. In
its simple form every external manifestation is not
interrupted, as in the grave, but the mental operations lose
their clearness, reflection its power, the will its decision,
action its elasticity. The patient does not care either to
converse, to amuse himself or to work; he often even feels
his head weighed down as if by a leaden cap ; he is conscious
of his lack of initiative and complains of the inexplicable chaos
of his thoughts.” The relation of occurring hallucinations
to the fundamental state is the relation of dreams to sleep.
Thus also isolated ideas remain when the confusion has
passed away (simulating monomania), and this is but the
u survival of a strong impression in the pathological dream.”
It is instructive to note how Delasiauve divides the general
class—“ stupidite, confusion , chaos ”—into the following sub¬
divisions—“Ordinary; epileptic, ecstatic: hysterical, etc.:
delirium tremens: delirium saturninum: following other
poisons: following serious fevers.” In other words the
symptomatic insanities fall into this class. This accords
with the modern view, accepting which, “ several authors
have endeavoured to find the origin of this affection in
auto-intoxication and infection.”
The second part of the work before us begins with a
description of the symptomatology of the affection. There
is nothing very characteristic in the incubation, though these
patients are conscious rather more often than others at this
stage that their mental power is impaired. Oncome is
sometimes gradual, sometimes sudden. The fully developed
condition is characterised by confusion, incoherence, an
emotional state either variable or indifferent, a certain
degree of torpor, perhaps hallucinations varying and
transient, with delusions quite unsystematised and usually
varying frequently. Looking at divisions of insanity purely
from the clinical standpoint, we see that an acute insanity
thus described is by far the most frequent form of acute in¬
sanity, being much more prevalent than the classical forms
of mania and melancholia. While it is surprising that so
common a type of disease should be so generally overlooked,
it must be also said that there is some danger lest so wide a
definition should serve to include more than one division, lest
in fact “ confusion ” should become, in old-fashioned asylum
phraseology, a “refractory ward” in which the outcasts
from all other forms would find refuge.
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As forms more or less distinct, Chaslain describes the
delirium of collapse, profound primary mental confusion (or
acute dementia), typhoid and meningitic forms, etc. He
glances at various forms of confusion symptomatic of various
intoxications, and other morbid states. He seems doubtful
of Korsakof’s polyneuritic psychosis, and leaves it for the
future to decide whether the typical symptoms of that affec¬
tion depend upon the association of mental disturbance with
a special etiological factor or with polyneuritis. We may
now perhaps regard it as decided that the former is the
case. No doubt many of the most exquisite cases of con¬
fusion occur in association with alcoholic neuritis, but the
same mental phenomena are to be found in chronic alcohol¬
ism without neuritis.
The physiology and pathology of confusion are considered
in a chapter which is of course chiefly speculative, the
fascinating but probably unsubstantiated theories of Meynert
being considered at some length, and set out with great
lucidity. Diagnosis is considered in another chapter. The
demarcation from mania or melancholia is rarely difficult
once it is admitted that mental confusion exists as a
distinct form. The chief point is the differentiation of con¬
fusion from what the Germans call acute paranoia (or
IVahnsinn). It must be said that these affections are often
very hard to distinguish, and that they probably often overlap
each other. The recognition of either as a common form of
acute mental disease is a distinct clinical advance.
Prognosis largely depends upon association with other
diseases. Etiology and pathogenesis are also chiefly con¬
cerned with its relations to other morbid states, and to the
very interesting and not yet fully worked question of infec¬
tion and auto-inoculation.
Dr. Chaslain considers at some length the place of mental
confusion in relation to classification. He discusses Meynert's
view as to its being a condition of exhaustion and also the
questions of infection, etc., in their bearings upon this point
of view. He clearly inclines to place confusion among what
Krafft-Ebing calls* the psycho-neuroses rather than among
degenerations (using the latter word in the limited sense).
He concludes this chapter with a definition :—
u Idiopathic primary mental confusion is an affection,
commonly acute, commonly consecutive to the action of an
appreciable cause, usually an infection. It is characterised
by the physical phenomena of impaired nutrition, and by
xwv, 11
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mental phenomena. The essential basis of the latter, im¬
mediately resulting from the bodily state, consists of a form
of intellectual weakness and disassociation, which may or may
not be accompanied by delusions, by hallucinations, and by
agitation, or, on the other hand, by motor inertia, with or
without marked variations of the emotional state.”
The last chapter deals with treatment. Naturally, in the
present state of our knowledge, there is not much special to
be said under this head.
The work on the whole will enhance its author’s repute as
a clinical observer and as a thoughtful physician. It
fittingly completes the work of the earlier French writers in
the delimitation of the clinical forms of acute mental disease.
La Descendance d 9 un Inverti . Contribution & Vhygiene de
Vinverdon sexueUe . Par Ch. F£b*5. Extraite de la
Revue GSnSrale de Clinique et de TMrapeutique
(Journal des Practiciens). (The Descending Heredity of
an Invert: A Contribution to the Hygiene of Sexual
Inversion. By Ch. F6rA Reprint, etc.).
The little work before us is characterised by that com¬
pleteness which all Dr. F6r6’s writings show. His numerous
works on nervous diseases and teratology, and his beautiful
experiments on the influence of poisons and mechanical in¬
juries on the development of the embryo, have all the
common note of a search for definite concrete facts, worthy
of the author, who tells us that “ science is that which can
be measured.”
This paper forms in a manner the complement of an
earlier one in which Dr. F6v6 related the case of a gouty
patient in whom attacks of morbid impulse or obsession,
taking the form of sexual inversion, used to appear at times
in place of the customary attacks of podagra, and used to
pass away when classical gout returned. In that case the
symptoms seemed to depend upon a definite poison, and
might be compared to the sexual excitement, of a more
normal type indeed, but still perfectly morbid in appearance
and degree, which results from poison by cantharides.
There seemed to be no question of corruption or any causa¬
tive influence on the moral side. Now, if we believe that
this condition can result from a definite poison, though we
cannot precisely trace how the poison acts, we can hardly
deny the possibility of its occurrence in connection with
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other physical causes equally well recognised in their
etiological import, and perhaps not more obscure in their
precise mode of action. First among these causes heredity
suggests itself, and thus Dr. F6r6’s podagrous patient
throws a side light on the question of congenital sexual in¬
version.
A more direct light is cast on the subject by the case now
brought forward. An epileptic patient of Dr. F6r6’s, who
was imbecile and impulsively violent, developed tendencies
towards pederasty. The epileptic was the eldest of his
family. There were two other sons who were idiots, and a
daughter had died of convulsions in infancy. The mother
had died in childbirth. No hereditary taint was recognised
on her side, and she herself had been a healthy woman. No
overt trace of neurotic heredity was discoverable in the
father’s family, but when his son developed this aberration
he became much distressed, and confessed to Dr. F6r6 that
he himself had been always a sexual invert. He dated his
troubles from his sixth year, when the sight of naked men
aroused sexual feelings. Later on he practised masturba¬
tion, not mutually. Women were repugnant to him, and he
only married through social compulsion. He never, at least
in his adult years, gave way to his morbid instincts or
allowed them to appear. He was a man of fine character
and unusual ability.
The evidence which this case affords, so far as it goes, is
of value. We look upon the vast volumes of confessions of
wretches who have given way to sodomy, mutual mastur¬
bation, etc., and who coram foro , or in the doctor’s confes¬
sional, protest that they are congenital inverts, as absolutely
valueless. They are what the law calls infamous witnesses,
and their uncorroborated evidence counts for nothing. An
impudent fallacy lies under the arguments of most of these
gentry, for they assume that people when once thev have
swallowed the doctrine of congenital aberration will make
no bones of the notion that the aberrant passion is also quite
uncontrollable. But there is really no reason why abnormal
passion should be pled as an excuse for crime more than
normal passion, and we are glad to notice that this opinion,
for which we have long contended, has been accepted by one
of the foremost German criminal anthropologists, Dr. Hans
Eurella (see his article “ Fetischismus oder Simulation ” in
Archiv.f. Psyche Vol. xxviii.).
To return to the matter in hand, F6r6 argues from the
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case of his epileptic that congenital sexual inversion is a
degeneration and therefore transmissible, and further that
such being the case it is wrong to prescribe marriage or
to endeavour to bring about such a degree of cure as will
result in the further transmission of this painful and shock¬
ing condition. However, the very postulate of all the
arguments as to congenital inversion gives this, and the
astonishing attempts at “ curing ” a “ congenital 99 con¬
dition are a singular proof of the looseness with which some
men think and write.
" Truly, even if acquired perversions are capable of being
effectively treated by such means as apply to pathogenic
conditions, still congenital perversion is quite beyond the
range of medicine. It is no more possible to restore the
sexual sense in a sufferer from congenital inversion than to
restore colour vision to a sufferer from Daltonism.”
It is hard to understand the logical position of those who
gravely propose to expel nature with so very feeble a pitch-
fork as hypnotism, or who think that medical methods will
really alter congenital instincts. Equally illogical appears
to us the advice of the “puella.” Sexual intercourse
undertaken for experimental purposes is in itself a perver¬
sion, and is little likely to be efficacious in overcoming
distaste for the opposite sex (on whatever cause depending),
as anyone with the most elementary acquaintance with
human nature might see.
Happily we are not likely to hear much more either of
hypnotism or the “puella” for a while. Dr. F6r6 seems
to firmly believe in the gospel of self restraint as preached,
not always in too restrained a way, by Raffalovitch.
With regard to both Dr. Fdrd’s cases above referred to,
though we cannot fail to see their force, we are prepared to
hazard certain interpretations which if tenable may to
some degree impair their validity. The first case recalls a
case recorded in this Journal some years ago in which an
habitual sufferer from asthma was seized by an obsession
instead of his usual asthmatic attack. His obsession was a
dread of killing or an impulse to kill his mother. Was
this a true perversion of filial instinct, or is it not rather to
be regarded as an effort of the pained or poisoned brain to
interpret itself, and analogous in a way to the horrible
delusion of the melancholiac ? And the second case, the
subject of the paper we are especially considering, would
prove more if it did not prove so much. The sexual per¬
version shown by the epileptic imbecile may be said to go
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1898.]
for nothing. Aberrations of any appetite are to be expected
in such mental states of degradation, and the mode of life
of such a patient would tend to foster the growth of the
abnormal rather than the normal appetite. As to the
father we would read his history thus:—In the indifferent
period before the appearance of the true sexual instinct he
was curious about male sexual matters, certainly no un¬
common condition among children. He subsequently gave
way to masturbation and thereby probably interfered with
the due development of his sexual instincts. It does not
appear to us to be beyond dispute, either that his sexual
irregularities were the cause of his children's degeneracy,
or that both conditions were indications of an increasing
degeneration of the stock, though the latter view is
no doubt consistent with the facts. Still the occasional
“ spontaneous ” appearance (that is to say, appearance
without any cause that is evident to us) of a family of
idiots and imbeciles among a formerly healthy stock is
not rare, and cannot be accounted for in many cases by
the supposition that it is the terminal stage of a degenera¬
tion showing itself in earlier generations only in its effects
upon the reproductive instincts.
Lemons Cliniques sur les Maladies Mentales et Nerveuses
(Salpetriere, 1887-1894). Par Dr. J. S£glas. Recueillies
et publics, par Dr. Henry M6ige. Paris : Asselin et
Houzeau. 1895. Un vol. in 8vo, 885 pp. 20 fr.
(Clinical Lectures on Mental and Nervous Diseases,
etc., by Dr. J. S6glas. Collected and brought out by
Dr. Henry M6ige, etc.).
These lectures delivered at the Salpetri&re remind us of
some of the best features of the work of the late Benjamin
Ball. They have the same lucidity of statement, the same
moderation of theory, the same strict adherence to observed
facts. They are inferior to Ball's lectures only inasmuch as
they do not attempt to treat insanity systematically nor to
cover the whole ground.
The first two lectures treat of hallucinations. The author
accepts the definition—a perception without an object—and
adopts Tamburini's view that an hallucination is a functional
trouble of the cortical centres. He proceeds to analyse
hallucinations in accordance with the centres engaged,
pointing out the correspondence of the elements of function,
the varying conditions of destruction of function, and the
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varying disturbances occurring in hallucination. Thus in
the case of hearing we have consciousness of sound, recogni¬
tion of the general nature of concrete sounds, and audition
of words: similarly we have gross cortical deafness,
psychical deafness, in which the sound though heard cannot
be referred to the object which produces it, and finally
verbal deafness; in the hallucinated we may have the
hearing of vague noises, the hearing of definite sounds, the
hearing of words and sentences, all existing without objects.
In the same way with vision, we can have elementary visual
hallucinations (fire, lightning, &c.), common visual hallucina¬
tions (devils, angels, &c.), or verbal visual hallucinations
(written words: mens tekel pares and the like). When
the associated motor centres are engaged with verbal
hallucination of hearing we have the existence of psycho¬
motor hallucination in which the patient seems conscious of
words through sensations that appear to him to be derived
from movements of the muscles of phonation and articula¬
tion, &c. Dr. S^glas has entered very fully into the
subject of psycho-motor hallucination in his monograph,
Troubles du langage chez les aliSnes. Hallucination may be
confounded with or complicated by illusion or by delusional
interpretation.
The various forms in which hallucination occurs, some¬
times exquisitely distinct, are more often mixed and vague.
The examination of the hallucinated often presents great
difficulty, partly owing to their habitual suspicion, partly, as
the Author points out, because they are bad psychologists and
Usually analyse their own symptoms incorrectly. Therefore,
in order to facilitate clinical examination, as well as for
scientific purposes, it behoves the physician to be familiar
with the varying forms in which hallucinations occur so as
to be on the look-out for each.
The co-existence, association, and combination of
hallucinations are considered and analysed in detail.
The three following lectures treat of obsessions or
impulses with consciousness (impulsions conscientes ). Under
the general head of obsessions, Dr. Seglas includes impulses,
the various “ phobia,” and the Zwangvorstellungen of the
Germans. He combats the notion, prevalent among his
countrymen, that obsessions are to be regarded as stigmata
of mental degeneration. He points out, quite truly, we
hold, that “the simple obsession may be met (in a very
attenuated form, it is true) among the most normal persons.”
He also shrewdly notes that “this strange stigma of
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degeneration becomes the more rare the more the degenera¬
tive state which it ought to characterise becomes marked,
and that it is an endowment of so-called superior degenerates
while it diminishes in frequency even to disappearance
in the most marked forms of mental degeneration.” Speak¬
ing generally we feel that the term degeneration is used too
loosely on the Continent even by scientific writers, and that
facts are not infrequently made to accommodate themselves
to theories of degeneration. In the matter before us
clinical experience seems to show that the tendency to
impulsive acts accompanying insanity is often associated
with other indications of constitutional mental diseases and
is so far an indication of “degeneration,” but that the
milder forms of obsession, certain insanities of doubt, are
not only very curable, but are actually to some degree
incidental to certain callings (for instance, Qrubelsucht
among printers and press correctors). Having glanced at
the neurasthenic theory of obsessions, our author goes on
to divide the condition into the congenital and the acquired
forms, taking the eclectic clinical view of facts.
The characteristics of the paroxysm are laid down: the
presence of the besetting idea, its irresistibility, retention
of complete consciousness, before, during, and after the
attack; concomitant distress; subsequent satisfaction.
Seglas points out that complete consciousness during the
crisis is not always present. He finds in the crisis some¬
thing analogous to the reduplication of personality in
delusion—a reduplication of personal consciousness. In
opposition to Falret, he holds that hallucination and obses¬
sion may be combined. In obsession he says there is an
hypertrophy of the involuntary spontaneous attention tc
the detriment of the voluntary and deliberate attention
Not only are the patients aboulic, but by psychical contras',
the involuntary attention dwells upon matters most repel¬
lent to the saner elements of the mind.
. Several lectures are given to the consideration of primary
mental confusion. Dr. Seglas recognises confusion as
occurring as a secondary symptom in various mental states;
as a state of alienation symptomatic of various toxic and
other conditions; and as a primary state. He adopts
generally the views of Chaslain on this subject. In a
separate lecture he discusses the diagnosis of primary con¬
fusion from general paralysis. It appears to us possible, by
the way, that some of the earlier cases of recorded cure in
general paralysis may have really been cases of alcoholic
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[Jan.,
poisoning (confusion, amnesia, loss of power owing to
polyneuritis).
The lectures on melancholia contain a good description
of melancholia sine delirio. With regard to suicide, Dr.
S6glas says :—“ It is, in my opinion, incorrect to insist, as
is often done, on the skill, the thought, the energy, and the
tenacity which melancholiacs display in their attempts at
suicide. Without denying that these conditions sometimes
exist, I believe we should in such cases recognise the exist¬
ence of circumstances quite exceptional and peculiar, because
such energy and resolution can by no means correspond with
what we know of the state of the will in melancholia. Un¬
doubtedly most melancholiacs meditate very long over their
projects for suicide and invent all sorts of plans. But they
put off the execution of them from day to day, and this
wealth of combinations really only serves to conceal the
absolute want of decision and initiative which is inherent
in their very condition as melancholiacs.”
Insisting upon the secondary character of the delusions in
melancholia, the author makes some acute observations on
the mode in which this relation is often concealed by the
retrospective nature of the delusional ideas.
He points out that in melancholia it is not infrequent to
find psycho-motor verbal hallucinations—the internal voice
—and that this is the condition to the relative frequency of
which Schiile draws attention under the name of pseudo¬
hallucinations.
Special attention is given to delusions of self-accusation.
These S6glas has found not only in true melancholia, but in
recurrent insanity, in folie circulaire, in conjunction with
obsessions, in folie du doute % in senility, in alcoholism, in
primary mental confusion, in acute paranoia, and in general
paralysis.
The existence of acute paranoia is maintained. It is
again subdivided into two forms—the simple and the hallu¬
cinatory. Transition to acute confusion is admitted.
Delusions of negation {syndrome de Cotard) form the sub¬
ject of a lecture.
Several lectures are devoted to systematised insanity,
paranoia, and especially to delusions of persecution. These
chapters are lucid, picturesque, and full of clinical acumen.
The description of the method of examining the persecuted,
often so difficult, is excellent. The contrast between the
centrifugal and divergently radiating mode of thought in
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the melancholiac and the centripetal convergently radiating
mode in the persecuted is well worked out. “ There is a
profound difference between the litany of the melancholiac
and the romance of the persecuted. Magnan’s fanciful
division of insanity of degeneration from chronic delirium
and fanciful description of the latter affection find no sup¬
port from S£glas. He does not think that logic has much
to do with the formation of insane delusion. “It is very
difficult to admit in view of the complete identification of
the patient with his insane conceptions that the latter are
only the result of abstract reasoning. To bring about such
ineradicable conviction they must have roots much deeper in
the essential nature of the individual personality; they must
attach themselves to an entirely earlier system of intellectual
and emotional states.” As indeed reason never persuaded
any sane man of anything he did not choose to believe, how
are we to imagine that it would have more power with
lunatics? even though the litigious paranoiac is the most
“ logical ** of all creatures.
Two chapters of great practical value are devoted to a
description of the morphological examination of lunatics
and idiots. The author does not allow anthropological
hobbies to run away with him, nor does he generalise on
isolated facts.
A consideration of some senile phenomena, of exalted and
persecutory obsessions, of delusions of defence, of abasia and
astasia, and of certain hysterical troubles, complete the
work, which we can heartily recommend to our readers as a
book of high ability and great clinical value.
PART III.—PSYCHOLOGICAL RETROSPECT.
AMERICAN RETROSPECT.
By C. Hubert Bond , M.D., B,Sc.
Sclerosis of the Cornu Ammonis in Epilepsy. —Dr. W. L.
Worcester ( Joum . Nerv. and Ment. Disease , April and May,
1897) details his experience as to the frequency with which this
lesion is found when systematically searched for, and discusses
its relation to the pathology of epilepsy. He prefaces his own
observations by a summary of previous ones, dating from those of
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170 American Retrospect. [Jan.,
Meynert in 1868. From these it would appear that the pre¬
ponderance of authority is in favour of the view that the lesion in
question is a result rather than a cause of the convulsions observed
during life. Worcester’s experience is based upon the appearances
presented by the brains of forty-three epileptics, which he
examined at the Arkansas and Danvers Asylums. In only nine¬
teen of these was there an absence of any gross cerebral lesion.
The one under consideration, namely, sclerosis of the cornu
ammonis, was present on one or both sides in twenty cases, in
eleven of which no other abnormality was found; while in nine
it was accompanied by other and more extensive lesions which he
believed had a common origin with it; and this association
appeared to him to throw light on the nature of the connection
between it and convulsions. Of these associated abnormalities
the most frequent he found to be microgyria of an entire hemi¬
sphere. The histological characters of the diseased cornu
ammonis seemed to have been remarkably nniform, and con¬
sisted of a general sclerosis, involving destruction of the neurons
having their origin in the stratum pyramidale and nucleus
fasciffl den tat®. Such a condition the writer failed to note in a
series of over a hundred and fifty brains of insane patients, save
in those of epileptics. Exception, however, must be made to this
generalisation, for the case of a patient dying subsequently to the
printing of this monograph. It was that of a general paralytic in
whom there was no history of epilepsy, nor had he suffered at all
from convulsions; yet after death changes were noted identical
with those above described. Still, the frequency of this condi¬
tion in epileptics and its great rarity in those not subject to this
disease, would seem to place it beyond the pale of mere coinci¬
dence. The question is whether the epilepsy causes the anatomical
changes or they the epilepsy. The chief reason why the former
view is held by the majority appears to be due, rather to the im¬
probability of this con volution, from anything that is known, having
any special relation to epilepsy, than to any definite theory as to the
way in which epilepsy could bring about such changes in a single
convolution. The writer himself would rather lean to the sup¬
position that the condition of the cornu ammonis is the cause of
the convulsions. In support of this view, he cites the fact that it
is known that a cicatrix of the cortex may act as a focus of irrita¬
tion, and gives references of evidence proving that irritation of
the temporal lobe may excite convulsions. He does not wish it
to be understood that he believes in this convolution having any
special prerogative in this respect, but rather that a scar in any
part of the cortex may have such an effect. Neither, also, would
he assert that all epilepsies originate in any part of the cerebral
cortex, for the certainty that epileptiform convulsions may be due
to peripheral irritations and to toxsemic conditions is too clear.
Tactile Amnesia and Mind Blindness .—Such a case is recorded
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1898.]
(Joum. Nerv. and Ment. Disease , May, 1897) by Dr. C. W. Burr as
occurring in an apparently healthy woman of sixty years of age.
Her mother and one brother had died of some paralysis, and her
father in a fit. The onset of the affection was sndden, for, while
the patient was sitting at supper, her vision began to fail and
decreased so rapidly that at the end of two days she could not
distinguish objects at all. A numbness of the upper lip and
slight frontal headache were also at the same time complained of,
but these rapidly passed off. Spontaneous speech was normal;
she understood all that was said to her and replied coherently,
but she appeared to be dull and apathetic, and exhibited a certain
amonnt of congenital stupidity. Examination of her eyes failed
to elicit any cause for the poor vision complained of. As a matter
of fact, however, she conld see well enough to walk and avoid
obstacles, though there was a slight impairment-noticeable in her
gait. She could also tell when an object was placed before her,
bnt entirely failed to recognise what it was, its shape, or its
colour. For instance, in answer to a question as to whether
a pair of scissors, placed in her hand, were a knife, she
replied, “ Yes, because it feels sharp ”; and again, she was
entirely unable to recognise a watch placed in her hand, but
immediately it was held to her ear she said “ It is a watch;
I hear it tick.” She could button her clothes, but if handed
a loose button did not know what it was. Touch, pain and
temperature senses appeared to be normal in the arms, legs,
and face, and she could localise sensations correctly, her failure
being the ability to identify by touch even familiar objects.
Taste, smell and hearing were also normal. The writer adds some
remarks upon the extreme rarity of the loss of tactile perception,
as manifested in this case. Her condition, he says, seems to be a
memory loss, a partial amnesia. There is the possibility, however,
that her tronble may be in grouping together the many sensations
received from one object by touch ; the making of them into one
whole, rather than in the loss of old mental images with which
the new are in health compared. Burr would assume that there
is some definite area of the brain concerned with tactile mental
images, but that its location is as yet questionable.
The Aim of Modem Education. —This is the title of a forcible and
commendable article ( Appleton's Popular Science Monthly , Aug.
1896), from the pen of Dr. Hanford Henderson, a perusal of
which would well repay those engaged in the cares of education.
A school, he says, is a tool, and his contention is, that the present
methods adopted in the majority of them are not basal enough—
they tend towards the solving of minor riddles, leaving the ques¬
tion of the sort of men and women we wish to produce too much
untouched. The success of the teacher should be measured by
“ the fulness of life that he opens to the children,” and gauged in
this way, many, he fears, would be found wanting. The lines in
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American Retrospect. [Jan,,
which their methods are guided are, in his opinion, not psycho¬
logical ; they are too cramped and narrow, and instead of appealing
to and encouraging the emotional side of life, their aim is rather
one of inhibition. Children, he says, are “reservoirs of feeling,
bits of concrete sentiment, bundles of desires/* all of which the en¬
deavour of our schools is too often to crush out. This emotional
life leads to action, and it is this self-activity that is the corner¬
stone to the success of the kindergarten system. Thus, instead of
the thwarting and incessant cry of “ Don’t *’! what is required is
the encouragement of these emotions and desires and their guidance
into the most wholesome channels, so that the activity may spend
itself along the most hopeful lines. What the teacher should most
dread is the child devoid of feeling and desire, the quiet little
mouse whom some would hold up as a pattern ; it is the trouble¬
some child, full of action and desire, that is really the most pro¬
mising. As to the teachers themselves, they should be selected not
for mere knowledge alone, they must neither be bookworms,
artisans, nor fragments of any sort whatever, but earnest men and
women, the “ very flower of the race, to whom nature and
circumstances have been kind, who have caught sight of the vision
of the complete life, and who would make this vision prevail.”
The Phenomena of Inhibition .—In a most suggestive paper (State
Hosp. Bulletin , April, 1897) Dr. Onuf puts forth a tentative ex¬
planation of some of the phenomena of inhibition on a histo-
physiological basis, including a hypothesis concerning the functions
of the pyramidal tracts. He expresses his belief in Joseph FrankeFs
recently stated views upon absence of the knee-jerk, in which he
maintains that the simple spinal reflex arc is not alone sufficient
for the production of the knee-jerk. A second arc is required,
consisting in a set of vertical ascending and descending cerebellar
neurons, which connect the simple transverse spinal reflex
arc with the cerebellum. Also that clinical facts en¬
force the conclusion that the cerebellum exhibits a tonic
influence upon the motor anterior horn cell, which is in response
to, and maintained by means of, those pathways which convey the
sensory impressions from the muscles, tendons and joints to the
cerebellum. Many physiological facts can only be explained on
the supposition of some inhibitory nerve apparatus; such a
mechanism is ascribed to the fibres forming part of the pyramidal
tracts. But, although the theory of inhibition has frequently been
applied to explain, for instance, the exaggeration of the knee-jerks
in lateral sclerosis, no one, Onuf believes, has attempted to give
an idea what manner of connections must be postulated either for
excitation of a given neuron or to facilitate inhibition of the action
of such a neuron. The theory he wishes to offer is, in his own
words, thus:—“ For the excitation of a nerve cell, the nerve
current has to pass in the direction from the cell-body or its
protoplasmatic processes toward the nervous process; for the
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American Retrospect.
173
inhibition of the cell, the current has to pass in the opposite
direction, that is from the nerve process, or its collaterals, hack to
the cell-body. In other words, to produce excitation of a given
cell, the current must enter this cell from the surface of its cell-
body or of its dendrites; but in order to inhibit or moderate the
action of the cell, the nerve current has to enter the cell from its
nerve process or collaterals thereof.” Diagrams are appended
which make this easier to grasp, and he maintains that the connec¬
tions there portrayed have to a large extent been proven: the
objection, that might be made concerning the peripheral ramus of
the T-shaped fibre of the spinal ganglion cell, could be met by the
results of investigations on invertebrates, which go to show that
it is actually not a nerve process, but the homologue of a proto¬
plasmatic process. Thus the fibres, conducting the tonic innerva¬
tion from the cerebellum upon the motor anterior horn cells, should
so end that their arborisations cling to th e protoplasmatic processes
or to the cell-body of the motor anterior horn cells; and the
terminations of the cortico-spinal pyramidal fibres come in close
contact with those of a collateral of the nerve process of the motor
anterior horn cell. Onuf would indeed say that the pyramidal
fibres have chiefly an inhibitory, moderating action upon the
peripheral motor neuron ; at any rate the investigations of others,
he says, show there probably must be at least one other motor path¬
way besides the pyramidal tract—thus, he would compare the
function of the latter to that of a rheostat in the application of the
galvanic current. In testing the knee-jerk, the peripheral motor
neuron, then, is acted upon from three directions:—From (a) the
peripheral sensory nerve fibre, probably through a collateral
thereof; ( b ) the cerebellum; and (c) the cortico-spinal fibres,
which have an inhibitory action and thus counteract (a) and ( b ).
Assuming this to be true, interruption of the cortico-spinal
pyramidal fibres would give rise to exaggerated knee-jerks, by
loss of the inhibitory influence; while interruption of the cerebello¬
spinal motor tract would result in absolute loss of the reflex,
because the sensory stimulus coming from the tendon will be
entirely counterbalanced by the inhibitory action of the pyramidal
fibres.
GERMAN RETROSPECT.
By William W. Ireland, M.D.
The Effect of Poisons on Nerve Cells. —Nissl gave a demonstration
of the result of his researches to the meeting of German alienists,
held at Heidelberg, 18th September ( Centralblatt fur Nervenheil-
kunde , October, 1896). He thinks it useless to discuss the question
how far the nerve cell which we see under the microscope resembles
that in the living organism; but he aims at having a pattern or
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174 German Retrospect. [Jan.,
typical cell not altered by our treatment. For this purpose the
animal should be killed in a particular manner, and the prepara¬
tion always made in the same way. Then any deviation from the
pattern cell must be owinjj to some other causes. In this way he
has studied the changes in the large motor cells of the anterior
horn of the spinal cord of the rabbit after administration of
strychnine, veratria, arsenic, alcohol, phosphorus, and the toxin of
tetanus. He had also studied the motor cells and the cells of Pur-
kin je and those of spinal ganglia of the rabbit after giving lead,
the cells in the sympathetic after poisoning by arsenic, and the
cells of the cortex of the same animal after poisoning by alcohol,
morphia, and lead. He had also studied the cells in the human
brain in a case of poisoning by phosphorus and typhus fever.
Nissl’s method is to give the animal sufficient doses to maintain a
toxic effect without ending life. He compares the cell thus acted
upon with a healthy cell from the same locality. He has found
that after the action of these poisons the effect is not uniform in
all the nerve cells; some are more affected than others, while
different cells are affected through different poisons. He observes
that in some the nuclei are altered, becoming rounder and more
homogeneous and take a deeper colour. Dr. Nissl gave twenty-four
illustrations of his preparations coloured in his own methods; he
also demonstrated the various kinds of nerve cells and pointed out
the relation of different species of cells in the nervous centres of
vertebrate animals to the different functions. He thought that
with the help of a more thorough clinical and psychological
analysis we might hope yet to find out the function of different
cells in the nerve tissues. He observed that when there are
marked alterations in the nuclei, the cells can no longer be restored
to their normal functions. Hitzig observed that in tetanus there
was found vacuolisation of the nerve cells on dyeing with carmine;
but Nissl holds these vacuols to be an artificial product.
Micro-Photography .—Tromner gave to the South-West German
Psychological Association at Karlsruhe (AUgemeine ZeiUchrift filr
Psyehiatrie , lii. Band, 6 Heft) a demonstration of the pathological
changes in the nerve cells. He showed the great advantage of
micro-photography over the subjective coloured drawings which
sometimes illustrate monographs and text books. The photogram
is objective, lends itself to no theories, is convenient for measuring,
and can be taken in much less time than a drawing. It adapts
itself readily to a series of views which show the successive
changes in nerve cells under pathological conditions. Tromner
showed magnified a hundredfold the appearances in normal and
paralytic conditions. He also demonstrated the changes in the
nerve cells of the dog after poisoning with alcohol and trional,
comparing them with nerve cells in the normal state. The follow¬
ing changes were noted in a dog to whom 120 grammes of alcohol
had been administered in two days. Some change of colour in the
Digitized by L^ooQle
1898.] German Retrospect . 175
spinal ganglia, bat no structural change. The motor cells of the
anterior horns of the cord and of the nuclei of the cranial nerves
admitted of dyeing (by Nisei's method), which they resisted in the
normal state. These coloured cells also showed traces of granular
degeneration. There were also swelling and degeneration of the
cells of Parkinje, and in the pyramids of the medulla there was
degeneration of the processes of the nerve cells. In a dog
poisoned by trional there were noted similar changes in the spinal
ganglia in the motor cells of the anterior horn ; the blue colouring
brought out five granulations. The processes were less affected
than the bodies of the cells. The cells of Purkinje were in part
atrophied with granular degeneration, and also vacuolisation here
and there.
1. It was found to be common in both these kinds of poisoning
that the ganglion cells were scarcely affected in comparison with
the motor cells.
2. Cells comparatively healthy were seen lying near cells
deeply altered.
3. The degeneration was found in many cases to commence from
the foot of the axis cylinder. In poisoning by alcohol the processes,
and in trional the nerve cells were more affected.
The After Dinner Sleep. —Dr. Romer ( Centralblatt fur Nerven-
heilkunde , October, 1896) has observed that after a long sleep the
mental activity remains for some time much less than usual. The
feeling of weariness is so much the greater the deeper the sleep from
which the person has emerged. When the awakened person had
fallen asleep early the evening before, and had slept deeply, the
inertness was not so great as with those who had fallen asleep slowly
and took their rest principally in the morning hours. Romer made
similar experiments on the alteration of mental activity in persons
who went to sleep after dinner, which the Germans generally take
about the middle of the day. He found that the persons experi¬
mented on also fell into two categories. Some felt very heavy
after dinner, soon fell asleep, slept deeply, and generally awoke of
themselves. The others did not feel heavy, were long of falling
asleep, required to be awakened, and then showed a considerable
diminution of mental activity. This was tested by learning off by
heart arithmetical addition and power of selection. An hour was
allowed for the siesta. From this it appears that those who
generally feel heavy after dinner should not resist the inclination
but take a little repose, after which they may expect to be more
capable for work.
On the Problem of Unconscious Estimation of Time. By Karl
Groos ( Zeitschrift fur Psychologic und Physiologic der Sinnesorgane ,
Band ix., Heft 5, u. 6).—Dr. Groos remarks that it is a well known
but hitherto unexplained fact that some persons can estimate with
surprising exactitude a long duration of time without any external
methods of limiting time. This capacity is specially exerted : (1)
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176 German Retrospect . [Jan.,
In fixing the hour by day and, also, if the person accidentally
awakes during the night. (2) When the person awakes to the exact
minnte intentionally, or at a time fixed by custom. (3) After the
post-hypnotic suggestion that he should do something an hour or
so after awaking. Dr.Groos quotes the following anecdote regard¬
ing the calculation of time in animals. Mr. Thomas Geering
stated that a number of geese in a small town in England came
regularly every fortnight after the market to pick up the corn
spilt on the street. Once, the market day being postponed, they
came on the regular day as usual.
In the effort to explain such facts one thinks of all the outer
distinguishing marks which could work unnoticed, of the difference
in the light, on the peculiar external signs of public and home life
to the different times of day, and on the different days of the
week. In this way one can easily understand why a cat returns
from her wanderings exactly at meal times ; why a dog waits for
his master at the night hour at his office, or remarks when it is
Sunday; why a man awakes at the usual time.
Many little outward marks of time are associated with the act, so
that they may serve as unconscious measures of time. However,
there are cases where snch explanations are insufficient. He quotes
Munsterberg, who says, “ that probably in calculation of time of
long duration the rhythm of our breath plays its part." Dr. Groos
quotes the case of a lady who was certain to awake at a given time,
if before going to sleep she repeated aloud “ one, two, three, four,
etc., o’clock I will sleep." If this be correct, we have here an
experiment or act along with auto-suggestion, which divides the
whole series of time into short rhythmic periods. Dr. Groos
mentions a case which seems shut out from all those means of guess¬
ing time by outward signs. In the Gartenlaube of 1860 there is a
story about an orang-outang which had been captured in Sumatra
and was kept on board ship during a voyage to Europe. He always
slept twelve hours, and his going to rest and awakening were
punctual as the clock. As Sumatra lies on the equator, his going
to sleep and his awakening were timed by the setting and rising
of the sun; but sailing westward and southward the ship lost
time. It was noticed that the ape went every day sooner to bed,
and as he slept twelve hours he got up so much earlier. When
the vessel reached the meridian of the Cape of Good Hope the
orang went to sleep about 2 p.m., and rose at 2 o’clock in the morn¬
ing. We are told that he kept this time as long as he lived (how
long this was is not said), although the time differed by two hours,
for oy correct geographical time the ape should have gone to rest
at noon, as the difference of sunset between Sumatra and the Cape
of Good Hope is six hours. Thus though the inward valuation
of time shown by this ape was not quite exact, still if we consider
that all the outward signs of the progress of the day were altered,
and the bodily activity of the animal much restrained, it seems
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1898.]
German Retrospect .
177
wonderful how nearly its going to sleep and its awakening corres¬
ponded to the times in its native forests, where the days and
nights are equal.
Dr. Groos comments upon the perception which men have of
traversing a certain distance with shut eyes, which he explains as
an unmarked valuation of the rhythmical repetition of the paces.
This, however, rests upon the perception of space, not of time.
That we have an inborn sense of the lapse of time lies in the
nature of the human mind. Men could only have arrived at the
belief that the rising and setting of the sun recur at regular
intervals from an initial sense of the duration of time which they
compared with their perceptions of the motions of the sun. This
sense of time is more or less exact in different persons; it is
capable of being cultivated by use, and is impaired by the habit
of often consulting watches and clocks.
In opposition to Wundt’s definition that expectation is a con¬
dition in which the active attention is directed not upon a present
but upon a coming impression, or a number of such future impres¬
sions, Dr. Groos states his view that attention is not the con¬
centration of the mind upon a present impression, but always and
exclusively the expectation of a future impression, which will be
answered with a more or less lively reaction. He distinguishes
three principal forms —motor, theoretical, and ©sthetic attention.
In motor attention one awaits the occurrence of an instinctive or
voluntary motion ; in the theoretical form one awaits the coming of
a certain association of ideas, and the ©sthetic form is associated
with the expectation of a burst of feeling which comes into the
front ground of consciousness. The first form is especially related
to the will; the second to the conceptions, and the third to the
feelings.
It seems to me that our natural sentiment of the lapse of time
is also shown by the correct anticipation of sounds which are apt
to recur at regular intervals. After experiencing a succession of
sounds, musical or otherwise, we learn to count upon their recur¬
rence after a certain lapse of time.
THERAPEUTIC RETROSPECT.
By Harrington Sainsburt, M.D.
The Sedative Effect of Calomel in Large Doses .—In an interesting
little book, entitled “ Rough Notes on Remedies,” Dr. Wm.
Murray, of Newcastle, draws attention to the danger of for¬
getting some of our old friends amid the host of new remedies.
Speaking of calomel he instances the great sedative value of
this drug in large doses and the good effects which follow
the administration of ten grains at the outset of delirium tremens
occurring in a robust subject. Such was the practice, he tells us,
XL1V. 12
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178 Therapeutic Betroepect . [Jan.,
of the late Mr. Sep. Rayne. He farther gives his own experience
of the beneficial action of large doses of calomel in states of
maniacal excitement: thus, in one case, an epileptic, suffering from
acute mania, having first by a little manoeuvring got the patient
sufficiently under chloroform, he administered 30 grains of calomel
to him. On returning in two hours he found the patient “ on the
night commode, perfectly subdued, very limp and nauseated. After
much profuse purging and vomiting he became as quiet as a child
and fell into a sound sleep, to awake in a perfectly calm frame of
mind.” In another case “ the patient was a man of immense
strength, and naturally of a ferocious disposition; ” he was in a
state of acute mania, and though secured hand and foot could
scarcely be approached, having bitten his attendants severely. Dr.
Wm. Murray contrived to throw a towel saturated with chloroform
over the patient’s head and to maintain it there until the man was
unconscious. He then administered a teaspoonful of calomel, which
proved to be about 80 grains. The patient became “ nauseated,
subdued, and occupied by his own internal sensations, and ere long
his fury entirely left him.” The patient was then removed to an
asylum and made a good recovery. Dr. Murray thinks that the
“ nausea peculiar to calomel ” is most valuable in these cases, also
that the action upon the disordered secretions generally present
in these cases is most beneficial. These are the remarks of a prac¬
tical man.
A Case of “ Delirium Tremens Paraldehydicum ,” reported by
Dr. G. Reinhold. Therapeutische Monatshefte , June, 1897.—The
writer refers to V. Krafft-Ebing’s original case, to which he
gave the above title in a paper read at a medical meeting in
Steiermark in 1887; also to two other cases discussed by Krafft-
Ebing, one a neurasthenic who took daily 35 grammes of
paraldehyde, the other a woman who was treated for the chloral
hydrate habit by paraldehyde, and eventually substituted this drug
for the former. The latter patient was found to be taking at least
40 grammes pro die. Jastrowitz’s case recorded in the Deutsche
Med. Wochensch. for 1889 is the only other one which Dr. Reinhold
has been able to collect; in this case, besides a daily dose of 6
grains of morphine, paraldehyde was taken to the extent even of
30 grammes a day.
Dr. R. proceeds to describe his own case admitted under the care
of Prof. Emminghaus at Freiburg.
The patient, a gentleman, ©t. 41, whose father had not been
quite normal mentally, but who gave no other history of psychosis,
had acquired the habit of taking paraldehyde for sleeplessness
caused by business worries. Before admission he had latterly taken
as much as 60 grammes daily.
On admission the patient showed marked physical weakness,
but he was very conscious of his state and anxious to be cured :
his speech was somewhat syllabic and stumbling. There was
Digitized by L^ooQle
1898.] Therapeutic Retrospect. 179
general malnutrition with pale earthy complexion. The hands and
tongue were very tremulous; pulse about 90, somewhat irregular.
Sensation was intact; the patellar reflexes somewhat weakened;
Rom berg* 8 symptom present to a slight degree.
Within the first four days after admission and cessation of the
paraldehyde the patient developed an increasing confusion of
thought up to a delirium on the 3rd and 4th days, and in addition to
delusions of persecution and visual hallucinations (cats on the edge
of the bed and sofa) there was marked insomnia. These symptoms
arose in spite of a full alimentation with beer or beer and wine and
a nightly dose of bromide and of trional. From the 5th day on
there was improvement and gradual recovery and the patient was
allowed to leave on the 16th or 17th day.
Dr. Reinhold’s case justifies completely Krafft-Ebing’s nomencla¬
ture, and it is to be recorded that the patient had not been the
victim of any other narcotic drug before succumbing to paraldehyde,
so that the effects are quite uncomplicated. That paraldehyde
should be able to cause a delirious state resembling alcoholic
poisoning is not to be wondered at seeing the close chemical
relationship of the two drugs.
Though paraldehyde is thus shown to be occasionally poisonous
by its prolonged and excessive use, the very largeness of the doses
required to act thus and the rare occurrence of toxic symptoms
prove its comparative safety; this is further borne out by the
readiness with which the poisoning is recovered from. Moreover
cases of poisoning by massive doses are rarely fatal. Lewin, it
seems, reports only one fatal case, and that a typhoid case who
received by mistake a large quantity of paraldehyde. There is also
in proof of its slight toxic action the case which Thomas Mackenzie
records of 105 grammes taken at once with recovery after 34 hours
of narcosis.
A Case of Successful Removal of a large Sarcoma of the Brain.
Qlasgow Med. Journal , April, 1897.—Dr. Eben Duncan and Mr.
Ernest Maylard report this case.
The patient was operated on in November, 1893; his symptoms
had commenced rather more than 34 years previously, and they
consisted of convulsive seizures on the left side followed by numb
sensations and paresis; for the most part the attacks were not
accompanied by loss of consciousness. There was at times a dull
aching pain over the right parietal eminence. An incomplete
specific history was present. Antisyphilitic treatment was pushed
for six months without avail.
On operation a pulpy tumour was found, which it was found
possible to enucleate with gentle pressure by the finger. The
tumour weighed 3oz.; Was oval in form, measuring 3in. by 2Un.;
it was flattened. The microscope showed the tumour to be a
sarcoma.
In March, 1897, i.e ., 31 years from the time of the operation, the
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180
Therapeutic Retrospect .
[Jan.,
patient was in good general health and able to attend to his busi¬
ness perfectly, but the left forearm and hand were rigid and
paralysed, the left faqial muscles paretic, the left foot paralysed,
though the patient could walk “perfectly well.” The fits, which
ceased for a whole year, had then recurred, and in all during the
21 years had been about twenty; they had not shown any tendency
to become more frequent of late.
Mr. Maylard, commenting on the operation, states that in
localising the tumour they were guided chiefly by the convulsive
twitchings of the left arm, but that, as it proved, the site of pain
and of tenderness complained of by the patient in the right parietal
region would have been the better indication. He thinks that a
more immediate closure of the wound without any attempt at con¬
trolling the slight haemorrhage by plugging, would have been the
wisest plan, and that th*is might not have been followed by the con¬
siderable protrusion of brain substance which actually occurred and
to the loss of which the paralytic symptoms which obtained were
due. He further thinks that the slight recurring fits were pro¬
bably due to the cerebral cicatrix formed and not to any recurrence
of the tumour, inasmuch as the fits had shown no tendency latterly
to increase in frequency.
Epilepsy: Its Surgical Treatment; icith Report of a Case. Dr.
F. A. McGrow. Medicine , May, 1897. Detroit, Michigan.—The
surgical treatment of epilepsy is very much exercising the
minds of medical men at the present moment, and in particular the
indications for interference. Many hold that where the disease is
of long standing—we are speaking of the traumatic or reflex form
of epilepsy—it is quite useless to operate, for the long habit will have
so to speak polarised the brain, and the removal of the primary
focus will fail to meet the requirements of the case, since a much
wider area will have taken on the morbid condition. This appears
certainly to be sound doctrine, and its deduction all will allow, viz.,
that interference should step in at the earliest possible period. Dr.
McGrow, however, pleads for interference at all and every stage
provided there be no other contra-indications, or, to quote him, he
says: “ But I am convinced by my own experience and the
recorded experience of others that the element of time should, in
by far the majority of cases, be entirely disregarded.”
Another fundamental of present teaching is that before operating
we should have precise localising, i.e., focal symptoms. Concern¬
ing this Dr. McGrew says : “ And moreover, heretical though it
may be, the demonstration of focal symptoms should no longer be
considered the sine qua non of operative measures. If present and
interpreted properly they offer a reliable guide to the site of the
cortical disturbance ; but if not present there may be other and
sufficient indications for attempting our patient’s relief.”
In a few words the writer may be said to urge that the time limit
is not to be an absolute indication or contra-indication, nor are we
Digitized by ^ ooqLc
1898.] Therapeutic Retrospect . 181
to hold our hands because the finger-posts do not point as clearly
as they might.
We are here in a dilemma, for unless strict rules are laid down
there is danger of careless operating and a discrediting of this
branch of surgery. On the other hand a too narrow observance of
the rules which should help will thwart the very purpose we have
in view, viz., the relief of disease.
The case which Dr. McGrow quotes certainly bears him out.
The disease, traumatic in origin, was of thirteen years’ standing, and
it was of a severe type, the convulsions being at least one daily,
and often many times in the day. Then again the localising
symptoms were very indistinct, not to say confusing.
The operation, undertaken at the earnest solicitation of the
patient, was undertaken at the site of the original trauma, and
without entering into the details of the procedure we may state
that it was entirely successful, and at the time of writing 15 months
had elapsed without the occurrence of any fits. The writer goes on
to say that “ experience has shown that a lapse of three years will
scarcely justify us in claiming that the restoration of cortical
stability is complete. But the interposition of even a fifteen
months' oasis in the monotonous and hopeless desert of these unfor¬
tunate lives is worthy of the conscientious efforts of the surgeon.”
The Nervous and Mental Phenomena follouring Surgical Opera¬
tions. By Harold N. Moyer, M.D.— Medicine , Detroit, June, 1897.
—In this paper Dr. Moyer makes some suggestive remarks upon
the effects of operative procedures and of anaesthesia. He main¬
tains that while in matters of technique, and in particular of
asepsis, we have made immense advances, “ our knowledge of shock
is about the same as it was fifty years ago.” Perhaps this is true
as to the intimate nature of shock, but surely great advance has
been made in the recognition of its etiology and of the means of
avoiding it. For all that the writer is probably correct in saying
that too little attention is paid to “ the nervous states which pre¬
dispose to shock.” He asserts that “ a confident feeling on the
part of the patient in the operator, and the result of the operation
is one of the most important factors in lessening shock andprevent-
ing the unpleasant nervous sequelae which follow.” Hence he
urges the value of suggestion and the hypnotising of the patients
before operation; he also thinks that the bromides may with
advantage be given in a few full doses before operating, or in their
stead alcoholic drinks and opiates. Dr. Moyer will be agreed with
by all practical men when he insists upon the importance of the
mode of giving the anaesthetic ; he throws out a useful hint when he
points to the absence of any data as to the relative influence of
ether and chloroform in the production of shock.
He holds that the nervous phenomena which follow operations
“ often have their foundation in the pre-operative period.” In the
treatment of the neurasthenic state which supervenes on the
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182
Therapeutic Retrospect.
[Jan.,
operation lie lays great stress on the obtaining of sleep, and again
be advocates the temporary use of bromides in large doses of thirty
to eighty grains. The neurasthenia must be dealt with at once.
Among the mental sequelae of operations he enumerates hysteria,
uncommon; mental disorders, such as delirium, mild or severe, the
“delirium traumaticum ” ; certain forms of insanity of the confu¬
sion al type; melancholia, hypochondriasis; “ simple mania and
sometimes paranoia.”
Dr. Moyer opens out a wide field for the patient observer.
True Extension of the Spinal Cord in Tabes. —In the Progres
Medical of May 1st, 1897, there is a report of a communication
by MM. Oilles de la Tourette and A. Chipault on a new method
of spinal cord extension. These authors point out that the older
method of extension by suspending the patient produces only
an insignificant lengthening of the cord, whereas flexion of
the spine, the patient being in the sitting posture with the legs
extended, will lengthen the cord by as much as 1 centimetre, and
almost the whole of the traction will take effect on the posterior
portion of the cord at the level of origin of the first lumbar pairs
of nerves. This statement is based on an experimental and
anatomical study.
The authors then proceed to describe the apparatus of which they
have made use in their clinical observations (for this we must
refer to the Progris Medical ), and by means of which they main¬
tain that the lower limbs and pelvis are so fixed that no slipping
or giving can take place when the application of the extending
force compels the patient to bend the spinal column. This extend¬
ing force is on an average about 70 kilos (154 lbs.), but is not
attained at the first sitting, indeed the patient in his forced
attitude experiences in the dorso-lumbar region a stress which
would speedily become painful if the force employed were too
great. During the first five or six sittings the tolerance increases
up to a certain point, when it becomes stationary. Another
guiding sensation controlling the extent of traction is a sense of
tension in the two sciatic nerves; this itself is the best proof accord¬
ing to the authors that there is a real extension of the cord and
the great nerve trunks of the lower limbs. No danger is to be
apprehended, it is stated, if the position ordered is accurately
attended to; the respiration being unimpeded and the circulation
free. The increase in the tension at the commencement of the
sitting is to be gradual and in like manner the relaxing at the end
of the same . The duration of the sitting will range between 8
and 12 minutes (the last is the maximum duration).
The clinical investigations were upon 47 ataxies, 39 men and 8
women. Selection of the cases is desirable, with exclusion of cer¬
tain cases of tabes of very slow progress, also tabes in the third
stage and cases running an acute course.
The authors maintain that of all methods of treatment of ataxia
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1898.]
Therapeutic Retrospect .
183
flexion of spine is by far the best. Thus in 22 oases,
nearly half, therefore, of the whole number, the patients were
benefited as to all their symptoms. Most notably the pains were
relieved; next in order the urinary troubles, in particular reten¬
tion ; thirdly, impotence was almost always relieved. Of the 22
cases, 12 showed a fairly marked inco-ordination, and of these 10
-showed considerable improvement. The ocular and bulbar
symptoms were but very slightly influenced.
In 16 cases benefit was experienced, but in a more limited
degree and extent, the number of symptoms influenced being
fewer. The remaining 10 cases received no benefit at all. This
compares well with the proportion of unsuccessful cases by the
suspension method, which in the practice of Charcot at the
Salpetriere averaged 35-40 per cent.
The authors advise a sitting every other day—if given every day
the sittings must not exceed 5-8 minutes. They are of opinion
that it is useless to continue the treatment for longer than 3-4
months (40-50 sittings). The treatment should then be inter¬
rupted and replaced by other therapeutic methods.
The Treatment of Perforating Ulcer by stretching of the Plantar
Nerves. Gazette des Hopitaux , April 8, 1897.—In this brief re¬
ference Dr. A. Chipault, of the Salpetriere, reports the treat¬
ment, radical as he says, of perforating ulcer by nerve stretching.
He considers that this form of ulceration is symptomatic, purely,
of a large number of nervous affections, and that to treat it by
a mere dressing on the one hand or to suppress it by amputa¬
tion on the other is in either case to treat it inadequately and
unphilosophically. By stretching the nerves presiding over
the nutrition of the part at fault he considers that one goes to
the root of the matter, and he claims for this treatment that it
will cure permanently the most obstinate perforating ulcers.
Of seven cases which he records, only one was a failure. Dr.
Chipault insists upon a complete removal of the whole of the
diseased surface at the site of the perforation, by a free curetting,
etc., at the same time that the nerve stretching is performed.
Only in this way can a direct union by first intention be obtained.
This topical treatment by itself is insufficient to effect a cure.
A Note on the Phenomena of Mescal Intoxication .—In the
Lancet of June 5th, 1897, Havelock Ellis, editor of the Con¬
temporary Science series, contributes a very interesting experi¬
ment with mescal upon himself. Mescal buttons are the fruit of
the Anhalonium Lewinii, anhalonium being a genus of South
American cactacese. The fruit, we are told, is eaten by the
“ Kiowa and other Indians of New Mexico, and their use .is
connected with religious ceremony,” and its properties have been
recently investigated by Prentiss and Morgan in America and
more recently by Weir Mitchell.
Mr. Ellis’s experiments were made with an infusion of three
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184 Therapeutic Retrospect. [Jan.,
buttons (a full dose, he says), which was taken in three portions
at intervals of an hour. The symptoms which followed were a
passing drowsiness, succeeded by a consciousness of unusual
energy, also temporary and quickly disappearing. Some
heightening of the muscular irritability, a fall in the pulse-rate,
and a feeling of faintness causing a desire to lie down were
then experienced, but not till an hour and a half after the
taking of the third portion of the dose did any visual phenomena
(the most marked among the symptoms described by other
observers) make their appearance. The coloured shadows seen
with open eyes, and the yet brighter kaleidoscopic appearances
which now became prominent are described in detail. The other
senses seem to have shared, with the visual, the mescal effects, and
Mr. Ellis speaks of the air as seeming to be filled with a vague per¬
fume and of the sense of hearing being hypersesthetic, so that he
was *• uncomfortably receptive to sounds of every kind; ” he was
inclined to think that at times he was the subject of faint auditory
hallucinations. Returning to the visual phenomena, he seems to
have been specially impressed by the coloured shadows seen with
open eyes, in particular he refers to the violet shadows which
gave a picture-like effect to the room. He says : “ The violet
shadows especially reminded me of Monet’s paintings, and as I
gazed at them it occurred to me that mescal doubtless reproduces
the same conditions of visual hypersesthesia, or rather exhaustion,
which is certainly produced in the artist by prolonged visual
attention.”
Throughout the intellectual judgment seemed to the experi¬
menter to be unimpaired, though the attention was certainly less
controlled. Mr. Havelock Ellis remarks upon this that one
realises under the influence of mescal how largely attention is a
matter of co-ordination.
Motor inco-ordination seems to have been present to an unusual
degree, and also a sense of thoracic oppression—these, he says,
were the only unpleasant sensations. In summing up he remarks
that the phenomena of mescal intoxication are mainly “ a
saturnalia of the specific senses and chiefly an orgy of vision.”
The psychological interest which attaches to the whole class of
“ vision-breeding drugs ” is evident, though the therapeutic possi¬
bilities of this agent may have to wait for their full development.
Pellotin as a Hypnotic. Fortschritte der Medicin , May 15, 1897.
—From the Anhalonium Williamsii an alkaloid, pellotin, has been
separated by Heffter, which he considers to be the active agent of
the narcotism produced by several preparations in use in Mexico,
and obtained from certain varieties of cactus plants. Experiments
with pellotin were made on 40 patients with doses of 2-5 centi¬
grammes f grain), either injected beneath the skin or given
by the mouth. In several cases the injection of § grain beneath
the skin caused deep sleep within a short period of time. In
Digitized by L^ooQle
1898.] Therapeutic Retrospect. 185
some cases of severe pain pellotin was able to diminish the pain
without, however, causing sleep, but in general there was no
decided anaesthetic action. A pronounced retardation of the pulse
was frequently observed after the exhibition of pellotin.
Desiderius Nagy on the other hand records failure with pellotin
in ten cases of mental excitement. His dosage was from 2-4
centigrammes Q-|. grain). In one case only did he obtain any
sedative action, and in this case it is probable that suggestion
may have played a part.
Langstein, working with the same remedy, obtained in one case
the severest collapse from the hypodermic injection of 1 centi¬
gramme. There followed cyanosis, a thready, almost uncountable
pulse and cold sweating ; the energetic use of stimulants was
needed to bring the patient back to safety.
Accordingly Langstein considers the remedy as by no means
free from danger even when well within the dosage recommended
by Jolly, who as a rule gave doses of 4 and sometimes 6 centi-
K mes hypodermically ( Centralblatt f. Nervenheilkunde u.
xiatrie , Aug. 1, 1897).
Phenacetin Poisoning. Verhandl. des Congresses fur innere Medicin ,
1896, Kronig. —A note of this case, which proved fatal, is given in
the Fortschritte der Medicin , July 1, 1897. The blood state is
specially referred to, and of this it is observed that the red cells
were largely disintegrated and reduced in many cases to mere
droplets of haemoglobin, which either floated freely in the serum
or were enclosed in leucocytes. These latter were for the most
part swollen.
Analgen. —This anti-neuralgic and anti-pyretic is recently
mentioned in the Lancet of May 1st, 1897. In the brief notice
given its chemical affinity to phenacetin is referred to, and also
the theory that it is less toxic than phenacetin because it con¬
tains in its molecule quinoline in place of phenol. Its anti¬
pyretic powers are said to be more controllable because slower or
more gradual in development. Its effect upon the urine is
further noted, viz., the blood-red coloration which is liable to
appear; the administration of bicarbonate of soda along with the
analgen is said to prevent this discoloration.
With regard to the latter statement, it depends perhaps upon the
power of an alkali to change the red colour to yellow when added
to the stained urine (see Helbing, Modem Materia Medica , p. 13) ;
but we would ask whether it is advisable to prevent this staining,
whether indeed this staining may not be an indication of saturation
of the system, and to this extent a warning signal. In any case
what we want to know is whether the alkali administered con¬
trols not a harmless colour change, but an undesirable effect.
Analgen does not seem to make great headway—it is referred
to in Merck’s report for 1892, issued in January, 1893, hut there
is no further reference to it in subsequent reports. Its dosage in
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186 Therapeutic Retrospect . [Jan.,
powder (enclosed in cachets) or in alcoholic solution is 8 grains
some five or six times daily.
The Action of Chlorhydrins. Journal of Physiology , Yol. xxii.,
by C. R. Marshall and H. L. Heath.—This paper is an in¬
teresting contribution towards the solution of the problem of
the relation between chemical constitution and physiological
action. The problem concerns ns all, for it would be an
immense gain if from the chemical formula of a given compound
we were able to give an approximate forecast as to its action
upon the body, or rather, to be not quite so general, if, given
the action of one compound, we were able to foretell the action
of another compound allied to the first named—we all know
what an immense significance attaches to the word allied , particu¬
larly at this juncture.
Drs. Marshall and Heath set themselves to determine the value
of the element chlorine in a series of compounds, the chlorhydrins,
which having the same molecular structure, differ only by the
• substitution of one or more monovalent groupings by one or more
atoms of chlorine. The conclusions they come to are that—
1. “ The introduction of chlorine atoms into a compound of the
fatty series increases its narcotic power.”
2. That 44 it increases also its toxic powers, unless the compound
is greatly changed as regards its physical characters and especially
its solubility.”
3. That 44 the influence on muscular tissue rapidly increases
with each increment of chlorine, and, as far as the chlorhydrins
are concerned, this action runs parallel with their power of pro¬
ducing narcosis.”
4. That “as a result of their influence on muscular tissue the
circulation is distinctly affected. By the higher chlorinated com¬
pounds the heart is more quickly paralysed, and the blood vessels
more markedly dilated than with those in the lower series.”
Now, it is well known that we derive a large proportion of our
an&sthetics and sedatives and hypnotics from the fatty series, and
that one of the drawbacks or dangers attending the administration
of these drugs is this very depressant effect upon the circulation.
If now we are able to attach the toxic and depressant action to a
given element in the molecular structure and can, so to speak,
proportion the danger according to the quantitative proportion
of this element, a great step in scientific therapeutics will have
been taken. As Drs. Marshall and Heath point out, it is no new
idea that chlorine is the element which specially exerts a narcotic
and at the same time a depressant influence. The names of
Richardson, Binz, Mayer, Ringer, and others are associated with
this theory, and the numerous attempts at modification of the
chlorine containing molecule, or at the elimination of the chlorine
atom testify to the belief in the same theory. Hence have arisen the
ammonia and the the amido-modifications of the chlorine contain-
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187
1898.] Therapeutic Retrospect .
ing soporifics, the ammonia and amido gronpings being introduced
to counteract the chlorine atoms. In spite, however, of the much
work done, the chlorine theory cannot be said to be established,
and there are some notable exceptions to the theory which are ill
explained— e.g., the weaker narcotic action of sodium tri-chlor
butyrate as compared with sodium butyrate itself—to this excep¬
tion the authors themselves allude.
The chlorhydrins with which Drs. Marshall and Heath experi¬
mented are bodies which “ may be regarded as glycerine in which
the hydroxyl is gradually replaced by chlorine” with formation
of mono-, di-, and tri-chlorhydrin, and these certainly seem to
show an increasing narcotic action with the rise in chlorine hold¬
ing, but the toxic action did not quite follow this order, for the
di-chlor compound was more powerful than tri-chlorhydrin. This
the experimenters set down to the greater solubility of the di-
chlorhydrin. To a certain extent then these experiments bear out
the chlorine theory of narcotic and toxic action, but proof is still
wanting, and if one might venture to criticise it would be to say
that the experiments recorded are too few.
Morphine Habit of Long-standing Cured by Bromide Poison¬
ing. Dr. Neil Macleod, Brit. Med. Joum ., July 10th, 1897.—
Two very interesting cases of treatment, to say the least
heroic, are here recorded. The first case, a lady aged 32, had
been the victim of the morphine habit for seven years. The
extent to which she had taken this drug is not given, but when
she came under treatment with symptoms of great nervous
irritability she had reduced her morphine to the, for her, very
small dose of 10 minims of Majendie s solntion (gr. £rd) every
four hours. She was ordered bromide of sodium in 30-grain doses
every four hours, but must have trebled this dosage, for in two
days 18 drachms had been consumed. She was removed to
hospital, and for four days received hypodermically 1£ grains of
morphine per diem. On the three following days she had four 30-
grain doses of sodium bromide, and on the second day from this
30 grains of chloralamide, thence on she received no drug6. For the
four days following removal into hospital the patient was quite pros¬
trate, passing urine and stools in bed and making no “ intellectual,
emotional, or volitional effort ” ; upon this ensued a period' of
“ restlessness and intellectual and emotional confusion,” with
delusions, hallucinations, and inco-ordinate speech lasting another
six days. On the 11th day of hospital treatment she could stand
without help; on the 20th day she left hospital feeling quite well.
From that time forwards she has felt no desire for morphine, and
has been quite free from the habit.
The second case was that of a pilot aged 36, who for three or
four years had acquired the morphine habit, and in the summer
of 1896 “ injected 40, 50, and 60 grains a day ” (!) The bromide
treatment (poisoning) was here more systematic, and at the outset
Digitized by L^ooQle
188 Therapeutic Retrospect. [Jan.,
was accompanied by a moderate morphine dosage for some 13 days.
The sodium bromide dose varied between 30-60 grains every
three, four, or six hours, it was then continued for another five
days without the morphine; from that time on no drug of any
kind was given. The patient passed through a longer period
of prostration, delirium, hallucinations, confusion, etc. On April
17th of this year, just over six weeks from the time of admission,
he left the hospital, and 10 days later he left Shanghai feeling
quite well and delivered of his habit.
Dr. Macleod claims for this treatment that it does away with
the suffering of enforced abstinence ; that the patient’s cunning, a
formidable bar to treatment, is circumvented ; that it requires
careful nursing, but no special institution or specially trained
attendants ; that no violence or excitement is likely to result.
ITALIAN RETROSPECT.
By W. Ford Robertson , Jf.D.
The Advisability and Efficacy of Ghirurgico- Gynaecological
Treatment in Hysteria and Insanity. —G. Angelucci and A. Pierrac-
cini (Rivista Sperimentale di Freniatria , 1897, p. 290) have reported
“ the results of an international enquiry ” into this question. The
observation of some cases, in which removal of the uterus and
appendages for hysteria had been followed by violent insanity, and
the want of agreement which they found among the authorities
who had written about the subject, led the authors to undertake
their task. They appealed to alienists, surgeons and gynaecologists
throughout Europe and America for exact accounts of their ex¬
periences, and received in reply a large number of valuable contri¬
butions, for which they desire publicly to express their thanks.
They enquired of each person, to whom their circular was sent, if
during the last ten years he had had any cases in which ablation
of the uterus and its appendages had been practised, with a view
to curing hysterical neuroses; whether in the event of this having
been so, the uterus and appendages had been found healthy or
diseased ; if they had performed this operation in any case of
insanity without manifestations of hysteria; and, lastly, they asked
for a personal opinion as to the advisability and efficacy of such
surgical interference in hysteria.
The authors give a long and interesting analysis of the reports
submitted to them. They have collected accounts of 109 cases in
which ablation of the internal organs of generation was undertaken
for the cure of hysteria or insanity. The result was beneficial in
only 17 cases. The remaining 92 were either uninfluenced or
affected injuriously. Insanity afterwards developed in 44 of these
women, 20 of whom had suffered from hysteria before the opera-
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1898.]
Italian Retrospect .
189
tion, while 24 had not. Other 23, who were insane and hysterical
E rior to the operation, were worse after it. Two, not previously
ysterical, had become so. Finally, 23 who had been in part insane
and in part hysterical, remained in the same state after operation.
The authors are inclined to considerably discount the reports of
the 17 favourable results. They observe that 12 of the cases were
represented as “ cured of nervous disturbances,” an expression
which makes it probable that they were not cases of true hysteria,
or at least not cases of grand hysteria. Further, nine of these 12
were operated upon because of disease of the organs. Of the
remaining five cases, two were reported as having undergone
“ sensible amelioration,” while three were spoken of as showing
“ apparent cure.”
In addition to the reports of these 109 cases, the authors received
accounts of six cases of hysteria which were favourably influenced
by suggestion, through simulation of the operation, and they there¬
fore think that there is strong reason to believe that the improve¬
ment which has been attributed to operation is in many cases
rather the result of suggestion.
There were 76 alienists who sent in opinions as to advisability
of surgical interference in hysteria. Of these 56 were unfavour¬
able to such interference ; 12 declined to commit themselves to an
opinion; five said they were uncertain upon the question ; only
three were in favour of operation. Replies were also furnished by
18 surgeons and gynsecologists, of whom 13 were against operative
treatment, while five were favourable to it under certain con¬
ditions.
The anthers sum up their conclusions as follows:—(1) Ablation
of the normal uterus or appendages is to be entirely proscribed as
a means of cure in hysterical neuroses and insanity. (2) The
existence of hysteria constitutes a contraindication to surgical
operation for the cure of gynaecological conditions. (3) Such
operations are only indicated when there is grave disease of the
organs, and they are to be undertaken independently of any con¬
siderations based upon hopes of eventually benefiting the neuro¬
pathic state of the patient. (4) In cases in which operation is
rendered indispensable by pathological conditions of the generative
organs, one can only hope to favourably influence the neuropathic
state by the operative act through the exercise of suggestion.
(5) After all known means of reputed efficacy for combatting
hysteria have been tried without success, one may endeavour to
influence the patient by such suggestion, by simulating the opera¬
tion of laparotomy.
Condition of the Thyroid Gland in the Insane. —Amaldi (Rivista
Sperimentale di Freniatria , 1897, p. 311) has made a histological
examination of the thyroid gland in 107 cases of insanity and in
22 persons who were mentally sound. He describes a number of
pathological changes which he has found to occur in a much larger
Digitized by LjOoq Le
190
Italian Retrospect .
[Jan.,
proportion of the case? in the former series than in the latter.
He thinks that there is very frequently evidence of a chronic
morbid process leading to atrophy of the parenchymatous portion
of the gland and to alteration or arrest of its function. In 60 cases
out of the 107 in the series from the insane there was evidence of
a more or less grave alteration of this kind, while it was present
in seven out of the 22 cases in the series from the mentally sound.
He believes that this morbid condition of the thyroid gland is a
factor of some importance in many cases of insanity, and therefore
advises that where such thyroid insufficiency seems probable,
thyroid extract be given in small continuous doses, as distinguished
from the ordinary mode of administration in “ thyroid feeding.”
The Treatment of Epilepsy by Hot Air Baths. —The subject of
the relation of epilepsy to auto-intoxication is one that has within
the last few years assumed much importance owing to the results
of the experimental observations which have been made upon it
by numerous workers, especially in France and Italy. It has been
proved that the blood, the urine, and the gastric juice in cases of
idiopathic epilepsy have a greatly increased toxicity about the
time of the occurrence of the fits. It has further been established
that this increased toxicity is not merely a result of the convulsive
seizure but a precursor of it. The general inference has been that
in such cases the fits are produced by the action of the toxines
upon a nervous system which is in some unknown respect congeni¬
tally abnormal and unstable. Various therapeutic measures have
been advocated with the object of preventing the formation or
accumulation of these toxines in the body, such as the free use
of purgatives, diuretics, intestinal antiseptics and washing out of
the stomach. Many important questions suggested by the ex¬
perimental results already obtained are still unsolved. One of the
latest contributions to the further elucidation of the subject is that
of Cabitto (Bivista sperimentale di Freniatria , 1897, pp. 36 and 52),
who has also deduced from his experimental results a method of
treatment which appears to be of considerable importance. This
observer has investigated the toxicity of the sweat of epileptics at
various periods in relation to their fits. He caused the sweat
glands to act by putting the patient into a hot-air bath. The
chief conclusions to which his observations have led him are as
follows: The sweat of epileptics in the prodromal period of the
fits displays a very greatly increased toxic action. Thus while
100 c.c. of sweat from a healthy person injected into the cir¬
culation of a rabbit was not sufficient to kill the animal,
18*5 c.c., and often a much smaller quantity, from epileptics who
were having fits, caused death preceded by convulsions. The
toxic and convulsive power of the sweat increases as the time of
the fit approaches, and diminishes shortly after the paroxysm. At
a distant period from the occurrence of a fit the sweat of epileptics
has no greater toxicity than that of healthy persons.
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1898.]
Italian Retrospect .
191
These observations led Cabitto to give the hot-air bath a care¬
ful and systematic trial as a therapeutic agent in epilepsy with a
view to eliminating the toxines by way of the skin. The patient
was generally kept in the bath for about half an hour. The ex¬
periments were varied in numerous ways, and the treatment was
occasionally stopped in order to ascertain if the natural course of
the disease was really being modified. Cabitto states that the
results of his observations have convinced him that the hot-air bath
is an excellent means of preventing and interrupting epileptic
attacks. He recommends its use whenever the prodromal symp¬
toms manifest themselves. He has observed that the beneficial
result is not merely transitory, and therefore he believes that the
bath has more than a mere diaphoretic action, probably exerting
upon other organs, in addition to the cutaneous glands, an influence
which can see them to eliminate the poison more rapidly. He
does not recommend this mode of treatment as a substitute for the
various measures that have been found of service for the preven¬
tion of auto-intoxication, but on the contrary urges that these
should also be energetically carried out.
A Simple Method of Estimating the Toxicity of the TJrine. —The
fact that the urine of the insane has in general a much greater
toxicity than that of the mentally sound has now been established
by numerous observers. Pelligrini ( Rivista Sperimentale di
Freniatria , 1897, p. 114) has made a series of experiments, which
go to show that the amount of potassium indoxyl sulphate present
in the urine is a reliable index of the degree of its toxicity. An
easy method of estimating the toxicity of the urine in any par¬
ticular case is thus placed within reach of the clinician.
Pelligrini recommends the use of Primavera’s test for potassium
indoxyl sulphate, which is as follows : Pour from 4 to 5 c.c. of
urine into a test tube, and add slowly one-third the volume of pure
concentrated sulphuric acid. Cool the mixture by dipping the end
of the test tube into cold water. Add 1*5 c.c. of pure chloroform.
Mix thoroughly, and then allow the chloroform to settle to the
bottom of the tube. When the salt in question is present in
normal amount the chloroform has a light blue tint. When a
deeper blue is obtained it is present in abnormal quantity, in pro¬
portion to the depth of the^colour. For exact quantitative esti¬
mation he uses Jaffe’s method.
Pelligrini maintains that the increased toxicity of the urine of
the insane is due for the most part to abnormal fermentation
within the gastro-intestinal tract, and he urges that one of the
chief aims that we should pat before us in treating insanity is to
correct any existing disorder of the digestive functions. When
there is evidence of auto-intoxication suitable measures should be
employed to secure proper disinfection of the whole gastro¬
intestinal tract.
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192
Asylum Reports.
[Jan.,
ASYLUM REPORTS, 1896.
Some English County and Borough Asylums.
Berkshire .—Dr. Murdoch gives yet another reason for the rush
of patients from workhouse to asylum.
Now, however, the workhouse authorities are providing more comfortabl®
surroundings for their deserving poor, and consequently a greater trial is im*
posed upon the officials in retaining patients that in any way exhibit the least
troublesome propensity. Of these they quickly relieve themselves by trans¬
ferring them to asylums, unless special accommodation is provided which can
only be done at the larger workhouses.
The Committee make the following statement in their re¬
port :—
This fact compels your Committee to again ask the serious attention of those
Justices who may be called upon to sign orders for the reception of patients into
the asylum to send only such cases as absolutely require asylum treatment.
It is difficult to see how the justices can exercise any discretion,
since medical opinion is the guide as to necessity for asylum
treatment, and even if a justice ignored such opinion, it would
rest with other medical opinion whether the patient remained in
any workhouse to which he might be sent.
Cheshire , Parkside .—Dr. Sheldon gives some extracts from his
report on the alleged increase of insanity which was asked for by
the Commissioners. He sides with those who believe with the
Commissioners. He has carefully examined the figures of the
contributing unions and shows clearly that as far as they are
concerned increase of asylum patients has been accompanied by a
decrease of lunatics in workhouses.
Cheshire , Upton. —This asylum was visited by a severe epidemic
of typhoid fever. The first case was imported from the outside.
Thirty-three cases in all occurred with five deaths. The line of
communication could not be discovered at first, but a patient per¬
sistent enquiry at last ran the fault home to the principal well,
which from repeated analyses was deemed to be above suspicion.
A very remarkable chapter of accidents led to water being pumped,
on each occasion of the engines being used, through a blind branch
of a pipe which conveyed water to the mortuary. The branch
had been disused for thirty years, but the end where it had been
knocked up had become again patent. The water thus freed had
worked back near the well, a long distance, and had been treated
as a spring. As long as no peccant material was introduced in the
circuitous journey no harm arose. But opportunity came for the
S oison to enter this unsuspected circulation, with the results above
etailed. The discovery of such recondite mischief was a matter of
much difficulty and only brought about by logical and creditable
reasoning. It affords another example, if one were wanted, of
the carelessness, often criminal, of leaving disused pipes in situ.
Digitized by LjOoq Le
1898.]
Asylum Reports.
193
Cumberland and Westmoreland .—The different views expressed
about thyroid extract are somewhat bewildering. The following
statement in Dr. Campbell’s report should be compared with Dr.
Macphail’s opinion as given below.
The treatment of cases of insanity by thyroid extract which has been much
vaunted in some asylums, in one described as producing true modern “ miracles
of healing/’ proved a signal failure in such cases as it was tried in here, and so
far as I can discover this form of treatment has not as yet left a marked impress
on the general recovery-rate of those asylums in which it has been used.
The difference also in the recovery-rates between contiguous
districts supplies food for reflection.
It is sad to notice that in Scotland the tendency of the recovery-rate seems
steadily downwards/and this in spite of all we hear as to the extreme advan¬
tages of the separate hospital system and the absence of airing courts. The
average recovery-rate in Scotch Royal and Distriot Asylums for the five years
ending 1884, 1889, and 1894 was 41 per cent., 39 per cent., 38*6 per cent., while
the recovery-rate for 1895 was only 35 per cent.; at Garlands the average
recovery-rate for the 24 years ending 1896 has been 45*6 per cent, calculated
on the admissions.
Derby Borough. —Dr. Macphail writes :
During the year there have been several undoubted cures by means of thyroid
feeding, a form of treatment now generally employed in suitable cases by moat
asylum physicians, and which was first introduced to the profession by re¬
searches carried out in this asylum three years ago.
Of the 18 general paralytics remaining on Dec. 31, no less than
eight were females.
Statistics given show that in eight years of the 276 patients
discharged recovered 36, or 13 per cent., have relapsed—a low pro¬
portion.
Dorset. —Dr. Macdonald reports the birth of two children in the
asylum. In each case the unions to which the mothers belonged
refused to receive the child on the ground that the settlement of
the child was in the union in which it was born, which appears to
us to be a pretty mean way of looking at things. In both cases
the difficulty was got over.
At the end of the report Dr. Macdonald gives a full and most
valuable account of the cost, working and distribution of the
electric lighting system. The former works out at l|d. per unit,
equal to gas at 1 Id. per 1,000 feet. This extremely low figure is due
no doubt to thoroughly sound arrangements in distribution and to
economical use of steam.
Glamorgan. —Dr. Pringle pleads for the institution of a county
fund, in commemoration of the Jubilee, for the purpose of giving
aid to those recovered patients whose homes and circumstances
have been impoverished by their illness. He rightly thinks
that a little help then would do much to obviate the risks of
relapse which may arise in a recently discharged case from such
penury.
xliv. 13
Digitized by
194
Asylum Reports .
[Jan.,
As to the causation of insanity he writes :
The counties that hare the greatest proportion of pauper lunatics to the sane
population are purely agricultural, and it is therefore not an unfair deduction
that potent though drink and fast living are as causes of insanity, stagnation
and intermarrying are still more so.
A point of treatment:
There were also many cases of mania of fierce but short duration, caused by
drinking bouts which had not produced the disorders of the special senses
characteristic of the former class. In all these alcoholic cases we find the
Turkish bath invaluable after the first stage is over.
Hereford .—The year under report was marked by the re¬
tirement of Dr. Chapman, after 26 years of WQrk, with a satis¬
factory pension and with the regrets of his committee and staff.
Mr. Morrison succeeds him.
The Committee have adopted what appears to us a very sensible
way of dealing with the blocking up of the asylum with harmless
dements.
The Committee on October I4th, by special resolution, declared the asylum
to be dosed for the reception of all classes of patients whenever the number of
beds in each division of the asylum, viz., 213 on the female and 187 on the
male side, were fully occupied. This resolution was arrived at after mature
deliberations connected with the overcrowding of the asylum, and the failure of
the Committee to obtain any immediate relief by boarding out cases, together
with the refusal of the various Boards of Guardians to deal with the chronic,
harmless, and incurable cases, which the Committee were of opinion could be
well provided for, in any case, temporarily at the various workhouses. To meet
the convenience, however, of Guardians in dealing with any exceptional and
urgent case a system of exchange has been permitted, which allows of a curable,
acute, or dangerous case being received at the asylum on the removal of a
chronic and harmless case to tne union from which the acute case has been
sent.
London , City of .—Dr. White writes that the success of the
undertaking private patients has exceeded his most sanguine ex¬
pectations. There are now 70 of these. We are pleased to note
that five males and two females were transferred from the pauper
to the private class. Doubtless in all County and Borough
Asylums there are several patients who would pay enough to
become private patients if a quid pro quo were given in the shape
of separate and better accommodation.
Nottingham Borough .—This asylum is now overfull. In anticipa¬
tion of this condition, the Visitors prepared plans for enlargement,
which were duly approved by the Home Secretary. But the
Council have refused to raise the money, and the responsibility for
the trouble which is sure to arise is very properly thrown on it
by the Committee and the Commissioners. The statement of the
Visiting Commissioners that “the wards are clean, bright and
cheerful, the dormitories well looked after,” is quite in accord with
the observations made by those members of the Association who
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Asylum Reports.
195
attended the General Meeting of February, 1897, when the asylum
was visited by the invitation of Dr. Powell.
Stafford , Bumtwood .—The Commissioners say of the new in¬
firmary wards, “ the result is so satisfactory that we hope that an
extension of a similar character will be effected on the male side.’*
They also write:
We saw every patient, and were struck by the quiet and general contentment
which prevailed. Many of the patients spoke gratefully of the kindness they
had received. The dinner to-day was meat pie and potato with bread. Three
hundred and eighty of the patients dined in the general hall, where the meal
was quietly and expeditiously served.
Dr. Spence, as is the Committee, is quite satisfied with the
results of these wards and is glad to be able to say that the male
side is to be similarly equipped. With regard to the character of
the admissions Dr. Spence speaks strongly.
The admissions—297 in number (males, 107; females, 190)—have been of a
very unfavourable type, and do not lend support to the idea which one hears
expressed from time to time, that many people are sent to asylums who have no
business there. Such is certainly not our experience; on the contrary, we find
that patients are frequently not brought here until it is impossible to keep
them outside.
We feel that on the whole he is right, though unquestionably
there must be, from the experience of others, a certain quantity of
old cases which could be cared for in a workhouse if a minimum
of extra attention were accorded. If the 4s. grant had been
available in the first instance for the supply of such extra attention
no doubt there would not have been such a determined rush from
workhouse to asylum. But now the impetus having been given
there is but little hope of stopping it. Asylums have improved
their nursing capacities enormously, while workhouses have lost
from disuse what little nursing power they had.
Sunderland Borough .—It is unfortunate that in a brand new
asylum septic diseases from bad drainage should have appeared.
This has been the case, however, and with serious consequences.
It might be supposed that such an occurrence was preventable.
The Committee gives £2 per annum extra wages for possession
of the Association’s Nursing Certificate. The Mayor presented on
behalf of the Committee a silver watch to Charge Attendant
James Anderson for following a patient who had got on a roof,
run along a ridge and climbed a chimney stack. The patient, who
was a lamplighter by calling, was brought down safely, thanks to
Anderson’s promptitude and bravery, which deserve recording.
Of the 33 deaths, nine were due to general paralysis, and 11
others to coarse brain disease as a principal cause, making 20
together.
Sussex , East .—The result of Dr. Saunders* enquiry into the
alleged increase of insanity—as concerns this county—is “that
the slight but upward tendency which the figures indicate does
not, in my opinion, warrant any alarm at the increase of insanity.”
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196 Asylum Reports . [Jan.,
In relation to the efficacy of hereditary predisposition in causing
insanity he writes:
The part which hereditary predisposition plays in the causation of lunacy is
reoognised and accepted, but tne extent to which it is manifested, even in one
generation, is, of course, not generally known. It may, perhaps, be of some
interest to note the following examples which are now, or have been, in this
asylum; and, in many instances, often repeated. Among these are: a mother
and two daughters; father and daughter; mother, sister and two daughters;
father and son; four sisters; two sisters and a niece; three brothers; uncles,
aunts, nephews and nieces; and, lastly, going to the very root of the whole
question, husband and wife. Showing how inherent the vice of constitution
must be in the progenitor, it is not an infrequent occurrence to find the off¬
spring becoming insane before the parent shows any sign of mental derange¬
ment; and for this reason the link is often missing which would oonnect father
or mother, or both, with insane offspring.
Wiltshire. —In this county asylum population rapidly aggre¬
gates, the numbers on December 31 being, 1894, 719; 1895,
744; 1896, 789. Dr. Bowes can give no special explanation. He
points out that in purely agricultural counties the ratio of sanity
to insanity is highest, Wiltshire standing third on the list. In
relation to causation he remarks :
There is a want of evidence that intemperance in drink causes much personal
and direct insanity in this county, but the evils of parental intemperance are
marked, and the cases arising therefrom more numerous. The possibility of
intemperance in drink being a sign of insanity should not be lost sight of, and
no doubt it is, in many cases, a symptom (the borderland) of such disease.
There are other intemperances which in their evil effects are equally destructive,
but go unnoticed until some crime may expose them or the bad habit necessi¬
tate confinement in an institution. Moral depravity, which exists to a great
and unknown extent in rural districts, is an active generator of insanity, and it
is a sad sight to see the lives of young people and persons in the prime of life
wrecked by such excesses.
Worcestershire. —The Committee have, on Dr. Cooke’s recom¬
mendation, made arrangements for" further rewarding good
service on the part of the staff.
We have found the system we instituted of presenting to both male and
female attendants badges for good conduct to be so much appreciated that,
upon Dr. Cooke’s recommendation, we have further determined, firstly, to
recognise meritorious conduct on the part of those attendants who may remain
in the asylum for a lengthened period by presenting them on leaving with
medals indicating such service and good conduct; and, secondly, to give to
those attendants who have been in the service of the asylum three years, and
who deserve the distinction, a certificate indicating that during that period
they have undergone training in mental nursing, that their conduct has been
exemplary, and that they are considered competent to discharge efficiently the
duties of an attendant.
Some English Registered Hospitals.
Bamvoood .—The epidemic of small-pox which fell on Gloucester,
caused much inconvenience here. The attendants’ leave was
stopped for two months, and no patients were allowed to enter the
town for shopping. The precautions taken were successful in
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Asylum Reports .
197
keeping the disease away. One curious result was that for three
months not a single case was admitted, the friends of patients
appearing to be frightened by the risk of residence near
Gloucester.
The Committee has been able to purchase the Wilderness,
which estate they have leased as a branch for several years past.
Bethlehem. —The new recreation hall has been finished, and is
much commended.
The number of admissions in 1896 was considerably below the
average, as in consequence of considerable repairs to some of the
wards space was much restricted. Nevertheless, the recovery-
rate was over 50 per cent. We note that melancholia provided
twice as many admissions as mania.
Virginia Water. —Dr. Rees Phillips makes some very sensible
remarks on the aspirations of nurses and attendants. Speaking
of changes in the staff he says:
Many of the resignations were due to the efforts which have been made at
St. Ann’s Heath to educate and elevate the nursing staff. There is an in¬
creasing tendency on the part of nurses and attendants who have passed the
examinations and obtained the nursing certificate of the Medico-Psychological
Association to jump at once to the conclusion that they are fully trained, and
quite competent to treat any mental case on their own account. Hence they
join private nursing associations which seem to offer better pay, or set up in
private business. In time many of them will find out their mistake. They will
nave given up permanent employment and pay in an institution, and the almost
certain prospect of a pension, for an immediately larger but often unoertain
salary, and the certainty that in time they will lose their work and their pay.
Wonford Rouse. —Dr. Deas writes about patients’ recreations :
In my last’year’s report I went pretty fully into the question of amusements
and recreation. It is sometimes said that these may be overdone, and cheap
sneers are launched against the idea that medical officers of an Institution like
this are more likely to be successful in their work, and to gain more influence
over their patients, if they are able to take a leading, or at any rate a prominent
part in organising the recreations and the social relaxations of the community.
But of the truth of this idea I am quite satisfied. It has to be remembered,
too, that apart from the recent acute cases, or those commencing to convalesce,
in which much care and discrimination have often to be exercised as to the land
and amount of amusement, there are a large number of patients, more or less
incurable, whose home must be the asylum, and in dealing with whom the
chief aim must be to make them as comfortable, and their lives as happy and
bright as possible.
It is satisfactory to read that there is substantial improvement
in the financial position of this Institution which does so much in
affording assistance to the less affluent members of the middle
classes.
Some Scottish Royal Asylums.
Edinburgh. —Dr. Clouston is able to report that the new Craig
House for private patients is nearly full, and a success financially
and in purpose. With regard to the question of managing the
house, he says:
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198
[Jan.,
Asylum Reports .
It is difficult to combine in a home for the mentally afflicted such freedom
and liberty as we now aim at with such continual observation as is necessary in
certain oases. It is the old story of human progress, order and safety v. liberty.
The faults of the old systems and asylums are seen and remedied, with the
result of the creation of new dangers to some extent. The weak points of
the old East House were so vividly impressed on me that I fully resolved they
should be effectually remedied in Craig House, with the result that other
kinds of risks were run in doing so, and they had to be met by new arrange¬
ments.
The north seems to have been exposed to the recrudescence of in¬
fluenza more than the warmer south of later years. Dr. Clou-
ston’s opinion confirms that which has been formed elsewhere as
to the readiness with which this disease produces melancholia.
This was one of the years, very rare before 1890, but common now, in which
the cases of depression of mind— Melancholia —equalled or outnumbered those
of morbid elevation of mind— Mania. In the seven years 1883-89, the average
number of our cases of mania was 46 more than of melancholia, and in no single
year was there an equality or an excess of the depressed form of insanity. But
in the seven years 1890-96, we have only had a yearly average excess of 18
oases of mania, and in three of these years, beginning with 1890, cases of
melancholia actually exceeded in number those of mania. I believe the ex¬
planation of this change of type of mental disease to be the influenza which
first appeared in this country in 1890, and has never left it since. Probably no
suoh destroyer of nervous energy, and no such produoer of nervous diseases, as
the influenza poison has appeared in the world in recent times. To me this is
the most striking medical fact of my time.
There is an interesting question connected with this production
of melancholia by a definite cause. Does the melancholia replace
mania P or is the extra melancholia an addition to the total amount
of insanity P
Montrose. —The present is the last report to come from Dr.
Howden’s hand as forty of its predecessors have done. Though
his report is matter-of-fact and guiltless of “ retrospect,” or other
evidence of what he had done for the institution, yet the other
entries of the Managers and Commissioners do not fail to express
admiration for his brilliant and abiding work. We note that he
will continue to give advice when wanted as consulting-physician.*
Some Scotch District Asylums .
Lanarky Hartwood .—Dr. Campbell Clark points out an etiological
factor of particular importance and serious significance. It is:
One factor in the production of insanity, not hitherto referred to as of par¬
ticular importance, has struck me as of serious significance. It is the sus¬
picion and moral indifference which characterises the marriage relations on one
side or both. Husbands speak with distrust of their wives, and even more so
wives of their husbands. It is curious that many female patients when asked
their name give the maiden name, and deny or ignore the married. How much
this is due to sexual aversion the result of disease, and how muoh to moral and
social causes, it is at present not possible to determine. We find out afterwards
bits of information that point as much to the latter as the former—drunken in¬
different husbands, wife desertion, etc.
♦ Since the above was written we have heard with great regret of Hr.
Howden’s death. This is referred to elsewhere.—E d.
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199
Asylum Reports.
The Commissioner remarks in his report :
The liberal manner in which the District Board have provided cottages for
the married members of the male staff deserves the wannest recognition. There
are 27 cottages on the Asylum estate, 15 of which are occupied by attendants
and nine by artisan attendants. Of these 18, three are charge attendants, four
are night attendants, and 11 are ordinary attendants. Of the male staff, whose
sole duty is the care of the patients, 64 per cent, are married, and provided
with suitable house accommodation. In providing these cottages the District
Board have adopted a very effioacious means of securing the permanent ser¬
vices of good men, and of thereby promoting the interests and happiness of the
patients.
Roxburgh .—The serious water question which has troubled Dr.
Carlyle Johnstone so long is settled now in principle, and will be
solved practically by the end of the year.
The death-rate has been remarkably low, and a fairly good recovery-rate has
been attained. It should be borne in mind, however, that the best work accom¬
plished in an asylum can hardly be displayed in figures. One may boast, or
one may feel sincerely thankful, that the recovery-rate is high and the death-
rate low, and that no suicide has darkened the last page of the history of the
institution; but the amelioration of the unhappy lot of those who are com¬
mitted to his charge must always be the chief concern of the Superintendent
of an asylum. He only knows how far he has failed in effecting this con¬
summation, even when he publishes his brightest statistical statements.
Egypt
Cairo .—We are very glad to be able to include in our notice the
report of this asylum. To Dr. Wamock’s great honour it is re¬
corded that mecnanical restraint has been abolished completely.
What this means in an asylum where three years ago anything
like enlightened treatment was utterly absent is possibly unknown
by the public; indeed, few of us experts would be able to say from
practical experience. We may claim with confidence that of the
many benefits which English administration has conferred on
Egypt none shine out more conspicuously than the complete trans¬
formation which Dr. Wamock has brought about in a couple of
years in the treatment of its lunatics. This he has done m the
face of many difficulties, chief of which was the ignorance of the
language of each other on the part of the doctor and the atten¬
dants.
Dr. Warnock has found time to work his medical facts for 1896
into tables, many of which follow the lines of our Association. The
recovery-rate is given as 43 per cent. The death-rate was 8*8 per
cent, on the total number, and 17 0 on the average population.
Of 425 admissions 22 men and seven women were general paraly¬
tics. The hasheesh habit accounted for a great proportion of the
admissions, and probably helped the recovery-rate.
Dr. Warnock comments on all matters, and makes suggestions
and demands for improvements just in the style familiar to
Medical Superintendents at home, and we can say nothing that
speaks more strongly for the manner in which he has created ovder
and routine.
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200
[Jan.,
PART IV.—NOTES AND NEWS.
MEDICO-PSYCHOLOGICAL ASSOCIATION OF GREAT BRITAIN AND
IRELAND.
GENERAL MEETING.
A General Meeting was held at the Rooms of the Association, 11, Chandos
Street, London, W. t on Wednesday, 17th November, 1897, under the presi¬
dency of Dr. T. W. McDowall. Present: The President (Dr. T. W.
McDowall), Drs. Hayes Newington (Treasurer), T. Outterson Wood, G. E.
Shuttleworth, J. Peke Richards, R. Percy Smith, Charles Mercier, E. B.
Whitcom.be, H. Rayner, Fletcher Beach, James Moody, W. J. Mickle, G. H.
Savage, Conolly Norman, Crochley Clapham, John A. Wallis, D. M. Cassidy,
R. Biavn, S. Rutherford Macphail, P. W. MacDonald, R. Baker, Walter
Smith fcay, Alfred Turner, James Chambers, H. Stillwell, T. Seymour Tuke,
Herbert Smalley, T. E. K. Stansfield, G. Stanley Elliot, Richard Legge,
A. W. Boycott, W. H. B. Stoddart, Ernest W. White, Maurice Craig,
James Greig Santar, J. E. M. Finch, J. F. Briscoe, W. H. Kesteven, G. E.
Mould, W. J. H. Haslitt, J. J. Rawes A. S. Newington, H. J. Macevoy,
G. H. Johnston, and Robert Jones (General Secretary). The visitors were
Drs. F. W. Binckes, Silvatico, and F. Farris Piper.
The minutes of the previous General Meeting, of May 18, 1897, were read
and confirmed.
The reply to the address of congratulation to her Majesty the Queen was
read by the President, and ordered to be entered on the minutes.
“ Whitehall, 19 October 1897.
“ Sir,—I have had the honour to lay before the Queen the loyal and dutiful
address of the Medico-Psychological Association of Great Britain and Ireland,
ou the occasion of her Majesty attaining the sixtieth year of her reign, and
I have to inform you that her" Majesty was pleased to receive the same very
graciously.
“I hav'e the honour to be, your obedient servant,
“ M. W. Ridley.
14 R. Percy Smith, Esq.”
The following members were elected : William Henry Winder,
M.R.C.S.Eng., L.R.C.P.Lond., D.P.H.Cantab., Deputy Medical Officer,
H. M. Convict Prison, Aylesbury. Robert Stuart, M.R.C.S.Eng.,
L. R.C.P.Lond., Visiting Physician, Newton Hall Asylum, Durham, 20,
New Elvet, Durham. Wilfred Robert Kingdon, M.6.Durham, Resident
Medical Officer, Ticehurst House, Sussex. Llewellyn Harris Liston,
M. R.C.S.Eng., L.R.C.P.Lond., L.S.A.Lond., Assistant Medical Officer, The
Lawn, Lincoln.
Papers were read by Dr. W. H. B. Stoddart, upon “ Some Physical Signs
in Melancholia ”; and by Mr. J. F. Briscoe, upon 44 The Osseous System in
the Insane.” These, with the relative discussions, have been unavoidably
held over for future publication.
SOUTH-EASTERN DIVISION.
The Autumn Meeting of this Division was held at St. Andrew’s Hospital,
Northampton, on Wednesday, 13 October. The following members were
present: Drs. McDowall (President), F. Beach, A. N. Boycott, D. G.
Thomson, N. Rawes, F. H. Edwards, S. R. Philipps, D. Bower, R. Jones,
' J. Bayley, J. H. Bayley, G. E. Shuttleworth, J. Chambers, R. R. Alex-
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Notes and News .
201
ander, and T. 0. Wood; and visitors, Messrs. C. Bayley, C. Dorman, and
the Rev. J. Cunningham. From 11 a.m. till 1 p.m. the hospital and grounds
were inspected. From 1 till 2.30 p.m. Mr. Bayley entertained the members
at luncheon.
COMMITTEE.
At 2.30 p.m. a meeting of the Divisional Committee of Manage¬
ment was held. Present: Dr. McDowall (in the chair), Dr. Bower, Dr.
Thomson, Dr. Boycott, and Mr. Bayley. The minutes of the last meeting
were read and signed by the chairman.
The following report on boundaries was read: “ Your hon. secretary begs
to report that in accordance with your instructions he attended the meeting
of the Boundaries Committee of the Association, when the appended reso¬
lution was passed. Tho resolution of the Annual Meeting, 1$)4, fixing the
boundaries of the South-Western Division, is also appended. Under the
circumstances, he sees no alternative for the South-Eastern Division but
to accept accomplished facts, of which no information could previously be
obtained.—(Signed) Ernest W. White, Hon. Secretary, South-Eastern
Division.”
Copy of minutes of Council Meeting, 18 May, 1897: — 11 The committee
appointed at the last Council Meeting to settle the boundaries of the
Divisions m England and Wales presented the following report : ‘ Your
committee beg to report that, having in view the fact that the boun¬
daries of the Soutn-Westem Division were duly authorised by the
Association in July, 1894, they recommend that the following counties con¬
tinue to form that Division—Hereford, Worcester, Gloucester, Oxford, Berks,
Hants, Wilts, Somerset, Dorset, Devon, Cornwall, Isle of Wight, Channel
Islands, Mid and South Wales; that the following counties should form the
South-Eastern Division—Kent, Surrey, Sussex, Middlesex, Bucks, Herts,
Northampton, Huntingdon, Bedford, Cambs, Norfolk, Suffolk, Essex,
London; and that the following counties should constitute the Northern and
Midland Division—Northumberland, Cumberland, Westmoreland, Durham,
York, Laacs, Lincoln, Leicester and Rutland, Notts, Derby, Stafford,
Shropshire, Warwick, Cheshire, North Wales.’ The report of the Committee
was received and adopted.”
Copy of minute at Council Meeting, 31 July, 1894:—“Dr. Weatherly
proposed and Dr. Morrison supported the application for the formation
of a South-Western Division. This was carried unanimously. The
application was made by thirtv-t^o members, and the counties com¬
posing the Division were Cornwall, Devon, Gloucester, South Wales, Here¬
ford, Worcester, Oxford, Berks, Dorset, Wilts, Somerset, and Hants.”
Dr. Thomson proposed and Dr. Boycott seconded that the place of the
next meeting be the Middlesex Asylum, Wandsworth, on the second or tliiid
Wednesday in April, 1898.—Carried
Dr. Thomson proposed a vote of thanks to Mr. Bayley for so cordially
welcoming the member*. 77iis was carried unanimously, and Mr. Bayley
replied.
DIVISIONAL MEETING.
At 2.46 p.m. the Divisional Meeting was held, Dr. McDowall in the chair.
The minutes of the last meeting were taken as read, and signed by the chair¬
man. A letter was read from l)r. Ernest White (Hon. Divisional Secretary)
stating that after having made all the necessary arrangements with Mr.
Bayley he was obliged to leave Northampton on the afternoon of the 12th,
to accompany his cnairmau (the Lord Mayor Elect) and Visiting Committee
on a tour of inspection of several Scottish asylums; but that Dr. R. Jones
(Hon. General Secretary) would be present, and would kindly undertake his
duties of the day.
Dr. Herbert Smalley, Medical Inspector of Prisons, Home Office, White¬
hall, proposed by Mr. Brayn, Dr. E. W. White, and Dr. T. 0. Wood; Mr.
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Notes and News .
an
Alfred Thomas Oliver White, Assistant Medical Officer (Acting Superin¬
tendent), Metropolitan Asylum, Darenth, proposed by Dr. E. W. White,
Dr. F. Beach, and Dr. A. E. Patterson; and Mr. Gilbert Harry Lansdown,
Acting Assistant Medical Officer, Metropolitan Asylum, Darenth, proposed
by Dr. W. L. Andrieron, Dr. A. E. Patterson, and Dr. E. W. White, were
elected ordinary members of the .Association.
The Chairman stated that the Divisional Committee had accepted the
invitation to hold the next meeting at the Middlesex County Asylum, Wands¬
worth, in April, 1898.
Dr. Fletcher Beach then read a paper on “Insanity in Children.” At
the express desire of Dr. Beach, this paper and the discussion thereon will
not appear until the April number of the Journal. The meeting concluded
with a vote of thanks to Dr. Beach for his interesting paper.
At 6.30 p.m. the members (about twenty) dined together at the Grand
Hotel, Northampton.
NORTHERN AND MIDLAND DIVISION.
A meeting of this Division was held at the North Riding Asylum, Clifton,
York, on 20 October, 1897, Dr. T. W. McDowall (President of the Associa¬
tion) in the chair. Members present: Drs. McDowall, Kershaw, Hitchcock,
Legge, Marieod, Cassidy, Gramshaw, Hearder, Macphail, Mackenzie, Pierce,
Holmes, Baker, Hingston, Percival, David Nicolson, Ray, Johnston, and
Crochley Clapham (Hon. Secretary); and a visitor, Dr. Crawford Watson, of
Harr orate.
Dr. Hingston kindly entertained the members with luncheon at the asylum.
Committee—It was proposed by Dr. Holmes and seconded by Dr.
Hingston, “That the following members be appointed a Divisional Com¬
mittee of Management, viz., Dr. McDowall (Morpeth), Dr. Ley (Prestwich),
Dr. Campbell (Carlisle), Dr. Mould (Cheadle), Dr. Hitchcock (Bootham).
Dr. Percival (Wbittingham), Dr. Macphail (DerbyJ, and Dr. Crochley
Clapham (Hon. Secretary) ”—Carried unanimously.
Proposed by Dr. Holmes and seconded by Dr. Percival, “ That the next
meeting of the Division be held in May, 1898, and, if agreeable to Dr. Mould,
at Cheadle.”—Carried unanimously.
Proposed by Dr. Clapham and seconded by Dr. McDowall, “That May
and October be the months chosen for holding the two Divisional Meetings
in each year.”—Carried unanimously.
Dr. M. B. Ray (Wadsley) read a paper on “Two Cases of Acute Insanity
occurring before Puberty, and showea photographs of the patients. This,
with the relative discussion, will appear in the April number of the Journal.
Dr. F. P. Hearder read a paper on “ Criminal Lunatics in the Wakefield
Asylum.” (See page 64.)
SOUTH-WESTERN DIVISION.
The Autumn Meeting of the South-Western Division of the Medico-Psycho¬
logical Association was held, by kind invitation of Dr. Fox, at Brislington
House, near Bristol, on Tuesday afternoon, October 26. The members
S resent were Drs. Aldridge, Deas, Morton, Sou tar, Bower, Wilson,
IcCutchan, Bullen, Blatchford, Fox, Hanbury, Green, MacBiyan, Lindsay,
Stewart, Manning, Benham, and Macdonald (Hon. Secretary). On the motion
of Dr. Stewart, seconded by Dr. Deas, Dr. Aldridge was unanimously voted
to the chat?.
ELECTION or NEW MEMBERS.
On a ballot Drs. Blackwood and Elliot, Assistant Medical Officers at the
Borough Asylum, Portsmouth, were elected as members of the Association.
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Notes and News.
203
THE PROPOSED SPECIAL PATHOLOGIST FOR THE DISTRICT.
With reference to the proposal to appoint a special pathologist for the
district, Dr. Macdonald reported that the question had been before the
Committee of Management prior to that meeting, and he had been instructed
to report that, “ while the committee were of opinion that the appointment
of a special pathologist for the district would be desirable, they were not at
present in a position to make any recommendation.'* Dr. Macdonald sup¬
plemented the report by explaining the feelings of the committee with refer¬
ence to the proposal.
COMPULSORY PENSIONS.
Dr. Macdonald explained that he had put this subject on the agenda paper
for two reasons—first, to extract, if possible, from the meeting an expression
of opinion as to whether or not there was any desire in that district to
further the objects of compulsory pensions as lately forecasted in a Bill
introduced into the House of Lords, but afterwards withdrawn; and secondly,
to ask whether or not it was proposed to do anything in the matter, or
merely to leave things to drift. Dr. Macdonald said in the first place they
had to thank the present Government for having recognised and adopted
the principle of compulsory pensions for public asylum officers and servants,
They introduced a Bill which was practically a Government Bill, and said
they were to have pensions on the scale of the Poor Law Officers Super¬
annuation Act. Immediately a wild shout went forth about the injustice
of the thing. Now, he happened to know personally that the Lord Chan¬
cellor never meant or wished that, asylum officers or servants should have
pensions according to the Poor Law Officers Superannuation Act. He put
it in so .is to give them the opportunity of moving or having moved for
them the necessary amendments, and he had no doubt when it came up again
this would be done. It would be within the recollection of those in public
asylums that what was known as the Worcester Amendment was sent round,
but since then a more liberal one was actually accepted by the Lord Chan¬
cellor, by Lord Kimberley, and Earl Spencer, and on the advice of Lord
Kimberlev was handed to the Earl of Northbrook, who was put up to oppose
it from the County Councils Association; it was also handed to Earl Bussell,
who was put up by the Iiondon Asylums Committee to oppose it for that
body. The result was that in the speeches recorded in The Timet they
absolutely and completely contradicted themselves. They began their speeches
by saying that the Bill or amendment was unfair to asylum officers and
servants, and finished up, as members would see from the pages of their
Journal, by stating that it was far too liberal. (Laughter.) He had reason
to believe that Earl Northbrook did not now hold tne same views; while
as regards Earl Bussell, there was one fact they should all remember. When,
some eighteen months ago, the asylum superintendents of England and Wales
signed a petition in favour of compulsory pensions, the only superintendents
who would not do so were the four of tne London asylums. He could only
say that if these four gentlemen wished to alienate themselves from their
brother superintendents in their efforts to get what was nothing but justice
and fairness, he thought they should do all they could to try and make it
known that at any rate as a general body they were agreed.” (Hear, hear.)
He had it on the best authority that if they were practically unanimous, or
generally agreed, on the question there was no shadow of doubt but that
tne principle would be acceded to, and fairness generally given to them in
this matter of pensions.
The Chairman invited discussion on the subject, and suggested that their
views might take the form of a resolution.
Dr. Dead moved for the appointment of a small committee to thrash out
the details and formulate a scheme which might be submitted to the next
meeting of their branch, and then, when adopted, put formally before members
of Parfifment or some members of the Government as might be decided upon.
Digitized by
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Notes and News.
[Jan.,
Dr. Benham said he had great pleasure in seconding. What Dr. Mac¬
donald referred to as the Worcester Amendment was placed before his com¬
mittee, and, he was glad to say, obtained its unanimous assent.
Dr. Bower said that when this question was brought up at the Three
Counties' Asylum Committee, of which he was a member, the difference of
opinion which appeared among the medical superintendents was enlarged upon
to such an extent that they simply allowed the Worcester communication to
lie on the table, and did nothing at all one way or the other. He thought
it was most important that this sub-committee should be appointed to con¬
sider the question; but he was not quite sure whether they ought not to
report and do something before the next meeting of the Division, which was
not till April, in order that the views of that Division, as of the Association
generally, should be put into the ltards of the Lord Chancellor before he
revised the Bill, which he was certain to put down for the next session.
Dr. Stewart asked whether Dr. Deas would agree to tack on to his
resolution something to the effect that the Division recognised the great
importance, for the benefit of the public who were treated in asylums, that
a clause should be introduced into the Lunacy Bill for the purpose of grant¬
ing pensions compulsorily to the medical officers and others.
Dr. Deas said he was quite willing to adopt the suggestion made by Dr.
Stewart.
Dr. Macdonald said he did not wish to throw cold water on the suggestion
of Dr. Stewart, but the rules of the Association would not allow them to
do what be advocated. They had no power to pass a definite resolution of
any kind like the one he had outlined. They might pass a resolution to
work up anything in their own district and report to themselves, but not to
hand over anything to the public as coming from their Association. That
must come from the general oody.
The resolution of Dr. Deas as originally moved—“That a small com¬
mittee be appointed to consider the question of compulsory pensions and
report at tne next meeting'’—was then put and carried unanimously, a
committee being straightway formed, on tne motion of Dr. Deas, seconded
by Dr. Souter, consisting of Drs. Benham, Macdonald, Wade, and Deas.
THE NEXT MEETING.
The suggestion of the committee that the next meeting be held either in
Oxford or Cardiff was adopted, after some discussion, the date being fixed
for 19 April, 1898.
THE NURSING REGULATIONS.
The consideration of these was postponed until the next meeting.
LETTERS OF APOLOGY.
Dr. Macdonald said he had received a letter from the President of the
Association, Dr. McDowall, regretting his inability to be preeent. He had
also one from Dr. Weatherly, who had been "suddenly prevented from
attending; and one from Dr. OoodAll. who was to have read a paper to
them, but who had to stay at home in consequence of illness among his
patients.
THANKS TO DR. FOX.
This being the close of the business of the meeting, the Chairman con¬
veyed the warm thanks of the members of the Division to Dr. Fox for the
kind and hospitable way in which he had received them.
On the motion of Dr. Deas a vote of thanks was passed to the chairman
for presiding, and the proceedings terminated.
The members afterwards dined together at the Royal Hotel, and a roost
pleasant evening was spent.
SCOTTISH DIVISION.
A meeting of the Scottish Division was held in the Laboratory of the
Scottish Asylums, 12, Bristo Place, Edinburgh, on Thursday, November 11.
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Notes and News .
205
1898.]
Present: Dr. Urquhart (in the chair), Dr. Lewis C. Bruce, Dr. Carswell,
Dr. Campbell Clark, Dr. Clouston, Dr. France, Dr. Qilmour, Dr. Hotchkis,
Dr. Ireland, Dr. Carlyle Johnstone, Dr. Macpherson, Dr. Middlemaas, Dr.
R. B. Mitchell, Dr. Oswald, Dr. Richard, Dr. Ford Robertson, Dr. Q. M.
Robertson, Dr. Turnbull (Secretary), Dr. N. P. Watt, Dr. Watson, Dr.
Yellowlees; with Dr. Christie, Dr. Findlay, and Dr. Orr as guests. '
ELECTION OF NEW MEMBERS.
Dr. Charles A. Bois, Hartwood, proposed by Drs. Campbell Clark, Beadl*
and Turnbull ; and Dr. William Cotxon, Bishopston, Bristol, proposed by
Drs. R. B. Mitchell, Clouston, and Turnbull, were declared duly elected
members of the Association.
THE NEW LABORATORY.
Dr. Clouston said that the reason why they met there that afternoon was
that their laboratory was now in working order. He had made the suggestion
to the Secretary, thinking it would be interesting for all of them to see it
thoroughly, instead of making a journey from the Physicians’ Hall.
The Chairman said he felt greatly honoured in being called upon to
preside on such an auspicious occasion, and thanked Dr. Clouston for the
invitation.
THE ROS8LYNLEE ASYLUM.
Dr. R. B. Mitchell showed and described the plans of an addition which
is to be made to the Midlothian District Asylum at Rosslynlee.
NOTES OF VISITS TO DANISH AND GERMAN INSTITUTIONS.
Dr. Ireland read part of a paper on his visit to Danish and German
institutions for the care and education of the'feeble-minded. (See page 46.)
The meeting agreed to postpone the discussion of this paper until the next
meeting, when Dr. Carswell is expected to address tne Division on the
subject, with special reference to the Barony Parish of Glasgow.
THE USE OF FORMALIN.
Dr. France showed pathological specimens prepared by the formalin
method. He said that formalin was a name applied to a saturated aqueous
solution of formic aldehyde, H.C.H.O. It was an oxidisation product of
methyl alcohol obtained by passing vapours of the latter mixed with air
over the heated surfaces of copper, silver, or platinum. This aqueous
solution could not be concentrated beyond 40 per cent, without decom¬
position. Formalin liad the chemical property of converting organic
gelatinous and albuminous materials into inert insoluble substances. It
was this property that made it so useful a fixing agent in pathological work.
Orth was one,of the first who, in the Berliner Klinisehe Woehensehrift on
March 30, 1896, pointed out its value. He advised a 10 per cent, solution
in Muller’s fluid. Tores, in the Centralblatt fiir Allgemeine Pathologie ,
advised a 10 per cent, solution of formalin to which was added Na.Cl. 1 part,
Mag. sulphat. 2 parts, and Sod. sulphat. 2 parts. He recommended that the
solution should btf changed once or twice during two days’ immersion. For
the last thirteen months he (Dr. France) had used a modification of these
methods. It corresponded most nearly to that recommended by Melnikow
Raswedenkow, viz., about 16 per cent, formalin, .1 per cent, of acetate of
potash, .075 of nitrate of potash. The proportion of these constituents
was not of much importance, as the first specimens immersed destroved the
accurate balance, ft was very inadvisable to wash the specimen, fie put
it in at once, and allowed it to remain from twenty-four to thirty-six hours,
according to the bulk of the material that he wished to preserve. For
instance, the intestines required certainly not more than twenty-four hours,
while the lung and spleen required thirty-six. He had used some formalin
for six months without the addition of any fresh, and it worked very well.
The specimens were thereafter immersed in a spirit both of alcohol—80 to
90 per cent.—for from twelve to twenty-four hours. They were then
mounted in glycerine and water, in the proportion of 44 parte of the formei
in 100 of water, and to that was added 3 parts by weight of acetate of
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206
Notes and News.
[Jan.,
potash, to make it diffuse more rapidly. At first the specimens would not
sink, and for that reason be fcund it much more convenient to stitch them
to glass slides as a preliminary measure. In the case of the intestines it
was very important to adopt this plan before putting them in the formalin,
because the formalin rendered them leathery, and they curled up into
various shapes. The advantages of formalin were obvious in preserving the
colour of the specimens as they were when removed from the body without
distorting their appearance. Besides, they could mount the specimens very
rapidly.
Dr. Ford Robertson said that this new method of preserving whole
organs, as described by Tores, had been largely used by several pathologists
in Edinburgh during the past year. There could be no question as to its
great value. Dr. France’s modification appeared to be simpler than Tores*
process, and this, of course, was an important advantage. The preparations
on the table were certainly very beautiful. In the post many valuable
pathological specimens had been practically lost owing to the want of a
satisfactory method of preserving their natural appearance. This want was
now supplied by formalin. The method was one that should be employed
in every asylum laboratory. The question had been raised as to wnetner
these preparations were suitable for microscopical examination. He was
certain that they were. Formalin had great penetrating power, and at the
same time fixed the tissues very rapidly. If a piece of an organ preserved
by this method was placed for a fortnight or so in. a bichromate solution,
it would give a good staining reaction with hematoxylin and eosine. In
the case of nervous tisanes, if a 10 per cent, solution of formalin was used,
and allowed to act for several days before the later stages of the process
were carried out, a good medull&ted fibre stain could be obtained bv either
Heller’s or Campbell’s method without further preparation, or by Weigert’s
method after pieces had been placed for some time in a bichromate solution.
In his experience, however, tissues hardened in formalin could not be relied
upon for the satisfactory study of the chromophile elements of the nerve-cells.
MICROSCOPICAL DEMONS TRATfoN UPON THE MORBID CHANGES AFFECTING THE
CORTICAL NERVE-CELLS IN INSANITY.
Dr. W. F. Robertson said that the series of preparations under the
microscopes were intended to illustrate some of the more important of the
morbid changes which could now be shown to occur in the cortical nerve-
cells of the insane. He had nothing that was really new to show, unless the
morbid,condition seen in one of the preparations from a case of idiocy could
be excepted. The brain from this case showed throughout nearly the whole
of both hemispheres a narrow band running through the layer of large
pyramidal cells, in which the nerve-cells were either quite undeveloped or
had only reached the full-time fatal stage. The first six preparations were
by the aniline black fresh method of Be van Lewis. They showed advanced
pigmentary degeneration in a case of senile insanity, vacuolation of nuclei
and granular degeneration of protoplasm in a case of acute mania, “ghost-
cells, or nerve-cells which remained practically unstained by the aniline
dye, in a case of senile insanity, paucitv of nerve-cells in a case of profound
dementia following acute mama, and tfie imperfectly developed layer in the
case of idiocy to which he had just referred. The degenerative changes
recognisable by this method were no doubt merely phases of the morbid
condition which, as demonstrated by some of the newer staining methods,
was termed "chromatolysis.” The next five preparations illustrated this
cordition. Alongside two examples of nerve-cells showing the chromophile
elements of the protoplasm in tneir healthy state were placed sections from
cases of early general paralysis, acute mania, and acute melancholia, showing
more or iess complete disintegration of these elements, as well as pallor,
distortion, and displacement of the nucleus. From 6 to 10 oer cent, of
the nerve-cells could be shown to be thus affected in such cases. He believed
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Notes and News.
207
1898.]
that this change was directly related to the mental disease. He was satisfied
that it did not occur in the brains of patients dying in general hospitals,
except, of course, in cases in which there had been severe cerebral disturb¬
ance for some time before death. He had found the new methyl violet
method which he had described in the October number of The Journal of
Mental Science of great service for the study of the cortical nerve-cells. It
brought out the small nerve-cells with a clearness that he had been unable
to obtain by other methods. The last five specimens were prepared by
Cox’8 modification of Golgi’s sublimate method, the mercurial deposit being
further blackened by the method of Mirto. They showed alongside two
normal cortical nerve-cells, the condition of varicose atrophy of the proto¬
plasmic processes in two cases of acute mania and one of acute melancholia.
Although this condition undoubtedly in many cases represented a genuine
morbid change in the nerve-cell, he thought that similar appearances in
such preparations were sometimes due to post-mortem change.
The Chairman said he would desire to convey the thanks of the meeting
to Dr. Ford Robertson, and also to Dr. France, for the care with which
they had brought these specimens before the meeting that day. That was
just the sort of work wnich one rejoiced to see, and which was a very
adequate answer to some of their critics.
REGULATIONS FOR THE EXAMINATION FOR THE NURSING CERTIFICATE.
The Chairman said that they had now to consider the proposed amended
regulations for the examination for the nursing certificate. He had one
suggestion upon this subject, which was to the effect that no nurse should
have a certificate till she had passed through the sick ward or the hospital
of the asylum, and had therebv gained practical experience in dealing with
the bodily sick. He hoped that would have the general support of the
Division. One of the criticisms that had been made was that tney certified
nurses and attendants who had never had opportunity of administering an
enema or putting on a poultice, and those of them who had to see cases
in private practice knew that they would be very scrupulous about engaging
a nurse who was so unaccustomed to the care of the sick as to be unable
to do such simple duties.
Dr. Turnbull said that those members who were at Newcastle would
no doubt have seen the report of the Educational Committee, which was
referred for further consideration to the Divisions, to ascertain, if possible,
what their opinion in the matter was, and for the Divisional Secretaries to
report afterwards. He thought it would help their discussion if he mentioned
the principal changes which had been proposed in the regulations. There
was a main one, which was that instead of two years* training the nurse
must now have three years’ training. Formerly the number of lectures
required could be attended at any time during the period of training; but
now a certain number (nine) would need to be attended luring each year.
If he got the opinion of the members on these and other points, he would
be able to report to the secretary of the Educational Committee. He sug¬
gested that tnev should first take up the question of length of training.
Dr. Ykllowlees thought that if they put before a woman who was
ambitious to be a good nurse that she would need to wait three years till
she got her certificate, they would deter some of the best women and drive
them from the service. It was for that reason that he had some doubt about
a change so serious. It was the universal experience, he thought, that a
nurse who intended to devote her life to asylum work either studied for
about eighteen months and then went away or stayed permanently in the
institution. He thought that the suggested period was too long.
The Chairman thought that the three years’ course was necessary to bring
them into line with the general hospital training.
Dr. Yellowlees said that he also had thought it was needful for that
purpose, but he had found that it was not. Ho was pleased to find Dr. Wood,
who took so much trouble in the matter, saying that it was not necessary.
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208 Notes and News. [Jan.,
Dr. Clouston concurred with Dr. Yellowlees’ views that they had not
got to that point at which they could extend the period to three years. It
was too much to expect that a nurse would spend three years in an asylum
and three years in a hospital before she was fully qualified for every kind
of work. As regards the lectures, he would certainly approve of their being
spread over two or three years, to prevent the cramming system. He thought
that every nurse should pass through the hospital before she was examined.
Dr. Carlyle Johnstone said he rose to support strongly the three years’
period. He disagreed with Dr. Yellowlees that it would deter the nurses,
and he thought it would have the effect of making them more competent.
There were a good many nurses who took the certificate and were not a
credit to the Association or the service of the public. He thought that there
were other reasons for urging the three years 1 course as a compulsory matter
instead of two. He did not think that in any ordinjury sized asylum they
would be able to give their nurses the real practical training that they
required within two years; it would take at least three years to do it. It
was quite impossible to put them through the hospital in two years, and
he moved accordingly.
Dr. Campbell Clark said that he was very glad to hear Dr. Urquhart
speaking about the practical part of the training. He had been, in season
and out of season, speaking and writing about the unsatisfactonr nature
of the examination and what he would call the utter valuelessness of the cer¬
tificate, and what Dr. Urquhart said just emphasised what he wanted to say—
that he would find many with the certificate who had never given an enema
in their lives, who did not know how to make a poultice, and who knew
very little about hospital work ; and if they were sent to private cases
they would assuredly disappoint the doctors in charge of these patients.
With reference to the three years’ course his mind was perfectly open. He
did not feel strongly as regards two or three years, but he felt that the
training should be very much more thorough, less ornamental, more prac¬
tical, and more useful, and he held that the system of examination should be
altered to this extent, that there ought to be a syllabus of practical examina¬
tion as well as a written examination.
In answer to Dr. Clouston, Dr. Yellowlees said that the British Nurses*
Association were prepared to register the Medico-Psychological certified
nurses with the training they had.
Dr. G. M. Robertson seconded Dr. Carlyle Johnstone’s motion for three
years. There were a great many who came for two years, got the certificate,
and left the asylum not so well trained as they might be; and as to Dr.
Clouston’s statement about spending six years in getting a hospital and asylum
training, it was not necessary for hospital nurses to remain three years
till they got a certificate: they got it after a year.
Dr. Macphbrson asked if it was necessary that they should attend the
same lectures during each of the three years.
The Chairman said that they had better keep to the motion, and he would
now take the vote.
Dr. Carlyle Johnstone said if it was to be a matter of taking a hurried
vote he would move the adjournment of the discussion to a future date, as
to which Dr. Yellowlees concurred.
Dr. Turnbull said that at the next meeting they could make arrange¬
ments to allow of this discussion. One proposal was three years against
two; another was lectures every year; and a third point was the system
of examining the papers—instead of having them examined by the Super¬
intendent and Assessor, that they should be examined by two Examiners
appointed for the purpose, and that the whole of the papers over the country
should go to the two Examiners. If that was done, it meant probably that
there would be a little more expenditure in getting it carried out, and con¬
sequently that the fee should be raised from 2s. 6d. to 5s. A minor point
was that each lecture must last an hour.
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Notes and News.
209
1898.]
On the suggestion of Dr. Yellowlees, the Chairman asked Dr. Carlyle
Johnstone to add to his motion for adjournment that Dr. Turnbull should
place on the agenda paper all the different points for discussion at the
Glasgow meeting on the second Thursday in March.
Dr. Carlyle Johnstone said he would be very glad to do so, but they
had been memorialised by the Convener of the Handbook Committee with
regard to the Handbook; and if they did not take any action now it would
be too late, because that committee met in a few days, and lie thought some¬
thing ought to be said about it.
The Chairman thought that they could hardly take up that matter with¬
out notice of motion.
Dr. Carlyle Johnstone said that they had got a notice of motion. They
were invited to come there and give their views about the Handbook.
Besides, as it occurred in the regulations, he thought it came up for discussion
tliat day, and therefore they ought to have a special meeting on an early
date.
The Chairman said that it had been moved by Dr. Carlyle Johnstone
that they should have a special meeting for the consideration of the regula¬
tions for the examination for nursing certificates, including the Handbook.
This was agreed to nem. eon., and the matter was remitted to Dr. Turnbull.
By the kindness of Dr. Clouston tea was then served, and the Laboratory
was inspected by the members present and these visitors: Dr. Batty Tuke,
kSenior (President of the Royal College of Physicians), Prof. Cru.n Brown, Prof.
Simpson, Prof. Greenfield, br. Sibbald (Commissioner in Lunacy), Dr. Wyllie,
Dr. Affleck, Dr. Berry Hert, Dr. Russell, Dr. Gibson, Dr. Philip, and Dr.
Bcddie. An apology for absence was received from Sir Thomas Grainger
Stewart.
The Chairman then moved a vote of thanks to the Committee of the
Laboratory of the Scottish Asylums for their kindness in giving them the
use of the rooms, and to Dr. Clouston for his hospitality, and the meeting
then terminated. The members afterwards dined in the Palace Hotel.
ADJOURNED MEETING OF SCOTTISH DIVISION.
The adjouined meeting of the Scottish Division was held in the Royal
College of Physicians, Edinburgh, on 27 November. 1897. Dr. Urquhart
was in the chair, and there were also present Drs. Campbell Clark, Carlyle
Johnstcne, Macpherson, Middlemass, G. M. Robertson, Rutherford, Watson,
Watt, Yellowlees, and Turnbull (Secretary). In accordance with the remit
from the Annual Meeting of the Association, the Division took into con¬
sideration the report of the Educational Committee giving the proposed
amended regulations for the nursing certificate. Considerable discussion took
place, and it was agreed to submit the following suggestions to the Educa¬
tional Committee: 1. That the minimum period of training should be fixed
at two years. 2. That Rule 3 should (consequent on the preceding sugges¬
tion) be deleted. 3. That section a. of Rule 5 should read—“ Systematic
lectures, in addition to the practical demonstrations provided for below, by
the medical staff,” etc. 4. 'That sections b. and e. of Rule 5 should be com¬
bined, and should read—“Clinical demonstrations of mental and bodily
disease, and practical instruction in sick nursing and in first aid, to be given
by the medical staff. At least twelve demonstrations, each of one hour’s
duration, must be given in each year of training, and no attendant will
be admitted to examination who has not attended at least nine demonstrations
in each year.” 5. That the last clause of section e., Rule 9, should read—
“The written questions being confined to subjects included in the Hand¬
book.” 6. That in the written examination the maximiim of questions tQ
hit. 14
Digitized by
210 Sates ana News. [Jan.,
be answered shall be six, and the minimum time allowed for answering
three hours.
As time did not allow of the other proposed changes in the regulations
being consideied, it was agreed to adjourn the discussion to the next meeting
of the Division.
BRITISH MEDICAL ASSOCIATION.
The Annual Meeting of the British Medical Association, held in Montreal,
proved an unqualified success as regards the scientific work and the
hospitality shown to the guests. The Psychological Section was fairly well
attended. Amongst those present from various parts of Canada were Drs.
Bucke, Clark, C. K. Clarke, Burgess, Hobbs, Russell. Vallee. Wilkins,
Anglin, Villeneuve; the United States were represented by Drs. Cowles.
Dewey, Brush, Steams, Crothers. Rohe. Spitzka. Van Gicson; and Drs.
Alexander, J. A. Campbell, J. G. B. Blandford, Hazlitt, Blair, and Urquhart
represented British psychologists.
MENTAL EVOLUTION.
The sectional meetings were opened by the President, Dr- R. M. Bucke,
of the London Asylum, Ontario, who gave an address upon “ Mental
Evolution in Man.” He claimed that there are two processes in the
evolution of mind—the perfection of faculties already in existence, and the
springing into existence of faculties which had previously no existence. Dr.
Bucke traced mental growth from mere excitability, through discrimination
to sensation with the capacity of pleasure and of pain; later still memory,
recognition of offspring; and successively thereafter reason, recognition of
individuals and communication of ideas. He placed the mental plane of
the- higher animals as equal to a human being at two years of age. There¬
after, for about a year, that mental expansion occurred which separates man
from the higher mammals. This represents to Dr. Bucke the age of the
Alai vs homo , a period of perliaps 100,000 years, during which our ancestors
walked erect; but not having self-consciousness, had no true language.
At the age of three, individual self-consciousness is bom, and from the point
of view of psychology the child becomes a human being. Thereafter Dr.
Bucke considers that the colour sense, the sense of fragrance, the human moral
nature, and the musical sense appear; and to these and self-consciousnees
he specially addressed himself. Re looks upon the last-named as the basic
and master human faculty, which appeared in the race several hundred
thousand years ago. He takes it as proved that the colour sense was
acquired not more than 30,000 years ago. Similarly, he places the era of
individual colour sense at five or six, and the moral nature at fifteen, while
the musical sense is delayed until adolescence, and cannot be more than
5,000 years old in the race. Dr. Bucke finds in the idea of evolution the
mystery of the past, the explanation of the present, and the sure prescience
of the future. His corollaries are, first, that all insane and idiots are cases
of atavism; and, second, that the human mind is still in process of construc¬
tion. Dr. Bucke sees new faculties springing up, and in these he includes
telepathy, clairvoyance, and spiritualism. Finally, he has observed several
men and women who have possessed a new faculty, a higher form of con¬
sciousness than self-consciousness, which will be the common property of a
higher race of men in the course of a few more milleniums. This new race
will occupy the same relation to us as we do to Atahts homo , and thereby
justify the long agony of birth throughout the countless ages of our past.
It will be observed that Dr. Bucke's argument bristles with difficulties,
and that he leaves off at the point where critical interest becomes keenest.
We know Dr. Bucke as the friend and biographer of Walt Whitman, and,
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1898.]
Notes and News.
211
more lately, as he who claims to have dethroned Shakespeare. We shall await
Jiis forthcoming book on Cosmic Consciousness, in which he is to continue
the thesis now presented, before we make any detailed examination of his
opinions. In the meantime we ask him to revise his observations in regard to
child-hfc. His obiter dicta cannot be accepted as to the times and seasons
of the evolution of the individual mental faculties, much less his guesses at
racial aeons. Greatly daring, he tells our mothers, who have sung lullaby
to their infants and held their children spellbound by the songs of innocence,
that the musical sense does not appear till the age of twenty. If Dr. Bucke
would not have us believe that ms atavistic theory of insanity, which seems
to mean that disease of the brain is something apart from all other physical
diseases, is evolution gone mad, he must hurry up with his proofs.
TELVIC DISEASE IN WOMEN AND INSANITY.
Two papers were read emphasising the frequency of pelvic disease and
the necessity for treatment of such cases. Dr. Rohe opened with a state¬
ment of the law in regaid to surgical operations upon insane persons, and
specially found fault with the very moderate objections raised in this Journal
when his work and opinions were lately reviewed by us. There is no
necessity to recapitulate our statements. The substance may be stated in
few and reasonable words. A surgeon is liable to be called upon to justify
his action in a court of law. He is happy who can offer a complete justi¬
fication, and thrice happy he from whom justification is never demanded.
The sum of I)r. Rohe s experience is that 60 per cent, of the women he
examined had some abnormal condition of the pelvic organs, distinctly
pathological and easily recognised. He claims, and rightly that the primary
question is relief of local disease, that the insane woman has the same right
to treatment as the sane ; and adds that if such treatment is likely to
benefit the mental condition it is our duty to carry it out. A summary of
thirty-four recited cases shows eleven complete recoveries (mental and
physical), nine improved, eleven unimproved in mental condition, and three
deaths.
Dr. A. T. Hobbs, of the London Asylum, is still more emphatic. A
systematic examination of all female patients, aided in nearly every case
by anaesthesia, seems to be his rule, with the startling result that ninety-
three out of one hundred insane women had pelvic disease. Eightv-nine were
operated upon. Dr. Wighsworth is quoted ( RcgU , 2nd ed., p. 360) as having
reported that he found only 38 per cent, of normal sexual organs in female
autopsies; but we refer our readers to his careful and discriminating paper in
the Journal for January, 1885. Dr. Hobbs gave an account of the cases and
the operative measures employed in eighty patients, and summarises the
results: 37.6 per cent, mental recoveries, 22.5 per cent, improved, 36 per
cent, unchanged, 6 per cent, of deaths.
AFTER EFFECTS OF SURGICAL PROCEDURE.
Dr. Russell, of the Hamilton Asylum, Ontario, followed with a paper
on the after effects of surgical procedure on the generative organs of females
for the relief of insanity. He protested against wholesale mutilation and
exaggerated claims made for operative interference, and went on to show
that the ratios of insanity between men and women are nearly equal, that the
analogous gland in man is not the subject of persistent attack, as it might have
been If naturally retained in the abdominal cavity. Dr. Russell gave three
coses which had terminated unfavourably after surgical operation on the
genital organs; and a collection of opinions by alienist physicians unfavour¬
able to such operative interference. One may be quolea, viz., the reply of
Dr. Putnam, the woman physician of Poughkeepsie State Hospital. She
says that out of 3,646 female admissions only forty-two cases were due to
pelvic disease, and that no improvement resulted from four operations.
REFLEXES IN PSYCHIATRY.
Dr. Daniel Clark, of the Toronto Asylum, read an important paper on
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212
Notes and News.
[Jan,.,
this subject.* In relation to diseases of the female pelvic organs, minor
abnormalities are magnified into important factors in producing insanity,
and it would be well for the present generation if there were less profes¬
sional officiousness exercised in the direction indicated. While 40 per cent,
of the admissions to the Toronto Asylum are certified as having become
insane owing to these diseases, be only found per cent, really affected.
Moreover, the knife created an artificial menopause in young or middle life,
and a number ot cases of insanity in his experience had resulted. Dr.
Clark quoted Dr. Bremer, of St. Louis, with approval, viz., that gynaecological
treatment, unless imperatively demanded, is a crime.
In the discussion of this subject, as might have been expected, the members
of the section showed but little sympathy with the practice of Drs. Rohe
and Hobbs. Dr. Alexander adduced strong evidence against the statements
in favour of the high percentage of disease when be said that out of the
thousands of post-mortem examinations at which he had assisted at Han well
but very few showed evidence of pelvic disease While we are bound to
interrogate the facts of the physical condition of our patients, male and
female, we have no such duty imposed upon us as Dr. Hobbs indicates.
His administration of ane&theiics and genital examination of every case
admitted are extreme measures whicn will surely find no support in this
country. And we shall require additional testimony before we accept hi*
statement that ninety three insane women out of one hundred show pelvic
abnormalities sufficient to justify his routine treatment. It appears to us to
be a record of misguided enthusiasm, and our rule should be to permit of
surgical interferem* with the genital organs of insane women only when the
same indications arc present which demand operation in the sane.
HEREDITY AND INSANITY.
Dr. II. P. Stearns, of the Hartford Retreat, read a paper entitled
“Heredity a Factor in the Etiology of Insanity.” He treated the subject
in view of the recent works of Weissinann, and produced a closely reasoned
and learned argument, which does not lend itself to condensation. We must
refer our readers to the pages of The British Medical Journal for the full
text, which will amply repay a careful study.
acute melancholia.
Dr. Brush, of the Sheppard Asylum, Baltimore, gave an analysis of one
hundred cases of acute melancholia, which is a mine of information on this
subject, and shows how carefully the patients have been considered and
treated under his care.
PHYSICAL AND MENTAL DISEASE.
Dr. Haslett, of Halliford House Asylum, read a paper upon the influence
of physical upon mental disease, containing a summary of authorities. He
concludes that debilitating and wasting diseases never produce any mental
improvement, but often the reverse; that sudden injuries, without loss of
blood, arc frequently of benefit; that sudden painful diseases are most likely
to result in improvement; that the stuperose and secondary stages of mental
disease are most readily influenced for good, but the convulsive neuroses
are incapable of amelioration in this way. Dr. Haslett states that unwonted
afferent impulses produce the influence owing to abnormal peripheral irritation.
INR1IUIKTY.
Dr. CrOthkrs, of Hartford, discoursed upon inebriety, supporting the
thesis tliat inebriety is insanity, and curable in the same way. Perhaps his
most interesting point was the exposition of cases where there was a latent
explosive tendency.
INSANITY ANI) THE STATE.
Dr. Russell, of the Hamilton Asylum, read a paper on the relation of
insanity to the State. The vast field which he surveyed does not permit
of our giving more than an indication of the remedies suggested. Dr.
Russell wisely says that neither legislation nor radical surgery will prove a
Digitized by
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213
1898.]
panacea. He looks to the operation of natural laws to elevate the human
race,-and to education as a mental discipline to prepare citizens for their
duties. We do not agree with him in his projects for the nationalisation
of land and the limitation of charitable aid. When Dr. Russell suggests
that the money spent in works of philanthropy should be diverted to in¬
creasing the earning power of the poor, he should follow up his suggestion
with practical indications of how it is to be carried out. Meanwhile, we
shall not withhold a helping hand to those in need, pending the millennium.
DEGENERATION OF NERVE-CELLS.
Professor Van Gieskn concluded the work of the last day with a most
valuable and interesting address on parenchymatous degeneration of the
paraneural system in locomotor ataxia. ' It was unfortunate that the most
important communication of the meeting should have been relegated to the
fag end of the scientific business. Professor Van Giesen’s position as
Director of the Asylums' Laboratory in New York should have commanded
a better hearing. His work relative to the degeneration of nerve-cells in acute
intoxication and sufistroke will shortly he placed before our readers in detail.
Meantime, we note that at Montreal* he traced the analogy between stroma
and parenchyma in organs of the body. He showed how the cells may be
regarded as working units, their expression of function varying with their
health. He showed how, under suitable hardening reagents, an intercellular
structure could be demonstrated; and how this structure was interfered with
by poisons, especially alcohol. The rate of this cytoclosis, as he called it,
depended on (1) the intensity and (2) duration of poison. This was the
probable cause of temporary improvement in locomotor ataxia. Finally, he
showed that similar changes took place in mental disorders.
THE SUB CONSCIOUS MIND.
Dr. Clark Bell, of New York, prepared a paper on the sub-conscious
mind, sub-liminal consciousness, and we have been favoured with proof-
sheets of his work. After giving dictionary definitions of consciousness,
Dr. Clark Bell goes on to enquire: Is there a consciousness beneath the
threshold of our ordinary knowledge of our own thoughts and actions out¬
side of and independent of the former: Have we an inner consciousness
that acts independent of the outer, and usual, perception? Is it a storehouse
of the memory, of acts, thoughts, and volition peculiar to itself, and not
directly related to what has been hitherto believed to be the normal con¬
sciousness of man? Is it reallv beneath the threshold of our thoughts regard¬
ing ourselves and our action? In answer to a circular letter addressed to
leading psychologists a large number of replies were received, from which it
would appear that diversity of opinion exists in reference to the definition
and existence of sub-liminal consciousness. For instance, Professor Sudduth
•‘oncludes that it is a state of the natural or subjective mind, and as much
to be clearly differentiated from objective and super-conscious mind. Pro-
feisor James objects that the term is vague and has narrowing implications.
Adopting the metaphor of the field of consciousness with its focus strongly
attended to, and its margin dimly recognised, he would rather speak oi
marginal consciousness. Professor Eskridge considers that sub-liminal con¬
sciousness is a pompous definition (tit) for subjective consciousness. Pro¬
fessor Catell does not think it better than the older term sub-consciousness.
We are disposed to agree with Professor James, for it seems to us that the
use of sub or supra in this relation is misleading, and unsupported by the
facte of physiological psychology.
ACTIVE TREATMENT OF GENERAL PARALYSIS.
Dr. Godding, of the Washington Asvlnm, submitted a paper on the
treatment of general paralysis, from which he had secured arrest of the
active symptoms. The main feature of this system is the employment of the
cold wet-pack with cold applications to the head. The simplicity and
efficacy of this mode of treatment should encourage experiments on this side
Digitized by ^ ooqLc
214 A'otes and Newi. flan.,
of the Atlantic, and we refer our readers to The British Medical Journal
for details.
THE NOSE AND SEXUAL APPARATUS.
Dr. J. N. Mackenzie, of Baltimore, read a paper in the Laryngology
Section on the physiological and pathological relations between the nose and
the sexual apparatus of man. He first gave the reasons which led him to
conclude that there is an intimate physiological relationship between these
organs, specially insisting on the occasional phenomena connected with
mensti nation, pregnancy, etc. Dr. Mackenzie alluded to the facts of
vicarious nasal menstruation, sympathetic irritation of the nasal erectile
tissues during the sexual act, and the probability of congestion of the nasal
passages owing to abuse of the sexual functions. In the discussion following
cases of masturbation cured by the removal of adenoids were referred to.
Unfortunately no psychiatrist seemed to have been present to confirm the
relationship from his point of view. It is undoubted that abnormal con¬
ditions of the nose ana hallucination of the sense of smell constantly occur
in cases of insanity connected with excessive masturbation.
INTERNATIONAL MEDICAL CONGRESS AT MOSCOW.
Section VII.— Nervous and Mental Maladies.
Whether an International Congress brings out the best work of the best men
may be questioned, but it is beyond question that in a city so full of interest
as Moscow foreign visitors arc apt to sacrifice sections to" sight-seeing.
Section VII. was one of the busiest and best attended of all the fifteen
sections into which the Congress was divided, and not a few communications
were left unread. Many nationalities were found at its meetings, and
Honorary Presidents of Section were courteously appointed from each, Dr.
Ycllowlees being chosen to represent Great Britain. As the section included
both nervous and mental maladies the field was very wide and tho subjects
very varied and very mixed: Obsessions and Fixed Ideas, Juvenile
Dementia, Pathology of the Nerve-cell, Hypnotism and its Legal Relations,
Tabes Dorsalis, Polyneuritis, Inherited Neuroses and Degeneration,
Transitory Alcoholic Mania, Treatment by Alternations of Temperature,
etc. Dr. Shuttleworth, of London. Dr. Sutherland, of Edinburgh, and
Dr. Robertson, of Glasgow were the only readers of papers from this
country.
The cordiality with which their foreign confreres were welcomed and
feted by the neurologists and alienists of Moscow can never be forgotten by
them, and it was fitly crowned by a poetic and beautiful compliment at the
close of the Congress, when representative foreigners from various lands were
personally requested by President Korsakov to plant a tree in the grounds
• of the Psychiatric Clinique in order to form a group which should be known
in after years as “ The Grove of the Congress.”
The Asylum of Moscow and this Clinique naturally attracted the interest
of the strangers. The former—called Hopital de Preobragenskoi6—has been
enlarged and modernised in recent years. Although within the city limits,
it is surrounded by ample grounds. Its wards are not up to our ideas ot
comfort, but non-restraint is practised as far as possible, and in part of the
building ‘‘open doors” are the rule. The medical and scientific work
receives great attention, and, indeed, could not fail to do so, for the Medical
Superintendent, Dr. Constantiircwsky, has four resident Assistant Medical
Officers and four others non-resident to aid him in the care and treatment
of 400 patients. The proport ion of attendants is very large—at least 1 to 4—
although many of the lunatics are chronic cases. The explanation given
was that quantity had to make up for quality. Probably the defective
Digitized by
1896 .] Motes and News. 615
education 30 universal among the lower classes in Russia makes our methods
jf training nurses impossible.
The cliniques and special laboratories attached to the University ot
Moscow were a wonder, a revelation, and a reproof to many of the visitors
who had deemed Russia behind the age. In the possession and in the most
complete equipment of these cliniques and institutes, in all departments oi
medical science, and numbering at least a score, Russia is far ahead ot
ourselves; though it may well be doubted whether our patients would agree
to the methods and arrangements which obtain there. All these cliniques
are associated with the University, and the teachers are on the University
staff. The patients reside in the cliniques only while the University is in
session and requires clinical material for teacmng: they are sent away at
the close of the session either to their homes or to some other hospital or
asylum.
The Psychiatric Clinique is a complete cure-asylum for fifty patients—
thirty men, twenty women—standing in its own ample and well-wooded
grounds, and equipped in the most complete manner with all the newest
and best instruments and appliances for the investigation and treatment of
brain diseases. It is the kind of cure-asylum which should be possessed by
the large cities of our own land (except that ours should be three or four
times larger), where recent cases could be received and every possible means
used for their recovery before passing them on to larger home-asylums;
in these, recovery, if attained, would be more tedious, and due more to
occupation and moral discipline than to direct medical treatment.
It must be regretfully confessed that the general impression left by the
work of the section was that much progress was being made in the investiga¬
tion and knowledge of disease and very, very little in its treatment. This
must be true in all departments of applied medicine until we gain a more
perfect knowledge which shall give us, if not the power of curing disease,
the power to avert its occurrence or to modify its "course. The knowledge
which brings depression to day will grow greater soon and bring blessing
to men.
THE BRITISH ASSOCIATION AT TORONTO.
Sir William Turner’s address to the Anthropological Section was of great
general interest and of special interest to ourselves.
On cranial capacity, ne arrived at the conclusions that this was greater
in the European than in the savage, that the range of variation was also
greater, that few male savage crania reached the European mean (1,500 c.c.),
and that there is less difference between male and female crania in savages
than in Europeans.
Flechsig’s recent observations and conclusions were very carefully sum¬
marised and commented on. Sir William points out that the problems they
suggest are “ the proportion which the association centres bear to the other
centres, both in mamn.als and in man; the period of the development of
the association fibres , in comparison with that of the motor and sensory
fibres in different animals; ana, if possible, to obtain a comparison in these
respects between the brains of savages and those of men of higher order oi
intelligence.”
FlechsigV? observations are described in this number of our Journal, and
their importance is testified by the expectation of progress of which these
problems give promise.
THE MORISON LECTURES.
Dr. Alexander Mori son delivered the Morison Lectures for the present
year in the Hall of the Royal College of Physicians, Edinburgh, during the
Digitized by {jOOQle
216 Notes and News. [Jan.,
first week of November, on “The Anatomy and Physiology of the Ner¬
vous Mechanism of the Viscera.”
In the first lecture he described the hardening and staining methods
employed in the histological study of the peripheral nervous system, and
described the nature of the nerve-endings at the secreting cell, at the
unstriped muscle fibre, and at the blood-vessel especially in excretory organs.
In the second lecture he demonstrated the peripheral nerve-mechanisms ot
the spleen, kidneys, adrenals, and other viscera, and traced the connections
of the terminal ganglia of the sympathetic with the nerve-endings in the
viscera on the one hand and with the fine fibres of the cerebro-spinal axis
on the other. The third lecture was mainly concerned with the physiology
of the subject, the innervation of the heait by the vagus and the sym¬
pathetic.
The lectures were most interesting, and were profusely illustrated by
lantern slides and microscopes. Next year Dr. Morison purposes dealing
with the nervous mechanism of the viscera in relation to pathology ana
clinical medicine.
RECENT MEDICO-LEGAL CASES.
Reported by Dr. Mkrcier.
[The Editors request that members will oblige by sending full newspaper
reports of all cases of interest as published by the local press at the time of
the assizes.]
Reg . v. Marriotini.
Prisoner stabbed his wife in twenty-five places, and about two hours after-
waids threw himself into the Thames, while in the water he discharged a
revolver four times. He was rescued, and then said, “ I have killed my wife
by stabbing her with a large knife. She worried me so much that I told her
Bne would make me murder her.” Subsequently he said, “I had a quarrel
with my wife. I have been unhappy for twenty years. I have had a
miserable life.” It was proved that three years before there had been an
explosion at the cafe kept by the prisoner, and that he received such injuries
that he was in hospital for five months. When be returned home he was
greatly changed, became \erv irritable, and complained of pains in the head.
For ten days before the murder he suffered very much from sleeplessness,
and used to wander about the house at night talking to himself.
Dr. Bastian, who had examined the prisoner at the request of the Treasury,
and Dr. Scott, medical officer to Holloway Gaol, were called for the defence,
and stated that they were of opinion that the prisoner was insane on the
date of the murder, and was not responsible for ms actions.
The jury found the prisoner ” Guiltv, but insane.”—Central Criminal
Court, September 15, 1897 (Mr. Justice feruce).— Tima , September 16.
The prisoner's own confession showed that he knew what he was doing
and alleged a motive for the crime. The medical witnesses were allowed
the freest license, and answered the very questions that had to be put to
the jury.
Commistionert r. Shaw.
In November, 1896, Dr. Maudsley was ordered by the Lord Chancellor,
at the instance of the Commissioners in Lunacy, to visit and report upon
two persons who were residing with Mrs. Shaw in an unlicensed house at
Elstree, and who were reported to be insane. Dr. Maudsley visited them
accordingly, and reported that one of the persons (J. F.) was an imbecile,
probably from birth, and was certifiable as a person of unsound mind; and
that the other (D. V. S.) was suffering from chronic insanity, with
hallucinations of hearing and delusions, and was certifiably insane. Dr.
Digitized by LjOOQLC
Notes and News.
217
1898.]
Maudsley further reported that the bedrooms occupied by these two patients
were ill-furnished) not clean, in need of painting and papering; and that the
wet had soaked through the roof and caused a considerable fall of plaster,
which left the laths exposed.
Upon this report the Commissioners, on the advice of the Solicitor to
the Treasury, instituted proceedings; and Mrs. Shaw was summoned before
the justices at the Barnet Petty Sessions for receiving and detaining in a
home, not Being an institution for lunatics or a worknouse, two lunatics;
for taking charge, for payment, of J. F.; and for a like offence with respect
to D. V. S. The justices are reported to have dismissed the second and
third charges, on the ground that they were satisfied that neither of the
alleged lunatics was a lunatic within the meaning of the Lunacy Act, 1890;
and they declined, on a similar ground, to commit the defendant for trial
on the first charge.
This case is another example of the lenity with which alleged offences
against the Lunacy Act are regarded by the public, so long as the allegations
are not made against medical men. ff it were alleged that in any licensed
house the bedrooms occupied by patients were ill-furnished, not clean, and
had the plaster dropping off the walls from damp, we can imagine the
howl of execration that would be raised by the halfpenny journals, and the
clamour for the instant cbolition of “private asylums.” But so long as the
persons charged are responsible to no one, are exempt from all supervision,
are unlicensed, and, above all, have no pretensions' to medical knowledge
or skill, they can do as they please, and the county Shallows will not
interfere.
Friendly Societies and Insanity.
William M*Rorie, a member of the Loyal Order of Ancient Shepherds,
became insane, and was removed to the Perth District Asylum, and Mr. D. T.
Clement, solicitor, Crieff, was Appointed curator bonis on his estate. The
patient was kept there at the expense of the Parochial Board of the parish
of Crieff till August, 1896. At that date the patient succeeded to some pro¬
perty by the death of his father, and the Parochial Board intimated a claim
for the patient’s board and lodging from the date of his father’s death, and
further that he must be transferred to a private asylum. The claim was
paid by the curator, and the patient was removed to Murray’s Royal
Asylum. By the rules of the society of which the patient was a member
members are entitled to relief in sickness and when unable to follow their
usual employment, or when in distressed circumstances; but if a member
becomes chargeable to a Parochial Board no relief is allowed unless the
member has some one dependent upon him, which was not so in this case.
Consequently the society were not entitled to pay sick benefit up to August,
1896. Mr. Clement, having paid bis ward’s board and lodging from that
date, intimated to the society a claim for sick benefit in respect that his
ward was being kept in the asylum at bis own expense. The society refused
payment of the claim under their general rule 63, viz., “If any member
afflicted with insanity, permanent debility, or loss of sight be provided for
in some place of refuge, the Ixidge officers shall have power to detain the
sick pay for his benefit/* Against this decision an appeal was intimated,
in terms of the society’s lules, to the Lodge Arbitration Committee on
behalf of the curator bonis , but the Arbitration Committee refused to sustain
the appeal on the same grounds as the Lodge had done. A further appeal
was intimated to the Arbitration Committee of the District of the Order.
After a lengthy discussion, this committee sustained the appeal, and found
(1) that as the ward had been in the asylum since August 28, 1896, at his
own expense, the society were bound to pay the sick benefit claimed; (2)
that the deposit of 10s. made in terms of the rules of the society by the
appellant be returned; and (3) that the society pay th9 expenses incurred in
bearing the complaint.
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m
[Jan.,
The Law and Insane Murderers.
The legal procedure in cases of homicide by certified lunatics seems to be
now clearly established in Scotland. Two murders occurred in two Scottish
asylums last summer. The patients were dealt with in the same way. On
intimation to the Procurator-Fiscal they were brought before the Sheriff,
who, being assured of their mental unsoundnegs, remitted them to the
higher courts. On their appearance there the advocate for the Crown inti¬
mated that they were insane, and led evidence to that effect by calling
expert witnesses. The judge immediately ordered the lunatics to be removed
to the Lunatics’ Department of the Perth Prison and there confined during
her Majesty’s pleasure.
THE ENLARGEMENT OF RAINH1LL ASYLUM.
We regret to observe that the Lancashire Asylums Board have decided to
provide additional “ temporary ” accommodation at Rainhill for 200 patients.
It is to be hoped that these buildings will be really temporary, and that the
Board will remove them as soon as possible. The evils of tnese overgrown
institutions have been so often the subject of unfavourable comment that
wo refrain from further remarks at present, except to express sympathy with
Dr. Wiglesworth in having this unwelcome addition thrust upon him. We
certainly cannot agree with Mr. Turner in his reported remarks to the effect
that, as in a very short time the lunacy requirements of the county would
be such as to occupy all the permanent provision that the Board anticipated
making, as many of the asylums as could should make temporary accommo¬
dation. If the requirements transcend the possibilities under the arrange¬
ments now completed, it seems to us lpgh time that the question of further
licrmanent provision should be faced.
EDINBURGH DISTRICT LUNACY BOARD.
An important report upon asylums on the Continent and in England has
been prepared by a committee of the Edinburgh District Lunacy Board, in
view of the proposed new asylum for Edinburgh. It is a document of special
interest to those interested in the provision of accommodation for the insane,
and especially to us as an expression of opinion in regard to recent methods
of asylum construction set forth by a body of gentlemen who approach the
subject with open minds. The deputation returned impressed with the
conviction that the asylum at Alt Scherbit* was the best they had seen, and
that Edinburgh should adopt that system. The estate of Wester Bangour,
rear Uphail, extending to 06 I acrefc, has been purchased for £13,000; and
the District Board have resolved to construct tneir institution on the villa
system, at an expense of some £160,000. We understand that the plans
will be open to a limited competition, and we shall watch the development
of this important hospital with great interest.
“THE GROWTH OF INSANITY IN SCOTLAND.*'
An article under this heading, “ contributed ” to The Scotsman of 8 Decem¬
ber, 1897, draws attention to the existence of “ crazy ” areas in Scotland.
Thus, while the ratio of the insane in Scotland generally for the 1895
quinquenniad was 27.1 per 10,000, this is described as rising to 90 per
10,000 in the parishes in Argyllshire, but the writer does not draw attention
to the fact that in the twenty-five remaining parishes the ratio must, on his
v wn showing, fall below the average.
Digitized by ^ ooqLc
Notes and News,
1893.]
210
Craignish and Kilmelfort, with populations of 389 and 407, are stated to
have a ratio of 170 pe** 10,000. This sounds very startling; but, when we
recognise that the basis of the assertion consists of about thirteen lunatics,
which two or three families might supply, it is not likely to cause serious
alarm. These raw*baked statistics and reckless methods are unfair and mis¬
leading to the ordinary newspaper reader. What would be thought of a
sanitary expert who seriously compared the health of the residential part
of any town with that of its slums as an evidence of the unhealthiness of
the whole district; or who drew conclusions from population groups of three
or four hundred and applied them to a whole community? The contribution
in question is unworthy of the subject in manner and matter, and not what
we have been accustomed to find in the columns of The Scotsman.
A REQUEST FROM RUSSIA.
We have received a circular from Professor Bechterew stating that the
clinique for mental maladies in the Imperial Military Academy of Medicine
at St. Petersburg has now been opened for thirty years, and that a new
separate building for nervous diseases will be inaugurated forthwith. It is
proposed by the physicians in charge to create two museums, psychological
and neurological, to commemorate this event. They ask for contributions
of plans, reports, publications, photographs, etc., relative to asylums and
their inmates, and for pathological specimens, preparations,* apparatus
ielative to nervous diseases. Those willing to aid are instructed to address
packages to “Russie, St. Petersbourg, Clinique des Maladies Mentales et
Nerveuses, Rue Samarskaya No. 9. The carriage will be paid by the
recipients. Our Library Committee might take a hint and negotiate a fair
exchange.
CORRESPONDENCE.
From Dr. Reid, Royal Asylum, Aberdeen.
The installation of the electric light at the Alierdeen Asylum, at the time
particulars were a$ked, was in an incomplete state, and is still so far from
king finished that we cannot give definite information either as to the first
cost or as to the cost of maintenance. The light has been in use in the
Hospital buildings for over a year, aud has recently been introduced into
Elmnill House, there being in all about 700 lamps “in use. It is not yet
introduced into the Asylum main buildings, but will be as soon as the pro¬
posed reconstruction and alterations are completed, which, however, will
not be for some years. When all is finished it is estimated that there will
be from 1,600 to 1,600 lamps in use.
With regard to our generating plant for electric lighting, there are two
50 horse-power gas engines with heavy fly-wheels, running at 200 revolutions
per minute, driving, by means of laminated leather belts, two dynamos,
which are shunt wound, each with a maximum output of 36 kilo-watts. The
current is continuous at a pressure of 110 volts. The E.M.F. in each dynamo
is regulated by a resistance placed in the field magnet circuit with contacts
for throwing more or less of it into circuit.
There is also a storage battery of sixty cells in leaden boxes, of 1,600
ampere hours* capacity on a nine hours* discharge, and a minimum discharge
rate not exceeding 300 amperes. Recording ammeter and voltmeter are
place ! on the main switch-board.
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Notes and Newt,
[Jan.,
The gas used for the engines is Dowson gas made on the premises; there
being also provided & connection with the town’s gas supply in case of any
failure in tne Dowson plant. When the current is taken direct from the
dynamos the lights are to a small extent unsteady. This is got over mean¬
time by running them in parallel with the battery.
Jn distributing the current conductors are taken from the main switch¬
board in dynamo room to distributing boards placed at various points
throughout the building. It is there divided into two main circuits, either
of which can be cut off independently of the other. From omnibus bars
connected with these main circuits leads are run to the lamps, which are
arranged in groups of from twenty to twenty-five for each pair of leads.
They ore also arranged so that one of the main circuits can be shut off
during the night.
Most of the lamps are 16 candle-power; a few are 32; and some 8. Arc
lamps are used in the dynamo room and for lighting the Asylum, Hospital,
and Elmhill House approaches.
In the Hospital all single rooms are lighted by bulkhead lights placed over
the doors with the switches outside. Day rooms have two-light pendants
and wall brackets, placed at about eight feet from the floor, and also a few
counter-weight lights. The dormitories and corridors have plain cord
pendants about nine feet from the floor.
Excepting in the single rooms, as above stated, all the switches are placed
inside the rooms, and are quite within reach of patients, but no trouble has
been experienced on that account.
At Elmhill all the lights have been placed as they would be in a private
house, except that in a number of the bedrooms tbe switches are placed
outside the rooms.
We have no means of decreasing the brilliancy of the light except by
turning out a number of the lamps. The dormitories are supplied with a
few 8 candle-power lamps with obscured glass, so as to subdue the lights left
in over night.
The men who attend to the lighting plant have* also charge of the steam
boilers; steam being required for purposes of heating, cooking, ventilation,
and laundry purposes; and thus it is not easy to state what proportion of
the expenses Bhould be assigned to the electric lighting. The staff consists
of one engineer and four assistants. It is expected that this staff will be
sufficient when the asylum main buildings—at present lit by gas supplied from
the city—are lighted by electricity as reconstruction proceeds.
There is at present no general dining-hall nor adequate recreation-room, but
these are included in the alteration scheme, and electricity will be used as
illuminant.
As to the suitability of electric lighting for an asvlum, we think there can
be no doubt that it is in every way superior to gas. Its cleanliness, the
freedom from vitiated air attending its use, and the ;ibsence of danger from
explosions and escapes are all in its favour.
From Mr. Townsend.
Referring to Dr. Jones’s paper in the last number of this Journal, Mr.
Townsend writes: —
Electric Lighting Engines .—Statistics taken during the last five years show
(as pointed out by Dr. Jones, p. 761) that high-speed engines coupled direct
to dynamos and with improved multitubular boilers, are coming into favour,
and prove that their cost of generating current is nearly 10 per cent, lower
than with slow-speed engines and belt-driven dynamos—especially when the
engines and dynamos are of 60 horse-power and upwards.
Wiring .—Tne best systems at present known are (1) to run the wires, both
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Notes and News.
221
positive and negative being twisted together, and drawn mto steel tubing,
which is lined with a bituminous composition. (2) Wires as before drawn
into plain iron tubes. In this system great care must be taken that the
insides of the tubes are quite smooth, otherwise the insulation of the cables
is certain to be damaged. (3) Concentric wiring, having the outer conductor
“earthed.” Tins outer conductor is sometimes of copper strip covered with
lead, and sometimes small iron wir* twisted closely together. The great
advantages of concentric wiring over the tube system are (a) lower first cost
and (b) less cutting away of fioors, ceilings, and walls. The disadvantage
is that the conductors cannot be so easily renewed as in the case of the
tube system.
More skilled labour is required both with the tube systems and the con¬
centric systems than with tne wood casing system. In the ease of the first
two systems a leakage will very soon find its way to the other conductor—
the result being a short circuit. In the wood-casing system a leakage may
go on for years—the only result being waste of current. The precaution of
** double M wiring as at 'Jlaybury is excellent but costly.
Gas Engines. —It is stated that “the speed of gas engines fluctuates
slightly, so that running the lamps direct from the dynamo gives an unsteady
light.” This is jperfectly true when gas engines of the “Otto” (Crossley)
type are used. These engines never run much above 200 revolutions per
minute, and only on full loads do they take an explosion every two revolu¬
tions, or say 100 explosions per minute. There is now a gas engine in the
maiket which I have had experience of for over two years, which runs at
750 i evolutions per minute and takes 375 explosions per minute. This engine
runs so smoothly that there is not the slightest visible “jump” in the
lamps. Indeed, it takes a very sensitive voltmeter to show any variation.
This engine is of the “ enclosed vertical ” type, and is generally used coupled
direct to dynamos.
Oil Engines. —My experience of oil engines has been large, and my advice
is, Never use one if you can possibly help it, especially for dynamo driving.
These engiues are very expensive to buy, and even more expensive in main¬
tenance. The best oil I have found is a Russian oil at from 5d. to 8d. per
gallon, according to the state of the market. Oil engines are “ nasty, noisy,
smelly things,” but I recommend the use of oil engines for small installations
up to about 10 horse-power or as “ stand-by ” in water-power installations.
Turbines. —The remark by the Superintendent of the Devon County Asylum
that “ turbines should be avoided ” seems to indicate that something is
radically wrong with the installation. Of course there must be abundance of
water at the driest time of the year, and the height of fall has to be taken
into consideration.
COMPLIMENTARY.
Presentations.
Mr. Richard Adams, L.R.C.P.Edin., M.R.C.S.Eng., Medical Superin¬
tendent of the Cornwall County Asylum, at Bodmin, on his retirement from
that office, which he had held over forty years, was presented with a valuable
silver coffee tray as a testimonial of esteem, subscribed for by 157 of the
officials, past and present.
Dr. Nathan Raw was, just before his departure from the Dundee Infirmary
for his new sphere of labour in the Mill Road Infirmary, Liverpool, the
recipient of a present, subscribed for by the nursing staff of the former
institution, which consisted of a pair of silver candlesticks and silver ink-
stands enclosed in a case. On the outside of the lid of the inkstand are
engraved Dr. Raw’s initials, and inside is the following inscription; “Pre-
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Notes and News,
[Jan.,
sen ted to Nathan Raw, Esq., M.D., B.S., L.S.Sc., F.R.C.S.E , by the
nursing staff of the Dundee Royal Infirmary in grateful remembrance of his
unfailing courtesy and consideration. October 2nd, 1897.”
HACK TUKE MEMORIAL.
By a v?ry handsome donation of £25 from Mrs. Hack Tuke the sum fox
investment has been brought up to £350. This sum has been handed over
to the Association and invested. The interest of the fund will prove of the
greatest service in developing the Library, which is probably tlie form of
memorial most fitting to Dr. Tube's memory, and which he would certainly
have approved.
OBITUARY.
W. H. HIGGINS.
Dr. William Henry Higgins died on October 26, 1897, at Birkenhead,
whither he had recently retired af~er leaving the Leicestershire and Rutland
Aeylum. He graduated at Edinburgh, having obtained both the gold and
silver medals for Anatomy, and in 1869 he became a member of the Royal
College of Surgeons, England. Immediately after this he was attached to
the Pacific Steam Navigation Company, sailing to the west coast of South
America for four years, during three of which he was Superintendent of
their hospital at Callao. He then returned to Fklinburgh to *nake a special
study of mental diseases. His first appointment in lunacy was as Assistant
Medical Officer to the Derby County Asylum, under Dr. Murray Lindsay.
From thence he went, in 1$76. to the Leicestershire and Rutland Asylum,
under the late Dr. Buck. After Dr. Buck’s death he was appointed Medicai
Superintendent, in 1881. During his term of office he carried out many
structural alterations and improvements on the asylum. Though he took a
great interest in the treatment and welfare of his patients, Dr. Higgins seldom
contributed any writings in connection with mental diseases. In 1894 his
health began to break down, and in June of that year he became seriously ill.
After several months’ leave of absence, he finally retired, in March. 1895, with
a pension sanctioned by the County Council. It was hoped that in the
retirement from the work and worries of an asylum his health would
improve, but to a severe recurrence of his former illness he succumbed. He
cccupied his leisure hours with astronomy, and in his latter years engaged
in the study of Hebrew and Swedish.
PROFESSOR HAUGHTON.
By the death of Professor Haughton. which took place on October 31, 1897,
the University of Dublin has lost one of its most remarkable ornaments and
Irish social life one of its most striking figures. Haughton was a man wl)o,
under more favourable circumstances (viz., most especially if he had been
blessed with a lesser measure of early success), might have been capable ot
almost any intellectual feat. His versatility and the agility of his intelli¬
gence alone amounted to genius. In the humdrum region of university teach¬
ing in which unhappily he early lost liimseif he always seemed the most
brilliant pioneer. Unfortunatelv he yielded to the temptations—to diffusion
and lack of concentration—to which a versatile genius is particularly exposed,
and consequently he did not really lead in any of the numerous subjects
which he illuminated. One example is afforded by his ill-fated remark on
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1898.]
Darwin’s epoch-making work that it contained nothing new that was true
and nothing truo that was new. Haughton’s knowledge, often profound,
always acute, dies with him, for he has written little that will last: his
sparkling wit and geniul good-fellowship will survive in the memory of
those who were favoured with his personal acquaintance. One great work
will, we hope, long bear testimony to his zeal for knowledge and his
disinterested public spirit. To him is due the revival of the so-called “ School
of Physic in Ireland ” (Medical School of Trinity College, Dublin), and we
trust the debt which that school owes him will never be forgotten. Dr.
Haughton exhibited much interest in the work of our Association at the
Dublin meeting of 1894, though the feeble condition of his health even then
precluded his taking any active part in our proceedings.
• JAMES C. HOWDEN.
Born at Musselburgh in 1830, Dr. Howden received his elementary educa«.
tion there. After taking his degree at the University of Edinburgh, in 1862,
he studied at Paris. He served as Assistant Medical Officer, under Dr. Skae,
at the Royal Asylum, Edinburgh; and-in 1857 received the appointment of
Medical Superintendent of the Montrose Lunatic Asylum, succeeding Dr.
Gilchrist, who had gone to the Royal Crichton Institution, Dumfries.
Before his appointment the managers laid found the grounds about the
old asylum too restricted, and a new site was selected at Sunnyside, about
two and a half miles from Montrose. This building, with its subsequent
aljuncts, grew up under Dr. Howdens eye, although he has not survived
to see the completion of the new hou*e for private patients. As the years
went on the main building was extended and improved. In particular, a
new and spacious recreation hall was opened, for Dr. Howden took the
keenest interest in all forms of recreation. Those who noticed his solemn
face and listened to his slow speech might at first have imagined that they
had iiit upon the—imaginary—typical Scotsman, devoid of humour. It
needed, however, but a moderate ucquaintunce to dispel that delusion. It
might have astounded some of his graver acquaintances to have seen the
interest which he took in The Sunny si .e ChronieU —in its quips and cranks,
mystifications and merriment—as if he had been an undergraduate running
Alma Mater or some other college magazine.
In 1890 a detached building, containing 100 beds, was erected. This has
been the model of various hospitals* erected in connection with Scottish
asylums during the last few years.
Thorough firmness, tact and courtesy, displayed through a long period of
years, resulted in harmony with central and with local authority, and dis¬
tinguished Dr. Howden s career. For many years before his death he was
aught but robust. The abyss of human woe into which an asylum super¬
intendent lias daily to peer must cast on him occasional shadow's of gloom,
unless he is more or less than man. From these Dr. nowden was not free,
nor is it advisable that men in his position should be free from the liability
thereto. But these were to him but as light clouds obscuring for a little a
midsummer sun. His general attitude to the outside world was that of
cheeriness; to his circle of friends—no small one—it was that of genial
hospitality. His very “ grumpiness ”—often, one was inclined to think,
humorously affected—was more cheery than the bland superficial smile ot
shallower natures.
Holding to a high ideal of duty for himself, he did not expect too much
from his fellow-creatures, nor worry himself when they did not come up to
the proper standard. Things which were under his own authority he, very
properly, Hked to have leguluted in his own way, and he would, very
naturally, find fault if there was a failure on the part of those who under
him were responsible. When he was away from his usual routine he could,
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Notes and News.
[Jan.,
in a philosophical spirit, recognise that other people had different disposi¬
tions and habits, not to be lightly thrown off. This trait in his character
came out noticeably in a trip to Ireland on which the writer and another
friend accompanied him a few years ago. Bad weather sometimes interfered
with pleasure, and there were delays and mistakes which reminded us
that we were not among the business-like Anglo-Saxons. These latter
troubles he took, not merely with composure, but on some occasions it
seemed with glee, as if they were the troubles of other people represented
for his amusement upon the stage. His ability to derive amusement from
small things was indeed a notable feature in his character.
Dr. Howden did not obtrude his scientific acquirements, but was glad to
co-operatc with those of a kindred spirit. For many years he was Vice-
President of the Montrose Natural History and Antiquarian Society. In 1888
he was President of the Section of Psychology at the Glasgow meeting of
the British Medical Association.
Dr. Howden constructed an ingenious and valuable form of index for the
registrations of the lesions recorded in pathological records or case-books of
hospitals and asylums, and made various contributions to medical literature,
among which was an interesting paper on The Religious Sentiment in
Epileptics and an important statement as to Granular Degeneration of the
Nerve-cell in Insanity.
A paralytic stroke, some three years ago, partially disabled him and
deprived him of the power of writing. To this loss he was by no means
indifferent, but he bore it calmly. In the beginning of this year increasing
infirmities induced him to send in his resignation. With regret at the
unavoidable necessity and with expressions of heartfelt esteem the resignation
was accepted, but it was arranged that Dr. Howden should continue his
connection with the asylum as salaried Psychological Consultant. Dr.
Howden had been married for thirty veers, but left no children.
Though the Royal Asylum of Montrose gives every promise of continuing
its honourable and useful career, yet there are those who feel that the loss
of the large strong soul that is gone leaves in their existence a dreary blank,
who feel that the world is perceptibly smaller.
We would add to the foregoing reminiscences of Dr. Howden’s career of
honest and strenuous endeavour our appreciation of his kindly good sense.
He was the oldest asylum physician in Scotland at the time of his death,
and with him passed away a shrewd, cautious Scot, whose contributions to
scientific work were always worthv of close study, whose friendship, esteem,
and counsel were highly prized.— Ed.
WILLIAM GURSLAVE MARSHALL.
By a somewhat remarkable coincidence, two former Medical Super¬
intendents of this asvlum—colleagues during twenty years—surviving
fifteen years more—died within one week of each other. Mr. William
Gurslave Marshall, F.R.C.P., F.R.C.S., succeeded Dr. Davey, the
first Superintendent of the Female Department, in 1852. The build¬
ing (of which the foundation-stone was laid by Prince Albert in 1851)
had been opeued about a year. Mr. Marshall had previously been Resident
Medical Officer of the Northampton Borough Asylum.
He continued in the active discharge.of his duties at Colney Hatch for
thirty-eight years. In 1868 he had a nearly fatal attack of illness, the
result of an accident. But until his health failed, shortly before bis
departure in 1890. ^ was equal to the heavy demands upon his strength ana
energy.
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225
1898.]
The entries of numerous details in the books of Us department were, it
is believed, largely made, day by day, by his own hand. The maxim, Qw
faeit per alim femt per did not'altogether find acceptance with him.
For many years it was his practice to visit all the female wards twice daily.
On his rounds words in profusion would assail his ear, would claim attention,
and often receive some reply.
Often fatigued, sometimes overdone, yet never complaining, he went faith¬
fully on his way, year in year out. His chief refreshment was found,
perhaps, in books. Blaekwood and The Athemeum were favourite magazines.
The society of familiar friends and occasional public entertainments (sharing
the pleasure with others) were diversions furnishing some "variegation of
existence.’* Mr. Marshall had a strong attachment to his kinfolk, and as
many passed away in his lifetime a sense of increasing loneliness no doubt
saddened his declining years.
Placidity of temperament was one of his marked characteristics. He main¬
tained unruffled demeanour in often disturbing circumstances. A patient’s
provoking words would receive no rejoinder, or a quiet reply, accompanied
perhaps with a little playful banter. The expression of his countenance,
which was somewhat immobile, was an index to the composure of (to use a
favourite phrase of his) his "mental condition." Yet an unemotional
manner by no means denoted want of sympathy. The writer of these lines
has personal reasons for gratitude to Mr. Marshall for his kindly and patient
interest on more than one occasion of anxiety.
Stare tuper antiquae vtat was perhaps a motto too inflexibly observed
by the subject of this imperfect notice. But Suum euique . To every man his
gift. And Mr. Marshall was rather a conscientious and thorough performer
of prescribed duties than either an originator or theorist. He left no detail
of work unattended to. No doubt he might have economised his arduous
labours, lessening his own fatigue. But he derived satisfaction from the
knowledge that each day's allotted work had not only been gone through,
but also accurately recorded. The writer recalls an incident of Mr. Marshall
at the commencement of a dangerous and well-nigh fatal illness sitting up
in bed with official books open before him.
He served during thirty-seven vears under successive committees of the
Middlesex magistrates and of the London County Council, to whom he ren¬
dered loyal allegiance. On the retiiement of the" former, in 1889, though he
might have claimed honourable release from an unusually prolonged period of
official work, yet, considerately judging that his continuance awhile in office
might be an assistance to the new governing body, he deferred his resignation
until failure in health compelled him to tender it.
Mr. Marshall’s personal acquaintance with his patients and his knowledge
of their circumstances was another characteristic of his long administration,
which came to an end in 1890. Now he himself has passed away, full ot
years, and another link with the older school of Medical Superintendents and
practitioners has been severed.
H. H.
EDGAR SHEPPARD, M.D., F.R.C.S., M.R.C.P., D.C.L.
With the death of Dr. Edgar Sheppard one more of the past generation
of Medical Superintendents has disappeared—a group that contained many
men of great ability and courage, who at a somewhat critical period in
asylum management so directed and established procedure that their suc¬
cessors have inherited the good results of their work in a way that they
perhaps scarcely appreciate.
At that time the position of a Medical Superintendent was an uncertain
one; he was not the recognised head of the establishment in the way that he
now is, and it is to a large extent due to the efforts of the men we are
XLIV, 15
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Note8 and News.
[Jan.,
speaking of that a stand in the right direction was made and the professional
dignity of the specialty was recognised. Lockhart Robertson, Brnshfield,
aud others we might name, all contemporaries, made a stout phalanx in
delending the position we allude to, and their foresight and character helped
to found that system which in its stability of to-day is a monument to their
endeavours.
The subject of this notice was born at Worcester seventy-eight years ago.
and was educated at the Bridgenorth Grammar School, being contemporary
with the present Lord Lingen. He first practised at Worcester and then
at Enfield, after which he travelled for some time on the Continent.
General practice was distasteful to him, and on the occurrence of a vacancj
he sought and obtained the Medical Superintendentehip of the male side of
the CoTney Hatch Asylum, a post which he held with distinction for many
years, and from which he letired (on a pension) in 1881. During his tenure
at Colney Hatch he became Professor of Psychological Medicine at his old
school (King’s College, London), and for his class there he wrote his
Lectures on Madnca. After leaving active asylum life Dr. Sheppard became
connected with the Treasury, and was frequently engaged in criminal cases,
where his ability as a witness was recognised and acknowledged bv the
judges. For many years he was a prominent figure in London, but failing
health caused his retirement to Worthing, where he died from diabetes, after
enduring much suffering, borne with great fortitude. Possessed of a fine
presence and bearing, Dr. Sheppard had a marked individuality and an
imperturbable temper. Few exercised so much influence upon the men with
whom he came in contact, and those who were intimate with him could
testify to the kindly heart which underlay a somewhat rigid and severe
exterior. He missed being a great man in the specialty because perhaps ot
the diversity of his accomplishments, and perhaps also because his training
had been more superficial than scientific. Indeed, at that time the scientific
study of insanity was far behind its present development, the treatment by
non-restraint had not very long been recognised, and the clinical and hospital
treatment of the insane had yet to be fully developed. The appearance of
the first edition of Dr. Maudsley’s book on Mind was a distinct epoch-making
addition to the literature of insanity, and Dr. Sheppard at once recognised
its value and importance.
As far as he could he tried to elevate the treatment of his patients by
introducing a home-like feeling of comfort and confidence in them, by
elaborating the Turkish bath treatment, and by developing freedom and
outdoor sports and exercise wherever possible. But if his methods were not
very exact, his general accomplishments were elaborate. He was a fair
linguist in French, German, ana Italian, and his acquaintance with general
literature was extensive and was kept well up to date.
At one time he criticised the Society of Friends in a book entitled A
Fallen Faith , at another he took up the hydro-therapeutic treatment of
insanity, and, always having a facile pen, he found favour in the columns
of The Times , and frequently appeared there in a polished and vigorous style
on matters of special public interest connected with his subject. He wrote
an elaborate article on *' Cremation ” in The Pall Mall Gazette, and, to
sliow the strength of his convictions on this subject, he gave definite instruc¬
tions for his remains to be cremated, a proceeding which, in deference to
his expressed wishes, was carried out at Woking.
The writer can bear personal testimony to the respect and confidence with
which he was always treated by his patients and by the staff with whom he
was immediately associated, and to the unostentatious but very substantial
manner in which he assisted by influence and money the necessitous whose
straits were known to him. His conspicuously fair* and judicial mind and
his practical acquaintance with his suDject qualified him for higher office
than he ever actually attained; but he was never an office-seeker, and as a
fact he never mixed* very fre?1y with contemporary medical men. nor did
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1898.J
he attend the medical societies, partly owing to circumstances and partly to
disinclination, and therefore bis qualities could not be fully appreciated by
those who might have been of most use to him.
His son, the Sub-Dean of the Chapels Royal, to whom he was greatly
attached, testifies to the large number of letters of condolence written by
people well known in the literary world, and it was just in this class that
his chief sympathies lay. At one time of his life his religious convictions
were by no means deep, but of late years they were greatly intensified after
long and earnest conference with cne of the most enlightened of ecclesiastical
dignitaries, and ultimately he died in the Faith, a sincere Christian.
Such is the brief history of a man who did much and who was capable of more,
who held a lofty ideal of his position and profession fiom the social point of
view, and endeavoured by precept and example to inculcate the same among
his pupils; and who, sometimes misunderstood and harshly criticised, was
always able forcibly to give his reasons and faithfully to follow his single
line of purpose, and of whom these who best knew his warmth and steadfast¬
ness of friendship will say with earnest fervour, “ Peace to his ashes.”
T. C. S.
ROBERT GILLIES SMITH.
We regret to have to record the death of Mr. R. G. Smith, the eldest
son of Dr. Smith, of the Durham County Asylum. He died at the early age
of thirty-six, on 3 October last, while undergoing a second operation for
fistula in ano. Mr. Smith graduated as M.A. of the University of Aberdeen,
and afterwards became H.Sc.Lond., M.R.C.S.Eng., and L.R.C.P.Lond.
After serving as Assistant Medical Officer in the Durham, Whittingham, and
Newcastle Asylums, he went as Medical Superintendent to Dunston Lodge
Asylum, which position he occupied until his untimely death 4
J. B. LUY 8 .
Dr. Jules Bernard Luys was born in Paris in 1828, and had just completed
his sixty-ninth year when he died. He gained the position of interne of the
Paris hospitals in 1853, took his degree in 1867, and became professeur agrtgk
in 1863, having been appointed Physibian to the hospitals in 1862. He was
first attached to the Salpetri&re, then to the Charite; .he was also Director
of the Lunatic Asylum of Ivry. He was elected a Member of the Academy
of Medicine in 1877, and in the same year received the decoration of the
Legion of Honour, being promoted to the grade of officer in 1895. In 1893
he retired. M. Luys founded, and for many years directed, VEneiphale , a
periodical devoted to nervous and mental diseases. He was the author ol
a number of works on neurology and the anatomy of the nervous system,
for some of which prizes were awarded him by the Acad4mie des Sciences.
Among his works the principal are tKe following: Reeherthet tur It Systbme
Xcrceux Ceribro spinal (1865); Leqont tur let Maladie* du Systhne Nervtux
(1875); Le Cervtau et »et Fonetiont (1878); Traiti Clinique et Pratique det
Maladies Mentalet (1881); and Traiiement de la Folie (1894).
In his later years M. Luys devoted himself to researches on hypnotism,
his views on the subject being given to the world in two works. Let
Emotions ehez let Hypno liquet (1888), and Lemons CUniques tur let print ipaux
PhSnomenet de VHypnotisme (1889). Unfortunately these volumes did not
n<aintain his position in the scientific world, but rather robbed him of a part
of the scientific reputation he had acquired.
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[Jan.,
ItUDOLF HEIDENHEIM.
We have to chronicle the death of Professor Heidenheim, at Breslau, on
13 October. His contributions to neurology were extensive and important.
Professor Heidenheim will be chiefly remembered by psychologists by his little
book on animal magnetism, which still remains authoritative.
THE LIBRARY.
The Libriry has been enriched by a handsome donation of books from
the library of the late Dr. Bucknill, given by his heirs. The book-plates
record the name of the donor or of the bequest, and the Library thus becomes
a permanent record of those who have been interested in and connected with
our Association.
NOTICES BY THE REGISTRAR.
Examination for the Nursing Certificate.
118 candidates applied for admission to the November examination for this
certificate. Of tms number 88 were successful, 23 failed to satisfy the
examiners, 1 withdrew, and the results of the examination of 6 candidates
have not yet been received.
The following is a list of the successful candidates: —
Norfolk County Asylum, Thorpe. — Males: Benjamin Bennett, George
Carter, Josiah Englebright, George Flegg, James Tooke, William Thompson,
John William Whatley, Charles Waterson. Females: Emma Hay, Celia
Ladbrooke, Fanny Mileham, Minnie Riches, Amelia Smith, Rebecca
Wheatley, Evelyn Yauldren.
London County Asylum, Banstead.—Females: Emily Adelaide Barnes, Amy
Baker, Emily Bucknell, Florence Briggs, Elizabeth Lock, Alice Maytum,
Emily Warr," Elizabeth Wilkins.
Warwick County Asylum Hatton. — Males: Albert Edward Batchelor, John
Blakeman, Orontes Byrne, Arthur Elijah Girling, Walter Hope, Albert
Jcsegh Owen, Ernest Prestwicb, William Pettigrew, Frederick Wright, John
West Biding Asylum , Menston. — Males: Newton Farrar, Alfred Gordon,
Dawson Myers. Females . Dora Banner, Annie Spivey.
Borough Asylum, Sunderland. — Males: William Anderson, James Hunter,
Stephen Littledyke, Beniamin Parker. Females : Dorothy M. A. Ayre.
Florence Ager, Annie Elizabeth Bostock, Mary Kitching, Leah Hollings
Watson.
Borough Asylum, Derby. — Males. Francis Samuel Ashton, Samuel Slack,
Thomas William Slack. Female: Agnes Poynton.
Birmingham City Asylum , Rubery Hill.—‘Male: Henry Johnson.
Holloway Sanatorium. Virginia Water. — Male: Alfred Herbert Legge.
Female: Edith Kingsley Corke.
StreUon House Asylum , C harsh S tret ton. — Males: Richard Price, Edward
James Holl.
Bethnal House Asylum, London. — Female : Georgina Naylor.
Northumberland House Asylum, London.—Female: Clara Elizabeth (Jowen.
District Asylum, Hartwood, Lanarkshire. — Male : Alexander Jackson.
Females: Jeanie Maxwell, Barbara Raeper.
District Asylum, Woodilee, Lemie, — Males: William Boyd, Alexander
Morrison, Donald MacCaskill.
District Asylum, Limerick.—Males: Matthew Baranc, Patrick Casey,
Timothy Healy.
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22 $
1898.]
District Asylum , Ktitarncy.—Mahs: John Browne, Thomas Donoghue,
Cornelius Galvin, William Herlihy, William King, William Murphy, Denis
O’Ponoghue, Thomas Price, Daniel Rahillv, Patrick Sullivan. Females:
Bridget Fleming, Ellen Kahilly, Nora Kelleher.
District Asylum, BaHinasloe .—1 faUs: Patrick Craddock, Thomas Crough-
well, Patrick Kelly, John Nevin, Edward Yarnell. Females: Julia Corless,
Sarah Fov, Mary Gleeson.
The following* is a list of the questions which appeared on the paper: —
1. Explain the process of digestion and name the organs concerned therein.
2. What are the general bodily symptoms indicative of kidney disease ?
3. If it is necessary to use force with a patient, what precautions would you
take? 4 Trace the course of ih? blood from the time it leaves the left
ventricle till it returns again. 5. What is meant by a “fixed” delusion, and
give the different types? 6. Distinguish between sensory and motor nerves.
What is reflex action? Give an example. 7. Name the clinical varieties ot
insanity, giving a short summary of the symptoms which each presents.
8. Mention the various methods by which suicide may be attempted as far
as you have heard, and briefly indicate the appropriate precautions to be
adopted in respect of each variety. 9. Describe the occurrence known as an
epileptic fit. Briefly say what special measures are required in the treat¬
ment of epileptic patients. 10. State the indications which would lead you
to believe that a bone was broken, and describe the steps that you would
adopt in such an event before the arrival of medical aid.
The next examination will be held on Monday. May 2. 1898, and candidates
arc earnestly requested to send in their schedules, duly filled up, to the
Registrar of the Association not later than Monday, April 4, 1898, as that
will be the last day upon which, under the rules, applications for examination
can be receiv**d.
Note.
As the names of some of the persons to whom the Nursing Certificate has
been granted by the Association have been removed from the Register,
Employers are requested to refer to the Registrar in order to ascertain if a
particular name is still on the Roll of the Association. In all enquiries the
number of the Certificate should be given.
Professional Examinations.
The next examination for the Certificate in Psychological Medicine will
be hold in July, 1898.
The examination for the Gaskell Prize will take place at Bethlom Hospital,
London, in the same month.
Competitors for the Bronze Medal and Prize of Ten Guineas must send in
their essays to the President before May 30, 1898.
For further particulars respecting the various examinations of the Associa¬
tion apply to the Registrar, Dr. Spence. Burntwood Asylum, near Lichfield.
NOTICES OF MEETINGS.
MEDICO-PSYCHOLOGICAL ASSOCIATION.
Oener>U Meeting. —The next General Meeting will be held in Sheffield on
16 February, 1896.
South-Eastern Division .— The next meeting will be held at the Wandsworth
Asylum on the second or third Wednesday in April, 1898.
Irish Division .— The next meeting of the Irish Division will be held at
the College of Physicians, Dublin, on Thursday, 16 March, 1898.
South - Western Division. —The Spring Meeting of the Sooth-Western
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230
Notes and News.
Division will be held at the County Asylum, Littlemore, near Oxford, on
Tuesday, 19 April, 1898.
Northern ana Midland Division .—The next meeting will be held in May,
1898.
Scottish Division. —The Spring Meeting will be held in Glasgow on the
second Thursday in March. 1898.
APPOINTMENTS.
Philipson, George Hare, M.D., D.C.L., F.R.C.P., has been appointed
Medical Visitor to the Dunston Asylum, Gateshead-on-Tyne, vice Dr.
Embleton, retired.
Goldib-Scot, T., M.B.Edin., appointed Assistant Medical Officer to the
Warreford Asylum, Oxford.
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INDEX MEDICO-PSYCHOLOGICUS.
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JOURNAL OP MENTAL SCIENCE, APRIL, 1898.
DR. RINGROSE ATKINS.
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THE JOURNAL OF MENTAL SCIENCE.
[Published by Authority of the Medico-Psychological Association
of Great Britain and Ireland .]
No. 185. NB K! ES * APRIL, 1898. Yol.XLIY.
PART I.—ORIGINAL ARTICLES.
Note on the Memory of Fishes. By W. C. McIntosh, M.D.,
LL.D., F.R.S., Professor of Natural History in the Uni¬
versity of St. Andrews.*
Those who have watched a larval cod about 4 mm. in length
nimbly avoiding the forceps following it for capture are in a
fair way to estimate the brain-functions of an adult measuring
three feet. Still more is this appreciation of such functions
strengthened by the behaviour of a large grey skate in its
endeavour to escape over a trawl-beam more than fifty feet
long which had been arrested in its rise—just above the
surface of the sea—by a temporary block in the machinery.
The dexterity with which it skimmed to and fro along the
beam to find where it dipped sufficiently during the move¬
ments of the ship to enable it to glide over was a study, and
relief was felt when at last its intelligent perseverance was
rewarded. The observation of a group of salmon on a
spawning-bed, and the acquired skill of young trout in passing
up a model of a salmon-ladder, are corroborative of both
intelligence and memory. Moreover, if those who have given
a green cod of six or eight inches a particular kind of “scale-
back ” (a kind of worm), and noticed, firstly, how eagerly it
seized it, then tested it in its pharyngeal region, and soon
ejected it, never again taking that species into its mouth,
would be slow to deny that fishes, and even very young fishes,
have a memory. It is well known that fishes prefer certain
kinds of bait to others, probably because they retain the
pleasant sensations of former occasions. Thus it is that
anemones are a fatal bait for cod, lob-worms and certain
Nereids for plaice, the toothsome mussel for most marine
fishes, and the stripe of silvery skin (like a young rockling
* In a letter to Dr. Urqulmrt.
XL1V. 16
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232
Note on the Memory of Fishes,
[April,
or mackerel-midge) so eagerly sought by the mackerel.
Muddy water, again, obscures the nature of bait, and mis¬
leads both observation and memory, so that a lure which
would not so readily capture in clear water is now effective,
because no suspicions are roused. On the other hand, the
presence of phosphorescent organisms on a mackerel- or
herring-net is said to prevent a successful haul.
In confinement the young of both cod and green cod
recognise a figure approaching the tank in which they are
fed, and so with flounders, dabs, gunnels, viviparous blennies,
sea scorpions, and other forms. Their expressions are those
of eager expectation as they glide forward, and some keep
an eye on the surface of the water, and with a swift rush
secure the food before the others have time to reach mid¬
water if they happen to rest on the bottom of the tank.
There can be little doubt they remember what happened on
former occasions. Similar actions are observed when the
keeper approaches the trout in the poods at Howieton. In
swimming about in a tank with large anemones in full expan¬
sion, fishes, especially the smaller forms, avoid the dangerous
tentacles of the “ sea flowers/ 5 of which they have unpleasant
experiences. Again, if adult cod are kept for breeding
purposes in a large enclosure, and an attempt is made to
capture them by a ring-net, they soon crowd, as Captain
Danevig found, into the most remote corner, and thus, after
the first examples, are difficult to secure. Functional differ¬
ences, indeed, between this species and the green cod are
noticed when only about three inches in length, for as they
glide in company through the mazes of the tangles and other
sea-weeds in the tidal pools, the former is much more shy
and sensitive than the latter. * The recollection of danger is
further manifested by the shanny when it is approached as
it creeps under the sea-weeds on a rock uncovered by the
tide. It instantly leaps into its pool, and seeks shelter in a
miniature cavern or recess under the sea-weeds.
Bearing these manifestations in mind, it does not appear
improbable that when much harassed by trawls, by nets, or
by lines, shoals of certain fishes gain experience which
renders them less easily captured, and perhaps causes them
to leave their wonted sites in the ocean for a time and roam
elsewhere.
In nest-making and in the care of the eggs and young,
memory is apparently present in certain fishes. The skill of
the fifteen-spined stickleback, for example, is remarkable,
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1898.]
by W. C. McIntosh, M.D.
233
and its recollection of the spots where the sea-weeds best
suited for its purpose are located is evident. The threads
which the male secretes for binding the nest together are
placed in no haphazard way, but are interlaced with the sea¬
weeds with some intelligence. The accuracy with which the
male lump-sucker finds his particular mass of adherent eggs
—of which he is the faithful guardian even to the rendering
np of his life—is well known. Devotion which impels fishes
to be almost left high and dry at low water, so that only a
runlet bathes one side of the gills, is of no common type, and
it is unfortunate that they so often fall a prey to the carrion
crows and rooks which come to feed on the eggs they protect.
If the male be removed to a distance from the eggs it will
even flounder through shallow water till its snout impinges
against its charges (the eggs).* It would be difficult for the
male Arius to retain the large eggs in his gill-chamber if he
did not always recollect they were there ; indeed, he is some¬
what more acute than those higher forms who search every¬
where for their spectacles which are in situ on their noses.
The habits of the climbing perch, of the flying-fish, of the
electrical fishes, and other forms indicate the same traces of
memory. It is probably more than blind instinct which
enables the three-spined stickleback to use its formidable
spines in attack, or which enables the picked dog-fish and
the “fire-flare ” to inflict serious wounds with their weapons.
The claspers of the male skate would not cut so readily if the
animal, when seized, did not thrust the knife-edge out. The
sword-fish knows the use of its spear-like snout, just as the
saw-fish manipulates from experience its snout with the
double row of tooth-like spines.
In connection with the fact that certain fishes return to a
fresh lure while the old hook is fixed in the jaw, their
sensibility has been the subject of remark. Thus sharks
will return to their prey even when severely wounded, not
perhaps from want of memory but from courage and voracity.
The latter may also present nice discrimination in regard {o'
hooks and lines. A porbeagle shark will pass along a fisher¬
man's line, biting off the snoods with their attached haddocks
to the number of a dozen or more, as if trained to the pursuit.
Nor do the hooks appear to give inconvenience after the
digestion of the fishes, being probably ejected by the mouth.
It seems to have no unpleasant associations with this method
of feeding. On the other hand, an adult porpoise, which has
* Ann. Nat. Hist., August, 1886, pp. 81—84.
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234
Note on the Memory of Fishes ,
[April
a brain more richly constituted than most mammals, trying
the experiment for the first time, may be held by a single
hook and captured, for its teeth are of less service in the case
than those of the shark. A saithe (green cod) will chase
haddocks as they are drawn to the surface by the lines so
closely that fishermen will strike them with the “ clip ” (a
kind of gaff), and it has happened that the hook of the gaff
has parted from the handle and remained in the fish, which,
nothing daunted, was captured by another gaff as it eagerly
pursued the haddocks, and the broken instrument recovered.
Gulls, indeed, show little more discrimination in regard to
hooks and bait than fishes.
It would appear, however, that the voracity of sharks does
not blunt their appreciation (and recollection) of a choice
repast; for instance, when they fall in with a group of
“ green-bones ” ( Belone ), as in the case of a male thresher or
fox-shark, the stomach of which was filled with them; yet in
our country the “ green-bone ” is by no means a common
fish, a single example, as a rule, falling under the notice of
zoologists at a time, though it enters the estuaries of certain
rivers in numbers.
The extreme hardihood of certain fishes after injury must
be borne in mind when doubts are thrown on their memories.
Thus a fall-grown female picked dog-fish was captured in the
stake-nets for salmon some years ago with its stomach dis¬
tended with food. In dissecting the apparently dead animal
in the laboratory the heart pulsated actively, though it and
the pericardium were covered with old and recent lymph,
caused by the irritation of a large cod-hook, the point of which
projected into the pericardium, and against which the heart
seemed to impinge during contraction. An eel will live for a
year or two with a hook projecting through the gut into the
abdomen, and the glutinous hag ( Myxine) is also hardy under
similar circumstances.
Remarkable structures, it is true, are occasionally found
in the stomachs of fishes, though perhaps not always swal¬
lowed at sea. Such things, however, occur so rarely in the
life of the fish that experience is of little importance.
With regard to the absence of the cortex of the brain in fishes,
this is probably only a question of degree—easily understood
by referring to the descriptions and figures of the brain in the
salmon and the wolf-fish.* Besides, who has proved that the
functiou of memory depends on the brain-cortex of the human
# Trans. Boy. Soo . Bdin., vol. xxiv, part iii.
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1898.]
by W. C. McIntosh, M.D.
235
subject ? I have seen many a curious case in the pathological
room, the history of which would not have led us to this con¬
clusion.
The Systematic Collection of Anthropological Data in Asylums .
By Edwin Goodall, M.D., Joint Counties Asylum,
Carmarthen.*
It is not my purpose on the present occasion to relate a
series of observations. I merely desire to ask your attention
to a field of work hitherto little cultivated, either abroad or
in this country, especially the latter. I have not, indeed,
come across any account from which it is to be gathered that
anthropological methods—which are what I now refer to—
have been adopted systematically in any asylum for any
length of time, although of late such have been in use in
certain asylums of America, and also of Italy. In respect of
France and Central Europe I have no certain information ;
but I have not seen any notice in the journals of the speciality
of the employment of these methods in the asylums of those
countries. That the grosser stigmata of degeneration have
been observed in the course of ordinary clinical work in
asylums for some time, we are all aware. It is common to
hear at clinical examinations that a particular case has a
u narrow ” or “ sloping ” forehead, a “ flat ” occiput; possibly
we are at times more venturesome, and describe the head as
“ dolico-” or “ brachy-cephalic ” (our remarks thereby ac¬
quiring a certain nuance of scientific gravity). Or perhaps
the palate is noted to be “ arched ” or “ Gothic,” “ semi-
V-shaped ” or “ semi-saddle-shaped or the chin to be
u recedingor, employing a dramatic generalisation, we
pronounce the patient to be of a “ simian ” type. I need
not illustrate further, my object being simply to bring to
mind the fact that it has for long been thought worth while
to record conditions ascribed to imperfections of develop¬
ment. I pass to the representation that if it is worth while
to record such conditions at all, it is proper that there should
be some system whereby they may bo recorded. There aro
pathological forms, as you are aware, in many asylums, on
which systematic Records of autopsies are kept ; and if at
* Read by Dr. Ballen for the author at the Autumn Meeting of the South-
Western Division, 1897.
*
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236 Collection of Anthropological Data in Asylums , [April,
some future period it is desired to ascertain with what fre¬
quency a particular diseased condition occurs, or whether the
supposed significance of such condition is real, the accumu¬
lated facts are available for consultation. But if one desires
to ascertain to what extent it is true that certain anomalies
of palate or ear occur in the insane, or that they occur parti¬
cularly in certain states of mental perversion, one looks in
vain for records. And if, haply, observations on the point be
forthcoming, what is their scientific value ?
The theory of the “ criminal born” has been severely
criticised, in fact rejected by the majority of writers;
though Lombroso has his followers, even beyond the con¬
fines of Italy. Nevertheless, the most irreconcilable of the
opponents of the celebrated Italian criminologist might un¬
grudgingly recognise the value of his work in calling atten¬
tion to the morbid heredity, the defective anthropological
“ make up,” of many criminals, and thus claiming our serious
consideration, and that of jurists, in reference to the question
of irresponsibility amongst this class. The effect of such
teaching is to “ give us pause ” ere we proceed summarily to
explain the conduct of a criminal by invoking the influence
of the environment; nor can punishment be prescribed for him
off-hand, on conviction, without careful inquiry into his ante¬
cedents, if regard is to be had to considerations of humanity
and justice. To this state of things Lombroso’s work has
contributed much. There is assuredly no likelihood of our
overlooking the influence of heredity in the promulgation of
insanity. But I conceive it is desirable to have a system by
which we may be enabled to judge the anthropological status
of each case coming before us by direct observation, aside
from and independent of such history of hereditary instability
as is obtainable. I have been especially struck with the de¬
sirability of such a scheme when compiling statistics for
annual returns. I may be permitted to quote from observa¬
tions made in a return of the kind which 1 lately had to draw
up. It was there remarked—“ In the last Report of the
Lunacy Commissioners congenital defect is stated to have
been noted in a proportion per cent, of 5*7 to the yearly ave¬
rage number admitted into asylums in general during the five
years 1890 to 1894 (this for males; a lower proportion still for
females). Without going further into this topic, I am
strongly of opinion that a verdict of minus habens is return¬
able against a much larger number of the yearly admissions
into county asylums than is represented by figures now avail-
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1898.]
by Edwin Goodall, M.D.
237
able. There are degrees of congenital defect far short of
imbecility, and a more critical examination of the cases of
mania and melancholia would doubtless show that the acute
insanity is merely superimposed on a congenital defect. We
shall not know to what extent the mark of degeneracy was
upon the inmates of asylums at their birth until, by the
adoption throughout these institutions of a system for re¬
cording anthropological data, we obtain a mass of informa¬
tion relating to the frequency of occurrence in the insane of
the stigmata of degeneration.”
In many of the cases coming before our notice the evidences
of defective physical formation and backward mental state
are so marked that they cannot fail to arrest even superficial
observation. But this consideration should not, in my view,
cause us to rest content without subjecting these cases to the
routine anthropometrical examination, the great object of
which would then be to note the relationship between the
degree of mental defect and the number and nature of the
degenerative stigmata—anatomical and physiological—which
are present. In other instances, however, our systematic
examination would not merely enable us to correlate bodily
and mental stigmata, but would reveal the existence, in the
first place, of such physical stigmata which had escaped the
ordinary examination. I refer to cases of mental disorder
referable to some exciting cause deemed in itself sufficient
prior to anthropological examination. Without the latter
there is risk of our according to such irritans some of the
influence which by right attaches to the irritable.
Apart from the propriety of studying the relationships
between physical and psychical stigmata amongst inmates
of asylums and cases submitted for private advice, with a
view to a better understanding of the groundwork of any
particular case, and so to a sounder forecast in respect thereof,
there is the interesting speculation—which for many may
have a mere academical interest—as to whether these dege¬
nerative signs indicate a reversion to type, whether they
have atavistic significance. We are struck by the presence
of a marked Darwin tubercle in the ear, and by its peculiar
shape, by cranial deformity, by prominence of the facial
over the cerebral • portion of the skull, by peculiarities of
teeth or lower jaw, and disproportionate length of forearm
to upper arm; or there is pronounced prognathism, or
the chin is lacking in prominence (it should project to a
certain extent in front of the perpendicular in European
Digitized by LjOOQle
238 Collection of Anthropological Data in Asylums, [April,
races); how do the measurements compare with those which
obtain in the lower races of mankind and in the anthropoid
apes ? If we compare anthropometrically our individual
of the “simian” type to the gorilla, how near do they stand
to each other ? This is a phase of the subject which will
doubtless be examined in the future. I here call to mind a
patient in the asylum with which I am connected, an adult
imbecile, whose parents, and brothers and sisters to the
number of five, are all imbecile, mostly in a pronounced
degree; it has often struck me that if this man’s hair of
trunk and limb were more in evidence, and he were photo¬
graphed grasping a bough, it would need some scrutiny to
distinguish him from a gorilla. I have not as yet taken his
measurements.
It remains to be seen how far extensive observations will
justify a priori opinions to the effect that the stigmata of
degeneration in the insane are especially found about the
cranium and face.
It is doubtless desirable that all persons should be examined
on an uniform plan, but with many of the insane we cannot
expect—by reason of the mental state—to get anything like
complete returns. In asylums it must commonly be a ques¬
tion of eliciting the maximum possible out of a total of
returns. The comparison with similar observations from
gaols would doubtless be of much interest. The Bertillon
system has lately been introduced in a modified manner into
gaols in this country, with the object of identifying criminals
and malefactors. My information from one of our leading
prisons is to the effect that it is only applied there in a limited
manner, for detection of recidivists. The object would not
appear to be other than an immediately practical one. Only
in the event of the authorities of prisons encouraging scien¬
tific work can we expect a scientific scheme for anthropo¬
logical purposes to be adopted in prisons. I have for some
time been of the opinion, which I have elsewhere expressed,*
that the associated study of insanity aud crime is desirable,
having in view the relationship existing between these dege¬
nerations; and this study would be much facilitated by
associating the asylum and gaol services, when the lunatic
and the malefactor might be conveniently studied from a
common anthropological basis.
Where the work undertaken is the anthropological exami-
* “The Associated Study of Crime and Insanity,” Lancet , December 26th,
1896.
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1898.]
by Edwin Goodall, M.D.
239
nation of the existing inmates of an asylum, in accordance
with a scheme, it is clear that a laborious and time-absorbing
task is contemplated. But I do not think that if each new
case as admitted is examined—supposing the asylum to be
adequately staffed—the undertaking will be particularly for¬
midable. At any rate, a system for recording anthropo¬
logical data, drawn up by Dr. Stearns, is in use in this
.manner in the Illinois Eastern Hospital for the Insane; and at
San Servolo, Venice, Dr. E. Peterson, of New York, informs
us cephalometry is systematically practised on every fresh
admission. Dr. V. Giuffrida-Ruggeri has this year published
a memoir upon the value of the signs called degenerative, in
which I find incorporated the results of his examination of a
large number of inmates of the Provincial Asylum of Rome.
In fact, we shall probably find time for a special study of
some one part of the organism, in addition to our work in
accordance with the scheme. For thorough study of any
part this kind of specialism is necessary. For example,
Benedikt prescribes thirty-eight cephalometrical formulae for
thorough students ; though probably in respect to the head the
most trustworthy results are obtained by Rieger’s system of
measurement,* another thorough method, taking a good deal
more time than the ordinary system. Experience induces me
to think that the cases of the hard palate and the ear illus¬
trate particularly well the need for special study. In the
case of the ear, for example, the best scheme for examination
is probably thac of Schwalbe,t of Strasbnrg, whose chart
contains thirty-four questions, of which not more than two or
there could be omitted if one is to be thorough. As regards
the palate, I have lately been engaged upon a method for its
examination, based upon cast-taking; to work through this,
supposing the cast to be ready, I find half an hour necessary 4
If the inmates of asylums, or individuals of a private
clinique, are to be examined anthropologically, we shall of
course need a normal standard by which to judge, and I antici¬
pate that experience will decide that it is best for asylum
workers to get a normal standard for themselves, by the
examination of asylum employes and of normal individuals
from the asylum district; since it is very improbable that, as
regards this country, any normal standard of the kind desired
* Dp. C. Rieger, Eine Exacts Methods der Craniographie.
t In the following Piiper Dr. Lord submits n scheme for the ear, drawn up
by him.
X Journal of Mental Science , October, 1897.
Digitized by L^ooQle
240 Collection of Anthropological Data in Asylums, [April,
(indeed, it would be necessary to have normal standards for
various districts of the country if we would conform as nearly
as possible with accuracy) will be available, unless as a result of
the work of the British Association in different parts of the
country. Most county asylums would appear to be in a good
position to carry out observations with the object of ascer¬
taining the anthropological status of their admissions. The
observations upon the insane and the Surrounding sane would
be made by the same persous, and the two classes of persons
observed would be mostly from the same district from which
the asylum draws. And I should judge that such series of
observations might, in many cases, be collated with those of
other asylums, especially neighbouring ones, with every pro¬
priety, for the purpose of accumulating a greater bulk of
facts.
For the purposes of comparison and the accumulation of
a mass of information, it is desirable that a uniform scheme
of examination be employed by different observers, and this
could only be drawn up by a committee chosen for the
purpose. I should say that much requires to be done ere
any such deliberation is possible. Individual workers must
first proceed after their own schemes; after sufficient indi¬
vidual experience has been gained these can be considered,
and a scheme for general use drawn up therefrom, by a
properly authorised body. Of late I have been putting into
practice a scheme drawn up after much consideration, and of
necessity based upon the work of such standard writers as
Bertillon, and Emil Schmidt of Leipzig. The difficulty is to
limit the measurements and descriptions within reasonable
compass, in consideration of the time at disposal, and yet to
avoid the omission of observations which perhaps should have
been made. Especially, I think, in regard to the extent to
which it is desirable that measurements of the trunk and
limbs, and of parts of these, should be carried, does uncer¬
tainty at present obtain. This will be resolved by experi¬
ence. It is precisely on account of the lack of sufficient
experience that I do not now present the scheme I follow. I
shall be glad of the opportunity to compare it with the plan
followed by any worker in this subject.
Digitized by k jOOQle
1898.]
241
The Collecting and Recording of Descriptive and Anthropo¬
metric Data of the Ear in the Neurotic , Insane , and
Criminal—a New Method. By John R. Lord, M.B.,
Joint Counties Asylum, Carmarthen.
The writings of Morel, Wildermuth, Binder, Gradengo,
Vali, Frigerio, Eyle, Schwalbe, have familiarised us with
several types of ear; and this, together with BertilIon’s work,
perhaps forms the bulk of our knowledge on the subject.
Recently, in America, good summaries have been published
by Meyer and Peterson.
It is not the intention of the present writer to write any¬
thing like an exhaustive paper on the subject. It is more to
remind English readers, or perhaps bring before them in a
preliminary way, an interesting branch of anthropology and
anthropometry, and to state a new method of measuring the
ear and of recording the same. This of necessity brings in
the topographical anatomy of the ear, which needs be stated
pretty fully, and in doing so several new and perhaps im¬
portant features will be brought forward. As before stated,
this is more a preliminary statement of a method to which I
am working than an account of results obtained. I append
also in a fairly complete manner the literature on the subject.
Before Schwalbe’s recent paper the study of the ear was
carried on in a very unsystematic way. Recently Schwalbe
(in 1895) published a new scheme for collecting data in the
form of a chart, which included measurements and various
descriptive data. This was a distinct move in a right direc¬
tion. It is only those who have devoted special attention to
the ear who can thoroughly appreciate its many varied forms,
and the difficulty in mapping out a 'series of measurements
which can be applied generally.
The scheme to which I am working is largely Schwalbe’s
modified, and in my opinion improved. The descriptive part
I have altered in several places, but only in a minor way. I
have, however, deemed it insufficient, and have therefore
added to it, as will be pointed out later. The measurements
given by Schwalbe are, however, open to criticism. The
chief objection is the lack of a definite modus operandi. The
points from which he takes his measurements are not defined
enough to base on them any accurate data. They may even be
absent in some cases, and, further, the direction and relation
to other measurements are in some instances not indicated.
My object, therefore, is to bring these into line with Rieger’s
Craniography, or the new method recently described by Dr.
Digitized by
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242 Descriptive and Anthropometric Data of the Ear, [April,
Goodall* for measuring the hard palate, with which he was
good enough to associate me. The value of all anthropo¬
metric data depends naturally on their accuracy; and their
practical side on their uniformity in all cases and comparison
with a normal standard. The difficulty meets one here, as it
has done before with regard to other data, i.e . the establish¬
ment of a normal standard. BertilIon’s measurements may
be satisfactory in France, but it is evident that they will not
apply to this country. The time is now ripe for suggestions as
to the establishment of normal anthropometrical data, not only
of the ear, but of other parts of more or less equal interest.
It is not my intention to claim more importance for the ear,
as showing neurotic and insane proclivities, above other
parts, as the skull, palate, limbs, &c. It is quite clear to my
mind that it is only from a more or less complete examination
of the body generally, according to one of the many schemes
now published, that one is justified in coming to the conclusion
that a person is a lower type of being, and therefore more prone
to mental disorder and criminality, and in whom, granting a
mental disorder, the prognosis is rendered more serious.
But I am of the opinion that it is only by a thorough study
of isolated parts, such as ear, palate, &c., by methods which
ensure accuracy and completeness, that a general scheme
can be correctly built and normal standards fixed.
Before going on to describe the method, I wish to draw
attention to the more important features in the topographical
anatomy of the ear, of which a diagram (fig. 1) is appended.
There is no one ear which shows all these features, some of
which are common and others rare. It will be seen that the
helix arises by the crus helicis , and runs in a curved direction
to the lobule. For descriptive purposes it is divided into an
anterior upper part and a posterior part. + The crus descendens
passes from the crus helicis downwards posteriorly to the ex¬
ternal auditory meatus. The satyr point is what the uninitiated
would call the point of the ear, the real morphological point
probably being Darwin’s tubercle.% The crura of the anthelix,
of which the number varies, join to form the stem and sur¬
round a fossa called the fossa ovalis . The most important of
these crura is the crus anthelicis superius.§ The crus anthelicis
* Journal of Mental Science, October, 1897.
f Frequently small tubercles are seen ou the superior and inferior edges of
the crus helicis.
X When found it is on the outer margin of the helix , and is usually associated
with the cercopithecus form of Darwin's tubercle.
§ Frequently the stem ends inferiorly in quite a marked prominence.
Digitized by kjOOQle
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JOURNAL OF MENTAL SCIENCE, APRIL, 1898.
Fig. 2.
TO ILLUSTRATE DR. LORD’S ARTICLE.
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Google
JOURNAL OF MENTAL SCIENCE, APRIL, 1898,
Fig. 3.
Left Ear.
Fig. 4.
TO ILLUSTRATE DR. LORD’S ARTICLE.
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1898.]
by John B. Lord, M.B.
243
tertium arises from the stem and proceeds upwards to Darwin’#
tubercle or near it, or to the anterior upper helix above.
The anthelix ends at the sulcus obliquus , and is separated
from the helix by the fossa scaphoidea and from the crus helicis.
by the fossa cymbse , and forms the posterior boundary of the
fossa concha .* The fossa cymbse is really part of the fossa
concha , except in some cases, and in measuring is reckoned
as such. The tragus has above it the tuberculum supra -
tragicum , and at its junction with the cheek there is fre¬
quently a sulcus, which I have called the sulcus tragi anterius .
Between the tragus and the antitragus is the incisura inter-
tragical The lobule for practical purposes has a base at the
level of the incisura intertragica. Between it and the anti -
tragus is a sulcus called the sulcus supralobularis , while its
surface is occasionally marked by a vertical groove called the
sulcus lobuli verticalis.
Data as regards the ear are both anthropometric and
descriptive. It will be convenient to first indicate the an¬
thropometric method. This is a new method which I have
devised, and which logically falls into two principal parts,
viz. marking of the ear, and measuring and transferring to
millimetre paper. Very little in the way of instruments is
required. A skin or copying pencil flat on one side, a
flexible rule, a pair of compasses, a small drawing set square,
and millimetre paper complete the outfit.
The things to mark first are the base line and the perpen¬
dicular. The former is done with the pencil and rule, the
position being the anterior limit of the insertion of the ear
into the skull, minus the lobule, and limited interiorly by the
lowest point of insertion of the cartilage of the ear. The
upper and lower limits are marked T (fig. 3, c, h). This line
is continued upwards and downwards tor a short distance.
The perpendicular is got by suspending a short line to which
is attached a lead weight, the patient being in the erect
posture with eyes looking straight forward and the line pass¬
ing through the lowest insertion of the cartilage (fig. 3, c).
One might note here that to ensure accuracy of measurement
the lead must be maintained in the erect posture throughout.
Next is to place the short side of the set square on the base
# The fossa; scaphoidea is not uncommonly represented by two fossa, one
soperior, one inferior, with a connecting channel.
f The antitragut consists of three prominences; a superior oue arched in a
vertical plane; an anterior one arched in a horizontal plane; and a posterior
one which ought to be distinguished from the tuberculum retrobulare.
Digitized by LjOOQLe
244 Descriptive and Anthropometric Data of the Ear , [April,
line, and to mark on the base line and on the ear the follow¬
ing, from above downwards (see fig. 3, kilg., &c.), taking care
not to move the ear in any way. The use of the set square
makes these points necessarily at right angles to the base
line. This requires a little practice to do correctly.
1. Highest point of ear (fig. 3, k).
2. Highest free edge of helix (fig. 3, i).
3. Greatest breadth (fig. 3, g —position varies).
4. Line of constant point for giving length of fossa concha ,
through intersection of crus helicis and middle crus anthelix
(fig-3,/).
5. Line of constant point for giving breadth of fossa
concha , through highest point of tragus (fig. 3, e).
6. Line of base of lobule through lowest point of incisura
intertragica (fig. 3, d).
7. Line of lowest point of lobular attachment (fig. 3, b).
8. Line of lowest point of lobule (fig. 3, a).
This completes the marking of the ear. One has next to
measure these points, and to transfer to millimetre paper.
This part is very simple and needs no description, as a
minute's study of fig. 2 will convey everything. In this way
one arrives in a constant and definite manner at the follow¬
ing measurements (see fig. 2) :
1. Greatest length of entire ear.
2. Greatest breadth of entire ear.
3. Length of ear-base without lobular attachment.
4. Length at fixed points of fossa concha.
5. Breadth at fixed points of fossa concha.
6. Breadth of lobular base.
7. Greatest length of lobule.
8. Distance between lowest point of incisura intertragica ,
and the highest free edge of helix.
The whole process can conveniently be termed aurigraphy.
Schwalbe gives a measurement from the bottom of the incisura
intertragica and the highest point of the ear. I fail to see
any importance in this, and have therefore omitted it, and
put in its place what I judge to be a very important measure¬
ment of the complete shell of the ear, namely, that from the
bottom of the incisura intertragica to the highest point of the
free edge of the helix. Schwalbe also gives a measure¬
ment from the upper point of the tragus to Darwin’s tubercle.
No doubt this is important, and the right one for the mor¬
phological index; but the fact of Darwin’s tubercle being
frequently absent or poorly indicated destroys its value. For
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1898.]
by John R. Lord, M.B.
245
the morphological index I therefore use the measurement
before indicated (fig. 2, x, e').
It will be seen that I have altered the base-line somewhat,
and restricted it to the insertion of the ear minus the lobule.
I have thought it advisable to exclude the lobular attach¬
ment, because the latter varies so much, and thus causes
too much variation in the morphological index.
I have made much fuller the insertion of the ear by indi¬
cating three angles, viz.—
i. Angle between base-line and perpendicular (fig. 2 ,g, c, h);
ii. Angle of the helix (fig. 2, Z, h, a);
iii. Angle of the lobule (fig. 2, a, c, v) ;
and the shape of the base, whether straight, concave, or
convex. The degree of convexity or concavity can be re¬
corded by moulding a thin strip of lead and tracing it.
Where Bertillon’s instruments are used his small calliper
rule can be used in place of the compasses. If deemed too
cumbersome (and I think it is) for a general scheme, the
millimetre paper can be omitted, the ear being simply marked
and the measurements taken and written down.
The various indices are arrived at as follows :
Length-breadth index of head . Breadth x 100.
Length.
Physiognomic index of ear . . Breadth x 100.
Length.
Morphological index of ear . . Base x 100.
Distance between
bottom of incisura
and highest free
edge of helix.
It is obvious that very abnormally shaped ears will need
special measurements. These ought to be taken on the same
plan as those already given, i. e . from definite points. With
this method the vertical and transverse measurements can be
multiplied indefinitely.*
The descriptive data remain to be taken. The chart indi¬
cates these fairly clearly. It will be seen that I have altered
Schwalbe’s table in one or two places, and have deemed it
insufficient in other, and have therefore supplemented it.
Further, I have omitted several points as being unnecessary.
The chief additions are in connection with the tragus and the
# Experience shows me that the ears move in a slow rhythmical manner in
some people. This should be noted or the measurements will be fallacious.
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246 Descriptive and Anthropometric Data of the Ear, [April,
various fossae, the latter being in Schwalbe’s table completely
omitted. The various sulci may be represented by more
than one ; if so, it should be noted.
The only manual part with regard to the descriptive data
that needs mentioning is in connection with the stem of the
anthelix as regards retraction, prominence, &c. Bertillon’s
method can be adopted here with advantage. It is as
follows :—Place a lead pencil against the tragus and posterior
helix in a horizontal plane, and note whether the anthelix
touches it or is away from it, or prevents the pencil from
resting on the post-helix.
It is impossible to draw up a chart in which there is a place
for every point. The chart given suffers, if at all, from over¬
crowding from a practical point of view. A chart three or
four times its size could easily be drawn up. To complete the
method photographs can be taken, but this is not essential.
It is more desirable in cases of hsematoma auris. Any special
peculiarity can easily be sketched in on the diagram, and
with sufficient accuracy, seeing that the most important
landmarks are already indicated. Special descriptions, &c.,
must be written in on the margins of the chart, and in the
space specially provided.
It is plain that ears deformed by disease, such as haematoma
auris, are not available for comparison with others. As before
stated, these should be photographed, and as near life-size as
possible, the photograph being added to the chart in place of
the aurigraph.
Fig. 4 shows two aurigraphs, illustrative of marked asym¬
metry, commonly known as Blainville’s ears. I shall be happy
to supply a few charts to any one interested.
In conclusion, I have to acknowledge my indebtedness to
Dr. Goodall for much kindly encouragement and advice.
Literature.
Binder. Das Morel’scbe Ohr. Deese’s Archiv, Bd. xx, 1889, S. 514 ff.
Gkadenigo. Ziir Morphologie der Ohrmuscliel bei gesunden und giesteskranken
Menscbeti und Deligenten. Archiv fiir Ohrenh&ilkunde , xxx, 1890.
-Ueber die Formauoinaliender Ohnnuscbel. Ibid., E ben da xxxii uud xxxiii,
1891.
- Centralblatt f. d. medic. Wissenschaften , 1888.
Schwalbe. Das Dartvin’sche Spilzohrbeitn mtnschlichen Embryo. Anat.
Anz., 1889.
- Derselbe. Iu wie fern ist die Ohrmuscbel ein rudimentares Orgau ? Archiv
f. Anat . u. Phys. t Anat. Anz., 1889, Supplement.
- Zur Methodik statistischer Untersuchungen iiber die Ohrformen von Geistes*
kranken, &c. Archiv f. Psychiatric u. Nervenkrankhtiten y Bd. xxvii, H. 3,
p. 635.
Digitized by AjOoqL e
iptive Data of the Ear.
Nationality.
Birthplace.
Heredity.
For other signs of
degr. see
length-breadth Index !
of Head. i
Physiognomic
Ear Index.
Morphological
Ear Index. “
II. L.
Aittiteagus.
j Direction of upper margin (horizontal, 1;
| medium, 2; oblique, 3).
Inclination oqtwards (absent,0; medium,
! 1; pronounced, 2).
Lobultts Aueictjue.
i Attachment (prolonged on cheek, 1;
sim ply adherent, 2; partially separated,
3 ; free, 4) .
j Sulcus supralobulare (absent,0; medium,
1 ; marked, 2 ; connected with scapha,
3 ). p ...:
I Sulcus obliquus (absent, 0; only in anti-
tragal region, 1; complete, 2) .
R. I L.
i Tuberculum retrolobnlare (absent, 0 ;
I medium, 1; marked, 2) .
| Sulcus lobuli verticals (absent, 0; me-
I dium, 1; marked, 3).
1 Direction of lobule (bent inwards, 1;
] Rtrnight, 2; bent outwards, 3).
j Lobule split (split, 1; not split, 0).
(thin, 1 ; medium, 2; fleshy, 3)
i Fossa.
i Concha (too large, 1; too small, 2).
Scaphoid (absent, 0; present, 1 ; con-!
i tinned on lobule, 2).I
Cyinbne (absent, 0; medium, 1 ; weii |
marked, 2) . I
Ovalis (absent, 0; medium, 1; weli i
marked, 2) .I
Various unclassiflable peculiarities as regards ac¬
cessory ears, fistula auris congenita, hairiness,
movements, &c.
*3
O
W
a
2
o
p
ns
H
►*3
H
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>
Date —
[ Page 246.
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Google
Digitized by {jOOQle
by John R. Lord, M.B.
1898.]
247
Schwalbe. Das Darwin'sche Spilzohr, etc., 1. c. und Beitrage zur wigs. Medicin.
Festschrift fUr B. Virchow, Bd. i, 1891.
Voli. Allgem. Wiener medic . Zeitung, No. ii, 1891.
Frigerio. L’oreille exterue. Archives de Vanthrop. criminelle, 1888.
Fbl. Eylb. Ueber Bildungsanomalien der Ohrmuschel, Zurich, 1891.
Schaffebs. Ueber die f5tele Olirentwickelung die ha ufglieitfo taler Ohrformen bei
Erwachsenen und die Erblichkeilsverh<nisse derselben. Archiv fur
Anthropologic, xx, 1892.
Bertillon. Identification Anthropometrique. Nouvelle edition. Melon, 1893.
Hi s. Zur Anatomie des Ohrlappehens. Archiv fur Anat. u. Phys Anat. Abth.,
1889, und Anthropolog . Correspondenzblatt , 1889, No. 3.
Adolf Meyer. Review of the Signs of Regeneration. Amer. Journ. of Insanity,
vol. lii, No. 3.
Peterson. Stigmata of Degeneration. State of New York Hospital Bulletins,
vol. i, July, 1896, No. 3.
Certain Physical Signs in Melancholia .* By W. H. B.
Stoddart, M.B., B.S., M.R.C.P., Pathologist to the
Lancashire County Asylum, Prestwich; late Clinical
Assistant at Bethlem Royal Hospital; late Resident
Medical Officer at the National Hospital for the Para¬
lysed and Epileptic, Queen Square, Bloomsbury.
There is but one important preliminary to my paper. It is
that I wish to take this opportunity of expressing my most
sincere thanks to the medical officers of Bethlem Hospital
(Dr. Percy Smith, Dr. Hyslop, and Dr. Craig) for their great
kindness and courtesy in putting every facility in my way
while I was making the following observations, for the
interest which they took in my work, and for the valuable
suggestions which they so willingly afforded me from time to
time.
It is now nearly a quarter of a century ago since Kahl-
baura described the symptom-complex, which he called and we
now know as Katatonia. This is a form of alternating
insanity, in the melancholiac stage of which there is a
secondary alternation. Rhythmical forms of movement and
of speech alternate with rigidity and mutism. The rigidity,
as Kahlbaum further pointed out, affects mostly the muscles
of the neck and shoulders.
I now wish to draw attention to the fact that rigidity
of this nature is not confined to cases of katatonia. It also
exists in, as I think, all cases of melancholia to a greater or
# Read at the General Meeting of the Medico-Psychological Association,
November, 1897.
ILIT. 17
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248
Certain Physical Signs in Melancholia , [April,
less degree; but it is especially marked in severe cases of the
disease, and especially in those cases in which there is an
element of stupor.
Now, if the nature of this rigidity be examined more
closely, it will be found that it is most marked in the muscles
of the trunk and neck, that it is less marked but very strik-
ingly present in the muscles of the shoulders and hips, that
it is again less marked at the elbows than at the shoulders—
less marked at the wrists than at the elbows, and that it is
practically absent from the fingers. Similarly the rigidity is
less marked at the knees than at the hips, very slight at the
ankles, and again practically absent from the toes.
In order that my premises may be clearly understood,
I repeat that rigidity of this nature is discoverable in all
severe cases of melancholia. It has appeared to me that it
is most marked in those cases which suffer a large amount of
mental pain, while it is difficult to detect in slight cases
of the disease.
It will be observed that this rigidity is of a nature the
converse of that which occurs in ordinary cases of hemiplegia,
where it is more marked at the fingers than at the wrist—
more marked at the wrist than at the elbow, and more
marked at the elbow than at the shoulder. Similarly in
hemiplegia, the rigidity is more marked at the toes than at
the ankle—more at the ankle than at the knee, and more at
the knee than at the hip.
It will be convenient for the sake of brevity to refer to
this latter form—the form which occurs in ordinary hemi¬
plegia—as peripheral rigidity, and to that form which I have
described as occurring in melancholia as proximal rigidity.
In making observations upon this point it is merely neces¬
sary to grasp the limb and move it about, taking it segment
by segment. For example, in the case of an arm, the elbow
would first be grasped, the upper arm moved about on the
trunk, and the amount of rigidity observed. The forearm
should then be grasped, alternately flexed and extended upon
the upper arm, and the degree of rigidity compared with
that observed at the shoulder. The hand should then be
moved upon the forearm, and so forth.
Two fallacies must be avoided, both of which are depend¬
ent upon the patient’s attention being attracted to the
observation. The first is that he may voluntarily resist the
movement, and the second is that he may, on the other
hand, so to speak, acquiesce in the attempts to move the
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249
1898.] by W. H. B. Stoddart, M.B.
limb, and move it himself in what appears to him to be the
desired direction, thus masking 1 the rigidity.
I look upon this rigidity as being more or less universal in
the melancholiac, affecting also the bilaterally acting mnscles ;
for example, among details, I regard the wrinkling of the
forehead as rigidity of the frontales muscles.
My reasons for believing this proximal rigidity to be a true
physical sign of melancholia are—
(1) That it does not occur in other forms of insanity.
(2) That it disappears from the patient as he gets well.
(3) That voluntary rigidity is of the peripheral type.
This is best observed in a resistent child.
Since rigidity is frequently associated with paralysis, one
naturally endeavoured to ascertain whether there was any
weakness of movement at those joints where the rigidity was
most marked. This paralysis, I think, I have detected.
There is very little weakness to be detected in the elbow or
wrist movements, but if such a patient as I have described be
asked to hold his hands straight above his head, he has
difficulty in doing so; and it will be observed in extreme
cases that the upper arm* is not nearly held vertically, and
that the elbow is not quite fully extended, even when the
utmost persuasion is used to get the patient to assume
this attitude. This symptom has again seemed to me to
be most marked in those patients who suffer a large amount
of mental pain, especially if associated with an element of
stupor.
As a corollary to this observation, I have another one,
which is this. There are usually in a large asylum one or
two female melancholiacs who can be induced to knit or sew,
but who cannot be induced to do housework; on the other
hand, it is rare to find a patient who is willing to do house¬
work but unwilling to perform the fine movements of knitting
or sewing. It is difficult to make many observations on this
point; because there are usually cogent reasons which demand
that the patient must be put to one or the other, especially
the disposition to suicide. Patients who are willing to
perform the grosser movements of housework, but unwilling
to knit or sew, are generally people who never did knit or
sew. The observation of this paralysis has previously been
put in other ways; I am now merely putting it in a new light.
For instance, it is an old observation that the attitude of the
melancholiac is one of general flexion. I now submit that
this attitude, which is also seen in senility and in paralysis
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250
Certain Physical Signs in Melancholia, [April,
agitans, is an attitude of weakness, or in other words of
slight—very slight—paralysis. There is, at least, paralysis
in effect. Again, the melancholiac patient will himself tell
us that he has difficulty in doing things, aud Dr. Bevan
Lewis' bases his hypothesis with regard to melancholia
entirely on this symptom. There is, as he puts it, failure in
the muscular element of thought.
The condition is one of very slight double hemiplegia, and
hence it would be expected that there should also be weak¬
ness of the bilaterally acting muscles. The tenderness, if I
may so speak of it, of the melancholiac to noise is probably
due to weakness of the tensores tympani, and I hope to show,
in a subsequent communication, that the indistinctness of
vision of these patients, by which people—for instance—look
dead to them, is due to temporary weakness of accommo¬
dation.
Kahlbaum also described, in the melancholiac stage of
katatonia, a diminution of the normal number of nictitations
of the eyelids, and also a diminution of the amplitude of the
movements of the chest in ordinary respiration. I have been
unable to confirm these signs either in katatonia or in melan¬
cholia ; and, indeed, I should not expect to find them.
These movements are involuntary, and are not therefore of
cerebral initiation ; they are movements relegated to a lower
level of the nervous system. I might expect weakness of the
power of voluntarily screwing up the eyelids and of volun¬
tarily taking a deep breath, but not of involuntary nictitation
and respiration.
In the explanation of these phenomena I make use of a
principle first enunciated on theoretical grounds by Dr.
Hughlings Jackson, and subsequently confirmed by direct
observation by Dr. Bevan Lewis. I refer to the fact that
movements at the large joints are represented in the cortex
by large cells, and movements at the small joints by small
cells. This is now well established.
It will be best at this point to digress for a moment to con¬
sider a mathematical fact as regards solid bodies. Taking a
sphere for example, it will be remembered that the content
varies as the cube of the diameter, while the surface varies
as the square of the diameter. The practical bearing of this
is that small bodies have a larger surface relative to their
content than large bodies, although of course they have a
smaller absolute surface. This is why a small body cools so
much more rapidly than a large body. Similarly, the large
Digitized by Le
251
1898.] by W. H. B. Stoddart, M.B.
cells of the cortex have a smaller relative surface than the
small cells.
It seems likely that some affection of these cells would
account for a rigidity and paralysis which affects the joints
according to their size, and again it would appear right to
suppose that the change is metabolic in its nature rather
than structural. Further, it is obvious that such a metabolic
change must depend either on intrinsic chauges within the
cell itself or on changes in the environment of the cell. If
we suppose some change in the environment of the cell (for
instance, anaemia or some toxin circulating in the blood or
lymph), the small cells would be affected more than the large
cells, because they have a greater relative surface exposed to
the deleterious influence. Under such circumstances the
rigidity would affect the small joints more than the large
joints,—that is to say, it would be of the peripheral type.
Such rigidity occurs in the second stage of chloroform anass-
thesia, where we have a poison circulating in the blood. I
have made several observations on this point. But we have
already seen that the rigidity of melancholia is of the con¬
verse or proximal type. Let us, then, suppose what appears
to me to be the only other alternative, that the cells of the
cortex contain within them some deleterious substance, some
effete product of their own metabolism. In such a case it is
clear that the large cells would be more affected than the
small cells, because the large cells have a smaller relative
surface from which to get rid of their products of meta¬
bolism. And this agrees with my observation that the
rigidity affects the large joints more than the small joints.
I submit, therefore, that in melancholia the cells of the cortex
cerebri fail to some extent in the excretion of their metabolic
products.
Having arrived at such a conclusion, it was in the natural
order of things that, as a physician, one's thoughts should
next be directed to the investigation of the effect upon the
melancholiac of those drugs which have the property of
causing cells to excrete their metabolic products. There is
one drug, viz. pilocarpine, which we know to have this pro¬
perty par excellence. Pilocarpine is a very appropriate drug
to try, because it acts, as Langley has shown, upon the cells
themselves, and its action is not to any great extent de¬
pendent upon modifications of the circulation or upon the
innervation of the cells.
Accordingly, observations were made on the effect of pilo-
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252
Certain Physical Signs in Melancholia , [April,
carpine on melancholiacs in two ways; to wit, by*the admin¬
istration-of infusion of jaborandi by the mouth, and by the
subcutaneous injection of pilocarpiue.
In these observations one discovered the very striking and
remarkable fact that melancholiacs are exceedingly tolerant of
this drug, or, in other words, that they react very feebly to
pilocarpine.
After gradually increasing doses, four patients were
treated regularly with 4 ounces of the infusion three times
a day, and in one case four times a day (i.e. 16 ounces
in the twenty-four hours), and yet the reaction to the drug
was practically nil. The skin was scarcely more than com¬
fortably moist; salivation was not perceptibly increased, nor
was there any marked contraction of the pupil. The only
control observation was made upon myself, in whom a single
dose of 2 ounces of the same infusion caused profuse perspi¬
ration and salivation.
In the above cases, too, the mental effect of the drug
appeared to be practically nil. K. W—, the patient who
had 16 ounces in the day, a case of melancholia attonita, was
being artificially fed at the time. She was more excitable on
each of these occasions than when she was not under the
influence of the drug, and she used unparliamentary language,
which, again, was not her wont when she was not under the
influence of jaborandi. Otherwise these patients were quite
unaffected. As regards the rigidity, it seemed to be very
slightly, if at all, relieved.
The next series of observations was made with hypodermic
injections of pilocarpine—£ gr. of the nitrate on each occasion.
As it was desirable to have some form of measurement by
which the reaction of cases of melancholia might be compared
with that of other cases, and also among themselves, I devised
the following method. Discs of ordinary Swedish filter-paper
were used. One of these was placed upon the patient’s back
between the shoulders, and covered in with a piece of ordinary
gutta-percha tissue, such as is used for covering in fomenta¬
tions. The gutta-percha tissue was held in place over the
disc of filter-paper by means of strips of lead plaster strapping.
The object of covering the paper in this way was, of course,
to prevent evaporation. It was then noted what interval
elapsed between the time of the injection of £ gr. of nitrate of
pilocarpine into the arm of the patient, and the time when the
disc of filter-paper was uniformly just saturated all over with
moisture.
Digitized by
by W. H. B. Stoddart, M.B.
253
1898.]
The results of the control observations were as follows :
In the case of patients who had not had an injection of
pilocarpine the paper remained comparatively dry at the end
of several hours. About twenty cases were observed under
these conditions.
Five control observations were made in the other direction;
three on cases of acute mania, one on a case of anergic
stupor, and one on myself. Of these the shortest interval
was in my own case, in which the paper was saturated in
two and a half minutes; and the longest was in the case of
stupor, where it was three and a quarter minutes. The cases
of mania took about three minutes on each occasion. In all
these cases the perspiration was very profuse.
Twenty-six observations were made on cases of melan¬
choliacs. None of these were of more than twelve months*
standing. In five of these cases the paper was still com¬
paratively dry after an interval of two hours. At the end
of this time one of the patients was sick.
The following are the times for the other patients:
Min .
Min.
Min.
M. C.
. 10
J. C. .
4
Miss B. .
9
K. W. .
. 11
Mrs. F. .
10
Miss K. .
. 13
J. L. C. .
. 10
B. E. J. H. .
10
Mrs. P. .
. 12
A. E.
. 9
Mrs. Wby. .
3
Miss H..
. 17
R. P.
. 12
Mrs. Wly. .
10
Mm. J. .
. 19
E. R.
. 16
Mrs. B. (saliv.)
26 1
1 Mrs. J. .
. 10
Miss P. .
. .11
Miss C. .
10 1
Mrs. C. .
. 21
A. F.
. 12
i
Leaving out, of course, the cases
in
which there
was no
reaction at all, the average of these numbers gives about
twelve minutes as the time for reaction of a melancholiac to
■j- gr. of nitrate of pilocarpine as against three minutes for
other people.
With regard to the case in which the paper was saturated
in three minutes, it is only fair to state that the original
diagnosis was acute mania, and although the patient de¬
veloped melancholic ideas subsequently, she was still in¬
coherent and deficient in self-control. This case suggests
that the reaction may possibly be useful as a help in diagnosis.
Before proceeding farther, let us here pause for a moment
to consider the pharmacology of pilocarpine. As Langley
has shown, pilocarpine is a drug which acts upon the cells
themselves, causing them to excrete their products of meta¬
bolism. Binz, 6f Bonn, came to the conclusion that this
drug acted through the influence of the nervous system.
Digitized by L^OOQle
254 Certain Physical Signs in Melancholia, [April,
The difference between the results of these two observers
depends upon the difference of their methods. Langley
paralysed the nerve-endings by means of, if I remember
rightly, nicotine, and noted the action of pilocarpine there
and then; while Binz waited for divided nerves to degenerate
before making the observations. The obvious result of this
latter method was that the cells degenerated before the effect
of pilocarpine was tried.
Coupling, then, my observations with those of Langley,
my conclusion is that in cases of melancholia the cells of
the tissues throughout the body have their function of ex¬
cretion diminished. I have already pointed out how the
nature of the rigidity in melancholia leads to the same con¬
clusion qua the cells of the cortex cerebri.
And if we review the symptomatology of melancholia I
think it will be agreed that it is in accordance with this view
of the pathology of the disease.
Ihe diminution of the quantity of saliva and the furred
tongue indicate diminution of the buccal secretions. The
indigestion and loss of appetite with consequent refusal of
food are more than probably due to insufficient secretion of
the digestive juices.* The constipation may be also explained
on this hypothesis, although the partial paralysis—to which
I have already referred—probably plays an important part.
It is certain that the faecal accumulation of the melancholiac
is excessively deficient in moisture.
A striking example of this deficiency of secretion is further
afforded by puerperal cases. Those who are attacked with
insanity within the first week or so after parturition are
usually cases of mania, and it is frequently necessary in these
cases to treat the patient with belladonna or potassium iodide
to arrest the secretion of milk. But those who are attacked
later than this usually become cases of melancholia, and with
these it is noteworthy that the secretion of milk is arrested
by the disease, and at the time when the secretion is normally
at its height. In those institutions where the breasts are
treated by merely squeezing out the milk before a fire, the
nurses always have more trouble with the breasts of maniacs
than with those of melancholiacs.
The urine is also diminished in quantity in melancholia,
but this probably has no bearing on my point. Most of the
constituents of the urine have merely filtered through the
* In this connection vide Dr. Greenwood’s paper in the January number of
The Journal of Menial Science.
Digitized by {jOOQle
1898.]
by W. H. B. Stoddart, M.B.
255
glomeruli of the kidney from the blood into the Bowman’s
capsules. Very few of the constituents are of the nature of
a true Secretion ; that is to say, they are not built up by
the cells of the kidney before excretion. And those consti¬
tuents which are formed in this way (hippuric acid, for ex¬
ample) are so variable in quantity under normal conditions
that it would serve no useful purpose to estimate them in the
melancholiac. The fact that the quantity of urine is di¬
minished in the melancholiac is, I imagine, merely due to
the fact that he does not drink so much as a healthy in¬
dividual.
I will refer to but one other symptom, viz. the amenor-
rhcea. Amenorrhcea is very much more common in melan¬
cholia than in other forms of insanity. In the consideration
of this interesting symptom the question arises as to whether
it is the part played by the maturation of the Graafian follicle
which is at fault, or whether it is the part played by the ute¬
rine mucous membrane. I am inclined to think that most
physicians would ascribe the amenorrhoea to failure of the
changes which normally take place in the ovary at the time
of menstruation, but it is a point which remains to be scien¬
tifically settled. It seems to me that light might be thrown
on this question by the study of cases of melancholia which
begin shortly before marriage. These cases are not very in¬
frequent, they are usually classed as post-connubial iusanity;
but closer inquiry into the history often reveals that there
were some symptoms of insanity before marriage.
In looking up some past records I came across notes of
thirteen cases of this kind; but in not one of them was the
menstrual history sufficiently detailed to throw any light upon
this point.
It must be admitted that we are here rather trespassing
upon unknown land ; but if the fault were proved to be at the
Graafian follicle, and if the maturation of the follicle be of
the nature of a secretion (as I am inclined to think it is), then
this symptom is also to be explained by the pathology which
I have suggested.
In submitting the above pathology it is not to be under¬
stood that I suppose these metabolic changes in the cells to be
the cause of melancholia, nor do I suppose the mental changes
to be the cause of the physical. Here, as in the domain of
normal psychology, I adopt the view of psycho-physical
parallelism. All that I submit is that the physical changes
which I have described go on co et par with the psychical
Digitized by LjOoqL e
256 Certain Physical Signs in Melancholia , [April,
changes. What the nature of the connection is between the
two I do not know, and it would open up too wide a question
for discussion were I to enter upon this point here.
Similarly it would be opening up too wide a question if we
were to discuss whether these physical changes in melancholia
are mere exaggerations of what occurs in physiological me¬
lancholy (as is quite probable), or whether they are limited
to the conditions of disease.
In conclusion, gentlemen, I must thank you for the kind
and patient manner in which you have listened to what I
have had to say. I cannot ask you now to discuss the merits
of my observations on the nature of the rigidity and para¬
lysis, or on the pilocarpine reaction. The value of these
observations must depend entirely upon their confirmation or
denial by other observers.
I hope, however, that I may have the great advantage of
your friendly criticism of my deductions and conclusions.
These may be right or wrong ; but should the observations
be confirmed, they cannot but add to the data from which
some abler mind than my own may some day present us with
a real advance to our knowledge of the constitution of mind
in health and disease.
Discussion.
Dr. Mebcier —To me, sir, this paper is a very interesting one indeed. It is a
very remarkable fact that this peculiar distribution of the rigidity which Dr.
Stoddart has noticed is precisely the distribution that I assigned many years ago
to certain other phenomena, but especially to rigidity in certain conditions. He
terms it proximal and peripheral; I called it centrifugal and centripetal. There
are certain phenomena, and especially there are certain rigidities, which begin at
the periphery, in the lingers, and are most marked in that position, and which
diminish as we approach the trunk and the bilaterally acting muscles. There
are certain other rigidities again which are most marked in the great muscles of
the trunk and the neck, and which diminish as we go towards the periphery. It
is a corroboration of the correctness of Dr. Stoddart’s observations that the
rigidity he has noticed follows a classical order; because, as he has stated, it is
most marked in those muscles which follow a natural order and In which rigidi¬
ties have been observed to occur before. I have no doubt that he is perfectly
correct in putting down the transverse corrugation of the forehead to the exten¬
sion of the rigidity to another bilaterally acting muscle. He did not mention
the condition of the masseters. Now I have always found in these rigidities
which I call centrifugal, that is to say, which are most marked in the great
trunk muscles and diminish towards the periphery, that tbe muscles of mastica¬
tion are associated with the muscles of the trunk ; whereas the muscles of the
lips ami the muscles of articulation are exactly at the diametrically opposite end
of the scale. I have not noticed whether the masseters and other muscles of the
jaws are rigid iti melancholia, although now thut Dr. Stoddart draws one’s atten¬
tion to it, it becomes manifest to one’s mind that this rigidity does exist in cases
of melancholia, and especially in cases of stupor. We have all noticed it, but
not with that vividness of perception which has enabled us to give the importance
to it that Dr. Stoddart clearly has. Then with regard to his explanation, it is
Digitized by LxOOQLe
by W . H. B. Stoddart, M.B
257
1898 .]
impossible for me at present to follow him in all his conclusions, but I would
point out that his description of the rigidity is that it occupies a certain definite
region in a certain definite order, and that that particular order and region are
complementary to another order and region. Then he puts this down to certain
changes or certain want of changes in the cells. My explanation was a very
different one. My hypothesis is that the movements in which the smallest
muscles—the fingers, the lips, and the movements in articulation—take the lead,
and are, as it were, the great motive of the movement, are cerebral movements.
They are produced by tho action of the cerebrum; and that the movements
which are first and last, the movements of the trunk, the neck and masticatory
muscles, which gradually spread, if they spread at all, away from the trunk
towards the smaller muscles, are cerebellar movements. That the cerebrum and
cerebellum represent movements of the body in two opposite orders, the cerebrum
representing them from the smallest muscles to the greatest, and the cerebellum
in the opposite direction. A classical illustration of a wave of cerebellar influence
is observed in yawning. When we yawn the trunk straightens out, the mastica-
tory muscles are thrown into movement, and gradually the wave spreads to
muscles that are smaller and smaller, and further and further away from the
centre of the trunk. Although the attitude assumed is not the same, this is the
order in which the muscles are affected in the rigidity which Dr. Stoddart has
described to us. The fact that this rigidity that he has observed does follow
precisely the order, which is a classical order, and has been observed in very
many rigidities, I think goes very far indeed to speak for the accuracy of his
observations. As to the explanation that he has given, well, it may be correct
or not. My explanation is that 1 believe in melancholia the cerebral influence is
weakened, and when this is so the cerebellar influence is proportionately
strengthened. Hence, the due balance not being maintained, the cerebellum over¬
acts, and produces too great rigidity of the muscles which it most prominently
supplies. This may be the correct explanation, or Dr. Stoddart's may be the
right one; but in any case we must recognise that the observation of rigidity
occurring in melancholia is very important, and one that is very likely to meet
with important results.
Dr. Conolly Nobman —I hardly feel competent, sir, after the remarks made
by Dr. Stoddart and by Dr. Mercier, to discuss the deeper aspects of this ques¬
tion, or, as I might call them, the speculative aspects. There are, however,
certain clinical facts that suggest themselves. We were told by Dr. Stoddart
that the rigidity in melancholia occurred in a certain order, and that fact I
am not prepared to dispute. I have no doubt that Dr. Stoddnrt’s observations
are more accurate than any I have ever made on the subject, and that he is in a
general way correct, but rigidity in cases of melancholia is not unknown in the
fingers. Not unfrequeutly in such cases, if the patients be neglected, the
fingers become permanently rigid. Now he has spoken of a certain degree
of paralysis which accompanies this rigidity, and he speaks of testing the
patieuts by making them elevate their hxnds straight over their heads. I am
not quite clear that this is a sufficient test by which we could say that the larger
muscles of the arm and shoulder are paralysed, because we all know that the
muscular system in cases of extreme melancholia is, to use a very slipshod clinical
word, relaxed, and no doubt weakened, sometimes absolutely wasted; but this
is a general nutritive change, and could hardly be classed as paralysis in the
strict sense of the word. With regard to wrinkling of the forehead, the explana¬
tion is that, it is due to a condition of tension in the frontalis muscle. If that
is so in melancholia, does that explanation cover the wrinkling of the forehead
which is a familiar indication of mental trouble in the physiological state?
There is something further than the mere engagement of a certain portion of
the brain. With regard to the state of the respiratory movements, it is a very
old observation, and 1 have many times confirmed it clinically, that the respi¬
ratory movements in melancholia are feeble and shallow. One also certainly
Digitized by {jOOQle
258
Certain Physical Signs in Melancholia, [April,
sees diminished nictitation. Cases are on record, and I remember one case which
1 could not distinguish from melancholia, in which the flies used to drink the
accumulated secretion out of the corner of the patient’s eye without producing
winking. Now this is obviously diminution of reflex action, and is probably
not due to any changed condition either in the cerebral or cerebellar cells.
Similarly the general diminution of all the secretions must be connected with
some general cause not merely due to change in particular brain cells. There
is another matter upon which I should like to say a word or two. When I read
the title of Dr. Stoddart’s paper it occurred to me that he was about to mention
that very curious condition that we are all familiar with in melancholia agitans,
which is hard to fit in with any of the theories that we have heard about the
condition of the brain. May be there is an explanation that does not occur to
me. In the state to which I refer there is a tendency not only to general large
movements, which are, of course, not very common in melancholia, but that
tendency to small movements which 1 am in the habit of describing to my
class as small pseudo-purposeful movements. A patient takes his dress and
picks it thread by thread to pieces, as if he had some task to accomplish.
The movement, though apparently voluntary, is, no doubt, to a large degree
to be considered as an involuntary, perhaps 1 might almost say an automatic
movement; and this condition of the muscular activity is one which I cannot
reconcile with Dr. Stoddart’s theories regarding the conditions in melancholia
which he has described. It is, however, a condition which one clinically sees,
and which needs to be accounted for in any theory which deals with the general
muscular condition in melancholia.
Dr. Julius Mickle— I understand the reader of the paper to say that a
condition of rigidity exists in all cases of melancholia. That is a statement I
should not be willing to allow to pass in this Association without raising a
dissentient voice. The muscular condition of cases of melancholia varies so
much that it is impossible to accept rigidity as the universal condition of the
muscular system in that particular affection. It all depends upon the kind of
melancholia—the clinical form it takes. There is a form in which rigidity is
the chief symptom. One has been accustomed to point this out to students, and
to show them that the most significant and most characteristic feature of that
rigidity is the difficulty iu raising the bowed head, the muscles of the neck
being so strongly contracted.
Dr. Stoddart —It is my misfortune and my fault that I have not read
Dr. Mercieris work on the subject. I feel sure that anything written by him
would throw much light on the subject, and it is no matter for great
surprise that both Dr. Mercier and myself have turned to the fertile brain of
Dr. Hughlings Jackson to obtain our explanations of the rigidity and the
paralysis. The explanation of influx from the cerebellum* and complementary
influx from the cerebrum is, of course, exceedingly likely, but it seemed to me
that the pilocarpine experiments and also the geueral observations of the secre¬
tions throughout the body point to the same conclusions ns I have arrived at
from the observations on the rigidity. Further, the result of clinical observation
goes to show that proximal rigidity occurs if cerebellar influx be cut off, and
peripheral rigidity if cerebral influx be cut off. On Dr. Mender's hypothesis,
therefore, the muscular conditions associated with melancholia are referred to
cerebellar mischief. This, I submit, is not probable. With regard to the mastica¬
tory muscles, I am afraid I have not come to any conclusion. I have tried to observe
whether there was any rigidity of these muscles, hut it is very difficult to notice
without inducing resistance on the part of the patient. Of course I quite agree
with Dr. Norman that rigidity of the fingers does occur, hut what I maintain
is that the rigidity there is nothing like so marked as higher up the limb. If
* In this connection vide Horsley and Lfiwenthal’s paper ( Proc . Roy. Soc.,
1897).
Digitized by {jOOQle
1898.]
by W. H. B. Stoddabt, M.B.
259
the rigidity be greater at the fingers than it is higher up the limb, then I should
conclude that there was something more than melancholia. I entirely avoided
discussing the question as to whether melancholia was a mere advance upon
physiological melancholy. With regard to the movements of small joints in
melancholia agitans, I think it quite agrees with the explanation which I have
attempted to set forth, namely, that the finer movements are still at work, while
the grosser movements are more or less paralysed and rigid. Rigidity is present
in cases of melancholia agitans, for while the movements are going on in the
fingers it will be noticed that there is sometimes a certain amount of rigidity in
the movements of the shoulders and elbows. With regard to the constancy of
the rigidity, as I have said before, in the very slight cases of melancholia it is
extremely difficult to observe. I think if Dr. Mickle makes the observation in
the same way that I have done he will find that rigidity almost constantly varies
co et par with the severity of the melancholia.
Alcoholism and Suicidal Impulses .* By W. C. Sullivan, M.D.,
and Stewart Scholar, R.U.I., Deputy Medical Officer
H.M. Prison, Liverpool.
The important part played by alcoholism in the causation
of suicide has been abundantly recognised by all observers of
both these social phenomena; and so far as debate now
touches the question, it is merely to deal with points of detail.
In the present slight contribution to one such detail of the
subject I have endeavoured to show, by the analysis of a
series of cases of alcoholism associated with suicidal ten¬
dencies, in what mode and under what special conditions the
intoxication determines the development of these tendencies.
For this purpose I have utilised, with the kind permission of
my colleagues, the clinical records of 142 cases in which
persons have been charged in the Liverpool police courts
with attempting to commit suicide, and have been sent on
remand to Walton prison, where they have been subject to
medical observation. As the practice of so remanding pri¬
soners charged with this offence is almost invariable, the
figure named represents practically the total number of futile
attempts at suicide in the city of Liverpool during the period
of eighteen months covered by the records.
I shall first submit in detail the analysis of these cases,
and subsequently discuss the inferences which they seem to
suggest.
(a) Proportion of cases due to alcoholism .—Of the 142 cases,
64 (45*1 per cent.) were in males, 78 (54*9 per cent.) in
* Read at the General Meeting of the Medico-Psychological Association,
February, 1898.
Digitized by L^ooQle
260 Alcoholism and Suicidal Impulses , [April,
females. Divided according to the influence of alcohol in
their causation, they give this result:
MhIm. Female*. Tot«l.
Non-alcoholic ... 10(15*6%) ... 22 (28*2%) ... 32 (22*5%)
Alcoholic . 54 (84*4%) ... 56(71*8%) ... 110(77*5%)
The proportion of non-alcoholic cases, if incorrect, errs on
the side of excess, for I have reckoned in this category all
those cases in which no positive evidences of the drink-habit
were obtainable. In some of these cases an element of
alcoholism was extremely probable, and even in the small
number of instances where it could be definitely excluded in
the individuals, it may have exercised an influence through
the ancestry.* The two following observations are suggestive
from this point of view.
(1) Female aged 21, domestic servant of good character,
attempted suicide by poison; no distinct motive beyond mo¬
mentary lack of work. Both parents in asylum, suffering from
chronic alcoholic insanity.
(2) Female aged 19, hard-working girl of good character,
attempted suicide by drowning; no cause assigned beyond
depression, owing to quarrels between her parents. Father
and mother confirmed drunkards.
(b) Influence of alcohol in actual and in attempted suicides.
—We may probably regard 77*5 per cent, as a fairly correct
estimate of the proportion of cases of attempted suicide to be
attributed to alcoholism. Since we have no means of de¬
termining a corresponding local formula for the alcoholic
influence in actual suicides, we are forced to fall back upon
general estimates of the factors of suicidal aetiology. In
different countries and with different observers these estimates
show considerable variations. In England Mulhallt attri¬
butes to alcoholism about 12 per cent, of suicides; Brown
puts the figure at 13’7 per cent. The statistics of Brierre de
Boismont and of Lunier for France give somewhat similar
results.! In extremely alcoholic countries the proportion is
naturally higher; thus in Sweden, before the legislative
restrictions of the drink traffic, the alcoholic contribution to
suicide amounted (1851-5) to the enormous figure of 65*5
per cent.§
Even if we assume that the above-cited estimate of 12 per
cent, for England is somewhat under the truth, there will
# Sollier, T>u RSle de VSSriditS dans VAleoolisme , Paris, 18S9.
f Diet, of Statistics , 1892.
X Quoted in Morselli, II Suicidio , 1879.
§ Baer, Der Alcoholismus , 1878.
Digitized by L^ooQle
1898.]
by W. C. Sullivan, M.D.
261
yet remain a very marked contrast with our figures, sug¬
gesting that the proportion of cases due to alcoholism is
considerably higher in the category of unsuccessful than in
that of actual suicides. Such a result is not surprising, in
view of the fact that nearly 80 per cent, of the attempts by
alcoholics were made in a state of actual drunkenness, when
the power of more elaborate co-ordmation was to a large
extent in abeyance, and where, moreover, the accompanying
symptoms of the alcoholic condition would probably draw
attention to the actions of the individual. Moreover in a
certain number of cases reckoned at attempts at suicide the
self-destructive impulse aborts, owing either to the develop¬
ment of a profounder degree of intoxication or to some
sensory impression, real or hallucinatory, diverting the atten¬
tion. In several of our cases this is clearly seen.
(3) Female aged 40, chronic alcoholic; father, brother, and
two sisters also drunkards. Found asleep on the bank of the
canal; recollected being very drunk and going to the canal to
drown herself, because the idea “ came over her;” could not
assign any other motive.
(4) Female aged 48, notorious drunkard. Found at the
dock with her boots off, talking to the water; was drunk,
and could recall nothing of the. incidents, but had expressed
the intention of suicide. Probably prevented from following
the impulse by some auditory hallucination referred to the
water.
(5) Female aged 34, chronic drunkard ; made an attempt on
her life three months previous to present attempt. Went to
the dock, took off her clothes, and put them into the water;
was very drunk at the time ; remembered having the idea of
suicide, and going to the dock to drown herself; could not
explain her subsequent conduct.
(c) Frequency of suicidal attempts compared with assaults
as results of alcoholism .—If we assume, according to our
observations, that 77*5 per cent, of cases of attempted suicide
in this city are due to alcoholism, then of the 117 such cases
recorded in Liverpool for the year 1896, 90 would be assigned
to this cause.
In the same year 6146 persons were apprehended in a state
of drunkenness, which in 712 cases was associated with
violence against the person, thus giving a proportion of 7 91
cases of assault for 1 case of suicidal tendency; or, expressed
in percentages of the number of drunken persons arrested, in
12*4 per cent, the intoxication was associated with acts of
Digitized by
Google
262
Alcoholism and Suicidal Impulses ,
[April,
violence, in 1*4 per cent, with suicidal tendencies. It is to
be noted that this proportion is arrived at by the analysis of
statistics regarding drunkenness, and not alcoholism; in
statistics dealing with alcoholism suicidal attempts reach a
much higher proportion.*
(d) Sexual incidence .—Of the 110 cases of attempted
suicide which were due to alcoholism, 49 per cent, occurred
in men, 51 per cent, in women. This predominance of
females is in striking contrast with the facts of sexual inci¬
dence observed in connection with actual suicides. Thus in
Morselli’s statistics the maximum proportion of women suicides
in any series of years for England and Wales is 28'2 per cent.,
the maximum in any European country 28*8 per cent. Com¬
parison with local statistics of actual suicides shows con¬
formity with the general law; thus in 1896 the proportion of
women amongst suicides was 33 per cent. The fact that this
proportion is a little in excess of the average figures for the
country doubtless depends in part on the local prevalence of
the drink habit. As we have seen that alcoholism is the
overwhelmingly predominant cause of futile attempts at
suicide, it is not surprising to find that the analysis of the
total number of attempted suicides in the last five years
shows that 50 per cent, of the attempts were mad9 by
women, a sexual preponderance similar to that which we
have observed in considering our alcoholic cases.f
(e) Condition at the time of the attempt. —Classified accord¬
ing to their alcoholic condition at the moment of the attempt,
our 110 cases divide thus:
Sober ...
Drunk l “ e,noI 7 retaiued
l Amnesia
Males.
16
17
21
Females.
7
16
33
According to these figures 79*1 per cent, of the attempts
were made in a state ot' actual drunkenness. Our figures are
too scanty to allow any other inferences; but it is interesting
to observe the progression of the numbers, especially in the
case of women, when classed as in this table, according to
the three conditions of sobriety, drunkenness with and
drunkenness without memory,—conditions which, in their
relation to suicide, may possibly correspond with degrees of
* Send, in observations on 1500 cases of alcoholic insanity at Ville Evrard
Asylum, noted'suicidal tendencies in 12 86 per cent., assaults in 14*46 per cent.
(Th. de Paris , 1896).
f In the five years 1892-6 there were 648 such cases evenly divided be¬
tween the sexes. 1 am indebted for these figures to the courtesy of the Head
Constable of the City of Liverpool.
Digitized by LjOoqL e
1898.]
by W. C. Sullivan, M.D.
263
chronicity in alcoholism. Of the 16 cases in which alcoholism
in men determined suicidal tendencies without immediately
antecedent excess, in 10 instances the suicidal attempt was
associated with a state of subacute alcoholic insanity with its
characteristic delusions and hallucinations. None of the
7 cases amongst women presented these symptoms.
(/) Age .—Classing our cases according to age, we get
this result:
Fenmles.
15 —25
10
15
25—55
22
20
35-45
...
12
12
45—55
y
... 6
Over 55
4
... 3
Thus the decade 25—35 shows a very decided maximum,
more decided in the males than in the females, in whom the
preceding decade is also well represented. In contrast with
this result, the maximum period for male suicides in England
(Morselli) is the decade 45—55, for females 35—45. The
significance of this fact will be discussed later.
{g) Chronicity of alcoholism .—In a large majority of the
cases the patients gave a history of alcoholic excess extend¬
ing over a considerable period prior to the suicidal attempt;
taking an average of their statements, the duration of this
pre-suicidal stage would be from five to seven years; in only
three cases was the alleged time less than one year, and
in one of these cases outside evidence and the presence of
well-marked symptoms proved the alcoholic habit to be one
of old standing. I give a summary of the notes of the two
other exceptional cases:
(6) Female aged 23, domestic servant. Attempted suicide
by strangulation while drunk. No memory of the act.
States that she began to drink six months ago, taking chiefly
whisky. Denies hereditary taint; defective intelligence;
facial asymmetry; internal strabismus. On admission
suffering from acute gastritis with haematemesis; had visual
hallucinations for a few nights. This patient made a pre¬
cisely similar attempt seven months later.
(7) Female aged 18, domestic servant. Attempted suicide
by throwing herself into the dock. No memory of the act
committed immediately after she had taken a large quantity
of raw spirit; no domestic or other troubles; states that she
had never previously taken any alcoholic liquor. Intelligent,
physically healthy ; no evidence of alcoholism, no hereditary
taint.
XLIV. 18
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Alcoholism and Suicidal Impulses,
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I have not encountered any other case in which suicidal
impulses have developed quite early in the alcoholic history
under the immediate influence of an acute intoxication.
This fact is the more curious seeing that cheap whiskey, rich
in amylic alcohol, is the principal intoxicating agent in the
population from which our cases are drawn.
Except in determining approximately the duration of the
drinking habit, the testimony of the alcoholic, even when
given in good faith, is practically valueless, and we are
accordingly forced to rely upon another class of evidence,
namely, the symptoms of chronic intoxication.
All our cases, with the single exception to which I have
referred above, presented in marked degree a number of such
symptoms, variously combined,—ovarian irritation, gastric
catarrh, tremor, hallucinations of sight, nightmare, insomnia,
cramps, and hyperaesthesia of the calf muscles, amblyopia,
colour scotoma, cutaneous hyperaesthesia of the lower
extremities.
With regard to the majority of these symptoms, their
relation to alcoholism is sufficiently established to leave no
doubt of their diagnostic value. A word of explanation is,
however, required in reference to the ovarian irritation; by
that is indicated a symptom similar to the “ ovarie ” in
hysteria ;* there is pain, spontaneous and on pressure, in the
iliac region on one or both sides, with corresponding pain
under the breasts, and on vaginal examination the ovaries
may frequently be found enlarged and tender. This symptom
is, no doubt, of common occurrence from other causes; but
when it is encountered in the absence of hysteria, anaemia,
and local disorders of the genital organs, when even to the
observation of the patient its development and aggravation
are influenced by her drinking habits, and when, above all,
it disappears or decreases with abstinence from drink, we are
fairly entitled to regard it as an effect of alcoholism, which
we know to be in fact among the most potent causes of
chronic ovaritis (Matthews Duncan). This symptom, which
is present in most of our chronic drunkards, its severity
corresponding with the chronicity of the poisoning, was
found in nearly all the suicidal alcoholics whom I examined.
(fc) Heredity .—The existence of insanity (certified) in
immediate relatives was ascertained in four of the 54 males
who enter into our statistics, and in three of the 56 females :
these numbers are probably below the facts, as in the special
* Charcot, Leqons sur les Mai. du Syst. Nerv., Paris, 1877.
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by W. C. Sullivan, M.D.
265
circumstances there would be an obvious interest in conceal¬
ing an insane taint. Two of our male cases and three of our
female cases were the subjects of epilepsy antecedent to
their alcoholism.
Our cases were not all examined as to the existence of an
alcoholic heredity; but, so far as the observations go, they
show such a taint in at least one half. None of our cases
were dipsomaniacs.
(i) Previous attempts .—In the cases of three males and
six females previous suicidal attempts were recorded—in one
case three such attempts, in another two. The interval of
time between the attempts varied from twenty-one years to
three months.
(j) Mode of attempt .—Classified according to the method
employed to carry out the impulse, our cases give this
result:
Drowning
Mules.
11
Females.
25
Poison
11
14
Hanging
6
4
Strangulation
...
3
7
Cut throat
...
21
5
Other means...
2
1
These numbers are obviously too small to base any conclu¬
sions upon.
After this brief examination of our cases it remains to in¬
quire how far the results obtained serve in any measure to
explain the psychological process which issues in the suicidal
impulse.
From this point of view, the fact of highest importance is
the almost constant relation between the development of the
impulse and the chronicity of the alcoholic poisoning.
In chronic alcoholism the special and constant psychical
condition is a dementia, variable in degree according to the
intensity of the poisoning and the antecedent level of mental
development. But this dementia does not in the majority of
instances present itself in the pure form, as a progressive
diminution of the functional activity of the brain; it is
coloured by a variety of symptoms of a more active kind in
the intellectual and affective spheres.
In the production of these secondary symptoms a large
part is to be referred to the extra-cerebral influences of the
poison. Obviously lesions of the digestive and circulatory
systems interfere in some measure with the nutrition of the
brain, and in this manner reinforce the direct effect of
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Alcoholism and Suicidal Impulses,
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alcohol upon that organ. But apart from this mode of
action there is another, from the psychological point of
view more important. The more or less generalised disorder
of function, which alcohol tends to produce in the entire
economy, has as its psychical counterpart a profound alteration
of the “ ego.” In the cerebral representations of the body
which form the basis of the personality, the vaguely felt
pleasurable nerve currents of normal function are replaced
by more or less defined sensations of strongly negative tone,
expressive of disordered action. The influence of these
visceral states upon thought and feeling becomes propor¬
tionally greater as the brain grows more enfeebled and the
higher forms of mental life disappear.*
There is, of course, in this psychic change nothing pecu¬
liar to alcoholism : all the intoxications which cause diffused
organic troubles at the same time that they degrade mental
function have a similar tendency to produce melancholic
alterations of the personality ; in morphinomania,+ in lead
poisoning, in pellagra, J the typical psychic condition is one of
depression.
It is, however, in alcoholism that the reaction of the
somatic disorders on the emotional and ideational life is
seen most clearly and most frequently. Extreme instances
are furnished by cases of typical alcoholic insanities; it is
enough to cite the delusions of poisoning associated with
gastric troubles, the delusions of electrical persecutions
associated with involuntary motor discharges, the delusions
of recent muscular actions in the immobilised victims of
multiple neuritis, &c.
In the earlier stages of alcoholism, when the mental change
does not yet amount to actual insanity, the alteration of the
personality is seen more on the affective side, in the sus¬
picious, irritable, gloomy character which is distinctive of the
chronic toper. At the root of this disposition lie the same
organic troubles that in higher degree determine the delirious
thoughts and acts of the alcoholic lunatic; the changed
* Cp. similar process in dreams determined by morbid organic sensations.
Ribot, Maladies de la Personnalite , 1897, p. 27; Maury, Le Sommeil et Us
M6ves % 1862, p. 75.
f Ziehen, Psychiatrie , Berlin, 1894.
J It is interesting to note that this disease, in which, if the dominant lesions
are nervous, they are yet extra-cerebral, is associated with strong suicidal ten¬
dencies. Morselli, op. cit., p. 398, estimates that in the decade 1866-76,
30 per cent, of suicides from mental disease, or about 16*5 per cent, of all
suicides in Italy, were due to pellagra.
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by W. C. Sullivan, M.D.
267
nature is the expression of general somatic disorder reflected
in an enfeebled brain.
It is in this stage of the alcoholic evolution, with distinct
physical signs of the intoxication, that we find the large
majority ot our would-be suicides; a bout of drunkenness
removes the last traces of the higher restraining functions,
the “ego” is reduced to the mass of sensations of negative
tone, and the conditions for the development of the suicidal
impulse are realised.
In a large proportion of cases, as we have seen, there is
complete amnesia of the act, and even considerable difficulty
on the part of the individual to understand how he came
to entertain the suicidal idea. In other cases, though the
memory of the act is vague, the suicide can recall a state
of consciousness preceding the attempt, when he felt in an
undefined manner that life was a weariness to him, or that
some precise misfortune made existence insupportable. The
misfortune which depressed feeling seizes upon in these cases
is frequently remote, and even to the alcoholic’s dull sense of
proportion preposterously trivial: one individual, a chronic
drunkard of eight years’ standing, tried to hang himself
because he had failed to sell five shillings’ worth of race
cards \ another, a woman of fifteen years’ alcoholism, at¬
tempted suicide because she was “low-spirited” owing to
the death of her mother, which occurred several years pre¬
viously, and the memory of which never preyed upon her
unless she was drunk. These cases form a transition to the
group where some external moral impression—a quarrel with
a neighbour, a difficulty about money, &c.—determines the
act in a state falling short of actual drunkenness; and last
of all we reach the cases where the act occurs in the absence
of all immediately antecedent excess, under the influence of
the melancholia developed by the chronic intoxication.
Though the organic troubles determined by alcoholism in
all these cases are generalised in character, and, indeed, owe
to that fact a large part of their influence, yet it is natural
to suppose that the mode and degree in which they react
upon the psychic life may differ considerably in the case of
different organs. As Maud si ey observes, “it is conceivable
that all the visceral organs have their several relations with
modes of feeling, as definite and constant in character as
the relations which the special senses have with modes of
thought.”*
* Pathology of Mind, 1895.
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Alcoholism, and Suicidal Impulses,
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We are not in a position to assign to the different viscera
their relative degrees of action upon the psychic life. We
know, however, that in the emotional sphere the generative
functions exercise an influence, the importance of which it
would be difficult to exaggerate. This fact—of familiar and
universal recognition—touches very nearly our subject; for
as the generative organs seem to have a peculiar suscepti¬
bility to alcoholic poisoning, it naturally suggests itself that
disorder of their activities may be a large element in the
negative emotional state in which the suicidal impulse takes
its origin.
In the examination of our cases this idea finds support in
several directions, and serves to explain some of the curious
contrasts which we have noted between the general statistics
of suicide, and our observations of the suicidal impulse in
alcoholism. Thus the greater tendency of women alcoholics
to suicide, contrary to the law of sexual incidence for suicides
in general, is readily explained when we consider, on the one
hand, the special liability of the ovaries to suffer in chronic
drink poisoning; and, on the other hand, the predominant role
of the generative function in women. The same influence of
disordered sexual function would explain the marked con¬
trast between our observations and the general statistics of
suicide with regard to the period of life, showing the maximum
development of the suicidal tendency. For our alcoholics of
both sexes, as we have seen, that period is the decade twenty-
five to thirty-five, while for the general mass of suicides it is
a decade later in women, and two decades later in men. But
this earlier age is precisely the period of intensest reproduc¬
tive activity, when the sexual instinct exercises its greatest
sway over the personality,—when, consequently, its disorder
might be expected to react most potently upon the mental
life. One further observation may be added in the same sense,
though I have not yet examined a sufficient number of cases
to justify ray offering it as more than an impression. It is
that the suicidal act very frequently coincides with or follows
some process, physiological or morbid, which temporarily
emphasises the sexual function. In several female alcoholics
—I cannot yet give numerical expression to the proportion—
the attempt was made during a menstrual period ; in several
others the suicidal tendency showed itself first at the meno¬
pause, which occurred, as is frequently the casein alcoholism,
at a comparatively early age. In the male a corresponding
mode of influence is less easy to determine; in some of our
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by W. C* Sullivan, M.D.
269
cases, however, the act may have been influenced by painful
emotions associated with the recent development of impo¬
tence ; in a few instances sexual excesses and acute venereal
disease were noted. Lastly, as bearing closely upon the
subject, may be cited the tendency to delusions and halluci¬
nations of sexual content which characterises the alcoholic
insanities in both sexes.
Conclusion .—The inferences suggested by these observa¬
tions may be summarised in the following propositions :
1. The suicidal impulse associated with alcoholism rarely
appears until the intoxication has attained a certain chro-
nicity.
2. In a very large majority of instances the chronic alco¬
holic makes the attempt during a bout of drunkenness; and
in considerably more than one half of such cases there is
amnesia of the act.
3. In the suicidal alcoholic the chronic intoxication ex¬
presses itself, on the one hand, by a variable degree of
dementia; on the other, by generalised disorders of function
—these disorders of function in viscera which furnish the
organic basis of the personality determine a depressed
emotional tone, from which the suicidal impulse takes its
origin.
4. The generative organs, especially in women, are pecu¬
liarly susceptible to the alcoholic poison, and their disorders
play a very important part in producing these emotional
alterations of the personality which precede and determine
the suicidal tendency.
Discussion.
Dr. Ybllowlebs said that the statistics on which Dr. Sullivan’s conclusions
were founded were exceptional as to district and at least somewhat contradicted
his general impression as to the relationship between alcohol and suicide. He
gathered that the 142 cases were from the police court in Liverpool, and
represented attempts of suicide charged as such. One had to fall back on his
own experience, and he confessed that the association between alcohol and suicide
had never seemed to him so marked as the statistics given by Dr. Sullivan would
make it, and some of his conclusions seemed to be rather too definitely deduced
from that special, limited, and somewhat exceptional series of cases. He should
say that suicide was not very often associated with alcohol, and that when a
drunken person destroyed himself it often was because he did not know what
he wns doing. Many of those cases had no real suicidal impulse or intention,
but simply did some stupid, drunken act, which happened to be a fatal one.
Then there were other conditions very properly alluded to in the paper. For
example, that many a suicide occurred during the menstrual period was a far
wider fact than the pnper indicated, and the fact that many of the suicides
occurred at the climacteric period was also of wider significance than the paper
made out. There was climacteric melancholia, which came on independently
of any special and recent alcoholic indulgence; but he wns in the habit of
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Alcoholism and Suicidal Impulses,
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distinctly recognising as a type of this melancholia that was a kind of
judgment on the individual for former abuse of alcohol, and which developed
at that particular period of life. That was a form of insanity they were all
more or less familiar with, and it was not to be attributed to the direct
and immediate effect of alcohol. The paper was full of suggestions, and it
would be a .shame if, in a gathering like that, it were allowed to pass without
discussion.
Dr. UrquhaBt said it was rather startling to hear from Dr. Tellowlees that
alcoholism and suicide were not closely connected. When he received an
alcoholic case it was present in his mind fiom the beginning that the person was
likely to endeavour to do away with himself. It would never occur to him to
modify the strict injunctions to the attendants in charge in respect of the care
with which such person should be observed.
In answer to a member who desired to avail himself of Dr. Sullivan’s large expe¬
rience to ascertain whether the practice was to regard cases ns insane or
criminal in connection withattempts nt suicide. Dr. Sullivan said the majority of
them are discharged after a caution in the police court when the medical adviser
testifies to the fact that the act has been simply an impulse of alcoholism, and
not due to any permanently chronic insane condition. There is a certain small
proportion who are alcoholic lunatics, and they are sent to the asylum, but
certainly 90 per cent, are discharged in this manner, and nre rarely prosecuted
unless they offend again in the Bame way, in which case they are occasionally
proceeded against.
Dr. Jonks said they had had a most interesting paper, and he did not think
from the prisoner’s aspect they often got much of the psychological side. It
struck him that amongst persons of both sexes coming into an asylum the most
marked alcoholic cases occurred at or about the climacteric, the time at which
other things, such as the effects of syphilis or influenza, made themselves
manifest, an age when there seemed to be an easier disturbance of the
physiological balance between waste and repair than at any other.
Dr. Adaib said he would like to add a few remarks in support of Dr. Sullivan’s
paper in regard to Sheffield. The facts seemed to be borne out as regarded the
patients they got from the district. Their experience there uvas that chronic
alcoholics were more or less suicidal. At that asylum they always gave the
nurses and attendants special instructions w*ith regard to constant observation.
As to the pathological conditions, ‘‘hobnail liver,” &c , seemed to be particularly
rare in that district, at all events.
Dr. Ybllowlebs. —I don’t want to be misunderstood. It is entirely true, as
has been said, that acute alcoholic cases need care, and are anxious esses, but
what I should like to hear definitely is this,—are these cases, as a rule, distinctly
suicidal ? Are suicidal attempts in such cases frequent ? I have not found it so
in asylums, and I should like very much to know w r hat the experience of other
men is who receive more of such cases tlinn I do.
Dr. Cbochley Clapham. —Are they suicidal on account of the alcohol, or
because of the deprivation of it ? You don’t often find a hobnail liver. Well,
a hobnail liver means a spirit drinker, but you get an alcoholic liver from beer
drinking, which means an enlarged liver of quite a different character. But
that does not indicate that there has not been any alcoholfc indulgence.
Dr. Stbwaet said he generally divided the few cases he had into two
classes. As a rule he found that an alcoholic suicide had hallucinations separate
from melancholia. But after a short time they got better, and were not under
supervision as suicides. They still had hxllucinations, but such a case was very
different from the ordinary melancholic who was always under supervision.
Dr. Kay said it would be interesting if they had a short analysis of the
method adopted in attempting the act of suicide. A man walking alongside a
river is seized by a sudden impulse to throw himself in, and did so without
thiuking of consequences; whereas an acute melancholiac would meditate for
weeks until he got an opportunity of committing suicide.
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by W. C. Sullivan, M.D.
271
Dr. Powell said he was of opinion that the vast majority of suicides were
not really suicidal acts. Only last week he had a man in his charge who cut his
throat in an alcoholic frenzy. A minute before he had not the slightest idea of
doing anything of the kind, but he did it apparently not knowing what he was
about. It was not an act of real suicide, although it was a suicidal attempt.
The P&K8IDBNT said his experience was that many cases of acute alcoholism
were exceedingly suicidal, and many of them succeeded in destroying themselves
in an alcoholic frenzy at home where there was a lack of supervision. That
could b$ easily understood, because they laboured under such terrific hallucina¬
tions of sight and hearing that they were driven in sheer terror to do terrible
things.
Dr. Sullivan, in replying, said Dr. Yellowlees seemed to think that the
figures he had quoted were not sufficient for him to base the deductions which
he had drawn, in his opinion, however, the percentages were markedly pre¬
dominant, and therefore numerically sufficient to allow of the conclusions being
drawn. Probably in reading the paper he did not express himself clearly, and
Dr. Yellowlees had misunderstood him. The very cases he proposed to parti¬
cularly treat of were those of alcoholic impulse unassociated with anything
else. He had set a«ide all cases of pure accident. A very small proportion of
the cases they >>aw under the circumstances mentioned were committed in the
early stages of alcoholic delirium. Very few of the cases developed ordinary
alcoholic instincts. Very few of the men had alcoholic hallucinations. There
were those who had made suicidal attempts on a real impulse, and it was
because he thought there must be some reason for the impulse that he thought
the cases w’ere worth analysing. In his opinion there must be some explanation
for the fact that the impulse to a suicidal act rather than any other should
develop, not on the first or second intoxication, but when the intoxication had
lasted a considerable length of time. As for what had been said respecting the
influence of the menstrual period upon the suicidal impulse, many of these
people had passed through a great many menstrual periods before they made the
suicidal act, and therefore, said Dr. Sullivan, I am entitled to my inference when
any comparison is made between the chronicity of the alcoholic and the menstrual
period, and their respective effects on the mind of the subject. He had treated
the question of the alcoholic suicidal impulse as distinguished from other
influences. He had pointed out the mode of attempt and the degree of delibera¬
tion, but the numbers are hardly sufficient to allow of any deduction. With
reference to the physical signs found in alcoholics, they are signs of influence on
the nervous system, and the ovarian sensation is to be regarded as a nervous
affection. As to the hyperasthesia of the muscles and the visionary effects, very
few of our cases in asylums present these grossly morbid changes, and very few
present marked signs of chronic cirrhosis.
Penal Semitude and Insanity . By A. R. Douglas, Deputy
Medical Officer, H.M. Prison, Portland, late Assistant
Medical Officer, East Riding Asylum and Royal Albert
Asylum, Lancaster.
In this paper I propose to consider the questions which this
subject involves, chiefly from observations I have made upon
convicts in this prison.
One constantly reads and hears statements to the effect that
individuals undergoing penal servitude are thereby prone to
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Penal Servitude and Insanity,
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engender forms of mental disease. In an admirably arranged
statistical table in his report for the year 1897 Dr. Herbert
Smalley, H.M. Medical Inspector of Prisons, proves such a
statement to be wrong, and that our prisons “are not manu¬
factories for the production of lunacy.”
It may be interesting to endeavour to show—by devoting
a little attention to the “material” which is subjected to the
penal environment—how undeserved is this accusation.
For the sake of brevity I shall consider criminals in two
divisions—the first offender and the recidivist. On taking a
man from the former class, we may find that he is one who
prior to his conviction occupied a good place in society, and
filled a position of trust. Such an individual has felt the dis¬
grace of his trial and condemnation keenly, and in the early
days of his imprisonment has beyond doubt suffered from
depression. It must be borne in mind that we are going on
the assumption that this man was of normal mental balance
on his conviction. Given, then, that this individual is of
sufficient mental calibre to have enabled him to take up to the
time of his arrest a fairly successful part in the battle of life,
it is absurd to suppose that this depression should deepen in
intensity and become acute mental pain, or that a maniacal
condition should supervene. This depression is, in my
opinion, “ normal,” and is not of sufficient duration to act
prejudicially upon the mind ; besides, I shall presently show
that the prison discipline itself affords as few facilities for
brooding and introspection as could reasonably be expected
under the circumstances.
A convict, then, who is a first offender, begins working out
his sentence by a term of separate confinement. During this
term he does not lauguish in his cell, as one occasionally
hears, with nothing to occupy his attention and to keep him
from introspection and brooding over his trouble. Labour of
a light description and easily learnt is provided for him, and
he is allowed the privilege of reading suitable books, to¬
gether with regular and sufficient open-air exercise. The
individual under consideration, whom we have assumed is a
man of average mental stability, very soon finds that his
normal depression gradually wears off; the discipline of the
prison enjoins that duties shall be performed, and exacts due
observance of the regulations; the predominant feeling now
in his mind is to make his prison life as little unpleasant as
possible by attention to work and amenability to discipline.
He knows that if he is industrious he will earn a certain
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by A. R. Douglas.
278
number of remission marks, which, if none are lost by bad
conduct or laziness, will shorten his sentence within certain
limits. Later on comes a change in his prison life, and he
marches out to labour with a party on public works, or is put
to learn a trade.
In numerous cases a convict’s labour is congenial to him,
and he often evinces lively interest in his work. He attends
the services in the chapel, and is visited by the chaplain.
He is also allowed to correspond with and receive letters and
visits from his friends at regulation times, provided his con¬
duct merits these indulgences. He has easy access to the
medical officers should he wish to consult them. After he
has completed his term of separate confinement he is tho¬
roughly examined by the medical officer, who decides for
what class of labour he is physically fit. No convict is put
to labour for which he is, by reason of any infirmity, unfitted,
and he can at any time obtain a change of work upon show¬
ing sufficient grounds.
A first offender is, by the Star Class system, kept strictly
separate from those habituated to crime, and it is difficult to
over-estimate the advantages of this. I shall only quote one,
which is relevant to the subject of this paper, and one which
I have repeatedly heard spoken of appreciatively by several
Star Class convicts themselves, that, inasmuch as whilst
keenly sensible of the degraded position in which they have
placed themselves, they yet feel that their future is regarded
in a more hopeful light, and that they are not counted as
utterly damned. From this many derive considerable mental
comfort and assuagement.
So much for the first offender, of which class I have pur¬
posely instanced as example a man of education and superior
social position.
To this man penal servitude is at first terrible indeed, not
because his prison life is a hard one, but because of the keen
sense of degradation aroused in him by his surroundings
during the early days of his incarceration. That this keen
sense of degradation amounts to depression, which is present
for some short period in a subacute form, I think there can
be no doubt, but its duration and degree of intensity is not
great enough to operate detrimentally upon a normally
constituted mind. It has also been urged that protracted
separation from his family and business must exert a
prejudicial influence upon the mind. I would contend that
it is highly improbable that a man free from mental heredity,
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Penal Servitude and Insanity,
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and having already taken his share of responsibility in the
struggle for existence, should not accept his position, and,
under adverse circumstances, adapt himself thereto. I
further contend that it would not be at all unreasonable to
believe that in certain cases where there is an hereditary
tendency to insanity the quiet routine life of the prison with
its freedom from excitement would conduqe, if anything, to
exempt the individual from the risk of an attack.
We will now consider the recidivists, which are of a type
very different from the one just described; and in order to
correctly estimate the mental effect of imprisonment upon
such, it is necessary to know something of their conditions of
life outside the prison walls. Emile Gautier, in one of his
chapters, remarks that such men see the world in two aspects,
either as an immense gaol or a huge brothel, and to a certain
extent this is true. The child is father to the man; from
their earliest years they have been surrounded by vicious
influences, the example of immorality, drunkenness, and
crime set by their parents or friends, their earliest recollec¬
tions being those of squalor, filth, and vice, and their daily
contamination from almost every source of moral pollution
whilst mere children, all contribute to mould the character of
the individual at present under consideration. He may be a
boy of twenty years of age, who, after having done several
short periods of imprisonment, we now find working out
a term of penal servitude; or he may be forty years older
and doing his third, fourth, or even fifth sentence in a
convict prison.
Havelock Ellis believes that imprisonment is for this class
of criminal their normal condition, liberty being their
holiday, during which, when not engaged in actual crime,
they wallow in debaucheries of every kind.
A noteworthy and constant attribute of their character is
a constitutional laziness almost amounting to inertia; they
are well-nigh incapable of any regular and continuous
exertion, but they have occasional spurts of energy, when
they sometimes display extraordinary activity. It is in this
connection that one can clearly comprehend their strong
craving for stimuli, which may be alcohol, gambling, or
sexual excitement, for by these they temporarily rouse them¬
selves from their lethargic condition. When at liberty, this
tendency attains its climax in periodical states of uproarious
and drunken exhilaration, so graphically described by Yidocq
in his Memoirs,
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by A. R. Douglas.
275
So much for the so to speak t( extra-mural ” conditions of
life of these criminals. In prison they may fairly well be
divided into two classes :— (a) Those who come to prison
with the intention of “ doing their lagging,” as they term it,
with a good grace, and whose conduct is often excellent;
they take their imprisonment as almost a matter of course,
and are accustomed to it from former experience; ( b ) Those
who from their day of conviction seem to make it their
business to give as much trouble as they can. They besiege
the visiting director and the governor in the hope of securing
advantages which, from previous bad conduct, they have no
right to expect. They also assail the medical officer, and as
they are often malingerers of a high order, every resource of
that art is employed in the endeavour to obtain indulgences
upon medical grounds. Refusal to grant such unreasonable
requests does not by any means result in worry on the part
of the petitioners, and it would be absurd to think that such
refusals operated prejudicially upon their minds.
Dostoieffsky describes an interesting condition at times
noticeable amongst criminals, which is a sudden accession,
autogenetically, of imperious desire to assert the degraded
individuality ; this manifests itself in sudden insubordination,
assault, or noisy rowdyism, and under other than prison en¬
vironment would have found an outlet in either an uproarious
orgy or a crime of violence. This is not temporary mental
aberration, for the reasoning faculties are then in their normal
and unimpaired condition, and the individual is in every way
responsible.
The troublesome part of the prison population, which I
have placed under the subdivision (6), are like those in
subdivision (a), inasmuch as they are accustomed to prison
life, but unlike the latter they appear constantly discontented,
and lose no opportunity of giving trouble. I say they
“ appear” to be discontented, for it is highly improbable
that they are so in reality, or that their “ discontented ”
frame of mind ever disturbs their mental equilibrium; it
certainly affects neither their appetite nor their sleep.
Instances frequently occur when a prisoner on reception
evinces signs of weak-mindedness, although perfectly re¬
sponsible for his actions, and very far from being insane
in the strict sense of the term.
A case of this description generally shows some congenital
abnormality, often in physiognomy. Such an individual may,
soon after admission, be reported for laziness, inattention to
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276
Penal Servitude and Insanity,
[April,
regulations, or for destroying his clothing. But it must not
be supposed that this prisoner is stubbornly kept under
conditions which are unfavorable to him; due consideration is
always given whenever possible, and not infrequently he goes
on steadily ultimately.
When we consider the factors concerned in the production
of mental disease, which are said to be offered by imprison¬
ment in a convict establishment, I think it may be safely
assumed that they are practically nil . To the recidivist the
aspect of imprisonment is by no means terrible; whilst there
he is kept clean and comfortable, with a sufficiency of whole¬
some food, and the labour which is exacted from him is less
severe than that which he would need to do outside to gain a
livelihood. In prison he is shut out from worry and anxiety,
from alcohol and deleterious excitement of all kinds; and
from the quiet uneventful routine of his life there, I am
convinced that, far from predisposing to insanity, it actually
shields many from attacks to which they would otherwise be
exposed, from the nature of the life they lead outside.
It certainly does not appear that length of sentence is
conducive to the production of insanity. My personal
experience of convicts doing their third or even fourth term
of penal servitude is that the majority of them are men not
only of more than average acuteness and shrewdness, but
that they are remarkably cheerful individuals as well. I
have repeatedly observed that prisoners who have done ten
or fifteen years of one long sentence are often persons of
exceptional physical and mental health. In the case of
recidivists, it must always be borne in mind that imprison¬
ment for them is not at all what ordinary law-abiding people
imagine it to be; as Ellis says, when they are at liberty they
wallow in a dolce far niente —a holiday which by some act of
their own they are well aware will assuredly have an end—a
termination which is foreseen and expected. Many people
are of opinion that remorse is an important cause of mental
derangement amongst convicts. After very careful observa¬
tion of the large criminal population here, I have very rarely
found this feeling present at all; in cases where I have
heard it expressed I have, from previous knowledge of the
character of the individuals concerned, had very strong
reason for doubting the sincerity of such professions.
Dostoieffsky and Gall, perhaps two of our most intelligent
criminologists, both assert that the feeling of remorse is
very uncommon amongst criminals, and that the regrets
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by A. R. Douglas.
277
which one does hear expressed are far more frequently for
the careless omission or neglected opportunity which led to
their apprehension and consequent conviction.
Finally, to return to the first offender, I do not think that
any intelligent person could possibly imagine that his prison
environment could have the effect of unhinging his mind.
Of course, given an individual with a strong hereditary
tendency to insanity, the effect of the disgrace attendant
upon his position might be a predisposing cause of mental
disorder; but I contend that a man of normally constituted
mind is not more than normally depressed by his position, and
that only at the commencement of his sentence, and by the
prison discipline his mind is sufficiently diverted from any
groove which might, so to speak, disturb the normal swing
of his mental pendulum.
The Delation of Acquired Syphilis to Insanity. A Critical
Digest. By W. R. Dawson, M.D. (Dub.), L.R.C.P.I.;
Assistant Medical Superintendent, Farnham House
Asylum, Dublin.
Modern opinion as to the nature of syphilis regards it as
an exanthematous fever, with a period of incubation, a stage
of efflorescence, and an epoch of sequelae, and in fact diverg¬
ing in no essential from the type of its class save in its more
protracted course, by which peculiarity all other seeming
variations can be explained. If the periods of incubation
and efflorescence be taken as one, each stage of the disease
may be said to have its own characteristic nervous phe¬
nomena, including psychoses; and this fact may serve as a
basis for the classification of the syphilitic insanities.
Owing to the comparative chronicity of the active period
of syphilis, the occurrence of nervous, and above all of mental,
phenomena at this stage depends to a far greater degree
than in other exanthemata upon predisposition, whether
hereditary or acquired. While the majority pass through
the disease without showing nervous symptoms, others suffer
from them to a greater or less extent, and in a few the mind
gives way. As might be expected, the amount of anatomical
evidence collected as to the affection of nervous structures by
the syphilitic virus is comparatively small, since but few die
at this stage, and the specific nature of the lesions cannot at
present be proved in all cases. However, implication of the
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278 The Relation of Acquired Syphilis to Insanity, [April,
nervous centres is indicated by the retinitis which is not very
uncommon, and the vessels of the brain doubtless share in
the universal arteritis and disease of capillaries which may
be present; Jurgens has described a simple acute encepha¬
litis, involving the entire brain and producing softening; and
softening of the cord, apparently due to vascular disease,
has been noted. Cases are also on record (Brasch, Atelekoff,
&c.) of disease of the cerebral vessels beginning as early as
two or three months after the primary infection, and in their
appearance and results strongly resembling tertiary pheno¬
mena. They differ from the latter, however, in being refrac¬
tory to specific treatment, and Neisser considers that such
lesions are not really instances of “ tertiarismus prsecox but
rather analogous to the secondary cutaneous phenomena,
—being, in fact, " 'papular ’ lesions situated in the cerebral
vessels .” In Atelekoffs case there was also hypersemia of
the brain and membranes, and slight cloudiness of the pia
near the vessels. A yellow exudation in the brain and mem¬
branes met with in one case (Lancereaux) may, not unlikely,
have been an early tertiary phenomenon.
There seems, however, to be a very general consensus of
opinion, based chiefly on clinical observation, as to the exist¬
ence of more or less transitory hyper®mic and inflammatory
conditions of the> brain and its membranes at this period.
Prior to, accompanying, or succeeding the appearance of the
rash there may be general uneasiness, lassitude, vague pains,
restlessness, melancholy, and moroseness, all probably due to
the cachexy of the period. But in addition the tendon and
skin reflexes are early increased, and this with the insomnia,
headache, sensory disorders (including vertigo and deafness),
and neuralgic (neuritic ?) pains, would seem to indicate some
degree of hyperaemia and inflammation such as above re¬
ferred to. Various paralyses, and also convulsions, which
have been described, seem to point in the same direction.
These phenomena are, of course, all within the bounds of
technical sanity; but they indicate nervous lesions which
would be likely to combine with worry and other moral
causes to produce some form of psychosis analogous to the
delirium of other fevers, or to mania a potu. The rarity of
such an occurrence must again be set down to the chronicity
of the disease.
Still there is evidence that such cases are occasionally
met with. Griesinger is referred to as stating that in cases
of predisposition, hereditary or acquired, sudden attacks of
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by W. R. Dawson, M.D.
279
delirium or wild mania may occur as early as the second week
after infection, before or with the first secondary symptoms.
Wille has stated positively that mental disease may super¬
vene from two weeks to two months after syphilitic infection,
certainly with the first secondaries, which, however, it may
precede. He appears to have ascribed the attacks partly to
anaemia, and partly to meningitis and cerebritis. Mickle
doubted the specific nature of these early cases, though
admitting that in some few the virus may act directly in the
production of insanity, and that there may be early mental
disease due to the other nervous symptoms, such as insomnia,
headache, &c. Savage, however, says that “ syphilitic fever
may be associated with delirium, and this may form the
starting-point of a maniacal attack,” but does not remember
having seen such a case, the more usual form of psychosis
being a stuporose or suspicious melancholy, or mental weak¬
ness, due to cachexia. Hyslop is of opinion that early
syphilitic insanity most commonly takes the form of mania,
melancholia, or alternation, but may be of an “ ordinary
idiopathic typeand that many cases recover on disappear¬
ance of the bodily symptoms. In AtelekofFs case, alluded to
above, in which both vascular and meningeal lesions oc¬
curred, the mental symptoms were depression and irritation,
followed by a stage of exaltation, and finally extreme con¬
fusion and apathy. Thus both classes of symptoms were also
present.
In this country cases have been published by Cadell,
Mickle, J. B. Brown, J. Hutchinson, and Clouston, which
have a greater or less bearing on the point. Cadell's case,
and perhaps that of Clouston, seem to have been genuine
examples of the mania of early syphilis; the rest are not con¬
vincing. Wiglesworth has published a fatal case of progres¬
sive dementia such as Savage describes.
The difficulties arising from the extreme rarity of this form
of mental disease are increased by the existence of three
sources of fallacy : 1st, the possibility of coincident insanity
unconnected with the syphilis; 2nd, the fact that tertiary
phenomena may encroach on the secondary period; and 3rd,
that, in the opinion of many, tertiary nervous disease is most
apt to occur in cases in which the secondary manifestations
have been transient and insignificant. Still it is probably,
upon the whole, safe to affirm the existence, first, of a very
rare early syphilitic delirium or mania, chiefly due to toxic
inflammatory conditions of the brain and its membranes; and
xliv. 19
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280 The Relation of Acquired Syphilis to Insanity, [April,
secondly, of a commoner but still rare asthenic melancholic
psychosis, dependent on general (and perhaps local) anaemia
and malnutrition. But actual scientific demonstration awaits
the discovery of the organism of syphilis.
There are, however, no such difficulties with regard to the
insanity of the tertiary period, the number of cases of which,
described clinically and anatomically, is very large, while the
lesions are usually characteristic. Tertiary syphilitic disease
of the central nervous system is stated to occur as early as the
fifth month, and as late as the twenty-sixth year, after infec¬
tion, but to be most frequent from the third to the tenth year.
The insanity to which such disease gives rise is characterised
by the same irregular polymorphism, whether as regards
symptoms, course, duration, or termination, which is seen
both in the other nervous phenomena and in the anatomical
lesions. This polymorphism renders it extremely difficult to
form any classification of the varieties which shall be even
approximately adequate. One on the liues of Oppenheim’s
arrangement, however, which has the advantage of being
based on the anatomical lesions, seems, upon the whole,
useful and sensible ; but neither it nor any other system can
pretend to include in its divisions all the varieties of psy¬
chosis dependent on a disease whose distinguishing feature
is the chaotic irregularity with which the phenomena are
mixed. Neither on the physical nor on the psychical side are
the groupings separated by any hard and fast line.
The characteristic lesion of the tertiary period is, here as
elsewhere, the development of gummatous tissue in the con¬
nective elements of the organs, and consequently occurs, for
the most part, where connective tissue is most abundantly
found, viz. in the meninges and in or around the blood¬
vessels.* In a certain number of cases the disease occupies
the convexity of the brain chiefly or entirely, in others the
base and blood-vessels, and in a few the vessels only; and
the symptoms, physical and mental, vary accordingly, the
latter being naturally best marked in disease of the con¬
vexity. In this situation the morbid process may start in
the bone, the dura mater, or the pia-arachnoid, but in any
case all the meninges are liable to be ultimately involved.
Here as elsewhere there may be merely one or more small
discrete nodules, or an extensive mass of gummatous tissue
may form, the favourite seat of disease being the area of the
# The following* account of the tertiary phenomena is mainly an adaptation
of the description in Oppenheim’s excellent monograph (see reference at end).
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by W. R. Dawson, M.D.
281
frontal and parietal lobes. The cortex may be merely com¬
pressed, and may show no changes even under the microscope;
but if the pia-arachnoid is involved the growth penetrates into
the cerebral tissue, causing an inflammation of all its ele¬
ments; softening, partly inflammatory and partly the result
of interference with the pial blood-supply; or a simple atrophy
due, no doubt, to pressure, faulty nutrition, and defective
elimination of waste products. Sclerosis is a less common
result. The vessels in the affected area show the ordinary
syphilitic changes, but in addition hyaline degeneration has
been observed.
A quick-growing syphiloma, even of comparatively small
size, in this situation, is liable to give rise to general epileptic
convulsions, sometimes associated with wild maniacal excite¬
ment. In less acute cases, where there is a succession of
epileptic seizures for a sufficient length of time, the ordinary
varieties of epileptic insanity may supervene. Here, however,
the mental symptoms are due to the epilepsy, independently
of its origin. But it is laid down as a general rule that,
in most of the cases in which mental disturbance is a leading
feature, the disease is found to extend over a large part of
the brain, or the process on the convexity is combined with
similar lesions at the base, or with disease of the vessels.
The course of such cases is usually chronic, the chief feature
being a dementia, of any degree of severity, with apathy,
moroseness, irritability, and confusion, and occasional fits of
excitement. Hallucinations (to be explained by the actual
sensory impairments) and transient delusions may also be
? resent, but delusions of grandeur are said to be uncommon.
n some of the cases there is a very close resemblance to
general paralysis, and it will be remembered that the part of
the cerebral cortex chiefly affected is apt to be the same in
both diseases.
When the disease is situated at the base of the brain the
pia-arachnoid is its usual site, but owing to the anatomical
relations of this structure the vessels and nerves rarely
escape, while the cerebral substance is frequently invaded ;
and it is impossible to separate the symptoms of basal gumma
from those due to vascular lesions. As distinguished from
disease of the convexity, there is an absence of focal pheno¬
mena, the mental symptoms being of the type met with
when the intra-cranial pressure is from any cause increased,
but usually with the addition of those arising from disease of
the vessels. Thus there may be impairment of intelligence.
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282 The Relation of Acquired Syphilis to Insanity, [April,
amnesia, hebetude, occasionally passing into somnolence or
even coma, or varied by fits of wild excitement, with or
without hallucinations. The fits of excitement probably
sometimes follow or replace epileptic seizures, which are not
uncommon (owing most likely to vascular lesions), though they
have not the persistent and progressive character of those
due to disease of the convexity. Intervals of comparative
sanity also occur at times, but may not be so complete as they
appear.
The syphilomatous growth in any situation of course in¬
volves the vessels within its area, either by mere pressure or
actual invasion of their walls, the latter being often accom¬
panied by proliferation of the intima. But the disease may
attack the vessels independently, in which case it may take
one of three forms: a gummatous arteritis or periarteritis,
with or without disease of the intima; an endarteritis, affect¬
ing the wall within the internal elastic lamina ; or a peri- and
mesarteritis, the intima being sometimes also involved. The
large basal vessels are those most likely to suffer, the cortical
twigs and other small vessels being but seldom affected,
though hyaline degeneration has been found in them. Obli¬
terating inflammation also occurs in the veins. The results
of arterial disease are narrowing and thrombosis with necrotic
softening of the area supplied, or, short of complete closure,
sclerosis.
If the vascular disease predominates, affecting a large
number of vessels, and especially of those supplying the
cortex, in such a manner as to produce slowing of the circu¬
lation and deficient blood-supplv, the group of symptoms
indicative of cerebral anaemia appears, viz. “ slowness and
difficulty of thought, indecision, amnesia, loss of interest,
hebetude, irritability,” &c., with occasional states of excite¬
ment. Vascular disease alone may also give rise to a group
of symptoms resembling general paralysis, and sudden com¬
plete closure of a large vessel may lead to convulsion, and
ultimately to the symptoms of cerebral softening, i. e. delirium,
and chronic insanity the chief feature of which is dementia.
Syphilitic disease, therefore, when sufficiently extensive,
produces certain mental symptoms, of which hebetude, de¬
mentia, and depression are prominent; but additions and
modifications are met with according as it affects solely or
chiefly the convexity, the base, or the vessels respectively.
Vascular disease is probably the most important factor in the
causation of psychosis, whether involving large or small
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by W. R. Dawson, M.D.
283
vessels, and whether primary or secondary; and next the
general and local pressure effects; the indirectly-produced
epileptic insanity depending probably on both causes.
Whether direct toxic irritation plays any important part is a
point which cannot at present be decided with certainty, but
that it does so is more than probable.
To complete this part of the subject it is necessary to
allude to the question of the existence of a simple tertiary
meningitis—a question occupying much the same position as
that regarding a similar process in the secondary stage.
Oppenheim seems to incline to the opinion that it is not un¬
common, and quotes Gilbert and Lion’s description of a sort
of intermediate variety, the meningo-myelite diffuse embry -
onnaire, which is characterised by a large development of
young cells, at first in the walls of the vessels and in the pia,
and a fibrino-cellular exudation in the meshes of the latter.
“ Pachymeningitis hmmorrhagica” has also been found in a
few cases. On the clinical side symptoms of a meningitic
character have been described, consisting “ in profound dis¬
order of the sensorium, fever, involuntary evacuation of
faeces and urine, and a course running on the whole rather
rapidly to a fatal termination ” (Heubner, quoted by Oppen¬
heim), and probably many forms of acute delirium, maniacal
attacks, and choreic phenomena in syphilitic patients may be
due to slight degrees of some such process.* It need hardly
be said that this “simple” meningitis may be combined with
gummatous inflammation.
Of the prevalence of the foregoing psychoses in syphilitic
cases there is no means of judging, in the absence of any
reliable data as to the percentage of the general population
affected with syphilis; but they form a very small proportion
(Clouston gives 4 per cent.) of the cases in asylums. The
incidence of the disease in the brain is determined partly by
heredity and partly by other factors, such as, above all,
alcoholism. Just as a contusion will form the starting-point
of a periosteal gumma, so the injury done to the brain by
alcoholic excess will determine the action of the syphilitic
poison to that part.
There is, however, a class of nervous diseases, much more
important numerically, the relationship of which to syphilis
can at this day scarcely be denied, viz. the so-called “ para-
* A case described by Alzheimer should he mentioned here, in which the
mental and motor symptoms were identical with those of general paralysis,
whereas the autopsy showed pure '* luetic meningo-inyelitis and encephalitis.”
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284 The Relation of Acquired Syphilis to Insanity, [April,
syphilitic ” or “ metasyphilitic” group, of which tabes and
general paralysis are the only members calling for notice
here. As these diseases are refractory to antisyphilitic
treatment, the proof of their connection with syphilis de¬
pends on the demonstration of its precedence in all cases, or
at least in a larger proportion than that in which any other
aetiological factor occurs, supported by other circumstances,
such as an analogy between the two classes of disease in the
form, and more especially in the distribution, of the lesions.
As regards tabes, most authorities are now agreed that the
percentage of cases of this disease in which there has been
preceding syphilis is very large. Gowers estimates 70—80
per cent., and some Continental authors give even higher
rates—Erb, for example, 89*2—92*5 per cent., and others the
same or more.
It has long been disputed whether the nervous elements,
or the blood-vessels and connective tissue, are the structures
primarily affected. If the disease is analogous to ordinary
syphilitic lesions the latter view would seem the more pro¬
bable. It is, however, that which upholds the essentially
parenchymatous character of the disease which now generally
prevails; but recently Obersteiner, as the result of observa¬
tions made in conjunction with Redlich, has put forward the
theory that “one, and perhaps the most important point of
attack of the lesion” may be “the weakest, most , sensitive,
and most vulnerable spot in the posterior roots, that is, at
their entrance into the spinal cord.” Certain changes of an
inflammatory or sub inflammatory nature have been observed
here, leading to connective-tissue hyperplasia, by which the
roots were constricted. The changes in the spinal cord
would thus be simply ascending secondary degenerations.
Whatever be the ultimate fate of the theory, this observation
is especially interesting in connection with the true syphilitic
neuritis described by Kahler and others as affecting the pos¬
terior roots; and it greatly strengthens the analogy between
the two diseases.
Uncomplicated tabes is of little importance as a factor in
the causation of mental disease. When psychical symptoms
do Occur, they are produced indirectly, as a result of the
pains, sexual impotence, &c., which give rise to ideas of per¬
secution, to melancholia, or to violence; unless, iudeed, the
uncontrollable sexual desire of the early stages forms an ex¬
ception. The real importance of the disease for the psycho¬
logist lies in the frequency with which it is associated with
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1898.]
by W. R. Dawson, M.D.
285
general paralysis. The association on the clinical side may
manifest itself merely by a “ slight optimism and mental
weakness,” or by anything between this and full-blown
paralytic dementia; while the anatomical lesions of the two
diseases may be found together. Indeed, an eminent autho¬
rity has asserted that “ general paralysis is but a cerebral
tabes.”
The intimate connection of general paralysis with a disease
admitted, in most quarters, to be in some way caused by
syphilis in the majority of cases creates a certain presump¬
tion in favour of a similar origin for the former, and this
presumption is strongly supported by other considerations.
The rarity of the disease in precisely the classes and localities
where syphilis is uncommon is an important fact in this con¬
nection, We have, for example, the well-known instance of
the York Retreat, peopled mainly by Quakers, and the fact
that the disease is seldom seen in remote countries, such as
Iceland (where but three cases seem to have been recorded,
all in persons who had been absent from the island or lived
in its single seaport); in rural districts, such as Highland glens
and country towns, even though drunkenness and illicit in¬
tercourse may abound, as in Scotland, or the people marry
early and procreate large families, as in Ireland.
Secondly, Fournier asserts, and cites the experience of a
host of French syphilographers in addition to his own to
prove, that a relatively large number of syphilitics “ gravi¬
tate into general paralysis.”
Nevertheless, when we come to actual statistics of ante¬
cedent syphilis in general paralysis, the discrepancy between
the results of different investigators is very surprising, the
proportion of cases with ascertained syphilis varying from
11 to 94 percent.; and accordingly some authors deny syphilis
any share in the aetiology of general paralysis, while others
(Mobius, Hirschl, &c.) attribute every case in some degree to
its agency. This discrepancy is due to the difficulty of ob¬
taining a distinct history, to the variability in the manifesta¬
tions of general paralysis, and to the occurrence of certain
groups of symptoms closely simulating this disease, and in
some cases, moreover, due to tertiary syphilis, as has already
been seen. But it is important to note that the percentage
of syphilitic cases is large in recent investigations, and in¬
creases with the care taken in eliciting the history and with
the opportunity for doing so—for example, the percentage is
higher in private than in pauper patients.
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286 The Relation of Acquired Syphilis to Insanity , [April,
Opinion in this country seems to incline in favour of assign¬
ing an important role to syphilis, though with notable ex¬
ceptions. Thus, although Clouston does not attach any great
importance to it, and Mickle seems inclined to think its
influence overrated, McDowall estimates the proportion of
syphilitic cases of general paralysis at about 80 per cent.;
Savage gives at least 70 per cent.; Gowers more vaguely
thinks that syphilis is an antecedent in “ a large proportion ”
of cases, and Hyslop in more than half. On the Continent,
however, where the subject has received much attention, the
importance of syphilis in the causation of general paralysis
is almost universally admitted. The results of a few of the
investigations may be mentioned. Mendel found syphilitic
antecedents in 75 per cent, of general paralytics, in 18 per
cent, of other cases. Rieger, as the result of a statistical
inquiry, found 364 to 436 syphilitic cases in 1010 general
paralytics, as contrasted with 33—45 syphilitics in 1010
ordinary cases. Hougberg found syphilis to be certain or
probable in 86*9 per cent, of the 107 cases investigated, and
in 4*22 per cent, of ordinary cases. Binswanger gives 50 per
cent.; Jacobson found syphilis certain or probable in 43 to
50 per cent, of his female general paralytics. Hirschl has
compiled a table giving the results obtained by fifty-five
investigators, which vary from 11 to 94 per cent. Thirty-seven,
however, give a percentage of 50 and over—many very much
over,—while the average is 56*89—60*63.
The most important recent work on the subject, however,
has been done by Hirschl himself, who examined the histories
of 200 male general paralytics in Krafft-Ebing’s clinic. In
twenty-five no history was obtainable, and these having been
deducted—which may or may not have affected the results—
syphilis was found certain or probable in 81 per cent, of the
remaining 175 cases, being enormously more frequent than
any other antecedent. He also made a new and important
point by investigating the histories of sixty-three patients
suffering from undoubted late syphilis, and only succeeded in
63*5 per cent, of these cases in obtaining a certain or probable
history of infection, i. e. a proportion under that in which the
general paralytics gave a similar history.
More recently still Greidenberg found syphilis to be the
sole cause in 32 per cent., and an associated cause in 62 per
cent., of 230 cases of general paralysis in which a history
was obtained; and the writer, in a rough investigation of
file histories of fifty cases, chiefly at the Richmond District
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by W. R. Dawson, M.D.
287
Asylum, found antecedent syphilis to be certain or probable
in 44 per cent.; but as in many of the cases there was no
history obtainable, while in none was the disease excluded,
it is probable that the percentage was really much higher.
Without going so far as Hirschl and others, who assert
that syphilis is the sole essential factor in the causation of
general paralysis, a position which cannot be maintained if
we accept the statement that in certain cases it has been
possible to exclude it, it may from the above facts be fairly
concluded that this disease is antecedent to general paralysis
in a far larger proportion of cases than any other single
aetiological factor, alcoholism giving a percentage of only
24*9, and heredity 31 ’37 to 32*63 (Hirschl). It may also be
noted that the existence of the developmental variety of
general paralysis supports this view, inasmuch as hereditary
syphilis has been detected in a large proportion (72*2 per
cent.—Justschenko) of the cases of this class.
The strongest argument* in favour of a syphilitic origin
for the majority of cases of general paralysis is at present
undoubtedly to be drawn from such facts as those just given.
At the same time they are to some extent supported by a
comparison of certain of the phenomena, clinical and anato¬
mical, of the disease in question with those of undoubted
syphilis. In seeking to establish an analogy too much im¬
portance must not be assigned to the frequent identity of the
ocular symptoms, such as loss of light reflex, diplopia, and
the like, as these, when occurring in general paralysis, are
open to the explanation that they were due to ordinary
syphilitic lesions, as in other cases, and have no real con¬
nection with the graver malady; but if this is so, on the
other hand, they go to prove that syphilis in these cases has
preceded.
The amount of weight to be laid on the resemblances
which certainly exist between the anatomical appearances
found in the two diseases, will largely depend on the view
taken as to the early pathology of general paralysis. If it
be held to affect the vessels primarily, it will be seen that the
analogy is a very strong one, since in some degree vascular
* The altogether unjustifiable experiment, tried in Krafft-Ebing’s clinic, of
inoculating eight general paralytics with fresh chancre-secretion, is of little
value as an argument, even though none of the cases showed any syphilitic
reaction, owing to the (happily) small number of patients so dealt with. More
important is his assertion that “it has never yet been observed that such a
patient acquired primary syphilis, although these patients, at least at the
beginning of the disease, probably give themselves up to numerous sexual
aberrations/*
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288 The Relation of Acquired Syphilis to Insanity , [April,
affections are probably present in all cases of syphilis
(Oliver), and come into particular prominence when this
disease affects the brain. Even in the special character of
the vascular lesions some resemblance may be detected, as,
for instance, in the hyaline degeneration of the vessel walls
observed in both diseases, and in the fact that nuclear pro¬
liferation may begin in the adventitia in syphilis, which
Bevan Lewis holds to be a peculiarity in general paralysis.
Attention may also be called to the resemblance between the
changes common in the pia-arachnoid in the latter disease,
and those in the syphilitic “ meningo-myelite diffuse embry-
onnaire” of Gilbert and Lion. Lastly, it has been seen that
syphilitic disease of the vessels only may give rise to a group
of symptoms resembling general paralysis. Even if, how¬
ever, the nervous structures be considered the point of
incidence of the disease,—a view which appears to be gaining
ground in this country—an analogy may be found in the simple
nuclear degenerations and the destruction of cerebral nerve-
fibres met with in undoubted syphilis. It is, however,
probably impossible at present to decide between these two
views, since whichever be the primary lesion, the other soon
succeeds it; but a point of resemblance which is unaffected
by the controversy is the distribution of the cortical changes,
since when syphilis affects the convexity of the brain the
seat of election is the fronto-parietal region, precisely the
area over which the changes are most marked in general
paralysis.
Since, therefore, syphilis and general paralysis are rela¬
tively co-extensive in their distribution ; since general para¬
lysis often follows syphilis, and syphilis is antecedent in at
least the great majority of cases of general paralysis, and
occurs in a larger proportion than any other sstiological
factor; and since, moreover, there are many points of resem¬
blance in the clinical and anatomical phenomena of the two
classes of disease; it may fairly be concluded that syphilis is
the most important factor in the causation of general para¬
lysis.
As to its mode of action, the most probable view seems to
be that it produces its effects by impairing the vitality of the
structures in such a way as to render them the locus minimse
resistentise, and so especially liable to damage by other in¬
fluences. The failure of antisyphilitic treatment is, to some
extent, at all events, an argument against the presence of an
active syphilitic poison, but nevertheless the latter view
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by W. R. Dawson, M.D.
289
cannot be held to be absolutely disproven. Indeed, Piccinino,
working with a modification of Lustgarten’s method, suc¬
ceeded in finding bacilli in large numbers in the cortex of
five general paralytics (some of whom, however, are said not
to have had syphilis). But his bacilli seem to be larger than
Lustgarten’s so-called “ syphilis bacilli/’ and in any case the
very doubtful position of the latter renders the observation,
interesting as it is, of little value in the present discussion.
Hirschl failed to find Lustgarten’s bacillus in the cortex of
three general paralytics stained by several of the recognised
methods, and with this result the observations of the present
writer, so far as they have gone, are in accord.
The conclusions of the present brief study of syphilis in its
relation to insanity may, though at the risk of seeming over-
definite, be finally summed up in the form of a suggestion for
a provisional scheme of classification as follows:—
I. Insanity of early syphilis (primary and secondary).
1. Acute toxic insanity (analogous to delirium or mania
apotu).
2. Melancholia with or without dementia, probably due
to cerebral anaemia.
II. Insanity of late (tertiary) syphilis.
1. Insanity due to syphilitic disease of the base and
vessels.
2. Insanity due to syphilitic disease of the convexity.
Most, if not all, cases of cerebral syphilis in which insanity
has been caused by epilepsy will fall under the second head
(II, 2), but should rather be classed with epileptic insanity,
being only indirectly due to syphilis.
III. Metasyphilitic (parasyphilitic) insanity.
1. Insanity of tabes (so far as due to other than
“ moral ” causes).
2. General paralysis of the insane.*
This classification only includes cases in which there is
certainly, or probably, a gross anatomical change at the basis
of the mental symptoms. But it is obvious that there are
various indirect ways in which a disease like syphilis may
produce morbid action in unstable minds. Such are the fear
of contracting the disease; the worry, remorse, and anxiety
produced by its existence; and the pain and insomnia and
other sensory symptoms so common in its course. With this
# If Fournier’s “ parasyphilitic epilepsy 99 should prove to give rise to
insanity (which this author, however, strenuously denies), the same remarks
will hold good us in the case of the tertiary variety.
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290 The Relation'of Acquired Syphilis to Insanity . April,
class of cases, as being but the indirect result of the disease,
and in no way peculiar, no attempt has been made to deal.
Literature.
Foubnieb, A. Syphilis and General Paralysis. Selected Essays; New Syden¬
ham Society, 1897, p. 375.
Gowebs, W. R. Syphilis and the Nervous System .
Hibbchl, J. A. Die Aetiol. d. progr. Paralyse. Jahrh. fUr Psychiatric u.
Neurologies Bd. xiv, p. 321.
Kbafft-Ebing, R. v. Aetiol. der progr. Paralyse. Communication, Twelfth
Intemat. Med. Congress, Moscow, 1897. (See abstract in Neurolog .
Centralb., September, 1897, p. 871.)
— Die prog, allgem. Paralyse. NothnageVs Spec. Pathol, u . Therap., Bd. ix,
Th. 2.
Lang, E., and Nobl, G. Art. Syph. Ruckenmarksaffect., Lnbarscli and
Ostertag’s JErgeb. d. allgem. Aetiol. d. Menschen-u. Thierkrankheiten,
p. 724.
Mott, F. W. Report of Pathologist to London County Asylums , Eighth Annual
Report, p. 87.
Obersteinbr, H. Die Pathogenese der Tabes Dorsalis. Communication,
Twelfth Intemat. Med. Congress, Moscow, 1897. (Sse abstract in Neurolog .
Centralb ., September, 1897, p. 872.)
Oppenheim, H. Die syph. Erkrankungen dcs Gehirns. NothnageVs Spec.
Pathol, u. Therap. % Bd. ix, Th. 1, Abt. 3.
Savage, G. H. Arts. Syphilis and Insanity, and, Locomotor Ataxy, as allied to
Neuroses, in Tulce's Dictionary of Psychological Medicine.
A Note on the Comparative Intellectual Value of the Anterior
and Posterior Cerebral Lobes* By Crochley Clapham,
M.D., The Grange, Rotherham.
It would be “ flogging a dead horse/* at the present day,
to offer arguments against the exploded phrenology of Gall
and Spurzheim, which has long been discredited by scientific
men.
Their, so to speak, “ lobular ” type of phrenology has been
replaced by one of a “ lobar ” type possessing more claim to
attention.
In this newer phrenology the parietal lobes have been
definitely occupied by the motor centres of Ferrier and
others, and the temporo-sphenoidal lobes by the centres of
the special senses, leaving unoccupied the greater part of
the anterior (frontal) and posterior (occipital) lobes.
Of these anterior and posterior lobes, the former have been
* Read at the General Meeting of the Medico*Psychological Association at
Sheffield, February, 1898.
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1898.]
Crochley Clapham, M.D.
291
usually selected as the seat of intellect, upon, I think, some¬
what slender evidence.
The claim of the posterior lobes to be considered the seat
of intellect rests on a wider foundation, composed, as it is,
of biological, ethnological, developmental, clinical, and patho¬
logical evidence.
It is believed that the higher intellectual and moral pro¬
cesses involve the activity of certain related cell and fibre
networks in the cerebral cortex, and are absolutely depend¬
ent upon the functional integrity of such networks: the
problem is as to their situation.
The claims of the posterior lobes have been supported by
Retzius, Carpenter, Bastian, and Hughlings Jackson (among
others), in isolated passages of their works.
The evidence may be arranged and supplemented as under :
Biological .—The occipital lobes appear late in the Verte-
brata—being absent even amongst the lower members of
the Mammalia,—and increase in extent as we ascend the
scale : an apparent exception to this occurs in the case of
some of the Quadrumana; but, as Bastian says, “ if these
parts seem to be relatively smaller in man, it must not be for¬
gotten that in monkeys and in apes their surfaces are smooth
and comparatively unconvoluted; whilst in man, in proportion
to their size, the area of superficial grey matter on the occi¬
pital lobes becomes enormously increased by reason of the
number and depth of their surface-foldings.”
Carpenter agrees that the part of the cerebrum which is
most developed in man in comparison with other animals, is
not the anterior but the posterior; and he says that “ the
philosophical anatomist well knows that the rudiment of a
cerebrum which exists in fishes represents the anterior lobe
only; that this enlarges as we ascend through the classes of
reptiles and birds, but does not change its character; that the
middle lobe is only developed as we enter the mammalian
class, presenting itself at first in a very rudimentary form,
and attaining increased development as we ascend; and
that the posterior lobe is developed from the back of the
middle lobe, making its first appearance in the carnivorous
group.”
In the more highly evolved brains the occipital lobes
become deeper, and also fuller and more rounded; moreover
there is a notable increase in the complexity of their convo¬
lutions.
Ethnological .—In the intellectually lower races of man the
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292 Comparative Intellectual Value of Cerebral Lobes, [April,
occipital lobes are of small size ; in the Bosjesmans, for
instance, they are not sufficiently large to cover the cerebellum,
thus approaching the simian type.
Professor Marshall in describing a Bushwoman’s brain
says, “ The curve formed by the under border of the cere¬
brum, above the cerebellum, is slighter, and its direction more
oblique upwards and backwards than in the European brain,
owing apparently to a want of downward development of the
occipital region, which is very shallow.” Comparing with
this the brains of three distinguished men, Bastian says,
“ The occipital lobe has a much greater depth in the brains
of Gauss, De Morgan, and the Journalist, than is to be met
with in the lower human types previously described.”
Developmental .—In the individual, as in the class, the occi¬
pital lobes are of late appearance, therein following the rule
of all highly evolved structures.
The biological history finds an exact parallel in that of
the embryonic development of the human cerebrum; the
rudiment which presents itself at a period when the chain of
sensory ganglia has attained an advanced development having
been shown by Professor Retzius to be the representative of
the anterior lobe only, the development of this making con¬
siderable progress before the middle lobe begins to be evolved,
and the posterior lobe being the latest in order of evolution.
The following is a summary of Professor Retzius's remarks
on this subject, taken from one of the monthly reports of the
Royal Academy of Sciences at Stockholm :
“ In the first period, which corresponds with the second
and third months, only the anterior lobes form ; in the
second period, which is comprised in the end of the third
month, in the fourth, and in a small portion of the fifth, the
two middle lobes appear; and after this time the posterior
lobes. During the first period the descending horns of the
lateral ventricles and the pedes hippocampi are wanting;
these are added in the second period. During a great portion
of the first period the hemispheres do not cover the thalami
nervorum opticorum; in the second period they completely
overlap these parts, approach the large corpora quadrigemina,
cover their anterior part, and then descend by the side of
the cerebral nucleus (cone or stem), and, as it were, fold
round it.
“ If we examine a brain at this period of development, we
might, from its external appearance, imagine that the posterior
margin of the hemispheres corresponds to their persistent
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by Ckochley Clapham, M.D.
293
posterior ends and margins, i.e. to those which are their
posterior margins in their perfectly developed state. But it
is not so. If we open the brain we come at once to the
descending horns of the lateral ventricles, in which are the
rudiments of the great pedes hippocampi. At a later period,
in the fourth month, a small superficial notch is formed at
the posterior margins of the hemispheres; and that part of
this margin which is above the notch is the first rudiment of
the posterior lobes of the hemispheres.
iC These, which are thus for a long time only rudimental,
begin above the middle lobes, gradually take in the posterior
margin, follow it down as development advances by the sides
of the cerebral nucleus, and terminate at that part of the
middle lobes which meets the pedes hippocampi.
u Even in the brain of the mature foetus, as well as in the
fully developed brains of older persons, the posterior lobes
are very clearly separated from the middle lobes'by a branch¬
ing furrow, which is especially distinct on the vertical side of
the hemisphere which lies next to the falx.”
Clinical .—The lowest class of those mentally deficient
shows the smallest occipital development. It is a well-recog¬
nised fact that idiots possess little or no “ back ” to the
head, but are remarkable for the neck being prolonged in an
almost straight line up to the vertex, the occipital prominence
being wanting.
Drs. Fletcher Beach and Shuttleworth both recognise the
ill-development of the occipital portion of the brain in
idiots; and the latter mentions a case which he inquired into
very thoroughly, and where he felt convinced the condition
was due to the arrested development of the cerebral hemi¬
spheres backwards and downwards at about the sixth month
of gestation.
Of careful measurements made by me of some 4000 heads
(sane and insane) I have tabulated the males (1944 insane
and 183 sane) with the following striking result as regards
proportional measurement of the anterior and posterior seg¬
ments of the circumferential line of the head.
The circumferential line was taken around the head above
the eyebrows in front and the most prominent occipital point
behind. The anterior segment was taken from auditory
meatus to auditory meatus around forehead.
Average percentage of anterior segment to whole circum¬
ference :
Sane, 52-15 ; insane, 52-27; idiots, 52-30;
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294 Comparative Intellectual Value of Cerebral Lobes , [April,
showing that as intelligence diminishes the anterior segment
of the head exhibits proportional increase.
Dr. Garson informs me that a similar proportional increase
of the frontal segment has been noticed by him and Professor
Flower in their measurements of skulls of lower races in the
collection at the College of Surgeons' Museum.
Pathological .—Post mortem the occipital lobes are found
small in idiots, whilst the frontal lobes are found large
in proportion to the weight of the whole encephalon.
In an article on the “ Weight of the Brain in the Insane,”
contributed by me to Hack-Tuke’s Dictionary of Psycholo¬
gical Medicine , will be found the following:
Average percentage of frontals to whole encephalon :
Idiots, 37-16; imbeciles, 37’11; all insane, 35-99 ;
showing that as the intelligence diminishes, the frontal lobes
exhibit increase in weight compared with the posterior parts
of the brain*.
In aphasia, the frequency and degree with which mental
degradation accompanies the condition is strictly propor¬
tionate to the approach of the lesion to the occipital lobes, as
pointed out by Marc Dax and others. In the brains of
chronic dements also marked wasting of the occipital lobes
is often found.
Of course, in speaking of the “ seat of intellect ” I must
not be understood to mean that intelligence and will have a
local habitation entirely distinct from the sensory and motor
substrata of the cortex generally. The point I am discussing
is the comparative intellectual value of the anterior and
posterior lobes, and the frequency of association or otherwise
of anterior or posterior cerebral preponderance with mental
strength or weakness.
I think the evidence above set forth scales heavily in
favour of the superior intellectual value of the posterior
lobes.
Since I wrote the above, Dr. W. W. Ireland’s article on
Professor Flechsig’s “ Localisation of Mental Processes in
the Brain ” has appeared, containing the following note :—
“ Flechsig observes that the height of the forehead depends
partly upon the size of the sensation sphere, and this in its
turn upon the size of the body. Thus the height of the fore¬
head is no direct measure of the mental powers. The most
important part of the brain* for great mental performance
seems to lie in the posterior regions.”
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by Crochley Clapham, M.D.
295
Discussion,
The Pbbsident said he had nothing to say beyond this, that Dr. Clapham
confirmed the statements made by Professor Cunningham at the Dublin
meeting in reference to two brains of idiots of a particularly low type, which
were characterised by the almost total absence of the occipital lobes.
Dr. Jones said it seemed to him that it followed from Dr. Crochley
Clapham's paper that they ought, when selecting their nurses and attendants in
future, to look at the back of the head rather than the front. Of course there
was a considerable want of the posterior part of the skull in idiots, but there
was also a very considerable want of the anterior part of the skull, and com¬
paring the brain of the monkey with the highly developed brain of man, the
thing which struck him was the increase in the part between the frontal and
the occipital—the so-called motor area. If they looked at the angular gyrus in
a monkey it was almost vertical. Looking at it, of course, in man it was much
more horizontal, which would have a tendency to push the posterior lobe back,
so that the development claimed for the occipital lobe was more apparent than
real.
Dr. Ybllowlees said they all believed that the brain acted as a whole, and
that it was very difficult to differentiate one part from another in regard to
mental and intellectual processes. They would have to reverse all the
teachings of experience if they were to believe it true that the people with
retreating foreheads were the intellectual giants of our race. With regard to
the pathological aspect, they seemed to have the strongest testimony against
Dr. Clapham’s theory in the brain death which they called general paralysis,
where the morbid changes unquestionably affect the anterior lobes. That
seemed to him a very great difficulty, which could not be explained away.
Dr. Cbochlet Clapham. —With regard to what Dr. Jones said as to the
posterior lobe being a very small part of the brain in man, I say that it is
very much smaller in the case of an idiot—a diseased man—in comparison with
the whole brain than in an ordinary man. Dr. Yellowlees says it is difficult
to differentiate the locality of intellect in the brain, and no doubt it is. 1 do
not wish to say that the seat of intellect is in this place or in that, but that
as regards the two the posterior has more to say for itself than the other.
As regards the necessity in that case of reversing the teachings of old, of
course we do not mind doing that if we can improve upon the teachings of old.
As regards the general paralysis, there is a very large implication of the whole
brain in general paralysis, as the brain has spots all over, and especially in
the motor region of the parietal lobe. I do not see that that affects very
much the question of the paper.
The Osseous System in the Insane .* By J. F. Briscoe,
M.R.C.S., Westbrooke House, Alton, Hants.
It would appear, by reference to the Blue-book of the
English Commissioners for 1896, that, out of 7182 deaths in
the asylums of England and Wales, thirteen resulted from
diseases of joints and bones, and eleven from fractures or
dislocations. In 1897, out of 6783 deaths, fifteen resulted
from diseases of joints and bones, and thirteen from disloca¬
tions and fractures.
* Read at the General Meeting of the Medico-Psychological Association,
November, 1897.
xliv. 20
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296
The Osseous System in the Insane,
[April,
The text-books on insanity have very little to say on this
matter, but Mr. Bryant, in his Practice of Surgery , states that
“ fractured ribs in the insane generally arise from direct
violence.” Dr. Mickle, in his work on General Paralysis,
writes on the bone condition in insanity. In Holmes’s
System of Surgery will be found a good reference of authors
on the subject of the pathology of the osseous system as at
present understood. Virchow and Ebertli, in 1856 and 1878
respectively, describe synostosis of the base of the skull in
connection with cretins and idiots. Parrot and Charcot
have also contributed important observations on this sub¬
ject. Mr. Arbuthnot Lane, in the Pathological Society’s
Transactions , vol. xxxv, states that “ taking the ribs as the
criterion of density, the strength of the bones bears a direct
proportion to the dentition of the patient,” and also that
" in the edentulous the ribs can usually be cut with a scalpel.”
He goes on to say that “ when once the teeth are lost the
osseous system degenerates even more rapidly.”
After examination of many pieces of bone in acid solution,
I conclude that rachitic bones are morbid, because the phy¬
sico-chemical union of animal and earthy matters is very
feeble. Dietetic errors in the feeding of fowls result in their
laying soft-shelled eggs; but Mr. Bland Sutton' informs me
that bone softening of any kind is extrerfiely rare in birds.
I show here a series of skulls and other osseous specimens
representative of hyperostosis, osteoporosis, raollities ossium,
osteitis deformans, syphilitic thickening, and erosions, from
sane and insane subjects. Among these is the calvarium of
an Arab child which I brought before you on a previous
occasion, and which I believe to be a good example of
rickets.
Specimen 1669 20 is labelled osteoporosis. The history
of the case was reported by the late Dr. Hilton Fagge. For
fourteen years the patient suffered from pain in the bones,
immobility of the chest, and brittleness of the ribs. Towards
the end breathing was difficult. Dr. Mickle repeats Mr. A.
Durham’s opinion as expressed in the Guy’s Hospital Reports ,
"that the nervous system has a distinct influence in pro¬
ducing malnutrition of bone.” Those calvaria illustrating
hyperostosis are separable into two classes. Typical of
these is (1) the Arab specimen, which is of a spongy light
consistence; and (2) a skull-cap from a general paralytic,
which is relatively dense, hard, and sclerosed.
Do these thickened skulls cause mental aberration ? From
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1898.]
297
by J. P. Briscoe.
what I can gather there is a difference of opinion in the psy¬
chological world. I believe that flattening of one side of
the skull, obliteration of the sutures, and other iregularities
are the precursors of affections of the brain; and that the
Pacchionian bodies when enlarged may cause cerebral dis¬
turbance. We know what serious results may follow from
various peripheral irritations—such as an aural polypus.
While I am prepared to admit that ill-proportioned skulls
may cause no morbid affection of the brain, we must be aware
that thickened skulls are not uncommon, and I suggest that
these may result from the carrying of heavy weights on the
head. With regard to mollities ossium in the insane a differ¬
ence of opinion seems to exist. Some observers believe that
it is not frequent, and certainly not peculiar to general para¬
lytics. I show the illustrations of a case of mollities ossium
reported by Dr. William Bromfield in 1773. These plates show
the woman before death, and her complete skeleton of softened
and distorted bones. I believe that this disease may arise
from gross dietetic errors, and that rickets is a disease of
growth, and that mollities ossium is apparently a disease of
decay. The pathological conditions of bones, specimens of
which I have brought before you, will explain the fragility of
the ribs of the sane and of the insane. When, in April, 1895,
Drs. Campbell and Mercier brought before the notice of this
Association the results of their inquiries on the breaking strain
of the ribs of the insane, they asked, what are the forms of
insanity which are accompanied by a low breaking strain of
the ribs ? This breaking strain must vary considerably at the
different periods of life, and we have not only to consider the
diathesis, but also the athletic powers and previous occupa¬
tion of the individual.
In conclusion, had I been able to expend more time and
observation in examining these osseous affections I might
have claimed the privilege of being original. So far I have
only introduced the skeleton of the subject, and it now rests
with others to further the pathology of these diseases.
Discussion .
Dr. Conolly Norman. —The fragility of the bones of the insane has been
under discussion for such a length of time that it is difficult to find anything
new to say about it. I am a little sceptical about the excessive fragility of b
lunatic's bones. I am clear about this, that an infinite deal of nonsense has
been talked upon the subject, because when lunatics die with broken ribs the
medical opinion given is usually to the effect that the bones of lunatics gene¬
rally and in the abstract are fragile. Whereas the question is not are the
bones of all lunatics fragile, but are these bones fragile P I have been perhaps
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298
The Osseous System in the Insane ,
[April,
more unfortunate than other people, for in twenty-two years* experience as
an asylum medical officer two patients of mine have been killed by having had
their ribs broken. They were both general paralytics, and I can safely aver
that the ribs were not in the least fragile as tested l>y ordinary methods, and
both patients were proved to have been subjected to treatment that would have
broken the ribs of any person. Mr. Briscoe showed us a number of skulls. I am
not quite clear about the clinical history and antecedents of the former owners
of those interesting bones. A good many presented a condition that we are all
pretty familiar with, irregular thickening of the interior of the skull. This is
much more common ia cases of chronic insanity than amongst other folk. I
do not know why it should be so, and I have no fine theory to account for it. I
believe it lias been suggested that it is a condition similar to hyperemia and
OBdeina e vacuo ; but that bones should grow inwards to supply the place of
wasted brain is too strong a proposition for me to accept. A deep curve for the
meningeal arteries is, of course, very common in old people. I was rather sur¬
prised to find that Mr. Briscoe did not refer to the work that Krause has been
doing lately under Professor Meyer at Gflttingen, where he has held very careful
investigations into the condition of the bones in the insaue. He disposes satis¬
factorily of the old idea that the insane are liable to osteomalacia, which is a
disease characterised by certain definite microscopical and chemical conditions,
neither of which is present in the case of fragility of the bones of the insane,
or not more frequently than in the bones of other people. He points out that
the giant-cells are absent in these softened bones in elderly lunatics or general
paralytics, that the change is otie of simple atrophy; that the osseous matter
which is reduced in quantity is replaced by fat, that the change is essentially
senile, and that it does not occur in general paralysis as frequently as in cases
of chronic dementia in the aged. It depends more upon the general physical con¬
dition of the patient than upon his mental state, and that is my own experience
so far a« I have been able to test it.
Dr. B. Percy Smith. — I remember two fatal cases at Bethlem Hospital in
which ribs were found to be broken. In one case the ribs were so extremely
fragile that they could he broken with the finger and thumb like a biscuit, and
in the other there was certainly no history of any injury in the institution. At
the post-mortem it was evident that we had discovered an old fracture which
had united with fibrous capsule, probably of several months* date. Nobody
knew of any injury at all, and one would think that there was a probability at
any rate in that case that the rib must have become fractured from some very
slight cause, which would not have acted in health.
Dr. Richards. —It seein9 to me somewhat extraordinary that this theory
about the softening and fragility of the bones of the insane only occurs in
reference to the ribs and sternum. I do not know whether any of the members
here present can state that the other hones of general paralytics are equally
softened, and whether fractures frequently occur. In my experience I have met
with very few fractures amongst cases of general paralysis of the insane, and
fractures are not more frequent in cases of general paralysis in the limb bones
than they are in other cases of mental disease, or in persons who are not
afflicted with insanity.
Dr. Hayes Newington. —Some twenty or thirty years ago I made many
post-mortem examinations at University College Hospital, and came to a
certain conclusion as to the normal resistance of an ordinary person’s ribs. At
Morningside I made still more post-mortems, and paid a good deal of attention
to skulls and ribs, and there can be no question as to the relative frequency in
which one could easily break a lunatic’s ribs, especially in general paralysis of
the insane. In these cases ribs rapidly become weakeued, and bend like brown
paper. It would be absolutely impossible to establish, even on the authority of
Dr. Norman, that there is not excessive softness, not perhaps always to breaking*
point, but to bending point, in the post-mortem room. I have heard of a case
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1898.] by J. F. Briscoe.
in which it was suggested that the breaking of several ribs was due to auscul¬
tation.
Dr. Robert Jones. — I think it has been established beyond all doubt that
the bones of old people are soft. I believe also from considerable experience
that the bones of certain cases of general paralysis are very much softened. I
have twisted them and broken them one after the other, and it is a question to
me whether these fractures do not occasionally occur spontaneously. I have a
case now in my memory of a patient who was an epileptic. He never went out
of the attendant’s sight, night or day, but after a very severe fit one day he
was discovered to have five or six ribs broken on each side, which probably occurred
from muscular spasm, and he made a good recovery.
Dr. Crochlet Clapham.—I have seen a case as regards the long bones. The
patient, a woman, broke the humerus of one of her arms on two occasions
during an epileptic fit.
The President. — I would like to bear witness, after the remarks made by
Dr. Richards, to the fact that 1 have on more than one occasion observed great
softening of the bones without fracture in male and female general paralytics,
and that I have been able to break them across with the greatest ease. That
condition of bone, however, is more frequently seen in senile cases.
Mr. Briscoe.— I have to thank you very much for the kind attention you
have given to my paper, and for the remarks which have been made there¬
upon. When one considers the mechanical arrangement of the thorax, one
knows that when one strikes a man he immediately if possible seizes his
opponent, draws his chest up, and takes an inspiration so as to fill his chest.
Mr. Ward in his Osteology says 44 it is easy to explain the altered condition of
the chest, it is like hitting a barrel.” Dr. Mickle in his book on General
Paralysis lays stress upon it, so that he is rather inclined to believe that the ribs
of insune people are liable to fracture, and in this he agrees with the late l5r.
Sankey. The fact is that the nervous system is blunted, the thorax becomes
placed disadvantageous^, and the ribs correspondingly more liable to fracture
than when the chest is fully distended. My experience has been limited, and I
cannot give you any practical information. 1, however, do believe that it is
quite possible that these friable ribs, as has been mentioned by Dr. Newington,
are not uncommonly to be found in the post-mortem room. We know that fat is
•one of the commonest products after the taking to pieces as it were of the
various higher orgauic constituents of the body. When degeneration runs to
absorption excessive fat is always to be found.
Reminiscences of “After-care” Association, 1879—1898.
By the Rev. H. Hawkins, Colney Hatch.
As far back as 1871 a paper named “A Plea for Con¬
valescent Homes in connection with Asylums for the Insane
Poor” was admitted by the Editors, Drs. Maudsley and
Sibbald, into the Journal of Mental Science . In 1879 an article
called “ After-care,” by the Rev. H. Hawkins, Chaplain of
the Colney Hatch Asylum, was allowed a place in the same
Journal. The then Editors were Drs. Clouston, Hack Tuke,
and Savage. On the 5th June of the same year a meeting
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300 Reminiscences of “ After-care ” Association , [Aprils
was held at the house of Dr. Bucknill, 39, Wimpole Street,
to consider the subject of the “ After-care of Poor and
Friendless Female Convalescents on leaving Asylums for the
Insane.” There were present Dr. and Mrs. Bucknill, Miss
Cons, Dr. D. Hack Tuke, Mr. W. G. Marshall, Dr. Harrington
Tuke, and others. A paper on the above-named subject was
read. It was moved by Dr. C. Lockhart Robertson, and
seconded by Dr. Hack Tuke—“ That this meeting do form
itself into an Association.” The names of Dr. S. Duckworth-
Williams and of Dr. Savage were added to those already
given. It was moved by Dr. Robertson, and seconded by
Mr. W. G. Marshall—“That Dr. Bucknill be invited to take
the office of President.” Also moved by Dr. Harrington Tuke,.
and seconded by Dr. Bucknill—“ That the Rev. H. Hawkins
take the office of Secretary.” These resolutions were unani¬
mously carried. Later in the summer a meeting of ladies to
consider the same subject was held at 84, Portland Place.
Miss Con8 consented to accept temporarily the office of
Ladies’ Secretary. Later in the same year another meeting
was held at Dr. Bucknill’s.
1880 is specially memorable as the year in which the late
Earl of Shaftesbury kindly consented to become President
of the Society. He had previously expressed his cordial
approval of its objects. Referring to the paper mentioned
above, he had written, “Your letter entitled ( After-care’
has deeply interested me. The subject has long been on my
mind, but, like many other subjects, it has passed without
any effectual movement on its behalf. Tell my friend Dr.
Bucknill that I shall be happy to serve under his presidency
in so good a cause.”
In 1881 Lord Shaftesbury presided for the first time at the
Anniversary Meeting held at the house of Dr. Andrew Clark
at 16, Cavendish Square. Lady Frederick Cavendish had
kindly interested herself in securing this reception. Among
other ladies present were Lady Lyttleton, Lady Brabazon,.
Mrs. Gladstone, &c. Dr. Andrew Clark, in effect, remarked
that, in the case of convalescents in hospitals, it was often sad
to become well, when the fostering care of the wards had to
be exchanged, without intermediate preparation, for the
privations and roughness of home life. Convalescent treat¬
ment for a while would be very valuable.
1882.—In the following year Dr. John Ogle, now one of
its Vice-Presidents, was good enough to receive the members-
of the Association at its Annual Meeting, at 30, Cavendish
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by Rev. H. Hawkins.
801
Square, when Dr. Hack Tuke called attention to the need of
some house or room in which business could be transacted.
1883.—The next Anniversary was kept by kind invitation
at Lord Cottesloe’s, in Eaton Place. Lord Shaftesbury stated
his belief that the “ After-care ” Society was required to
supply a real want, and that it was (in his own phrase) a
“ seed-plot,” from which in time good results would spring.
The Annual Meeting of 1884 was memorable as being the
last occasion when Lord Shaftesbury (who had presided at
the Society’s Anniversaries since 1881) was in the chair. The
tryst was Lord Brabazon’s, at 83, Lancaster Gate. Though
himself absent from home, he kindly placed a room at the
service of the Association. The President remarked that he
considered a “ Home ” a necessity, and did not see how such
a resort could be dispensed with.
1885. Bethlem Hospital. —The c genius loci , of Bethlem
Royal Hospital afforded appropriate tryst-room for two
meetings in the summer and autumn of 1885, by the kind
arrangement of Dr. Savage. On one occasion J. Copeland,
Esq., the Treasurer, was in the chair.
Bazaar. —Earlier in the same year a Bazaar, lasting two
days, was organised by Mrs. Ellis Cameron. It was held in
the Kensington Town Hall. The proceedings of the first day
were opened by the Rev. C. Carr Glyn, Vicar of Kensington,
the present Bishop of Peterborough. The pecuniary result
was a handsome addition to the funds of the Association.
Death of the Earl of Shaftesbury. —The death in the autumn
of this year of the veteran philanthropist, Lord Shaftesbury,
was the cause of sorrow to very many, among whom were the
members of the “ After-care ” Society. The great Earl was
buried on the 8th October in Westminster Abbey in the
presence of a large concourse of friends, among whom were
Drs. Bucknill and Hack Tuke.
Lord Bmbazon , President. —Later in the year an interview
with Lord Brabazon, at 83, Lancaster Gate, led to his accept¬
ance of the vacant Presidentship. Though he was seldom
able to attend meetings, yet the prestige of his name and
permission to hold occasional meetings in his house—the
resort of many charitable gatherings—were no slight advan¬
tages. He once remarked that he accepted his position as a
legacy from Lord Shaftesbury.
1886. —An important event in the annals of the Society,
and very advantageous to its interests, took place in 1886. At
more than one of the Annual Meetings the Hon. Secretary
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302 Reminiscences of “ After-care " Association, [April,
had stated his opinion that it was essential to the progress of
“ After-care " that a secretary should be appointed who
could devcfte a substantial portion of his time to promoting
the objects for which it was founded. The work was not of a
kind that could be a * irapepyov ,' that could successfully be
taken up merely at bye-times. It needed fostering care and
continuous work.
H. T. Roxby , Secretary .—The Committee selected for
the post Mr. H. Thornhill Roxby, whose appointment has
been entirely justified by results. Previously to his con¬
nection with the Association its existence was kept in
evidence by occasional meetings (such as have been referred
to), and in some other ways, and a few practical cases of
€t After-care" were not wanting; but when Mr. Roxby
joined the Society's work a new and vigorous departure
became manifest. A “ constitution," which before had been
almost non-existent, was formed ; Committee meetings were
appointed, subscriptions invited, cases requiring convalescing
“After-care" were brought forward for investigation by
members of the Committee (partly composed of ladies), and
dealt with according to the circumstances of each case. It
is due to the Secretary to mention that his preliminary
inquiries into applications for “ After-care" have been of
great assistance in Committee. The number of cases which
have come before them since 1886 have exceeded 979 ; “ some
have come up for help two or three times, relapsed, and
are counted as fresh cases. Besides work in his office and at
Committee meetings, the Secretary has brought the subject
of ‘ After-care' under the notice of many in the suburbs
and the provinces as well as in London."
1886. Princess Christian , Patroness .—It was also in this
year that the Princess Christian conferred the great honour
on the Association of becoming its Patroness. This favour
was obtained through the kindly offices of the Rey. Edgar
Sheppard, Sub-dean of the Chapels Royal, and son of Dr.
Edgar Sheppard, for many years Superintendent of the Male
Department of the Colney Hatch Asylum.
1887. Interview with Cardinal Manning .—An interesting
incident in our history was the reception of a deputation
consisting of Dr. Hack Tuke, the Rev. Father Cox, Mr.
Roxby, and Rev. H. Hawkins, by His Eminence Cardinal
Manning at his house in Kensington. The twofold object of
the interview was to secure the Cardinal's interest in the
Association's work, especially in the case of Roman Catholics,
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by Rev. H. Hawkins.
- 303
and to request him to become a Vice-President of the Society.
The Cardinal’s demeanour and reception were courteous and
kindly.
1889.—With the sanction of the Earl of Meath a concert,
organised by Mrs. Ellis Cameron, was given at 83, Lancaster
Gate. The pecuniary proceeds, if any, were inconsiderable.
But it was one amongst other methods by which the name
and objects of the Association became gradually better known.
On several occasions the lady named above has shown
interest in the progress of After-care.
1891. Dr. Rayner , Treasurer .—On the resignation of Dr.
Claye Shaw of the office of Treasurer, which he had held
almost from the beginning, Dr. Henry Rayner kindly con¬
sented to keep the Society’s accounts—perhaps a not very
onerous duty, yet imposing some amount of trouble which
many decline to undertake.
Office at Church lIouse.^A useful suggestion by Mr.
Roxby resulted in an initial occupation, in 1891, of very
limited accommodation in the “ Church House/’ West¬
minster, which was enlarged in 1895 by the acquisition of
an “ office,” so that the Society has now the more indepen¬
dent status of being a tenant at will instead of on sufferance.
Besides, the display of the word “ After-care ” on the office
door imparts dignity to transactions within.
After-care in France .—Any supposition that the “After¬
care” Association was first in the field was dispelled by
information, furnished by Dr. Hack Tuke, that one with a
kindred object, and in some respects wider scope, had long
been in operation. It is known as the “Asile Ouvroir,
Sainte Marie, situated at Grenelle, near Paris.” Its founder
was Doctor Jean Pierre Falret, and it is managed by Sisters
of the Order of St. Vincent de Paul. The Asile dates from
1841. The Society not only affords “After-care” within its
walls, sometimes even to an inmate’s life’s end, but also keeps
touch with mental convalescents at their own homes.
The “Reunions du Dimanche ” are occasions when, under
certain regulations, Sainte Marie receives as guests not only
former inmates, but also husbands and children in company
with some convalescent friends, or on a visit to wives and
mothers still in residence at the Asile. In the course of one
year more than 1400 persons took part in these gatherings.
The English Society was not the originator of “After-care ”
treatment for mental convalescents, and perhaps could hardly
do its work on the same lines.
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304 Reminiscences of “ After-care ” Association , [April,
1892. Meeting at Colney Hatch .—As an exceptional con¬
cession, the committee of the Colney Hatch Asylum granted
the use of their Board for chiefly a local meeting of friends
of “ After-care.” Dr. Hack Tuke was in the chair. Among
others present were Drs. Seward, Savage, Rayner, &e.
1893. Home discontinued . — The experiment of a joint
occupation of a house in Surrey for the purpose of the reception
of mental convalescents proved unsuccessful. An imperium
in imperio is not often of long duration. The house partner¬
ship was dissolved, and the plan of boarding out reverted to.
1895. Death of Dr. Hack Tuke. —A great loss and sorrow
befell the Association in the spring of 1895, when death
removed Dr. Hack Tuke, who had been its invaluable
supporter and guide from the first. His grave, kindly face
was regularly to be seen at committees, where, as chairman,
his counsels were of much service. His experience and
research in his branch of the medical profession secured for
him a wide reputation. A distinguished alienist happily
described him as the “ Historian of his speciality.” No doubt
his laborious literary occupations overtaxed his constitution.
In particular, his editorship of the Dictionary of Psycho¬
logical Medicine must often have severely strained his
mental and physical energies.
Dr. Rayner , Chairman. —The Association was most fortu¬
nate in being able to secure the valuable services of Dr.
Henry Rayner as their Chairman in succession to Dr. Tuke.
Great thanks are due to him for the regularity of his attend¬
ance, and for the kindly courtesy with which he presides.
Ladies 9 work. —Mention should not be omitted of help given
to mental convalescents by ladies’ working parties. One at
New Southgate has, during many years, given parcels of
clothing to female convalescents leaving the great asylum
close at hand. Ladies have been valued friends to the
Society from the commencement. Lady Frederick Cavendish,
Miss Agnes Cotton, Miss Cons at the outset of its career,
Mrs. Henniker, Miss Paget, Mrs. Hack Tuke, and others in
later years have helped on its work. Although, as we have
been reminded, the Society may never become popular, yet
it has a good object in view, and work to do which, as years
go on, may be helpful to many mental convalescents.
“ ’Tis not enough to help the feeble up.
But to support him after."
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305
CLINICAL NOTES AND CASES.
A Case of Hsematoporphyrinuria * By Keith Campbell, M.B. r
formerly Assistant Medical Officer, James Murray’s
Royal Asylum, Perth.
The occurrence of haematoporphyrin in the urine of
patients, and its relation, when excessive, to the exhibition of
sulphonal, has of late years attracted the attention of both
clinicians and physiological chemists. Although the exact
processes which lead to this change in the urine have not yet
been determined, the group of clinical symptoms associated
with the appearance of haematoporphyrin in the urine is now
fairly well defined. The subject is of great interest, espe¬
cially to those whose practice is among the insane; and the
present case, which gives a very complete clinical picture of
the symptoms in such patients, has been thought worth
reporting.
K. D., aged 22, was admitted on 3rd July, 1897, suffering from
subacute mania.
History, —a. Family. —Father died, aged 68, of cardiac disease.
Mother died of cancer, aged 58. A sister was for three months in
an English asylum suffering from mania, a sequela of influenza.
p. Personal. —Patient, a domestic servant, was active and regular
in her habits, and had always lived under good hygienic conditions.
The catamenia were regular until.within two years of the attack,
when she suffered from anaemia with amenorrhoea.
Inception. —The attack began with depression, followed by
fancies and suspicions. In October, 1896, she thought she would
lose her reason, as her head was “ moving on the top.” It seems
that from this date she was never quite well mentally, and from
February till April she was under treatment for oedema of the legs
and ankles, with pain. She was habitually constipated, and was
treated with tonics and aperient pills. On June 30th—three days
before admission—she had two powders, R Sulphonal gr. xv, Pot.
Brom. gr. xx, Phenacetin gr. xv. Beyond this, after careful inquiry,
no evidence of any sulphonal having been administered could be
obtained. The sleeplessness and maniacal symptoms did not im¬
prove under treatment, and she was admitted on July 3rd, as she
could no longer be controlled outside.
On Admission — Physical. —She was a well-developed young
woman with no obvious organic disease of any of the organs, but with
a very poor circulation, as shown by the “ blue oedema,” coldness,
* Rend at the Qeneral Meeting of the Medico-Paychological Association held
at Sheffield, February, 1898.
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306
Clinical Notes and Cases.
[April,
and clamminess of the extremities. There was a marked degree of
sluggishness of the alimentary functions and excitability of the
nervous system. The urine received from the ward under her
name contained no abnormal constituent. The specific gravity
was 1026.
Mental. —She was excited, constantly talking quite iucoherently,
and she had many fleeting delusions. She was very restless and
jerky in all her movements.
Progress of the Case. —July 4th.—She had a restless night, and
next day was even more excited. As she had disturbed the other
patients the night before, she to-night had Jiss of paraldehyde as
a draught. She took a fair amount of nourishment during the
day.
5th.—A good night, but still restless and talkative; taking food
well.
6th.—Out all afternoon ; tired on coming in ; asleep at 10 p.m.
7th.—This morning she was sick, and vomited persistently. She
also complained of abdominal pain, not very defined. The bowels
were confined ; she had poultices over the epigastrium. Mentally
better to-day.
8th.—Still sick and vomiting ; bowels obstinately confined. She
had aperients, which, however, she could not retain. Much calmer
mentally.
9th.—Still sick and vomiting, but not so persistently. Worse
mentally.
]0th.—Quite maniacal again. Enema produced little effect. Be¬
came sick again at night. Marked hiccough at intervals.
11th.—Mustard leaf over epigastrium; enema with little effect.
With the persistent sickness the pulse had become very weak, and
she now had brandy jj in the hour. The sickness and tendency
to vomit disappeared to-dav. Hiccough again troublesome.
12th.—No more sickness. Took and retained a good deal of
milk and potash, as well as brandy. The maniacal symptoms had
now passed off, though she was still distinctly “ silly ” in conduct.
13th.—Satisfactory enema. Very sensible to-day.
14th.—Temperature rose to 100‘4° in the evening. Urine to-day
cherry-red ; guaiacum test negative ; no microscopic, appearances of
blood. Provisional diagnosis of hsematoporphyrinuria; sent to
Clinical Research Association. (It is probable that wrong speci¬
mens were submitted by the nurse during the past week.) She
took a fair amount of fluid nourishment to-day.
16tb.—Diagnosis confirmed; very low. Considerable paresis
and diminished sensibility; pupils dilated, but react.
17th.—Worse. Pupils widely dilated; perspiring freely. Caked
dry lips; foul tongue; sensibility to touch showed further diminu¬
tion ; reaction time for sensation slowed over lower extremities to
three inches above knee—for pain over body generally. No loss of
power apart from weakness in the arms aud extensors of legs, but
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Clinical Notes and Cases,
307
the flexors markedly paretic. Swallowing interfered with. No
sickness. Blood examined: red blood-corpuscles almost 7,000,000,.
well formed ; no poikilocytosis or change in the cell-pigment could
be seen. Passing very little urine, only a small quantity being
secreted. Superficial reflexes now practically gone, knee-jerk
absolutely so. By evening more restless, moving about in bed;
control of bladder and rectum gone; heart very weak. She had
now no pain or sickness, but there was a tendency to diarrhoea.
Breathing laboured, mostly thoracic.
18th.—A bad night; constant chattering. This morning lying
very “dead;” could not move legs, but moved arms slightly.
Lower lip sloughing and discharging on its mucous surface, where
she had bitten it during the night. Taking nourishment freely.
Passed urine normally ; colour the same; sp. gr. 1020, acid; small
amount of albumen ; mucus. Pulse rapid, thready. Breathing
laboured. By afternoon much changed ; did not recognise those
about her; quite helpless; hardly able to move a finger. Pupils
dilated ; when fixing for a near object a marked tendency to double
internal squint. The breathing, which had all day been laboured,
was now almost entirely dependent on the action of the inter-
costals and extraordinary muscles of respiration. Posteriorly the
lungs full of moist sounds. Swallowing still difficult. Incon¬
tinence again this afternoon. A check examination of the blood
gave almost 7,000,000 red blood-corpuscles per cubic millimetre.
19th,—Diaphragmatic action almost absent. Breathing a con¬
stant struggle, and in evening almost gasping. Nystagmus, lateral
for the most part, slight in the morning, marked in the evening. No
hiccough since 11th. Taking a considerable amount of nourish¬
ment. Still incontinent; colour of urine the same. Supra-renal
tabloids, one every two hours, powdered in a little milk. To-day
convulsive movements of the neck muscles, with slighter twitchings
of the facial muscles, appeared, and during this the squinting was
marked. During the seizures the pupils, usually dilated, were
contracted, aud the nystagmus disappeared. Each convulsion
lasted from a few seconds to a minute, and the earlier ones could
be stopped by passing the hand in front of the face. Patient did
not speak all day, and was unconscious almost the whole of the
time. Corpuscles rather over 7,000,000; no marked change in
their form, though many of them were small. By midnight the
breathing was laboured and of the Cheyne-Stokes type. The
convulsive attacks came on at intervals of twenty to thirty
minutes. Ophthalmoscopic examination of the fundus gave
negative results.
20th.—Just alive. Before each convulsive attack the breathing
became a succession of gasps, and after each it was shallow and at
long intervals. The convulsions were now much more frequent,
and distinctly epileptiform in character. A typical one half an
hour before death was as follows. The breathing became very
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Clinical Notes and Cases.
[April,
hoarse and gasping. The lip and face muscles began to tremble
and twitch slightly. The eyes were open and staring; pupils
dilated ; face flushed. Then followed a very short time stage,
when the mouth was firmly closed, the face congested, and neck
veins engorged. During this stage of tonic spasm and for some
seconds after the pupils were contracted. This was succeeded by
a clonic stage, with increased working of the face muscles and
jerking of the arms and hands (especially left index finger), and
also slightly of some of the thigh muscles; the whole being in
marked contrast to the “dead” wav in which she usually lay,
with only the intercostals and extraordinary muscles of respiration
acting. After a fit she was completely exhausted. The pulse be¬
came a mere run. The heart sounds could barely be made out.
The breathing was very shallow and at long intervals; the pupils
widely dilated, and the eyes rolled up. The fits increased very
much in severity towards the end, and followed each other every
ten to fifteen minutes. Power of swallowing was quite gone for
some hours before death. She died at 3.30 p.m., thirteen days
after the first appearance of the vomiting. Just before death the
temperature, which had been steadily rising, reached 103° F.; post
mortem it rose to 104 2° F.
Report on urine by Clinical Research Association.—“ The pig¬
ment in this specimen was haematoporphyriu, and its quantity was
such that we* believe that sulphonal or an allied drug must have
been taken in excess. No blood was present, and no tube-casts.
Albumen present was in very small amount only.”
Post-mortem. — There were Jiv of fluid in the left pleura. The
right lung was extensively adherent. The subdural fluid was slightly
in excess, and there was some effusion into the meshes of the pia
posteriorly. There was marked congestion of the venous sinuses
and meningeal veins. There were localised patches of rusty
staining over parietal regions. There were some minute recent
haemorrhages over the outer aspect of the parietal lobes and on
the under aspects of the occipital and frontal. The whole brain
was soft in consistence. The blood generally was dark and fluid.
Report on organs by Dr. W.F. Robertson .—“ Right adrenal shows iu
the cortex numerous large areas in which the epithelial cells have
undergone a marked degenerative change, consisting of the replace¬
ment of the protoplasm by clear globules. These globules, which
vary considerably in size, do not (with an occasional exception)
give a fatty reaction with osmic acid. There is no evidence of
any tubercular disease in any part of the organ. Left adrenal shows
similar changes. There is no tubercular disease. The degenera¬
tive changes above noted are evidently the same as those that are
so commonly to be observed in the adrenal epithelium in various
diseases, and therefore they probably have no important bearing
on the case. The ganglia of the coeliac plexus appear to be healthy.
“ The kidney8 are much congested. The epithelial cells of the
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Clinical Notes and Cases.
309
tubules appear swollen and degenerated, but the change may be
partly a post-mortem one. They do not for the most part give a
fatty reaction with ostnic acid. There is no evidence of any acute
or chronic inflammatory changes.
“ Lungs .—Numerous tubercles in the apical portion of right,
some of the larger being caseous iu the centre. The surrounding
tissues are much congested, and are consolidated by recent inflam¬
matory changes. There are several caseous nodules, about the size
of small peas, loosely attached to the pleura.
"Brain —Vessels and neuroglia appear healthy. Nerve cells
show no distinct evidence of chromatolysis or other morbid
change.”
Notes on the case .—In comparison with other cases where a
similar class of symptoms has been described in connection
with the administration of sulphonal, it is interesting to note
in the present instance the very small amount of the drug
taken. In all the other cases where sulphonal has been the
exciting cause of the symptoms, large quantities have been
taken over a considerable period. In this case only thirty
grains of the drug had been taken in two doses three days
before admission. It is doubtful, however, if this small
amount of the drug could be said to have been the absolute
cause of the train of symptoms. There was no evidence
certainly of any of the other diseases, e. g. rheumatism,
pneumonia, typhoid, peritonitis, &c., in the course of
which hmmatoporphyrinuria has been observed; but Dr.
S. M. Copeman ( Lancet , 1891, p. 197) has described two
cases where there was haematoporphyrin in quantity in the
urine, and at the same time great prostration, inability to
move, &c., and two other cases were referred to by him.
Three of the four died collapsed. There was no evidence of
sulphonal having been given, and there was no concurrent
disorder to account for the symptoms. The description of
these women, who were highly neurotic and suffered from
sleeplessness and habitual constipation, exactly corresponds to
the description in the present case. They were, however, of
middle age, while the present patient was a young woman.
But even this small amount of sulphonal cannot be entirely
ignored, especially if we are to consider that the appearance
of large quantities of hsematoporphyrin in the urine of certain
patients who are having sulphonal and not in others is due to
an idiosyncrasy on the part of the patient for that drug, and
more especially as it is probable that the progressive and
far-reaching results are not to be set down to the direct
action of sulphonal itself, but to chemical changes, almost
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310 Clinical Notes and Cases. [April,
certainly alimentary in the first place, and probably hepatic,
of which the sulphonal has been the exciting cause.
It is to be regretted that the condition of the urine in this
case was not earlier recognised. The first symptoms of ali¬
mentary disturbance were observed on July 7th, but it was
not till the 14th that the characteristic cherry-red colour was
seen by the medical staff. During this week more than one
specimen of the urine was examined. It seems that the
impression amongst the nurses was that the patient was
menstruating, and it is certain that the specimens which were
examined were pale straw*coloured, and presented no ab¬
normal features, chemical or microscopic. It is very unlikely
that, with the gastro-intestinal symptoms so urgent, the urine
should not have presented the red colour before July 14th.
The clinical picture presented by this case is very complete,
and remarkable in some of its aspects.
It might be divided into three stages:
1. Where the symptoms were almost entirely gastro-intes¬
tinal. This lasted nine days, and presented very markedly
all the usual features.
2. The stage of progressive toxic paralysis, where, begin¬
ning with the flexors of the lower limbs, the whole muscular
system was paralysed,—the upper extremities being affected
rather late. Along with this motor change, and beginning
also with the lower extremities, diminished sensation was
observed. The knee-jerks and superficial reflexes were early
affected and finally absolutely lost. The sphincters were
paralysed three days after paresis became apparent. The
more vital functions of breathing and swallowing were
affected early. Hiccough was noted as a rather persistent
symptom during the first stage. From the tenth day from
the onset of gastric symptoms and up till death swallowing
was increasingly difficult. The fact that the action of the
diaphragm is much diminished in certain of these cases is
noted by Dr. Oswald in his case (Glasgow Medical Journal ,
January, 1895), and in this case the rapid failure of its action
was very marked after the eleventh day from the onset of sym¬
ptoms. From that date the extraordinary muscles of respi¬
ration were constantly in action, and the failure of the
respiratory mechanism would seem to account for the third
stage in the clinical history of the case, and eventually to
have caused the death of the patient. The pupils were
dilated all through, except during the convulsive attacks.
The fundus showed nothing of note.
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Clinical Notes and Cases .
311
3. The third stage might be described as the convulsive
stage. Twitchiugs of the arms and face were noted in a
case which occurred at Gartnavel, for notes of which I am
indebted to Dr. Hotchkiss. In the present case the convul¬
sive seizures were eventually quite epileptiform in their
character. The first indication of convulsive action was
noted on the eleventh day from the onset. It consisted in
marked squinting when the patient fixed for a near object.
Next day couvulsive movements of the neck and face
muscles appeared, accompanied by double internal squint.
The intensity and frequency of the convulsive attacks in¬
creased up till death. The symptoms observed agreed
closely with those got in asphyxia, and this stage seemed to
be accounted for by the failure of the mechanism of respira¬
tion, and the consequent slow asphyxiation. The results of
the post-mortem examination seemed to bear this out.
As regards the blood examination, the results were
different from what might have been expected. In other
cases reported the red blood-corpuscles have been found
rather diminished in numbers, 3,250,000 to 4,600,000
being the usual limits. In a case which occurred at
Morpeth, for notes of which I have to thank Dr. France,
the red blood-corpuscles were found “of various shapes, irre¬
gular, large, crenated, and oval. Many were granular, the
granules arranged in a crescentic form. In many cells what
looked like a nucleus was seen.” Iu the blood of the present
case the red blood-corpuscles averaged 7,000,000 per cubic
millimetre as the mean of three examinations by separate
observers. Only a few were altered in shape, but a large
number were small in size. No granular appearance was
observed, nor any nuclei. These examinations, however,
were conducted after the tenth day from the onset of sym¬
ptoms, and in the case reported by Dr. Oswald he observed
that “ some days before death the corpuscles increased, aud
apparently the destructive process had stopped. The per¬
centage of haemoglobin was 49 per cent.”
Supra-renal tabloids were administered, but as they
were not available till late in the course of the disease their
effect could not l e properly estimated.
The urine all through was small in amount, and the
sp. gr. never w ? as much over 1020. There was always a trace
of albumen, which increased in amount towards the end.
No blood-cells were ever detected in the urine.
Post-mortem .—The condition of the adrenals is interest-
xlix. 21
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Clinical Notes and Cases.
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ing, as is also the condition of the blood, and evidences of
meningeal venous congestion, in view of the termination of
the case.
The prognosis in such cases of hacmatoporphyrinuria
is at best a very grave one. From a survey of the literature
of the subject it would seem that when paralytic symptoms
become evident, and especially when the diaphragmatic
action is at all affected, the outlook is hopeless * Where
the symptoms are purely gastrointestinal, or accompanied
merely by prostration and weakness, the prognosis is not so
absolutely bad. A progressively increasing temperature
is a bad sign, but the higher degrees—over 101° F.—are
usually only reached towards the end of the case.
I have made no reference here to the mode of production
of haematoporphyrin and other nllied morbid urinary pig¬
ments. The subject is one of the greatest importance in
view of the fact that a drug which is of immense service in
the treatment of many cases of mental disease evidently
bears a causal relation to the special changes observed. It
is also important from the point of view of treatment, which
at present is to all practical purposes nil . The researches of
McMunn, Garrod, and other physiological chemists have
done much to elucidate the nature of this pigment, and as
recently as February 5th of this year, in the British Medical
Journal , Dr. D. F. Harris, of Glasgow University, in a retro¬
spect of twelve cases, has described the spectroscopic
appearances produced by morbid urine pigments allied to
hcematoporphyrin. The pathological changes which produce
the pigment are, however, as yet obscure, and in the circum¬
stances I have limited myself to the clinical phenomena.
Discussion.
Dr. Clapham doubted if it would be of any use to watch the urine were
thirty grains of sulphonal to produce such effects. It would be too late after the
mischief was done.
Dr. Adaib.—A few years ago he spent some time trying to find out the
relationship between hsematoporphyrinuria and the administration of sulphonal.
They used sulphonal pretty freely, and patients might have 60 to 100 grains
a day. The nurses were instructed to watch them, and to take particular note
of the urine. In no single case could he find any discoloration. They some¬
times had cases of sulphonal poisoning, but knew the symptoms, and stopped
# In connection with this progressive paralysis of the respiratory muscles, it
is interesting to note that broncho-pneumonia has been observed in two cases
reported. In one observed by Hammarsten the broncho-pneumonia appeared
eight days after the urine change was noticed, and was the cause of death.
The other was a case of acute sulphonal poisoning (Brit. Med. Journ ., Supplement,
September, 1897), where broncho-pneumonia supervened before death.
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Clinical Notes and Cases.
313
the fmlph m »1 at once. They always kept their eyes open for the possibility of
snlphonal poisoning. As they gave so much sulphonal with negative results in
spite of care in watching, he was inclined to think they would have to fall back
on the supra-renal capsules as the cause of the condition rather than the
administration of sulphonal. If he obtained any further information as
the result of further investigations in that institution, he would be pleased to
send it to the Journal.
Dr. Campbell said he thought it was generally acknowledged that if there
was to be t*ny chance of recovery for a patient with hsmatoporphyrinuria, the
urine change must be recognised early. Therefore the urine should be watched.
He thought every patient who was taking sulphonal ought to be a marked
patient for the nurse or attendant, and if these knew that the patient’s urine was
being watched for a particular purpose they would also more keenly observe any
small change in the mental and physical condition. In that way the clinical
appearances of the patient are well noted.
The President congratulated Dr. Campbell upon having read such a minute
and interesting clinical record. The case recalled the only similar one he ever
saw. It occurred at Morpeth a year or so ago, and had been reported by Dr.
Evans. It was, indeed, a very serious matter that a drug which they had found
of such immense use should be undoubtedly, under certain circumstances
unknown to them at the present time, occasionally toxic and fatal.
Dr. Ubqtjhabt said it would be very important, seeing that these cases of
disease of the adrenals had been recorded, that when any one had a chance the
supra-renal extract should be tried in the future. If 30 grains could produce
this trouble, which otherwise is almost unknown, it was a very serious matter for
those who are in the habit of giving sulphonal every day.
Notes on a Case of Yew Poisoning . By Dr. Bedford Pierce,
The Retreat, York.
Mrs. F. E. S. was admitted to The Retreat, York, on 28th July,
1894, with puerperal insanity of the melancholic type. She was
26 years of age, and had become insane six days after her confine¬
ment, two months before admission. She had made several
attempts at self-injury, and had been dangerous towards her child.
On admission she was well nourished, and presented no signs
of bodily disease; it was noticed, however, that her palate was
high and narrow. Mentally there was much incoherence of
thought; she was confused, muttered inarticulately, and had
hallucinations of sight and delusions of a painful character.
The next four months saw very little change, except that she
became somewhat more coherent. She made several attempts at
self-injury, tried to thrust aknitting-needle into her neck, to strangle
herself. She secreted a knife, and when out for a walk tried to
get in the river on one occasion.
During December she began to show signs of improvement,
occupied herself, and before Christmas helped in decorating the
ward; and on December 26th wrote home more cheerfully than
usual, saving how Christmas had been spent.
On December 27th I saw her twice in the forenoon, and noticed
nothing unusual. She dined as usual with the other patients, but
the nurse in charge thought she did not look well, and asked her
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314 Clinical Notes and Cases. [April,
if there was anything amiss. Mrs. S. said she had a slight head¬
ache, but she ate a good dinner nevertheless.
On the way back to the ward from the dining-hall, patient stag¬
gered and fell; she partly rose, and fell again. I was at once
summoned, and was there in less than a minute, and found her
looking bluish, her pulse feeble but regular; she told me she felt
better, and tried to rise and could not. I left to get an ether
draught, and on returning found her unconscious. There was
some retching, the pupils widely dilated, the breathing long drawn
and stertorous, and at one time a little stiffening of the left side
was noticed as if a fit was impending. In spite of two ether in¬
jections tdie patient died within fifteen minutes of the first symptom.
We were entirely at a loss to explain the sudden illness. The
throat was clear, since artificial respiration showed that air entered
the lungs freely. There seemed no possibility of poison, and there
was no evidence of injury. The patient had been under observa¬
tion continuously since admission, and the nurses were unable to
throw any light upon the matter.
At the post-mortem examination the veins in the skull were
unduly gorged with blood, and there seemed a little wasting of the
convolutions on the left side near the vertex. The lungs were
natural. The left side of the heart was very firmly contracted,
and empty. The right side contained one small clot of blood.
There was some slight thickening of the mitral valve, and one or
two minute atheromatous patches in the aorta. The right ovary
contained some small cysts, and the uterus was normal; and the
other viscera appeared natural with the exception of the stomach,
the walls of which were unduly injected. The stomach contained,
in addition to undigested food, a considerable quantity of yew
leaves, some pieces of cypress and ivy. The small intestine
throughout its whole length contained fragments of yew, but its
walls were not inflamed. The contents of the large intestine as far
as the sigmoid flexure were stained green, though no particles of
yew were detected. The lower bowel was empty.
On the facts of the case being notified to the coroner an inquest
in due course was held, and the verdict brought in was to the
effect that Mrs. F. E. S. died of 44 failure of the action of the
heart due to her having accidentally poisoned herself by surrepti¬
tiously eating yew leaves used in decorating the day-room of the
gallery in which she was living, and that in our opinion the nurses
in attendance upon the deceased were not to blame for her death.”
In view of this official declaration, I had no alternative but to
return the death as being accidental, and not due to suicide,
though the terms 44 accidentally ” and “ surreptitiously,*’ as used
by the coroner’s jury, seem hardly in harmony with each other.
In my own mind the matter was quite an open one, since there
was no evidence to show that the patient was aware that the
evergreens were poisonous.
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Clinical Notes and Cases .
315
As regards the time of taking the yew, it would appear probable
that a considerable quantity was obtained whilst she was assisting
in decorating the ward, viz. on December 24th—that is, three days
prior to her decease. Still it was quite possible that she obtained
fragments subsequently, as the architraves of the doors had been
trimmed with yew leaves, and nothing was more easy than to pick
off a fragment unknown to the nurse on going in and out of the
day-rooms.
There seems, I fear, no escape from the conclusion that the effort
made by the staff to brighten Christmas-tide had been the means of
causing the death of a patient whom we fully expected would
soon be convalescent.
It will be interesting to compare the case just recorded
with one published by Dr. Deas in the British Medical Journal
for 1876, vol. ii, p. 392, and in the Parhside Asylum Reports .
Dr.Deas’s patient ate some holly leaves and berries and some
fragments of yew, and died in all probability within an hour
of taking the leaves. The symptoms preceding death con¬
sisted of rapid collapse, convulsions resembling epilepsy, and
failure of the heart. At the post-mortem examination, besides
the holly five grains of fresh yew leaves were found in the
stomach.
Although in the manner of death there was a great resem¬
blance between the two cases, yet it should be noted that in
his case the amount taken was very small, and had only been
recently taken.
It so happens that in March, 1894, a patient in The Retreat
(Mr. E. R., aged 41) swallowed a sprig of yew with
suicidal intent. He had been but a week in The Retreat,
and before admission had made two suicidal attempts. The
yew was taken on the morning of March 30th, when I was
from home, and the patient himself reported the matter to
my colleague, Dr. Mackenzie, in the evening, saying that he
did not feel well and that he had a headache. An ounce of
castor oil was at once given with some brandy, and during
the night the yew was passed. The quantity was about four
grains. The next day the patient said he felt as usual.
In view of the case quoted by Dr. Deas it would seem
probable that this very small quantity of yew was beginning
to affect the patient, but that the castor oil prevented further
trouble.
I have to thank Dr. Urquhart for furnishing me with par¬
ticulars of another case of recovery from yew poisoning. An
elderly female dement at Murray’s Royal Asylum was observed
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316
Clinical Notes and Cases.
[April,
to become suddenly collapsed and pale. Some fragments of
yew leaves were lodged in the mouth, and the stomach was
at once washed out, after the administration of an emetic.
There was less than a teaspoonful of chewed leaves in a
recent state. Castor oil and stimulants were given, and the
patient soon recovered.
Cases of poisoning by yew are but rarely recorded in
medical literature. The best account of the subject I have
seen is in a work entitled The Yew-trees of Great Britain
and Ireland , by Dr. John Lowe, published in 1897. Not
only does this give an excellent account of poisoning by yew
in men and animals, but the literature of the subject is fully
dealt with. Much of the information given subsequently
has been derived from this book, which is likely to be a
standard work on the yew for a long time to come.
In commenting upon Dr. Deas’s case, Dr. Lowe suggests
that either some other cause of death existed or that the
patient had chewed a much larger quantity of the leaves,
swallowing the juice, since he is convinced that five grains of
the leaves is too small a quantity to cause death.
This illustrates one of the difficulties which surround this
subject. The uncertainty of the effects of yew has been a
cause of perplexity for a very long time, and the historical
notices collected by Dr. Lowe are remarkably conflicting, it
being impossible to reconcile the statements made by the
various observers.
Dr. Balding, of Royston, in the British Medical Journal ,
1884, related the case of a servant girl aged 24, who com¬
plained of headache one evening, but was able to do her
work, and the next morning was found dead in bed. She
had not vomited. Four or five pieces of yew leaves were
found in her stomach post mortem. There was reason to
believe that the yew was taken for an improper purpose, as
she was five months’ pregnant.
Three cases, quoted by Dr. Percival, of Manchester, in
1774, are noteworthy. Three children were each given a
spoonful of the dried leaves for worms. No effect being
produced, they each were given, two days later, a second
spoonful of the fresh leaves. Two hours after the last dose
the children stretched and yawned and became uneasy; the
eldest had abdominal pains and vomited, the others had no
pain. It is expressly stated that no agonies accompanied
their dissolution.
A case very similar to that quoted by Dr. Royston is
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Clinical Notes and Cases .
317
recorded in the Report for 1878 of the Shropshire and
Montgomery Asylum, and I am indebted to Dr. Strange for
sending me the account of the case.
Patient, female aged 27, ate yew leaves obtained from the
front grounds of the asylum. At bedtime she was in her
usual health, and at 6 a.m. the following morning she was
found dead. A large quantity of leaves was found in the
stomach and intestines. In this case the jury decided that
the case was one of suicide, and so it was returned, although
Dr. Strange considered the death was accidental.
It is well known that the fleshy pericarp of the fruit is not
injurious, but the seeds are poisonous, and several cases of
death from eating the fruits whole have been recorded.
When I was a schoolboy it was a proper thing to suck the
yew berries, and having disposed of the juicy-red envelope
to reject the hard seeds within. We were evidently well
brought up. I find that the same practice continues to exist
in the same school, and I believe it is common elsewhere.
That yew is hurtful to cattle is universally known, but the
experience of farmers is very conflicting. Numbers of cases
are recorded where very small quantities of yew have caused
the death of cattle and horses, while one hears of farmers
who say their cattle regularly browse off yew trees with
impunity. Many explanations of this uncertainty in the effect
of yew have been given, but none are thoroughly satisfactory.
There is reason to believe that under some circumstances
cattle living amongst yew acquire a tolerance and so escape
injury, and it is also possible certain soils may grow a more
poisonous variety than others.
The most likely explanation is that the male and female
trees differ in their poisonous effects; and several observers
state that the active principle, tax in, is found much more
abundantly in the male than the female trees. (It will be
remembered that the yew is dioecious, and the sexes are dis¬
tinct and on different trees.)
The Field for October 5th, 1895, gives an interesting
account of the effects of yew on animals, and describes an
experiment made at the Royal Veterinary College, when an
attempt was made to poison some cattle and horses with yew
clippings. After considerable difficulty the animals were
induced to eat the yew freely, but they were none the worse.
It is, however, significant that it expressly states that the yew
was well covered with berries, and we may safely assume that
the clippings were from female trees.
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Clinical Notes and Cases.
[April,
Dr. Ernest Colby, of Malton, has told me of a case in which
a horse having lost the companion of many years, a pony living
in the same field, became wild and excited. Next day the
horse was found dead, having broken down a fence and eaten
largely of yew. Dr. Colby tells me that he and the owner
deliberately formed the opinion that the horse committed
suicide. However that may be, it was found that the leaves
of the male plant had been eaten.
The balance of evidence is decidedly in favour of the
opinion that the male plant is more poisonous than the
female.
The physiological action of yew is due to an alkaloid, taxin,
which has not as yet been satisfactorily isolated. There is
but a grain and a half of taxin in a pound of the leaves. It
is not soluble in water, hence decoctions of the leaves are not
poisonous in high degree.
Taxin has a decided action upon the heart, and in the case
which occurred at The Retreat death was probably due to its
cardiac effect.
Yew has been considered by many authorities to be a cardiac
tonic of considerable value. Dr. Lowe says, “ I have under¬
taken a large series of experiments with taxin made upon
myself at various times. The tracings of the pulse show
beyond doubt that it is a cardiac tonic of no mean value.
The heart’s action is decreased in frequency by small
doses, such as the one twentieth to one eighth of a
grain; at the same time the cardiac pressure is very distinctly
increased. These effects I have found to be durable. In
larger doses it generally depresses the heart’s action. On
the whole it contrasts favourably with digitalis and con-
vallaria, and is worthy of more extended observation.”
Before the drug can be trusted it would, however, seem
necessary that the chemical characteristics of the alkaloid
contained in yew should be fully investigated, so that a really
reliable and uniform substance is available. One requires to
know the explanation of its apparently capricious effects be¬
fore confidence can be placed in yew or its active principle as
a medicinal agent.
The manner in which yew causes death is very remarkable.
There are usually no premonitory symptoms whatever. In a
few cases there has been a little headache, and in one or two
some intestinal disturbance; but in the vast majority death
has occurred with alarming suddenness.
Seeing that yew is within the reach of almost every one, it
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Clinical Notes and Cases .
319
would seem well that the general public should remain igno¬
rant of these matters, since were it generally known that
sudden and painless death awaited those who eat a handful
of yew leaves, cases of yew poisoning instead of being rare
might become alarmingly frequent.
With reference to the use of yews in gardens and pleasure-
grounds of asylums, the Scottish Commissioners in Lunacy
issued a circular to the following effect in 1871 :— (t Three
cases of poisoning by yew leaves or yew berries have lately
occurred among the inmates of asylums, two of them ending
fatally. In all these cases the leaves or berries appear to
have been obtained by the patients from the evergreens used
for purposes of decoration. Your attention is directed to the
occurrence of those accidents, in order to suggest the pro¬
priety of not employing the yew in the way indicated, and of
removing any yew plants which may exist in the grounds.”
Dr. Deas, in 1876, stated that yew should be excluded
from the grounds of asylums in all places frequented by
patients likely to pick and eat fragments of shrubs within
their reach.
After the second case recorded I came to the same con¬
clusion quite independently, and it was with considerable
regret that I ordered the removal of the yews from those
parts of the grounds to which suicidal or troublesome patients
have access. A well-grown yew is one of our most beautiful
trees, and a yew hedge is more lasting and more uniformly
close than any other; hence the exclusion of the tree from the
grounds of asylums materially impairs their beauty. Still
yew is not the only beautiful evergreen, and the deprivation
can scarcely be said to be serious compared to the risks run
if yews are within the reach of demented or suicidal patients.
It would seem prudent, in planting yews in borders and other
places not readily accessible to patients, to be careful to select
the female trees, and so reduce the possibilities of accident.
The Irish yew is, I believe, almost invariably female.
As regards the internal decoration of the wards, it is
evidently advisable, except under special circumstances, to
exclude yew altogether. Our painful experience at The
Retreat three years ago has resulted in considerably less
effort being made in decorating the wards and day-rooms
with evergreens at Christmas time, and I must confess that
the change has relieved the staff of much heavy though self-
•imposed labour; at the same time it has had a beneficial effect
as regards wall-papers and paint, whilst from the patients*
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Clinical Notes and Cases.
320
[April,
point of view I do not think Christmas has passed in any
degree less comfortably.
Case of Acute Mania occurring in a Boy * By M. B. Ray,
M.B., L.R.C.P.Ed., Assistant Medical Officer, West
Riding Asylum, Wadsley.
The following case of acute mania is of interest chiefly on
account of the fact that it arose at a time of life when one
does not expect to find acute insanity. Of course cases have
been recorded as occurring in very early life. Puberty is,
however, generally looked upon as the first critical period in
the life of the individual.
The age of the boy, fifteen, might make one inclined to
regard the case as one of pubescent insanity; but as there
were practically no signs of puberty present, I think we are
justified in regarding the case as one of acute insanity arising
during boyhood.
I recently had a case of acute melancholia in a girl
under observation, the notes of which were published in the
Quarterly Medical Journal for April, 1897.
The patient, J. W., a boy aged 15, was admitted into Wadsley
Asylum on 6th September, 1897, under the following medical
certificate.
Facts observed .—“ Rambles and cannot keep still a moment.
Shouts and talks nonsense constantly; cannot speak connectedly
for a moment. Talks about cutting peoples’ throats.”
Other facts communicated. —“ Father states that patient has been
off his head some days. Has had to be held in bed, and cannot
keep quiet a moment. (Not epileptic, suicidal, or dangerous.) ”
Has been insane four days. Cause stated to be the death of his
mother. Family history good. No relatives insane as far as can
be made out.
History of onset .—His mother died some months previously, and
the lad had brooded a good deal over it. He is of a neurotic habit,
and was often noticed to worry over small matters. The first
noticeable action that he did was to tell one of his Sunday school
teachers that he intended to make a speech the next day at a
meeting he was in the habit of attending. As he was of a shy,
retiring disposition, this naturally excited some comment. He rose
the following day, which happened to be Sunday, went to Sunday
school and church as usual. In the evening he suddenly began to
sing aud became very restless, walking about the room and puttiug
* Head at the Meeting of the Northern Division of the Medico-Psychological
Association, October, 1897.
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Clinical Notes and Cases.
321
the pictures, &c., straight. On retiring to bed he talked aud rolled
about, shouting and singing, and at times seemed in great fear.
His father tried to soothe him, but without avail. He remained
very restless and excited during the next few days, and it was
found necessary to remove him to the asylum four days later.
State on admission. —A boy of somewhat under the average
height for his age, tbin and ill-nourished. Shoulders high, with
slight stoop. Hair light brown ; irides brown; pupils equal, and
react to light and accommodation; palatine arch normal; eyes
placed widely apart; skull broad in frontal aud parietal regions.
The voice is still shrill, and there are practically no signs of
puberty present.
Respiratory system. —Expiration prolonged at right apex ; has a
short dry cough at times.
Circulatory system. —Normal.
Alimentary system. —Tongue furred ; breath offensive ; bowels
irregular.
Nervous system. —Knee-jerks almost absent on both sides; no
clonus; superficial reflexes normal; gait, co-ordination, and speech
normal.
Mental state. —He has a wildly excited appearance, stares about
him, and points to surrounding objects and people; be is very
restless, constantly struggling and turning about; tries to climb
up the doors and walls of the room; rolls about on the bed,
stripping off his clothing. He is very resistive, and resents anything
being done for him. He keeps up a continual incoherent chatter,
will not converse or answer questions; repeats in a perfectly
meaningless manner any phrase he may hear in the ward. Has
probably hallucinations of both sight and hearing.
Progress of case. —For the first few days he remained very
restless and excited. He then became quieter, but inclined to be
very emotional at times. During the next few days he improved
rapidly, and became quite cheerful, rational, and orderly. For
about a week he continued improved, wheu he had a relapse, which
came on suddenly. He had been talkative during the night, and
next morning was again very restless, excited, and dirty in his
habits. He remained in this state for about four days, and again
began to improve. He was soon much quieter and more settled,
but at times was very emotional for no apparent reason. He then
developed suspicions about his food, saying it was poisoned, and
that his mother had been poisoned. He also said he was being
influenced by evil spirits, which he attempted to exorcise by various
antics. He continued in this deluded irrational state for about a
week or ten days, when these ideas gradually faded away, and he
was practically convalescent two months after admission. He was
discharged on a month’s trial a fortnight later, aud finally dis¬
charged “ Recovered ” on December 30th, 1897.
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Clinical Notes and Cases.
[April,
Discussion,
Dr. McDowall, after thanking Dr. Ruy for his paper, said that it was curious
that the same subject had been treated by Dr. Fletcher Beach at the meeting of
the South-Eastern Division over which he (the President) had recently presided.
He could not call to mind that he had ever met with similar cases to those
recorded by Dr. Ray, though he had frequently met with moral insanity in
children, of which he quoted instances.
Dr. Baker (York) thought such cases should not be sent to public asylums if
any other provision could be made for them.
OCCASIONAL NOTES OF THE QUARTER.
The Darenth Scandal and Scapegoat,
The members of our Association must have read with
amazement of the dismissal of a medical officer by the
Metropolitan Asylums Board on a report by a special com¬
mittee, which gave no adequate reasons for thus ruining the
career and blasting the prospects of a medical man who had
served them for sixteen years, with such honour and ability
that he had been promoted to the post of Acting Superin¬
tendent.
The facts of the case are as follows:—A female patient in
the Darenth Imbecile Asylum was reported in July last by
the Acting Superintendent (Acting Superintendent under
the Asylums Board means Superintendent’s work with As¬
sistant Medical Officer’s pay) to the chairman of the com¬
mittee as being enceinte. The patient made a charge against
a lay official (since dismissed for another offence). Counsel
was consulted by the committee in regard to the possibility
of prosecution, and a communication was made to the Com¬
missioners in Lunacy. The patient died in November from
exhaustion after childbirth. It should be noted that the
patient became pregnant at a date prior to the appointment
of the Acting Superintendent.
The special committee appointed to investigate the case
reports that the Acting Superintendent (and his assistant)
“ spared no pains and neglected no attention to the patient
during her confinement;” but they make a leading count in
their indictment against him that “he committed an error of
judgment in undertaking the delivery of the woman.”
The other counts of the indictment are—that no entry was
made in the case book that the woman was enceinte; but,
considering that the chairman, the committee, the Cornmis-
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Occasional Notes of the Quarter .
323
sioners in Lunacy, and a learned counsel must have spent
much time, talk, and voluminous correspondence over the
case, it seems absurd to complain that no entry was made in
the case book. The only entry that could have been made
would after all have amounted only to a diagnosis. This
charge is too trivial to demand consideration.
The other charges, if they can be so called, are, firstly, that
there was no post-mortem examination; but these are by no
means the rule in this institution, and the cause of death was
quite obvious : and, secondly, that no special report was made
to the coroner; but no reason is given why such a special
report was deemed necessary. Both these indictments are
as trifling as the preceding.
The error of judgment, therefore, remains as the only
possible reason within the scope of the inquiry on which the
recommendation of the special committee could be based.
In regard to this, asylum superintendents would unani¬
mously agree that if the medical officer, backed by the aid of
his assistant and the resources of an asylum, had declined to
undertake a responsibility which is often delegated to an un¬
skilled midwife in the poorest homes, lie would indeed have
committed an error of judgment, but that by accepting it he
did not. Deliveries are not infrequent in asylums; they are
invariably attended by the medical staff, and usually by the
junior members of the staff. Such a delivery took place a
few months prior to this occurrence in an asylum under this
very Board. The only conclusion, therefore, that can possibly
be formed is, that this committee was utterly wrong in the
only real charge which it makes against its victim, and that
the other trivial matters were merely brought in to give some
colour to their finding.
The clear inference, from the facts, is that the medical officer
has been made a scapegoat. The dismissal under such
circumstances of a medical officer of sixteen years’ standing,
constitutes, we may safely affirm, a scandal of much greater
magnitude than the one which it was intended to gloss over.
The immediate result of this will be that the Asylums
Board will find some difficulty in obtaining professional men,
of character and standing, willing to risk their reputations to
the tender mercies of a body so deficient in all sense of
justice or right feeling, and that the doubly unfortunate im¬
beciles will suffer from the lowered standard of medical care.
A more remote contingency is the possibility of such a
dismissal being made a precedent for similar action in regard
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Occasional Notes of the Quarter.
[April,
to other asylum superintendents. The Metropolitan Asylums
Board is fortunately unique in its composition, and it is to be
hoped in its principles; but it nevertheless behoves all
exposed to such a danger, however improbable, to exert
themselves in a way that may be deterrent to the perpetra¬
tion of similar injustice by other bodies.
A board has been said to have no body to be kicked, or
soul to be damned. The first part of this proposition is true,
sometimes even regrettably true, but the second part is not
so accurate. It is 4 indeed, very much the exception to find
a board or committee utterly lost to the recognition of truth
and justice. The board in question, however, appears to
have no other moral sense than to dread the demon of the
daily press, whom it worships by these propitiatory sacrifices
of individual victims ; and this victim is by no means the
first it has immolated.
This profession and the medical press have a clear duty
before them, to omit no effort that shall tend to convert this
board to the recognition of a higher tribunal than that of the
daily penny-a-liner, and to endeavour to gain some redress
for the sufferer, who is both a member of our Speciality and
of our Association.
Criminal Law Reform .
Various problems in criminal law reform seem likely to
receive in the present session a legislative solution. At last
the evidence of prisoners may be made legally admissible.
The merits and the demerits of this change have been
threshed out with unprecedented completeness, so far as the
annals of modern legal controversy are concerned. The
balance is, we think, on the side of the Bill. But very great
precautions will have to be taken by the judges against
improper forensic comments on the fact that a prisoner stands
on his legal rights, and declines to go into the witness-box.
In time such a refusal will no more prejudice a defendant
than a reservation of his defence in magisterial proceedings
does now. But at first the new procedure will want careful
watching. A Court of Appeal Bill has less—but still some—
chance of passing. The present arbitrary manner in which
the question whether a point of law arising in a criminal trial
is to reach the Court for Crown Cases Reserved is decided is
utterly indefensible. Perhaps if such a tribunal is established
we shall at length get the rules in Macnaughton’s case revised.
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Occasional Note * of the Quarter.
325
We have always wondered why it has never occurred to
some ingenious barrister, in defending a prisoner, to contend
and tell the jury that the rules have no legal validity, and to
challenge the judge to direct them in accordance with the
charge in Hadfield's case. It would be difficult for any judge
to refuse to reserve a point of law of such vital importance.
Inebriates Bill .
We cordially hope that the report that the forthcoming
Government Bill to amend the Inebriates Acts will deal
only with police court cases, may prove to be inaccurate.
Such a Bill would be scarcely worth accepting, even as sin
instalment; for having once touched the question again, in
however perfunctory or unsatisfactory a manner, the legislature
would certainly leave it alone for another decade. The mini¬
mum that can be regarded as acceptable is the enactment of a
measure (1) providing for compulsory sequestering, (2) raising
the maximum period of compulsory detention from one to two
years, and (3) simplifying the procedure relative to admission
and recapture. We trust that magisterial bodies throughout
the country will follow the excellent example of the Manchester
Justices in pressing the Home Office for a really serious
measure of reform. The evidence furnished by the recent
report of the Lunacy Commissioners that the insane popula¬
tion of the country is increasing, constitutes a good reason
for the exhibition of some insistence in the matter ; and much
as a readjustment of the powers of the Lunacy Commissioners
and the various local authorities in regard to pauper lunatics
is needed, we shall be quite content to wait another session
for it, if only an adequate Inebriates Bill is passed.
Medical Confidentiality .
The public discussion of the legal aspects of the question
of medical confidentiality, to which a recent cause celebre has
again given considerable prominence, has, in our judgment,
proceeded too largely on the assumption that the sole point
at issue is whether confidence is a necessary implication in
the contract between doctor and patient. The basis of the
doctrine of confidence must, in truth, be sought far less
in any contractual relationship than in the policy of the law.
The law recognises that there are certain relations in which
it is of high social importance that the utmost mutual confi-
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Occasional Notes of the Quarter.
[April,
deuce should prevail; aud in order to secure the existence
and preservation of such confidence, attaches a privilege from
disclosure to communications made in the course of them.
A typical instance is the relatiou of legal adviser and client.
A lawyer retained to defend a person accused of crime, for
example, is privileged absolutely, if the client so desires,
from giving any evidence as to statements or admissions
made to him by his client, nor can he get rid of the privilege
by discharging himself from the retainer (Reg. v. Cox , 1885,
14 Q. B. D, 153). Medical confidence comes well within
the raison d’etre of this class of cases, and although the
courts have not in England accorded it a privileged position
(see Duchess of Kingston’s case), there can be little doubt that
if the medical profession would steadily put their case on the
ground of public policy instead of on any contractual obliga¬
tion they would make good their claim. They do not stand
in a much worse position at present than Roman Catholic or
Anglican priests. Although Lord Chief Justice Kenyon,
Chief Justice Best, and Baron Alderson, in well-known dicta
favored the privilege of penitential confessions, the only
ruling on the subject (that of Justice Buller in R. v .
Sparkes) was on the other side. And yet who can doubt
how the controversy would issue if it were raised again and
fought out to the end. The exercise of the privilege would
of course have to be tempered with discretion, and by a sense
of honour. But the medical man is nob less competent to.
exhibit these qualities than the lawyer or the priest.
Premature Discharge and the Increase of Lunacy in the
Metropolis.
The report of the Asylums Committee of the London
County Council states that there are no less than 19,054
imbeciles and lunatics under their charge. The existing
asylums are already insufficient for this number, and as the
yearly increase is about 700, two new asylums (at Norton
Manor and Bexley) are already projected.
Dr. Claye Shaw in his annual report frankly suggests that
by the too early discharge of patients the propagation of
insanity by heredity is favoured ; and Dr. Robert Jones reports
that heredity is found in only 26 per cent, of his cases, but
that 70 per cent, did not reply to this question, and that
probably many do not own to it where it exists. The pre~
judice against admitting the existence of heredity is no new
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Occasional Notes of the Quarter .
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thing, however, and the ascertained cases of heredity are
only 3 per cent, above thao reported in the Commissionors*
returns at any time in the last thirty years; so that this
alone would not go far to account for the accumulation of the
insane.
The premature discharge of patients which Dr. Claye Shaw
deplores is a much more important matter, as it may lead to
relapses of an incurable character. That relapses are unduly
frequent seems to be borne out by the fact stated by Dr.
Robert Jones, that previous attacks and heredity are reported
in 49 per cent, of his cases, while these causes account
for only 41 per cent, in the quinquennial, 1890 to 1894,
in the Commi8sioners , tables. As heredity accounts for only
3 per cent, of this excess, relapses must be 5 per cent, in
excess of the average for England and Wales. One point
of interest, therefore, is whether these relapsed cases do not
furnish a large proportion of incurable cases. If this is true,
premature discharge is responsible for a double evil, viz. the
propagation of hereditary insanity and the increase of incur¬
able insanity.
Harvard v. The Hackney Guardians and their Relieving
Officer .
This action for false imprisonment as a lunatic arose out of
the plaintiff having been removed to the workhouse infirmary
by the relieving officer, acting on information received from
plaintiff’s wife. The jury returned a verdict for the plaintiff
for £25, on the ground that the relieving officer did not exer¬
cise reasonable care to satisfy himself that the plaintiff was a
dangerous madman. •
“Reasonable care” is a very uncertain quantity; has, in¬
deed, about the definiteness of a “ lump of chalk.” If the
relieving officer in a similar case had not acted on the infor¬
mation, and the alleged lunatic had committed some criminal
act, the relieving officer would have been censured.
“Reasonable care” would seem to demand that the parish
official should obtain medical advice in all cases where this is
possible; but such procedure is probably opposed to the
principle of false economy which so often actuates the guar¬
dians in these matters.
iLrv.
22
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Occasional Notes of the Quarter.
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The After-care Association •
The Annual Meeting of this Association was held on 31st
January at the house of Sir William Broadbent, who presided.
Sir William gave a brief but able sketch of the aims and
work of the Association, concluding with the remark that he
knew of no society which did so much work so economically
on so small an income. The report showed that the total
subscriptions, &c., for the year amounted to £561; that 147
cases had been before the Council, of whom the majority had
been suitably helped.
Mr. Mocatta promised the Association a donation of £25 if
the subscriptions for the year reached £1000, and the Council
makes a special appeal to medical superintendents to aid
them in obtaining this sum by means of local meetings,
concerts, or bazaars.
The British Medical Association and its Council .
A deadlock seems to have arisen on the point whether the
Annual Meeting controls the Council, and whether its resolu¬
tions are so binding that the Council is obliged to put them
in force.
The Council, on legal advice, maintains that as it is elected
by the branches it is therefore responsible to them. The
Council claims the right of adopting or disregarding resolu¬
tions passed at the annual meeting, since a small vote might
be easily passed at such a meeting, owing to small attendance
and owing to the necessary predominance of local attendance.
The Council is elected to manage the affairs of the Associa¬
tion, and it would certainly seem right that it should have
the power to hinder a chance or local minority from imposing
its will on the majority. If the Council at any time dis¬
allows a resolution which is the will of the majority, there
can be little doubt that means would be found to render the
Council obedient. The power is only a useful check against
hasty, impulsive, or factious movements.
The matter is of importance, however, and should be
definitely settled, not by litigation, but by definite resolu¬
tions of the branches, or by a poll of all members of the
Association.
Since the British Medical Association decided that the
branches should have an active interest in the central manage¬
ment, new life has poured into it from all parts of the Empire.
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Occasional Notes of the Quarter .
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Excepting a handful of noisy faddists, who, by persistent
beating of tom-toms, snatch mass votes at the annual
meetings, the members generally are satisfied that the Council
is formed in a fair and impartial manner, and capable of the
best results.
That is certainly a very strong position, and one which
would naturally follow on similar procedure being adopted
by the Medico-Psychological Association. In the administra¬
tion of the affairs of a widely spread society representative
members should be elected by districts or divisions.
Enteric Fever in Asylums .
Under the heading " Insanitary Conditions,” the Annual
Report of the Commissioners in Lunacy gives, year by year,
a brief account of any occurrence of zymotic disease in
asylums. In these reports typhoid fever takes a prominent
place. It is quickly apparent on perusing accounts relating
to typhoid in asylums, that in these institutions it is not a
question of water- or milk-borne disease, but of a malady
associated commonly with local defects of sanitation. We
doubt if the history of enterica as it occurs in asylums is
much known outside the lunacy speciality, and we think that
if trustworthy material for a study of the disease as it occurs
in asylums were accessible, a memoir of interest could be pre¬
sented, particularly instructive as showing the association of
enterica with defects of drainage, alone or in combination
with other insanitary conditions. Sometimes no defects of
drainage at ail are found in connection with the outbreak ; a
curious instance is given in the fiftieth report of the Commis¬
sioners, where a series of twenty-five cases occurred in an
asylum, most of them originating in one portion of the build¬
ing. These were attributed to the foul state of the old
air-flues, and their disturbance in the process of cleaning.
Asylums would appear to afford peculiar facilities for the
illustration and investigation of the connection between
typhoid and local defects of sanitation. The legacy of faulty
drains, with aggravated local defects of these—drains laid
from twenty to fifty years ago; the local overcrowding; the
risk of admission of a case of the disease in the incubation
period or in an early stage of invasion; the faulty habits of
the inmates, enhancing the risk of spread by contagion—
these are some of the conditions which obtain particularly in
asylums. As regards investigation of sanitary defects, these
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Occasional Notes of the Quarter.
[April,
institutions are also unusually circumstanced; there is the
combination of medical man, clerk of the works, engineer,
plumber, mason, ou the spot, with a full knowledge (if—and
the proviso is not unimportant—plans have been conscien¬
tiously kept up to date) of the drainage arrangements, whose
business it is to discover and remove sanitary defects which
may be associated with such a disease as enterica, with all
possible dispatch. It is instructive to note how frequently
local defects of drainage are found in connection with the
outbreak of the disease in asylums, and the disappearance of
the latter on remedying these defects. But whilst the practical
result in these instances of local occurrence is highly satisfac¬
tory, we are unfortunately in most instances entirely ignorant
of the mode of introduction of the typhoid germ. And even if
it can be established that a case has been originally intro¬
duced from without, and we are able with plausibility to
suggest that thus the contents of faulty drains have become
infected, that amounts to very little in the way of explana¬
tion, granting even a local leakage to have been discovered.
It is very far from clear in, we think, the majority of in¬
stances how infection is carried to the inmates of a ward in
the vicinity of which a leaky or choked drain is found. The
evidence, as far as we know it, is against the conveyance of
pathogenic organisms (excepting Staphylococcus pyogmes) in
sewer gas. And in the majority of cases it is most difficult
to imagine how the materies morbi could be wafted into a
ward with dried particles upon which it may have lodged.
Formalin as a Disinfectant .
Formalin is a substance which has already attracted the
attention of our pathologists, and promises to be, perhaps,
the most useful addition to our laboratory armamentarium
which has been made for the last generation. It has been
steadily growing in favour also as a disinfectant, and bids
fair to supersede perchloride of mercury in the disin¬
fection of buildings. We would draw the attention of
our readers to an article on “ Household Disinfection by
Formaldehyde ” in the British Medical Journal of December
25th, 1897, by Drs. Wyatt Johnston and D. D. McTaggart.
These observers, working in Canada, have confirmed the
observations made in England, France, and the United
States as to the value of this drug. They claim that it is
effective, cheap, and not destructive. In the method which
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1898 .] Occasional Notes of the Quarter . 381
they adopt the gas is liberated under pressure from a mixture
of equal parts of formaldehyde and 20 per cent, calcium chlo¬
ride solution. They use an apparatus made by the Sanitary
Construction Company of New York. They say " we found it
was advisable to use larger quantities of formaldehyde than
are generally advised, and our results, at first disappointing,
became very satisfactory upon using one pound of formalde¬
hyde per 1000 cubic feet.”
Dr. Rambaut, of the Richmond Asylum, Dublin, tells us
that experiments which he made last autumn by culture
methods gave strong proofs of the value of formalin as a
sterilising agent, the apparatus used in that institution being
Trillat's for the generation of formic aldehyde vapour under
E ressure from an aqueous 30 per cent, solution of formalde-
yde, free from methyl alcohol, containing calcium chloride in
solution, and known in trade as formochlorol.
Chargeability of Irish Lunatics.
The methods which Irishmen adopt for seeking redress of
grievances are probably beyond the comprehension of any
other people.
We mentioned in the January number of this Journal that
the Governors of the Richmond Asylum and the Guardians
of the two Dublin workhouses contemplated requesting the
Chief Secretary for Ireland to introduce provisions effecting
a law of settlement into his new Local Government Bill. A
deputation, representing the three bodies in question, accord¬
ingly waited upon Mr. Gerald Balfour on January 18th.
This deputation added to its original programme a request
that the Treasury rate in aid should be increased from 4 s. per
head per week to some larger but unspecified sum, and this
although it would appear from a subsequent correspondence
in the newspapers that the Chief Secretary “ had written to
say that the speakers must confine their remarks to the ques¬
tion of * the deportation and chargeability of lunatics/ ”
One member of the deputation, being a prominent poor-law
guardian, struck new ground by complaining that the lunatics
were not taken proper care of. It turned out that he meant
the lunatics in the workhouses; and while nobody denied
the justice of this confession, its pertinency to the question
at issue is by no means clear. Another speaker boldly sug¬
gested that the Treasury should contribute half the expense
of maintenance, and that the other half should be levied by
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Occasional Notes of the Quarter.
[April,
a national as distinguished from a local rate. This sugges¬
tion, by the way, left the grievance of deportation of Irish-
born lunatics from England and Scotland untouched. One
gentleman dwelt at much length on the expense which the
district was put to by the erection of a new asylum.
The speakers do not seem to have agreed beforehand as to
the matters to be discussed, or the proposals to be made, and
they do not appear to have had professional advice, either
medical or legal.
The natural result ensued. The Chief Secretary pitted
the arguments of one against those of another, and gave no
satisfaction to any one. Talking apparently on the assump¬
tion that the expenses of maintenance in the Richmond
district were higher than anywhere else in Ireland, he
recommended economy. As for improving the condition of
the workhouse lunatic, that would, of course, cause increased
expenditure, which all parties seemed to deprecate. He dis¬
claimed any intention of increasing the Treasury grant. As
for widening the area of taxation for the maintenance of
lunatics by nationalising the rate, he slyly pointed out that
such a proposal, if accepted, would have the result that local
government, as regards that particular function, would have
no raison d’etre. He was not sympathetic with regard to
framing a law of settlement, thought the absence of such a
law was on the whole an advantage, and disliked the idea of
altering the simplicity of the law in Ireland in respect of
this matter. Obviously he was unwilling to burden his Bill
with a subject which does not necessarily belong to local
government as such.
The Government and Lunatic Asylums .
Under the above heading there appeared in a Dublin daily
paper on the 4th of February the remarkable report which,
with slight abbreviation, we subjoin. We should premise
that Granard is a Poor Law Union in the County of Long¬
ford, and that the County of Longford is portion of the
district of the Mullingar Asylum.
At the Granard Board of Guardians meeting, Mr. A. E. Edge-
worth, D.L., said he would like to propose a resolution which he
had been requested to bring forward, and one which would be a
matter of pleasing consequences to the ratepayers. It was a
resolution to the effect that the Government be asked to take over
the Irish asylums in the same way as they have taken over the
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333
1898.]
prisons. He had reason to believe that if a strong effort were
made to impress upon the Lord Lieutenant and the First Lord of
the Treasury the importance to the country cesspayers of taking
over these very expensive institutions, it might have a very good
effect. He had, been requested by repeated letters to leave this
matter before the Granard Board. One reason why the Govern¬
ment should take over the asylums was that they only gave a
maintenance grant of £10 yearly, which was totally inadequate.
Besides that, the Government appointed the Board of Governors
and the Board of Control. Sometimes the Board of Control did
things which entailed expenses and which the Governors could
not resist. At one time the Governors decided on making
some wooden flooring, and they had carried it out when a sealed
order came from the Board of Control that it should be done
with oak, and that cost a thousand pounds. The asylum had
been originally built for 350 patients, and there came into it
lately 780, and the Governors had to build a new block. The
Governors wanted to expend £8000 on it, but the Board of
Control insisted on having £18,000 spent on it, and £3000 on
the hospital, which came to £21,000, or £13,000 more than
the Governors wished to spend. Then the Governors wanted
to have the asylum heated at a small cost, but the Board of
Control insisted on the “Vacuum” system, which tended very
much to make a vacuum in the pockets of the ratepayers (laugh¬
ter). Those were cases in point to show that the Government
should take over the asylums. The Government calls the tune,
and the Goverment should pay the piper. The Chief Secretary
admitted that the Government should increase the maintenance
grant, but they said “ no,” that what they wanted was that the
Government should take over the asylums altogether, and then let
the Government try any amount of experiments for which the
English ratepayers would help to pay. This resolution, if passed,
would be brought before very influential members of the Cabinet.
The resolution was passed unanimously.
This method of discussing the “financial relations” of
lunatic asylums has that charm and freshness which are
peculiarly Hibernian. Anywhere except in Ireland a county
magnate and asylum governor who used such language
about his own asylum might be esteemed “gey ill to live
wi'”—like the late Mr. Carlyle. If, as we gather from this
report, which must surely be incorrect, however, the go¬
vernors of the Mullingar Asylum, or the Board of Control
for them, can accommodate 780 patients (or even half that
number) for £21,000, we can only wish that such “extra¬
vagance” could be made universal throughout the three
kingdoms.
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334 Occasional Notes of the Quarter . [April,
It is perhaps not strange that the Irish country gentlemen,
who have suffered much of late years, should regret that
transfer of power to another class which the Bill will effect,
and should be anxious that this transfer may not injuriously
affect the insane. It is, however, very singular that, as we
learn from the Irish papers, the Granard resolution was
adopted subsequently, not only by the Mullingar and several
other Asylum Boards, but also by some popular Boards of
Guardians. That the last-named bodies should have taken
up anything so contrary to their constant contentions shows
how little they understood what the proposal amounted to,
and how much needed was a broadening of the basis of
asylum management such as will enable “ the man in the
street” to take some intelligent interest in what are, after
all, his own affairs. There is probably only one class with
whom the change desired by Mr. Edgeworth would be
popular—office seekers. To carry out from a State centre
the duties heretofore performed by local governors would
require an army of officials.
In our view the adoption of State management and State
control would be an unfortunate and retrograde move¬
ment. Government in Ireland is not paternal, is not even
grandmotherly. The source of wisdom is no longer recog¬
nised (if it ever was in the distressful island) as springing from
the Imperial Governntent, and the centre of political power
has entirely shifted. Asylums governed by the State would
be hateful both to the public and to the patients. The cast-
iron discipline of a prison would supersede the freedom which
is possible under popular control, while at the same time no
central government in Ireland will ever again be strong
enough to support an unpopular institution against attacks,
so that at any crisis of difficulty the real ruler of the asylum
would be the proprietor of the loudest of the local news¬
papers, or the most excitable of the local politicians. Such
indirect popular control is wholly pernicious.
Irish Local Government Bill.
The long promised Local Government (Ireland) Bill was
introduced into the House of Commons on February 21st by
the Chief Secretary to the Lord Lieutenant in a speech the
singular ability and lucidity of which evoked flattering com¬
ments from all sides of the House.
Mr. Gerald Balfour’s introduction contained numerous
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references to lunacy questions, and we find a curious indica¬
tion of the interest which such subjects are beginning, under
the pressure of recent events, to attract, in the fact that
there were no portions of his opening speech which were
received with more satisfaction by the Irish members, and none
which attracted a larger share of attention in the Irish press.
From the old-time standpoint the Bill, so far as it deals with
lunacy affairs, may fairly be called revolutionary. It places
the management of asylums, financially and otherwise, on
the same broad democratic basis as in England.
The most important and fundamental portion of the Bill as
to asylums is contained in Section 9, which runs as follows :
“ 9 . —(1.) It shall be the duty of the council of every
county to provide and maintain sufficient accommodation for
the lunatic poor in that county in accordance with the Lunatic
Asylums Acts, and if it appears to the Lord Lieutenant that
any council fail to perform such duty, he may order that
council to remedy the failure within the time and in the
manner (if any) specified in the order.
" (2.) The duties of the council under this section shall be
exercised through a committee appointed by them, and if the
Lord Lieutenant fix a number, of the number so fixed; and
out of that committee a number not exceeding one fourth
may be persons not members of the council.
“ (3.) There shall be transferred to the council, acting
through that committee, the business of the governors and
directors of the asylum under the Lunatic Asylums Acts, and
the committee, subject to the general control of the council
as respects finance, may act without their acts being con¬
firmed by the council.
“ (4.) Plans and contracts for the purchase of land and
buildings, and for the erection, restoration, and enlargement
of buildings, shall not be carried into effect until approved
by the Lord Lieutenant.
“ (5.) The county council through the said committee shall
properly manage and maintain every lunatic asylum for their
county; and, subject to the provisions of this Act, may
appoint and remove the officers of the asylum, and regulate
the expenditure; and the powers, under the Lunatic Asylums
Acts, of the Lord Lieutenant or the inspectors of lunatics, as
to those matters, and as to land and buildings, and as to the
appointment of governors or directors, shall cease, and also
the Board of Control for lunatic asylums shall be abolished.
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Occasional Notes of the Quarter.
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“ (6.) The county council, through the said committee,
may, and if required by the Lord Lieutenant shall, make
regulations respecting the government and management of
every lunatic asylum for their county, and the admission,
detention, and discharge of lunatics, and the regulations
when approved by the Lord Lieutenant with or without
modifications shall have full effect.
“ (7.) Where a district for a lunatic asylum comprises two
or more counties, this section shall apply with the necessary
modifications to those counties and to the councils thereof/*
&c.
This brief section, which we may parenthetically say
appears to have been accepted with universal applause,
revolutionises the entire system of lunacy administration in
Ireland. The local bodies are in future to build and own
their own asylums, manage their own affairs, spend their own
money, employ their own servants, and make their own rules.
Hitherto the Board of Control provided accommodation,
built and owned the asylums. The Board of Governors
appear to have been merely a sort of tenants, and though,
like other tenants, they have latterly agitated a good deal,
they did not succeed in securing much addition to their legal
rights. Hitherto the Governors have been appointed by the
Lord Lieutenant; in future the Asylum Committees, who
take the place of the Governors, will hold office from the
county council. Hitherto the medical superintendent was
appointed by the Lord Lieutenant, the assistant medical
officers under His Excellency's sanction, and only the servants
(nurses and attendants) directly by the Board of Governors.
The new committees will in these respects have powers
identical with the English. The salaries and wages of
employes were hitherto fixed by Order of the Lord Lieutenant
in Council. This vexatious and unnecessary restriction on
their powers is removed from the new committees entirely.
Each asylum committee will frame its own code of rules,
subject to approval as in England, and the Privy Council will
no longer be empowered to frame general rules. In this
Journal we have often during the last forty years drawn
attention to the unsatisfactory nature of the General Rules
of the Privy Council. Even if the Privy Council in Ireland
had cared about such matters it would have been impos¬
sible to frame a working code applicable to a number of
differently circumstanced institutions. We have only to hope
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Occasional Notes of the Quarter .
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that the necessary approval by the Lord Lieutenant will not
lead still to too much uniformity in minor details.
With reference to funds for building, it would appear that
the county councils will have power to borrow under condi¬
tions similar to those laid down in the Local Government Act
of 1888, one of the Acts scheduled with this.
As to maintenance, the Treasury rate in aid will be discon¬
tinued, but a grant similar in amount (4 s. per head per week)
will be made out of the Consolidated Fund to the Local
Taxation (Ireland) account on behalf of each lunatic in a
public asylum. The remainder of maintenance will be met
out of a county rate, known in Ireland as the “ cess ” (or
colloquially “ cut; ” words of interesting etymology, compare
Norman-French taille). Now half this tax, as far as relates
to agricultural land , will be in future paid by Government out
of a fund derived from the Consolidated Fund, known as
“the agricultural grant.” How far this will be a relief to
local burdens in country districts appears to be disputed
among those who have studied the complicated financial
clauses of the Bill. There is no concession similar to the
agricultural grant provided for the relief of taxation in urban
districts, which will, therefore, remain much as before in this
respect.
With reference to existing officers, Section 72 provides
(clause 1) that “ where the business of any authority is trans¬
ferred by or in pursuance of this Act to any county or district
council, the existing officers of that authority employed in
that business and not in any other business of that authority
shall become the officers of the council of that county or
district; ” and that " the officers of every lunatic asylum
shall be deemed to be existing officers of the governors and
directors of that asylum;” and further (clause 14), that
* € subject to the provisions of this Act, every existing officer
transferred under this section shall hold his office by the
same tenure and upon the same terms and conditions as here¬
tofore, and while performing the same or analogous duties
shall receive not less remuneration than heretofore.”
These provisions appear to secure existing rights in a
satisfactory manner.
With regard to future appointments, Section 56 provides
that—
“ (1.) Subject to the provisions hereinafter contained, the
county council, acting through their committee,—
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“ (a) shall appoint for each lunatic asylum a resident
medical superintendent, and at least one assistant medical
officer; and
“ ( b) may appoint such other officers as they consider
necessary; and every officer so appointed shall perform such
duties and be paid such remuneration as the council may
assign to him.
“ (2.) Every resident medical superintendent shall be a
legally qualified medical practitioner of not less than seven
years' standing, and shall have had experience in the treatment
of the insane, and every assistant medical officer shall be a
legally qualified medical practitioner.
“ (3.) The Pauper Lunatic Asylums (Ireland) (Superannua¬
tion) Act, 1890, shall apply to every officer appointed under
this section.
*****
“ (5.) This section shall be without prejudice to the pro¬
visions of this Act respecting existing officers.”
This section introduces the notion of special training and
qualification for the post of medical superintendent, and
thereby shows the sagacity and alertness of those who
advised the promoters of the Bill. But we feel bound to
point out that this will not satisfy medical opinion. The
qualification laid down is quite insufficient. All medical
students now-a-days are required to take out a course of
clinical instruction in mental disease, and many of the
older men took out such courses voluntarily as students
or in the post-graduate stage. These gentlemen might
all claim to have had experience in the treatment of the
insane. So might any general practitioner of a few years*
standing who had treated a dozen or twenty cases of
insanity. The subject of psychiatry is a very special one,
and requires long study to learn thoroughly. Besides, asylum
management is a subject that can only be acquired slowly,
and capacity for the important official work and responsibility
thrown upon the medical superintendent of an asylum can
only como through years of familiarity with such duties. In
the interests of the insane the framers of this Bill have
recognised that a qualification is needed. They should be
urged to make it a full and satisfactory one. We would say
that not less than five years* service as assistant medical
officer should be required. As this is merely an amplification
of a requirement which the Bill admits, Government would
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339
Occasional Notes of the Quarter .
probably adopt such a suggestion if it was urged upon them.
As we go to press we learn that this suggestion has been
urged by the Irish College of Physicians and by the Dublin
Branch of the British Medical Association.
The Bill requires no special qualifications for the post of
Assistant Medical Officer. The Chief Secretary was probably
not acquainted with the fact that our Association holds an
examination and gives a certificate in psychological medicine,
and that the Royal University of Ireland does the same. We
do not think it would be too much to ask that an Assistant
Medical Officer should hold one of these or a similar qualifi¬
cation when appointed, or take out such a qualification within
say a year of appointment. We think that such a test, easy
though it may be, would be of distinct value.
It is to be noted that the provisions with regard to pension
leave this question just as it was before, and just as it still is
in England. It is understood that the attendants in the
Irish asylums petitioned Mr. Gerald Balfour to take up the
matter of pensions in this Bill, and to provide, even at a
somewhat less liberal rate than at present, a pension scale
which would be fixed, as pensions are in other public services,
and would come to its recipients as a matter of right. This
he has apparently not seen his way to.doing, being probably
unwilling to seem to limit the fiscal powers of the new bodies.
It is a reform which ought, we think, to be effected, and
which is evidently bound to come some time or other.
The Sheppard Asylum , Baltimore*
The development of hospitals for the insane of the middle
and wealthy classes of the United States of America has not
been checked, as with us, by the intervention of State aid.
The magnificent buildings of the Maclean Hospital at
Waverley, near Boston, have been recently erected in con¬
formity with the latest ideas of asylum construction under
the wise direction of Dr. Cowles. They have already been
supplemented by gifts of detached houses, so that the accom¬
modation for all classes of private patients is on a level with
the demands of the most fastidious.
The Sheppard Asylum, near Baltimore, has lately been
enriched by the munificent bequest of the late Mr. Enoch
Pratt under circumstances of special interest. We briefly
recount the history of this institution, which has the advan¬
tage of the able services of Dr. E. N. Brush as medical
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340 Occasional Notes of the Quarter . [April,
superintendent, in the hope that we shall yet hear of similar
charitable projects on this side of the Atlantic.
Mr. Sheppard procured an Act of Incorporation from the
Legislature of the State of Maryland, and left nearly the
whole of his property to a board of trustees to be used to
found an asylum for the insane. He made no suggestion as
to the name of the institution; but reluctantly acceded to a
proposition that the board, which was in actual existence at
the time of his death, should be called “ The Trustees of the
Sheppard Asylum.” He said, “ I want no such monument to
my living fame.” Mr. Sheppard desired to try the “ experi¬
ment” of ascertaining how much could be done to bring
about recovery in cases of insanity by liberal expenditure of
money on buildings, nursing, dietary and scientific treatment.
He wisely directed that only the income of the trust should
be spent, and that the principal should remain intact, antici¬
pating that such a stipulation would permit of the reception
of patients gratis or at nominal rates. For that reason it is
only within the last few years that the asylum has been in
operation.
In September, 1896, Mr. Enoch Pratt, another prominent
citizen of Baltimore, died, and by his will left the Board of
Trustees of the Sheppard Asylum his residuary legatees, on
condition that the name of the corporation should stand as
“ The Trustees of the Sheppard and Enoch Pratt Hospital,”
and that the money should be applied in the same manner.
A question has arisen as to whether the change of title
proposed would not qualify the honour due to the original
founder; but it seems to us that the association of the names
of Sheppard and Pratt, par nobile fratrum , cannot be regarded
as derogatory to the man whose aim was, irrespective of post¬
mortem fame, to benefit the insane. We should rather expect
that Mr. Sheppard's feeling would have been to accept the
help tendered by Mr. Pratt in the name of humanity, and to
regard imitation as the sincerest form of flattery. We hope
and trust that this benefaction will be conserved in the
interests of the Sheppard-Pratt Hospital, with which are so
intimately connected the future interests of the insane of the
State of Maryland.
Since these lines were written we have learned with lively
satisfaction that the Charter of the Sheppard Asylum has
been amended by the State Legislature in terms of Mr.
Pratt’s will.
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341
PART II.-REVIEWS.
Recherche8 sur les Centres Nerveux — Alcoolisme, Folie des
Hereditaires Degeneres, Paralysie Generate , Medecine
Legale. Par le Dr. Magnan. Paris: G. Masson,
editeur, 1893. Pp. 572. Pr. 12 fr.
This volume is a collection of a number of Dr. Magnan’s
contributions to mental science, mostly between the years
1876 and 1892, a complement to the first series of Recherches
sur les Centres Nerveux, published in 1876. Some of the
articles were written in collaboration with various colleagues,
and communicated to various societies and congresses ; others
are reprints of lectures delivered at the Sainte-Anne Asylum
in Paris, &c. In its present form it is a useful book of
reference to the scattered writings of one of the leading
French alienists.
For purposes of convenience the contributions, mostly
relating to the hygienic and medico-legal aspects of insanity,
are arranged into four groups—alcoholism, insanity in the
degenerate, general paralysis, medical jurisprudence.
In the first part we are shown the pernicious influence of
alcohol and alcoholic beverages on the general health, and
on mental diseases generally; the influence of alcohol in the
production of general paralysis, and on the descendants of
drinkers. We find here included Magnates well-known and
interesting observations on the effects of various poisons
(absinthe, furfurol, &c.) which are added to certain alcoholic
beverages to give them their characteristic flavour, “ bouquet,”
&c. Much of our knowledge of the association of epilepsy
with alcoholism and its causation dates from these observa¬
tions. “ Alcohol is a poison, but becomes a much more
dangerous one when associated with the various toxic products
which are added to flavour it.”
In the second part are nineteen papers relating to the
symptomatology, aetiology, &c., and the various forms
of insanity in the hereditarily degenerate. From a medico¬
legal point of view a study of these papers especially is of
the greatest interest, as it is in connection with this class of
individuals—the degenerate—that some of the most delicate
medico-legal questions arise. A warped judgment and im¬
perfect moral sense predispose them strongly to a path of
crime; but it is above all among them that obsessions,
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uncontrollable impulses, &c., are found, often associated with
apparent sanity; hence the importance and difficulty of
settling the question of the degree of responsibility which
should belong to their offences against the laws. Whether
we are in presence of the kleptomaniac, the pyromaniac, the
homicidal maniac, the “ exhibitionist,” &c., the leading
phenomenon is of the same kind—an over-excited centre
which calls for the sensation or the act which can alone quell
it, and which the will of the patient frequently cannot resist.
In this second part are included Magnan’s writings (with
notes of many cases) on sexual perversions, and several
articles on the physical and psychical stigmata of the
degenerate, and on the association of crime with insanity.
The i€ insanity of anti-vivisectionists ” is an article which
might be read with profit by a section of noisy agitators who
are always with us.
The third part consists of nine articles on general paralysis
of the insane, dealing with the symptoms and pathology of
the disease, special stress being laid upon its medico-legal
aspect.
Finally, in the fourth part, headed “ Insanity and Medical
Jurisprudence,” are included papers on recurrent insanity,
on the simulation of insanity, and on unrecognised insanity,
with a strong plea for the systematic examination of criminals
by medical experts.
La Syphilis des Centres Nerveux. Par le Dr. Henri Lamt,
Paris: G. Masson, Editeur, and Gauthier-Villars et
Fils, Imprimeurs-Editeurs. Pp. 192. Price 2 fr. 50 c.
This small monograph, one of the series of the “ Encyclo¬
pedic scientifique des aide-memoire,” forms a useful intro¬
duction to the study of syphilitic affections (acquired and
hereditary) of the brain and spinal cord, excluding those
diseases which, like locomotor ataxy and general paralysis of
the insane, are often of syphilitic origin but not strictly
syphilitic in nature. The author begins with a description
of the pathological anatomy of syphilitic cerebral lesions, in
which he draws attention to the importance of inflammation
of the vaso-vasorum in the early stages of syphilitic arteritis,
and then gives a clear though brief account of the prodromal
or preparatory period of cerebral syphilis. This is the period
which it is so important not to overlook, for energetic treat-
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menfc at this time may be of most vital moment to the
patient.
While certain forms of insanity in their manifestations
may suggest a syphilitic origin, the author quite supports the
view that there is no such thing as true syphilitic insanity;
but in presence of the observations of Sehiile, Foville,
Desnos, &c., he is in favour of retaining the denomination
of syphilitic pseudo-general paralysis for a certain number of
cases which, at all events for a time, present the greatest
resemblance to cases of ordinary general paralysis. Syphi¬
litic cortical lesions with partial epilepsy he looks upon as
the most curable manifestations of cerebral syphilis; the
extreme importance of descending optic neuritis in these
cases is wisely emphasised.
Clinically, the following classification of cases arising from
syphilitic arterial thrombosis is simple and rational.
а. Transitory symptoms (e.g. temporary aphasia) due to
ischaemia of the brain.
б. More permanent symptoms arising from true cerebral
softening.
c. Bulbar and pontine manifestations due to syphilitic
arteritis, and manifestations of cerebral haemorrhage.
Generally speaking, one may say that, as regards prognosis
in syphilitic diseases of the brain, it is decidedly gloomy;
Fournier's statistics of fourteen deaths and thirty cures in
ninety cases are no doubt approximately correct. Dr. Lamy
gives a useful summary of the important points to be at¬
tended to in the diagnosis of cerebral syphilis (pp. 101—110).
In Chapter iii, on syphilitic diseases of the spinal cord, the
great importance of vascular alterations is dwelt upon, and
in most cases they are the first involved. The commonest
cases are described under the various headings—syphilitic
spinal meningitis, spinal paraplegia, transverse myelitis,
and acute myelitis. This classification is clinically useful,
although one may find all gradations between typical cases of
Erb's spinal paralysis (syphilitic) and of transverse myelitis.
The prognosis here is even more unfavourable than in
cerebral syphilis; pure meningitic cases are often curable
when treated early, but they are comparatively rare cases;
chronic or subacute spinal paralyses are frequently incurable,
and cases of acute softening are particularly fatal. A few
helpful remarks on the often extremely difficult question of
diagnosis of these cases closes this chapter.
Chapter iv is devoted to the cerebro-spinal complications
xliv. 23
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of inherited syphilis, which are even more varied and deeper
than those of acquired syphilis. Owing to arrest of develop¬
ment, and to premature birth in these cases of inherited
syphilis, the nervous system is particularly liable to be
affected, and intellectual disorders are especially constant.
The prognosis is especially gloomy.
Le Gatisme au Gours des fitats Psychopathiqiies. Par le
Dr. Marcel Manheimer. Paris : Felix Alcan, Editeur,
1897. 8vo, pp. 194. Price 3 fr.
The importance of the symptom incontinence in nervous
diseases generally is sufficient justification for the publication
of a work which deals with the subject in a full and compre¬
hensive manner, as Dr. Manheimer does in this work. For,
from the medical point of view, its detection and certain
features concerning its mode of onset, &c., may help in the
diagnosis (differentiation of dementia, advent of stupor, &c.),
and especially in the prognosis of some mental affections ;
from the psychological aspect, incontinence often occurs under
curious circumstances in certain psychoses, giving an impres¬
sion of grossness to psychical tendencies, and may give rise to
problems of much interest; finally, it appeals to the mind of
those who undertake the treatment of the insane as an
important administrative question.
There is some want of agreement among alienists and
others as to the meaning to be attached to the French word
“g&tisme” ( gater , to spoil), so the author gives his defini¬
tion : “ Recto-vesical incontinence, or simple rectal incon¬
tinence, or simple vesical incontinence; but in the latter case
including only that form which may become complicated with
rectal incontinencethat is, he excludes from his definition
that essential incontinence of urine which is generally seen in
children.
In his introduction Dr. Manheimer remarks upon the dearth
of observations recorded in which stress is laid upon this
symptom, and the dearth of literature dealing with its
physiology or pathology. The question of incontinence
seems at first to have only interested administrators ; and it
is only since the time of Morel, who first suggested the
advisability of making distinctions and subdivisions in the
groups of incontinent patients huddled together in asylums,
that it has been considered clinically. More recently Schiile,
Linderborn, &c., have discussed its pathogeny in the insane.
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Statistics show unmistakably its marked predominance in
general paralytics, and the much greater frequency of simple
vesical incontinence. In the first of the three parts into
which his work is divided Dr. Manheimer discusses the
physiology and pathology of incontinence, from its occur¬
rence as a simple spinal reflex to its association with purely
voluntary impulses. He adopts the hypothesis of the exist¬
ence of cortical centres presiding over anal and vesical con¬
tractions (as determined by J. Meyer, Sherrington, &c.) as
best explaining many of the clinical facts observed. However,
one of the important points which may be deduced from this
study is that there is an analogy between the anal and vesical
sphincters, both as regards the anatomical disposition of
their governing centres and their physiological function,
which accounts for their association in disease ; the vesical
muscles, however, whose function is more delicate, and there¬
fore more easily disturbed (a frequent rule in pathology),
being often the only ones affected.
The second part—which occupies the bulk of the volume—
is devoted to a consideration of incontinence in the various
psychopathies, and of its probable mode of occurrence. The
great variety in its aetiology, and one might add its great
uncertainty, practically preclude the suggestion of a satis¬
factory classification of cases of incontinence. With the
difficulty which exists in the classifying the psychopathies
themselves a clinical classification is not practicable; a
pathogenic one is still more difficult, for a good deal of hypo¬
thesis is assumed in explaining the mechanism of incontinence,
so Dr. Manheimer devises a mixed classification, in the divi¬
sions of which can be ranged not mental diseases alone, but
all brain disorders in which incontinence may be found.
Three large groups of diseases are differentiated :
a. State of coma.
/3. States of dementia.
y. Delusional states.
Under states of coma are discussed the varieties of incon¬
tinence which we find in apoplectic conditions, in hysterical
sleep and stupor. Here we are dealing with a more or less
complicated reflex phenomenon, consciousness being in abey¬
ance.
A very large number of cases of incontinence come under
the second category—states of dementia. And in this con¬
nection one may remark that the best way of realising how
complicated and unsatisfactory is our knowledge of the
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[April,
pathogeny of incontinence is to read the author's pages on
incontinence in general paralysis of the insane. With such
factors present as fatigue of the attention, modification of
character, enfeeblement of voluntary inhibition, &c., common
psychical disorders in this disease (and often associated), and
each one competent apparently to cause loss of control over
the bladder, how can one decide which is in play in any
particular case ? especially in presence of paresis, or actual
sphincter paralysis of the bladder, which may arise from a
spinal lesion, as in tabetic general paralysis, for example.
The incontinence of senile dementia also comes under this
group. In one case, notes of which are given, the early
appearance of this symptom in a doubtful case of dementia
helped in the diagnosis of general paralysis, which was sub¬
sequently confirmed. As in general paralysis, the incon¬
tinence may be due in dementia to a weakness of the
sphincters (paresis; hence it is more frequent when the
patient stands or takes exercise, &c.), or may be psychical in
origin.
In the third group we are dealing with incontinence as a
psychical phenomenon. Subconscious psychical causes the
author believes may explain some of the cases; but frequently
some illusion, some hallucination, an idea (delusion, obses¬
sion), an emotion, or a mixture of these, is the real explana¬
tion; and the author endeavours to explain the occurrence of
incontinence in impulsive states, in maniacal conditions, &c.,
on this basis. There is a good deal of interesting matter in
this part of the work, but much of it is speculative. The
pages on incontinence in cases of partial or total loss of the
personality, in which this symptom is frequent, are perhaps
the most practical.
The third part of the work is devoted to the question of
incontinence in the asylum. The author believes that asylum
life in a certain class of cases favours incontinence, and
may help to make it permanent. Among the factors which
may act in this direction are the disposition of the wards
in relation to lavatories, the question of imitation, &c.,
especially with patients with diminished will and activity;
then such factors as laziness, evil disposition, systematic
opposition, vague sentiment of grudge, &c., towards attend¬
ants and others in delusional cases, &c. He also analyses the
evil effects in this direction of isolation and restraint.
Under these circumstances, realising the difficulty which
exists in many cases of deciding whether incontinence is
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primary or secondary— i\ e. whether due to the natural or
logical evolution of the disease, or occurring as an epipheno-
menon attributable to neglect of attendance, or other occa¬
sional causes which may be treated—Dr. Manheimer urges
that these cases should be, for a time at all events, under
attentive and uninterrupted observation in special wards, and
that careful notes of them should be taken by their attend¬
ants, as enjoined by Von Gudden Ludwig, Linderborn, and
others,—a plan already carried out in certain asylums ( e . g.
Hubertusburg). This book is a useful contribution to the
literature of the subject, and a testimony to the industry of
the writer.
TJntermchungen uber die Libido Sexualis. Von Dr. Albert
Moll. Bd. I, 1897. Pp. 872. Price 18 mk.
Dr. Moll is well known as the author of two books, on
hypnotism and on sexual inversion, dealing with delicate
psychological and practical problems in a thorough, skilful,
and judicial manner, which is only too rare in fields so inviting
to hasty and ignorant investigators. He has now approached
another very difficult field in a characteristic fashion, as we
may learn from the preface. He here tells us that he has
been for a long time preparing to write a large monograph
on the sexual impulse, but that he met with so many
important unresolved problems on the threshold of the
subject that he considered it first necessary to deal with
these in a preliminary work. The massive book before us is
thus merely the first volume of the preliminary work. This
spirit of scientific thoroughness is shown throughout, and
if any amateur of that literature which the second-hand
bookseller calls “ curious,” attracted by the title, should
come to this elaborate discussion of definitions and of com¬
plicated questions in heredity, one may be glad to think that
he will for the most part go empty away.
The serious reader will, on the other hand, be correspond-
ingly grateful to Dr. Moll for his careful and minute dis¬
cussion of general problems which are too often ignored or
settled off-hand by those writers who undertake to deal with
the sexual impulse in the course of a few pages.
The author takes up his subject at the beginning by a
scientific discussion of the various senses in which the term
“ instinct ” has been used, and seeks to define the sense in
which it can be used in the region of sexual psychology.
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He decides, further, that neither in man nor woman, save as a
rare exception, can we trace any impulse that can correctly be
called a reproductive instinct. He then sets himself to the
chief task before him in the first chapter (occupying about
100 pages), and endeavours to analyse the sexual instinct.
His main point here—and it is one of the most noteworthy
and prominent points in the work—is the breaking up of the
sexual instinct into two distinct instincts, a step which goeB
far to make the subject clear : the ts detumescence ” instinct
and the “contrectation” instinct. By the first term he means
the impulse to seek the relief of physical turgescence of the
sexual organs ; by the second the impulse to seek the embraces
of another person, normally of the opposite sex. These two
impulses may each exist apart from the other, but normally
they are combined to produce the reproductive act; and they
may both, Moll holds, be regarded as irresistible and funda¬
mental. Together they constitute what we call the “ sexual
instinct.” The detumescence instinct appeared much earlier,
phylogenetically, than the contrectation instinct (in fish, for
instance, it constitutes the whole of the sexual instinct), so
that the former instinct may be regarded as primary, while
the latter is secondary. In individual development it is not
so easy to say whether the instinct of detumescence or that
of contrectation appears first; Moll finds that either may
appear first, usually, however, the former, and both of them
before puberty: this is the case in animals as well as in man.
Moll refers to the important work of Groos on the play-
instinct in young animals, and considers that puberty must
not be regarded as a necessary condition of the manifestation
of either component of the sexual instinct. The contrecta¬
tion instinct may be regarded as a secondary sexual character.
Moll supports his position on these points by a consideration
of the phenomena in castrated individuals.
In the second chapter the author discusses at great length
(over 200 pages), and on the basis of the fullest acquaintance
with all the modern literature of heredity, the question of the
inherited character of the normal sexual impulse. It is alto¬
gether a most masterly discussion, in which the question is
treated on the broadest and most fundamental grounds, with
constant reference to general scientific literature and to per¬
sonal experience. The author shows that no organ of sense
is absolutely essential to the awakening of the sexual impulse,
and that from the standpoint of teleology, of Darwinism, of
comparative anatomy, physiology, and psychology it is im-
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349
possible to accept the conclusion of Meynert and others that
the normal sexual instinct is acquired. It is inherited, but
we must not regard heredity as extending to representations
or ideas; it is the reflexes only that are inherited—certain
modes of reaction in the presence of stimuli proceeding from
the opposite sex. The author’s discussion of this important
point may fairly be regarded as convincing.
In the following chapter the allied question of the inherited
character of the homosexual impulse is discussed, and a con¬
clusion—in harmony with the previous chapter and with the
author’s book on the subject—is reached that here also we
must admit a certain congenital element, and at the least an
inherited weakness of the normal mode of reaction.
In Germany there appears to be a certain fear lest the
modern doctrines of sexual pathology should lead us back to
the old theory of monomanias as formulated by Esquirol.
In his fourth chapter Moll deals with this question, treating
it with his usual thoroughness and erudition. He concludes
that there is no ground for any return to the monomanias.
If the dominance of an isolated instinct involves monomania,
then we must sometimes postulate monomania of the normal
sexual instinct. There are, moreover, great differences be¬
tween the sexual impulse and, for instance, kleptomania.
Not only are the affections once described as monomanias in
reality general affections in which a morbid impulse has
become rooted, but the sexual instinct has this further dis¬
tinction, that it is founded in a definite organic condition.
At the same time the author does not consider that his posi¬
tion will satisfy the extreme opponents of the doctrine of
monomanias; it must often happen that a single psychic
symptom alone appears in the foreground, as in many ob¬
sessions.
The last chapter of this first volume deals with the legal
aspects of the matter, and of course has special reference to
the code of the German Empire. Moll accepts a partial re¬
sponsibility (as admitted by the law for deaf-mutes and
children between twelve and eighteen), and points out the
objections to the term “ partial insanity.” Partial responsi¬
bility is not equivalent to diminished responsibility. In
every case, he insists, we must decide according to the indi¬
vidual facts, as general propositions are valueless.
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350
Reviews.
[April,
La Puberta . By Antonio Marro. Turin: Fratelli Bocca,
1897. Pp. 507. Price 10 lire.
This work, of which the full title is "Puberty studied in man
and woman with relation to anthropology, psychiatry, educa¬
tion, and sociology/’ has occupied its author for many years.
Dr. Marro, who is now the chief medical officer of the Turin
Asylum, and who has had long experience as a prison surgeon,
is the author of a work (J Caratteri dei Delinquents) which,
although ithas never been translated, is the most precise, careful,
and laborious contribution to criminal anthropology which has
come from Italy. He is, as Professor Lombroso once described
him to the present reviewer, emphatically "a laboratory
man.” He has no literary skill, and none of that genial
enthusiasm and love of large generalisations which distinguish
Lombroso himself. While the qualities of his work have
secured Marro from the too noisy praise and blame which
have surrounded his friend and colleague at Turin, they have
rendered it a quarry to which many less original writers have
constantly had to go for materials. The present work is full
of carefully recorded facts and observations, not always very
well wrought together, and impossible to summarise in a brief
space, but all the more valuable because they are set down
without partiality, and without bias in favour of any theories.
The work is largely founded on observations made on the
inmates of various Italian schools and institutions, and on
more minute and prolonged investigations carried out on the
author’s own children.
In its general outlines the book begins with consideration
of the age at which puberty appears, and of the various in¬
fluences which modify its appearance; proceeds to consider
the anatomical and physiological changes which accompany
puberty—in genitals, hair, breast, voice, height, weight, vital
capacity, elimination of carbonic acid and urea, tactile
sensibility, reaction time,—and considers modifications in
character and conduct. Then the anomalies of puberty are
studied, and the modifications produced in degenerate sub¬
jects. The psychoses of puberty are considered at length,
with special reference to the views of German, French,
English, and American alienists; and the concluding chapters
are devoted to a very full and detailed consideration of the
hygiene of puberty, and the treatment and prevention of its
morbid variations. A few points may be noted.
It was found that there was a gradual increase in urea, in
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351
relation to the weight of the body, in the years preceding
menstruation, but a diminution after menstruation begins;
the output of urea is at its minimum during the menstrual
period, and at its maximum at the greatest distance from the
menstrual period. Even then, however, it never reaches the
amount attained before menstruation is established. Marro
thus finds reason to believe that there is a real retrogression
in the process of organic oxidation in women, lasting
throughout the sexual life, and most marked at the menstrual
periods.
Observations on the various senses showed/ that, on the
whole, girls and women have a more delicate sensibility than
boys and men, but that, especially as regards tactile sensi¬
bility, it tends to decrease with age. Olfactory sensibility,
which was specially investigated, was found to show certain
peculiarities. While more delicate in women, it showed a
greater development on the advent of puberty, and, uulike
other forms of sensibility, there was no tendency to become
obtuse with age. This, Marro points out, is additional
evidence of the sexual relationships of the organs of smell in
women.
Marro finds, on investigating the records of educational
institutions, that there is a physiological period of bad
behaviour. A chart founded on the conduct of 3000 boys
shows that the ages from thirteen to fifteen are those of worst
behaviour, the smallest percentage of well-behaved-being at
fourteen. It is curious to note that in the well-nourished
social classes, among whom growth is precocious, the epoch
of bad behaviour is also precocious. In girls the age of bad
behaviour is about fourteen and fifteen, and good behaviour
is maintained to a later age in girls who have not yet men¬
struated. Girls, absolutely compared, are better behaved
than boys, except in the important respect of “ sins of the
tongue.”
After giving a full account of the historical growth of
opinion in various countries concerning the psychoses of
puberty, Marro points out that the German conception of
a special form of insanity peculiar to puberty has gradually
lost ground in favour of the view which attaches importance
to two ®tiological factors—hereditary degeneracy and physio¬
logical puberty—as imprinting their special seal not only on
one, but on all the psychoses which arise beneath their
influence. There are, as studied by Marro, three stages in
the physiological evolution of puberty and adolescence:
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352
Reviews.
[April,
(1) that in which the sexual organs develop and sexual
activity awakes ; (2) the period of increased growth ; (3) the
period during which growth is completed. Applying these
stages to the interpretation of the insanities of puberty,
Marro finds that the first, which extends to the fifteenth or
sixteenth year, is marked by few morbid developments,
except (in agreement with Gowers) those of epileptic form.
The second period, extending to the twentieth or twenty-
first year, is, on the other hand, marked by psychoses of
every kind, and especially those which, resembling hebe¬
phrenia, indicate great disturbance of consciousness. The
third period, with which puberty (or, as we should say,
adolescence) terminates, shows a notable reduction of psy¬
choses. The special form of insanity manifested must always
be in relation with the conditions under which it arises.
These various forms are well illustrated by cases. A number
of special and peculiar cases are also presented showing the
influence of sexual anomalies on the general development,
notably on the osseous system (osteomalacia, acromegaly,
infantile gigantism). Special reference is also made to the
relations between the sexual organs and the respiratory
apparatus.
The concluding chapters of the book, on the hygiene of
puberty and adolescence, while full of insight and experience,
are perhaps less novel than the earlier chapters. The whole
work, however, is one on which great labour and care have
been expended, and it is in a high degree interesting and
instructive.
On the So-called Divining Rod or Virgula Divina. By Pro¬
fessor W. F. Barrett ( Proceedings of the Society for Psy¬
chical Research , Part xxxii, July, 1897, pp. 282, price
3 s.6d.).
On the Evidence for the Efficacy of the Diviner and his Rod in
the Search for Water. By T. V. Holmes ( Journal of the
Anthropological Institute, vol. xxvii, No. 2, November,
1897).
These two papers may be coupled together as contribu¬
tions to an obscure subject. The former is important by
reason of its length and detail, and the great amount of
labour expeuded upon it. The latter has the advantage of
being written by a very able field geologist, and is almost
the first attempt to deal critically with the diviner’s preten-
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353
sions from the very pertinent point of view of the geolo¬
gic
The divining rod, it is scarcely necessary to state, is an instru¬
ment—usually a simple forked hazel twig—which is carried
by the water-searching diviner (usually a more or less unedu¬
cated countryman, in England called a “ dowser”), and which
moves involuntarily in his hands when {ex hypothesi) he is
passing overrunning water; at the same time the dowser
usually feels more or less unpleasant physiological symptoms,
which are variously described. The divining rod has been
known since the seventeenth century, and at the present day
is used to a considerable extent in England, especially in
Somersetshire and the western counties generally. It has
sometimes been considered as mere trickery ; this opinion is
now abandoned by careful investigators of the phenomenon.
The dowser is undoubtedly, in many cases at all events,
an honest practitioner of his art; moreover the twig cannot
be moved by voluntary muscular movement, and it is beyond
question that the dowser often finds water. We still have
to discover how the twig is moved, and whether it is by
chance, by skill, or by some yet unknown power that the
dowsers successes are achieved.
Unfortunately, it cannot be said that Professor Barrett’s
report, while honest and laborious, is a model of investigation.
It is a little confused, and, what is of more importance, evi¬
dence of very varying value is mixed up together in a way
that leads one to conclude that Professor Barrett, while per¬
fectly fair and open-minded, scarcely possesses the sternly
1 ‘udicial temper of mind, and the power of summing up and
►alancing evidence, which are essential to carry so difficult
and complicated an investigation to a really satisfactory con¬
clusion. Moreover, as a physicist, he does not bring to this
task any acquired training which is helpful in unravelling the
problem; for the only point at which the divining rod touches
physics—the assumption that electricity is its motive power—
may be dismissed without investigation. A weak point in
the report is, further, the large amount of historical investi¬
gation which is introduced. However interesting the won¬
derful stories of ancient writers may be, they furnish us very
little help in investigating any natural phenomenon, for we
are to-day unable to discover the amount of evidential value
which such records possess. Even the reports of contem¬
porary achievements by dowsers, with which a large part of the
report is taken up, have somewhat less value than Professor
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354
Reviews.
[April,
Barrett seems to imagine. It is true that he has not usually
depended on the newspaper accounts sent him by press-cutting
agencies, but has also sought verification from the dowsers,
their employers, and, if possible, eye-witnesses. But it very
seldom indeed happens that any of these people are trained
observers, or possessed of any scientific geological knowledge,
so that their estimate of the achievement is of little value.
This is sufficiently shown by the almost invariable way in
which they accept the dowser's own statement that what he
finds is a “ spring," i. e. a strictly limited channel of water
which might be missed by a few inches, thus witnessing to a
ludicrous ignorance of the geological conditions which usually
exist in water-bearing strata. It is when we come to the
test experiments carried out by Professor Barrett himself that
we feel that we have at least reached something really tan¬
gible and decisive. But unfortunately it is just at this
crucial point that, as Professor Barrett himself admits, the
evidence is weakest. Professor Barrett made two series of
experiments, one on a successful dowser called Stears, much
respected by all who know him ; the other on Rodwell, a
Yorkshire youth, who had been said to be very successful.
These experiments were conducted with all due scientific
care, and, so far as original contribution to the subject is
concerned, they form the kernel of Professor Barrett's report.
The experiment with Mr. Stears began well, for the rod
moved over a spot on level greensward, which (as the gardener,
who was not present, afterwards declared) was the site of an
old well; afterwards the rod moved at a number of spots,
some of which, indeed, were in a straight line; when blind¬
folded the dowser discovered another set of spots—about a
dozen spots were thus marked (a plan is given),—which do
indeed show a certain symmetry of disposition, but as no
boring was made no conclusions can be drawn. Mr. Stears
then remarked that the rod also moved over small masses of
iron; accordingly three experiments were made with lumps
of iron placed in nine bandboxes, all precautions being taken
to avoid thought-reading. These experiments were signal
failures, the successes being not more than could be accounted
for by chance. So that, so far as Mr. Stears was concerned,
little definite evidence was acquired. With Rodwell eight
experiments were devised and planned so as to cover ground
containing concealed wells and pipes of known location.
There was one success, three decisive failures, while four of
the experiments were inconclusive. Thus it can scarcely be
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1898.]
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355
said that Professor Barrett’s experiments have greatly ad¬
vanced the inquiry. He considers that he was unfortunate in
not obtaining more experienced dowsers. Unfortunately the
most successful operator, John Mullins, has been removed by
death beyond reach of experiment.
In considering this alleged power we have two distinct
problems to deal with—the cause of the rod’s movements,
and the cause of the diviners occasional or frequent success.
Regarding the first point there need now be no difference
of opinion. Both Professor Barrett and Mr. Holmes are
agreed on this point, and we may thrust aside the crude
belief that the movement of the twig is a trick of legerde¬
main. The movement of the rod is due to involuntary
reflex action which cannot be imitated by voluntary muscular
action. Dowsing thus belongs to the same group of phe¬
nomena as table-turning and automatic writing. The divining
rod may be compared to the planchette or the pendule ex-
plorateur. Professor Barrett proposes the generic name of
autoscope for this group of appliances. It should be added
that dowsers do not always use hazel twigs ; some use watch-
springs; some merely spread out their hands; one German
operator used a long German sausage. Whatever is used,
curious physiological symptoms often occur, and Professor
Barrett very reasonably believes that there is often a partial
degree of hypnosis.
The second problem—to determine how far the dowser's
success is to be set down to chance, to more or less uncon¬
scious skill, or to some unrecognised physiological sensitive¬
ness—is much more difficult. It is of course quite possible
that the last alternative may have to be accepted. With our
present knowledge of the vagaries of idiosyncrasy, and of
the aptitude acquired in hypnosis and allied conditions, we
cannot assert that this is impossible. But we must first prove
that chance and skill are not adequate explanations. Mr.
Holmes, who treats the problem with fairness and sagacity,
as well as geological knowledge, is distinctly inclined to con¬
clude that chance and skill account for all the dowser's dis¬
coveries. He points out, in the first place, that the astonish¬
ment caused by the dowser's success is largely due to the
fact that the dowser himself, and usually those who employ
him, always believe that water-finding is a matter of locating
a “ spring," which it is possible to miss by a few inches, so
that the achievement becomes as wonderful as finding a
buried jar of ancient coins. But, as Mr. Holmes points out.
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Reviews.
[April;
while water sometimes runs in underground fissures, water¬
bearing strata usually cover acres or miles, over any point in
which a well may be successfully sunk. He insists, moreover,
that while so-called experts, even if engineers or eminent
geologists, may have no special knowledge regarding the best
spots for sinking wells, an observant countryman may easily
acquire a practical knowledge of the indications furnished by
water-bearing strata ; and in this connection he refers to the
fact, demonstrated by the sites of ancient villages, &c., that
primitive man possessed this skill. He concludes that
“ the available evidence seems to me to suggest no qualities
on the part of the diviner beyond practical shrewdness, and
a good eye for indications of the presence or nearness of
water in surface rocks.” Professor Barrett would also admit
an element of skill, and he refers to various trifling indica¬
tions which may suggest the existence of water below; but
although he can bring forward no decisive proof, he will not
admit that skill will alone explain the dowser’s success, and
believes we must assume “ some peculiar instinct or faculty”
having its roots not in conscious experience, but in “ the
wider realm of subconscious life.” He compares the dowser
to a pointer, the dog’s scent, more delicate than any scientific
instrument, corresponding to the dowser’s “scent,” the ner¬
vous excitement of the auimal corresponding to the dowser’s
psycho-physiological disturbance, and the dog’s rigid tail to
the involuntary motion of the rod. The dowser’s art, he
believes, affords a “ striking instance of information obtained
through automatic means being often more reliable than, and
beyond the reach of, that derived from conscious observation
and inference.” Thus the solution of the problem—as
between chance and skill on the one hand, and an unknown
kind of physiological sensibility on the other—still awaits a
decisive investigation.
Manual of Mental Diseases. For Practitioners and Students.
By A. Campbell Clark, M.D.Edin., F.F.P.S.G., Mackin¬
tosh Lecturer on Psychological Medicine, St. Mungo’s
College, Glasgow ; Medical Superintendent of Lanark
County Asylum, Hartwood. University Series. Bailliere,
Tindall, and Cox, 1897. 8vo, pp. 484. Price 10s. 6d.
The object of this book is to supply students and practi¬
tioners with a concise and readable account of mental diseases.
One hundred pages are devoted to the consideration of the
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1898.]
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357
constitution, character, and health of mind; sleep and its dis¬
orders; and the causation, diagnosis, prognosis, and treatment
of insanity. The rest of the book is taken up with a descrip¬
tion of the various forms of insanity, idiocy, and imbecility,
and concludes with a brief account of the legal and civil
aspects of mental disease, and the functions of medical men
in relation to these.
In reviewing any book we have to ask how far the author
has fulfilled his object. In this instance the object has been
fulfilled if absence of controversial matter, terseness of
view, and a free and easy style of diction constitute what is
“concise and readable.” To the student who, for examina¬
tion purposes, requires merely an elementary knowledge of
the subject, and to the junior practitioner who has little time
or inclination to study the more complete text-books, the
present volume will prove of real assistance. To those,
however, who have already acquired some knowledge of the
symptoms and types of insanity, either by clinical observa¬
tion or by reference to other works on insanity, it will hardly
repay perusal.
Emanating as it has done from Scotland, the home of
metaphysics, we would hardly expect the opening sentences
to be as follows:—“To the question, what is metaphysics?
a shrewd Scotch rustic replied, 'When the person wha
listens disna ken what the person wha speaks says, and when
the person what speaks disna ken what he says himsel’, that's
metapheesics.'” This, the author observes, had a vein of
truth in it, and we cannot but conclude that this is to a
certain extent the author’s mental standpoint. With regard
to psychology, however, the author appears to take a more
enlightened view than some of his present compatriots, inas¬
much as while he regards the study of mind as wearisome
and unprofitable to the average student, he nevertheless re¬
commends the acquisition of a knowledge of mental constitu¬
tion as an essential to the satisfactory study of mental disease.
With regard to the anatomy and constitution of the brain
substance he maintains perfect silence throughout, whilst the
pathological teachings at present in vogue are not only left
severely alone throughout the text, but even discredited in
the preface. We question the wisdom of withholding from
the student the results of the researches of a vast body of
competent observers in the pathological aspects of diseases of
the mind, and the object of the book will be defeated if the
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358
[April,
student has to turn to other manuals for even the most ele¬
mentary information.
Many of the chapters dealing with the types of mental
disease are excellent, and show that the author has devoted
great care to the clinical material at his disposal. Other
sections, however, are meagre in the extreme,—in fact, they
scarcely touch upon the subjects. The book is well printed
and of convenient size.
Hallucinations and Illusions. By Edmund Parrish. London:
Walter Scott, “ Contemporary Science Series.” 8vo,
pp. 390. Price 6s.
The aim of the author is to classify into one great group
the whole range of fallacious perceptions, and to establish
the fact that they all depend, with minor differences, upon a
uniformly abnormal cerebral condition—“Dissociation.”
“ Dissociation ” is the opposite of “ Association,” and
means here a state in which the usual association paths are in
certain regions for some reason obstructed or inhibited.
The author, it is true, speaks of pathological and physio¬
logical causes of dissociation (pp. 152, 153), but it simplifies
the subject and expresses his meaning better if we regard the
condition as abnormal.
The old idea that hallucination is ideation equalling sensa¬
tion in vividness is finally disposed of, let us hope for ever
(although even to this day it finds approval in general
writings), and a new one substituted in its place. It is as
follows :—“ Every psychological phenomenon that takes the
character of a sense impression is a sense impression, for an
hallucination is not merely like or related to a sense
impression, it is identical with it” (p. 14). From this stand¬
point the transition to the next proposition is a simple one.
Much confusion has arisen in literature by the persistent
reiteration of the divisions of hallucinations into morbid
and normal, or rather on account of the tendency to
place the hallucinations and illusions of insanity in
opposition to those of other states. “ All hallucina¬
tions and illusions may be reckoned as fallacious per¬
ceptions, whether observed in the sane or the insane,
whether occurring in sleep or in the waking state, whether
arising spontaneously or experimentally induced” (p. 17).
The author qualifies the foregoing statement to the extent of
admitting that the physiological processes accompanying
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1898.]
. Review a.
359
hallucinatory perception are probably not dependent in all
these cases on similar brain conditions, but he considers it
highly probable that they rest on analogous functional
principles.
In Chapter II the hallucinations of insanity and other
morbid conditions, such as the various forms of intoxication,
are discussed. Here the alienist need look for nothing new,
and apart from the internal evidence which leads one to
suppose that the enormous mass of facts which under this
heading has been condensed into such a short space is
intended merely to carry out the scheme of argument, this
chapter until the very end is a disappointing one.
The third chapter is occupied by an account of waking
hallucinations and the result of the international census.
The data are taken from the report of Professor Henry
Sedgwick’s committee in the Proceedings of the S. P. R.,
vol. x, 1894. The author confidently assumes that most if
not all these cases of Ci waking” or conscious hallucinations
are, like the hallucinations of crystal vision, hypnosis, and
intoxication, due to cerebral “ dissociation.”
In the next chapter (IV) we reach the main argument of
the book, and the author’s theory of fallacious perception,
which, as has already been indicated, is that of “ dissociation.”
Before enunciating his own theory he criticises the various
theories which up till quite recently have held the field.
Chief among these are the centrifugal, psychic, and sensory
theories, and the centripetal theories. The fundamental
conceptions underlying the former group of theories are
shown to depend upon (1) the belief that, as all hallucinations
were images of the memory or imagination, there occurred a
refluent impulse from the cortex to the sensorium; (2) on
the assumption of a centrifugal discharge, which produced
4t eccentric projection ” of the hallucinatory image; (3) on
the adduction of a great number of cases which pointed to
the implication of the retina in visual hallucinations. This
view is maintained by Griesinger, Krafft-Ebbing, Schiile, and
Tamburini, as well as by Sergi and Lombroso, the two latter
assuming in every sensory perception a refluent wave to the
peripheral sense-organ.
The arguments against the centrifugal theories are—(1)
that, however, vivid and energetic an ideational image may
be, it can never rise to the level of sensation itself; (2) the
partiality which hallucinations display for primary colours,
red, blue, and yellow, makes it difficult to refer them to
xliv. 24
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860
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[April,
ideational excitation; (3) if hallucinations depended upon
energetic ideational stimulus their voluntary and involuntary
appearance would be much more common ; (4) the hypothesis
of a descending current in ascending nerve tracts is inconsis¬
tent with generally accepted physiological theories.
The centripetal theory is, strangely enough, not criticised
by the author, though equally powerful arguments might be
urged against it; but we are left to infer by his subsequent
adoption of an entirely different position that it holds no-
serious place in his mind. “ It is clear,” he says, “ that the
whole controversy as to whether hallucination arises in the
ideational or in the sensory centres, and whether the process
travels centripetally or centrifugally, becomes meaningless
when once we have seen adequate grounds for concluding
that the centres of sensation and imagination are not locally
separated, but occupy the same part of the brain, and
that the difference in character between sensory perception
and ideational reproduction corresponds only to a different
degree of excitement in the same cells ” (p. 134). The cor¬
tical localisation theories of many writers he dismisses as
futile circumlocutions which serve only to complicate our
view of the subject.
Parrish’s view of the origin of hallucinations is practically
in accord with that of James, to whom he accords priority,
but upon whose theory he claims an advance, which is not
quite clear from the description. The theory depends upon
the assumption that the sensory and ideational elements are-
one and the same, and that the difference in the processes
depends upon the intensity of the stimulus. In other words,
the currents flowing in from the periphery are of greater
intensity and produce a more powerful effect than those
flowing in from neighbouring cortical regions, i.e. they have-
greater power in overcoming resistance ; and upon this dif¬
ference in intensity depends the faculty of normally distin¬
guishing between reality and phantasy, by means of which
our actions are adjusted to the environment. The intrinsic
molecular cohesion of the cells is proof against the feebler
currents from the association paths, unless the latter front
any cause accumulate in the nerve elements; and the normal
free communication of the cells with one another prevents
the incoming association currents from accumulating. But—
and here is the crux of the theory —“ if from any cause the*
outflow is blocked, wholly or in part, the inflowing nerve cur¬
rents accumulate and reach the maximal explosion point, the*
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process of perception takes place, and the result is an hallu¬
cination.” This is the process of “ dissociation,” which
depends usually and ultimately upon exhaustion of certain
groups of cerebral elements from any cause. From this
point the author proceeds to show the similarity in origin'
between hallucinations and illusions.
Hallucinations are thus the result of forced association .
Illusions in the same way are caused through the suppression
(by dissociation) of certain cerebral processes which are
usually present in normal perception, and the absence of
which causes misrepresentation of the sensation. The sen¬
sation lacks completeness, “ and the correction and adjust¬
ment which the dormant elements in consciousness could
alone have supplied. . . . No hard and fast line can be
drawn between them [hallucinations and illusions], though
generally either the plus or minus quality predominates, and
the phenomena can be classed as ‘ hallucinations ’ or ‘ illu¬
sions ’ accordingly.” Enough has been quoted to show how
admirably the theory of “ dissociation ” adapts itself to all
the difficulties which surround the whole subject of halluci¬
nations, and how dexterously the author has applied it.
As a working theory we must admit it to be the latest and
most scientific explanation which has yet been propounded;
but as a final solution of the problems which underlie these
complicated phenomena it should only be accepted with
reservation.
Having established his theory, the author comprehends
within it all the phenomena with which we are familiar under
the names of crystal vision, hallucinations in the sane, second
sight, and the positive and negative hallucinations in
hypnosis. He attempts to demonstrate that in all such sub¬
jective apparitions there is a condition of dissociation, either
induced voluntarily by inhibition of the mental processes, as
in fixing the attention solely on one thing, as in crystal
vision, or involuntarily, as in nervous exhaustion, or in the
dream-like state between sleeping and waking, which is so
prolific of ordinary “ sane ” hallucinations.
The work concludes with a chapter on telepathic halluci¬
nations, which the International Census has proved to exist
in numbers excessive of what can be accounted for by coin¬
cidence. These hallucinations are usually associated with the
apparition of the dying to friends or acquaintances, and the
general veracity of the returns may be assumed. Our author,
however, remains sceptical; he considers that before we can
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accept the conclusions to which the Sedgwick committee
points, it is necessary to eliminate at least three sources of
error: — (1) the possibility of the occurrence of hallucinations
of memory; (2) the reading back of details after the event;
and (3) the personal condition of the subject at the time of
experiencing the hallucinations, whether exhausted or in the
hypnogogic state, &c.
While a little more clearness and definition in the arrange¬
ment of the difficult and complicated subjects which are dealt
with might be desirable in order to render the book more
readable, it must be admitted that the author has succeeded
in presenting to us the most comprehensive and most
scientific work on false perception that has up till now been
written in any language.
A Contribution to the Study of the Medulla Oblongata , the
Cerebellum , and the Origin of the Cranial Nerves . By
S. Ramon y Cajal. German edition, translated from the
original by Johannes Bresler. Leipzig: J. A. Barth,
1896. Pp. 132.
This brochure presents the results of Ram6n y CajaPs
recent researches into the histology of the brain areas named
in the title. Chapters are given upon the following subjects:
—The origin of the trigeminus ; upon a bundle of fibres origi¬
nating in the superior cerebellar peduncle; upon the cere¬
bellar cortex; the anterior corpora quadrigemina; the inter¬
peduncular ganglion of mammals; the olive; the origin of
the vagus and glosso-pharyngeal nerves ; the nuclei of GolPs
and Burdach’s columns; the posterior longitudinal bundle; the
origin of the vestibular nerve; the nervus cochlearis and the
acoustic nuclei ; the structure of the thalamus; the red
nucleus and the region of the tegmentum; the inferior cere¬
bellar peduncle; the hypoglossal nucleus ; the facial nucleus;
the cells of the substantia reticularis of the bulb ; the pineal
gland; the termination of association fibres in the molecular
layer of the brain. The silver method was employed, and
upon new-born and young rabbits, cats, mice, and the foetus
of the last named. We are aware that the silver method has
been instrumental in elucidating some of the difficult problems
which these portions of the nervous system present in such
profusion; in the present memoir the author confirms many
of the recent statements made by workers in this sphere,
adding original observations of his own. There are besides
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many interesting suggestions as to the connections and
functions of tracts of fibres and of cells, of a kind with
which we are familiar in the author’s writings. These
seem to emphasise the need for patient inquiry into the
structure of the obscure areas under consideration, an indis¬
pensable adjunct to which is an adequate knowledge of the
work already done, to which reference is made in the biblio¬
graphy at the end of the present memoir. We do not
think that any useful object would be served by selecting
for mention such few of the author’s observations as the
limits of space would enable us to allude to; in this highly
technical and complex field it is difficult to pick out one
item as more important than another. We rather regret
that the author has not adopted the plan of giving a
precis or summary of the chief points brought out by his
work in the different regions investigated at the close of
each chapter concerned. The somewhat abstruse subject-
matter is elucidated by numerous illustrations. Doubtless
the memoir is one to be possessed by the neuro-pathologist.
Nevertheless it is perhaps with many, as with us, a matter
for regret that so much good work is published in monograph
form—a practice much in vogue on the Continent—instead
of in a few well-accredited journals or archives, such as would
come under the notice of the great bulk of readers in any
given branch of work.
Le Monisme: Lieu entre la Religion et la Science. Profession
de Foi d’un Naturaliste. A translation into French by
G. Vacher dk Lapouqe from the German of Professor
Ernest Haeckel. Introduction by the translator.
Schleicher Fr&res, 1897, Paris. La. 8vo, pp. 47.
If we cannot accept all the eulogies of the introduction,
still the work is a masterly statement of the arguments in
favour of the faith of the monist. It does not tend to re¬
concile that form of belief with any generally accepted
religion, but iR a profession of yet another, claiming to be
the one true faith; basing the arguments in its favour on
acknowledged facts of science.
The introduction was written for the French, and therefore
it does not as a whole appeal to the English reader.
The author, in his preface, states that the essay was an ex¬
temporary speech delivered at Altenburg on October 9th,
1892, on the occasion of the seventy-fifth anniversary of the
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Naturforschende Gesellschaft des Osterlandes; partly in con-
firmation, partly in refutation of a discourse by Professor
Schlesinger, delivered at the same meeting. He says that
his objects are two, viz. to give an idea of the rational
conception of the world, and to establish a connection be¬
tween religion and science, and by this means to cause the
disappearance of the opposition wrongly interposed between
these two “ superior domains ” of human thought.
Haeckel gives at the commencement of his discourse his
definition of monism. a We express by this the conviction
that a spirit is in all things, and that the whole knowable
world exists and develop^ according to a common law.” He
then argues in support of his profession of faith against the
dualism of most religions and the pluralism of many, and states
that their fundamental idea is the anthropomorphism of the
Deity, with the placing of man in a position separated from
the rest of nature, which commonly carries with it the idea
that man is the centre of the universe ; and further, that each
important accession of knowledge carries with it a separation
from dualism and pluralism and an approach to monism. He
then passes in rapid review the uninterrupted series of
natural evolution from the lowest to the highest, showing
therefrom that man’s place in nature has now been rightly
defined.
If it is true that the human body has been developed from
a long series of ancestral Vertebrates, then the mind is in
exactly the same position. Haeckel traces the mind backward,
and claims to find some traces of it in the lowest animals
(Infusoria, &c.). He objects to the consideration of the soul
as a separate entity, and claims that the only immortality is
that due to the indestructibility of matter and the conserva¬
tion of energy. He theu demolishes some of the objections
to his faith, such as the charges of materialism, atheism, and
of its failing to satisfy the wants of human sentiment.
. The whole discourse is written with clearness, and is freely
annotated, references being given to numerous works. It is
very interesting reading, both as a profession of faith and as
a review of the present state of knowledge regarding the
subjects of which it treats.
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Abhandlungen zur Gesundheitslehre der Seele und Nerven
I. Arbeit und Wille : ein Kapitel-Klinischer Psychologic
zur Grundlegung der Psychohygiene . (Treatises on the
Hygiene of the Mind and Nervous System. I. Work and
Will: a Chapter for a Groundwork to Mental Hygiene.)
Von Dr. E. Hallervorden. Wurzburg : A.. Stuber, 1896.
Demy 8vo, pp. 42, 56. Price each number M. 1.20.
We have received two numbers as instalments of a pro¬
mised work upon mental hygiene. Dr. Hallervorden means
to proceed by what he calls the clinical method,—the study
of human beiugs in situations where their passions and
motives are laid bare. He observes that our ordinary books
on psychology have become shadowy, because the personality
is lost in the average, the individual in the generalisation.
This is true to a great extent. Your professional psychologist
and metaphysician is a man who has spent most of his time in
reading what has already been written on the subject, and for
this very reason he has little experience of life. Otherwise
he gains a livelihood or a university chair, with a good
position, by repeating his time-honoured terms and defini¬
tions. His pupils are mostly young men who have not seen
the world, and as they are bound to listen, the teacher does
not himself feel the need of going to school. What physicians
have observed in the complex dissociations of the mind in
disease he either entirely neglects or looks at in a very airy
way. A wide experience of human nature will, of course,
help a man to write on psychology, the wider the better.
He should use all methods, and neglect no sources of informa¬
tion ; but a difficulty commences when one has to communicate
his knowledge. Mr. Squeers’s method of teaching botany
was to send the boys to weed the garden, and no doubt his
pupils would thus gain some acquaintance with the natural
flora of Yorkshire; but if after leaving the seminary of
Dotheboys they were to try to teach what they had
learned, they would need to have recourse to definitions
and generalisations. Dr. Hallervorden writes vigorously
against schema,' —that is, the old pedantic terms and methods
of treating the subject; but in these numbers he gives us
little else save an array of theses, paragraphs, numbered
sentences, A and b subdivisions, with occasional big type to
make his ideas striking— plus a number of quotations from
Kant, Goethe, Lessing, and other great German authors. He
Vill say that he requires to lay down his methods, but they ar0.
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quite as formal as any of his predecessors, and it is to be
feared that if we spent time in conning them we should*
forget them before he came to the more practical parts of his
work. This is the inconvenience of bringing out such a
treatise iu parts. The author promises much, and we are
willing to learn something new in psychology; but a reviewer
at least cannot take the promise for the performance. Dr.
Hallervorden tells that the best psychologist he ever met
with is a judge who has the charge of a prison. The under
officials also showed a surprising “ psychological understand¬
ing.” Amongst other practical psychologists he thinks more
highly of teachers, despite their pedantry, than of physicians;
waiters in large hotels have a delicate appreciation of the
social and paying qualities of arriving guests; some police
officials have made the best of their opportunities, and they
often preserve under a rough exterior humane feelings, for
they have learned by experience that there is much good in
human nature. Dr. Hallervorden courageously remarks,
“ Freilich im Amte borstig zu sein, halt der Preusse fiir seine
Pflicht.” Very true, but difficult to translate! One might
try, “ Every Prussian official considers it his duty to try to
be like a hedgehog.”
Om Tvangstankar och d&rmed Beslagtade Fenomen. (On
Imperative Ideas and Related Phenomena.) By Dr. Bror
Gadelius, Asylum of Lund (Sweden). 8vo, pp. 239.
Lund: Gleerup.
This is an elaborate and interesting work which deserves
to be widely known beyond the bounds of the Scandinavian
kingdoms. The author gives a scientific definition of impe¬
rative ideas and the symptoms attending them. He points
out that a peculiar double life is characteristic of those who
suffer from this mental disorder: on the one side there is an
intrusion of ideas into the foreground of consciousness; on
the other an active recognition of the intruding ideas as
unfamiliar and strange ; in their mental life there seem to
be two centres, two sources of energy, two wills. The im¬
perative idea can be compared with the phenomena of hyp¬
notic suggestion, especially with the post-hypnotic ones, and
persons with imperative ideas yield very readily to sugges¬
tions. In those visited by dominant ideas there is a chronic
inability for voluntary attention, and want of power to resist
the automatic activity of certain ideas which are not admitted
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into consciousness in the common way, that is through a
synthetic action natural to the mind, but breaking into con¬
sciousness as if from a source out of the patient's own per¬
sonality. From the physiological side Gadelius treats the
imperative idea as a phenomenon of irritation in a centre or
complex of centres, more or less dissociated from another
cortical area where at the same time another process of con¬
sciousness is going on. This dissociation is only func¬
tional, depending partly on mental feebleness. The patient's
attention and will are feeble and trembling, and there is a
greater or less irritability in the brain centres of the cortex.
This hypothesis is almost the same as that of Meynert. Ga¬
delius gives a critical account of what has been written
about dominant ideas in different countries under the names
of Grilbelsucht, folie de doute, &c. The varying forms of this
disorder can be referred to two main groups—imperative ideas,
and fears or phobias; both may pass into the motor regions
of the brain, appearing as imperative actions. Often the
ordinary modus of association called simultaneous contrast
asserts itself in an abnormal way, so as to produce persistent
ideas of a lascivious or homicidal character, which the patient
does not willingly entertain. The dissociation of conscious¬
ness rarely rises to complete mental confusion, and impera¬
tive ideas are seldom transmuted into hallucinations and
impulses. The disease generally remains in a chronic state,
getting worse at intervals. Sometimes the imperative ideas
take a more systematised form, agreeable to the character of
the individual; the minds of those affected are filled with
absurd fears and precautions for unlikely contingencies.
These precautions are altruistic or egotistic, as the patient
is more disposed to care for his own welfare or for that of
others. The agitation and motor vehemence are much alike,
but between the paroxysms the temper of the altruist has amore
melancholic, and that of the egotist a more paranoiac aspect.
The author adds to the literature of the subject some cases
observed by himself Amongst these one is especially note¬
worthy. The disorder commenced with real attacks ushered
in by a sensorial aura, a simple hallucination of sight, a flame
of fire in the sky, and a hallucination of blasphemous words.
The disorder now amounts to the intrusion of thoughts of a
blasphemous nature in contrast to religious feelings, a rest¬
less desire to see what people were about and to put ques¬
tions to them. Another patient, “ an egotist," had such a
horror of touching anything that she had not allowed her
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own hands to come into contact with one another for many
years, and her bathings and dressings were done with so
many precautions that it is marvellous her attendant could
put up with her. In some instances the disease could be
traced back to childhood, and there are three descriptions of
cases occurring in children.
The Education of the Central Nervous System . By R. P.
Halleck, M.A. (Yale). Published by the Macmillan
Company, New York. 8vo, pp. 258.
This work is a compilation of facts relative to the training
of the nervous system, fairly well up to date, and put in a
clear and popular manner.
The key-note of the book is that given in the preface, viz.
“ That it is always too late to be what you might have been.”
From this point of view he discusses the “fatalistic aspects”
of mental development, and the limits of “ the possible modi¬
fications of the brain,” and enforces in a special chapter the
importance of early training.
The author’s theory of training is more accurate than his
practical views of how to carry it out. He does not seem to
have grasped or to have fully emphasised the importance of
training definitely related to the order of mental evolution.
The fact that teaching is attempted to be based on physio¬
logical psychology is, however, sufficient to commend the
book to the attention of teachers, many of whom, in this
country at all events, are in happy ignorance of all that per¬
tains either to physiology or psychology.
Ueber die Tabes : eine Abhandlung fur prakische Aerzte, von
Dr. P. J. Mobius. Karger, Berlin, 1897. (On Tabes : a
Treatise for Practitioners, &c.) 8vo, pp, 132. Price 3s. 3d,
In his introduction our author makes the history of the
late recognition of tabes point a moral: “ Unprejudiced ob¬
servation was despised ; people’s heads were full of scholastic
theories; what was read in books was deemed more im¬
portant than what one saw with one’s own eyes, and conceit
led men into physiological explanations rather than into
observation. One must add, indeed, that if the late recogni¬
tion of the thoroughly distinct tabes is damaging to the
intelligence of the men of earlier times, the rapid increase
of tabes, on the other hand, is a reproach to the morality of
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recent days. We now know that tabes is metasyphilis—that
is, a disease consequential on syphilis (eine Nachkrankheit
der Syphilis ); in proportion as syphilis spreads tabes becomes
more frequent. We need not, therefore, deem ourselves over
clever since it has been *made easier for us now to study
tabes than it was for the old physicians.”
Mobius here anticipates, in a rather question-begging way,
the conclusions arrived at later on in his chapter on the
causes of tabes. . At the same time he suggests what is,
perhaps, the main difficulty in accepting the metasyphilitic
or parasyphilitic nature of tabes. Mairet and Vires, in their
recent brochure on general paralysis, dispute the views now
general on the Continent as to the universality of syphilis as
an antecedent to general paralysis, and their arguments
apply closely to tabes as well. Par ant, in commenting on
Mairet and Vires, remarks, "It is notorious that the African
Arabs are almost all syphilitic; general paralysis is unknown
among them. According to our American colleagues, it
was equally unknown among the black race till the time
when they became addicted to alcoholic drink. In our country
there was a time when syphilis, the French disease, raged in
a feai*ful degree. . . . Nevertheless, the medical observa¬
tions, imperfect though they be, have recorded nothing which
could correspond to what we know of paralytic insanity.”
Nominibus mutandis , Parant's remarks apply to tabes.
Mobius, however, says that "among the Arabs of North
Africa, more accurate observations have shown that in pro¬
portion as syphilis spreads, tabes and general paralysis
appear ”! The question is not so easily disposed of. In
modern times and in civilised countries the association of
syphilis with tabes and general paralysis is brought under
our notice so frequently that it cannot be overlooked; it
often attracts the attention of patients themselves and their
friends. In earlier .times, when syphilis raged terribly, and
when the natural tendency would be to attribute almost every
ailment to this taint, how did tabes and general paralysis
escape attention f
Mobius subscribes to the opinion, recently accepted,
"though by no means universally,” that tabes and progres¬
sive general paralysis of the insane are one. " We speak of
c tabes 9 when the centripetal nerve-fibres are pre-eminently
diseased, and of progressive paralysis when the cerebral
cortex is pre-eminently diseased.”
The introduction, from which we cull the above opinions,
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and which contains an interesting account of the earliest
descriptions of tabes, is followed by a chapter on the signs
and course of the disease. This comprises in a Comparatively
brief form a very full and careful account of the symptoms of
the affection, and of the methods of clinical examination.
The value of the loss of pupillary reflex is rightly insisted
upon. “ Paralysis of the pupils is observed in various
diseases, loss of pupillary reflex occurs only (practically) in
tabes and in progressive paralysis.Usually a man
comes to the doctor complaining of some tabes-symptom or
other, .... and when the former finds loss of pupillary
reflex the diagnosis is made.” The rare “ paradoxical pupil¬
lary reaction ” is described (apparent expansion of the pupil
to light) and explained: “ while the eye has been in shade
the patient has strained the accommodation, when relaxation
occurs the pupil expands.” The feeble action of atropine on
the pupil in tabes is mentioned. “ Sometimes the pupil is no
longer circular, but displaced, elliptical, or altered irregu¬
larly.” To these conditions the term irregularity as distin¬
guished from inequality ought to be restricted. In the
kindred affection—general paralysis—irregularity in this
sense is even more common, in our experience, than in¬
equality.
The importance of bladder troubles from the diagnostic
point of view is pointed out, “ for they are the rule in tabes,
but a very rare exception in neuritis.”
Leimbach’s statistics are quoted. Out of 400 patients with
tabes 92 per cent, had lost knee-jerk (while in 4*25 per cent,
more it was impaired); 88*25 per cent, had lancinating pains;
80*50 per cent, had bladder trouble; 70*25 per cent, had
altered pupillary reaction ; and 48*25 per cent, had inequality
of pupils.
With regard to ataxy the author says, “ In tabes it appears
to me to be certain that the ataxy is nothing but a result of
anaesthesia, particularly of deficient sensation about the joints
combined, perhaps, with paraesthesia of the deep parts. Loco¬
motor ataxy is not an essential of the disease. Many tabes
patients die without ever having become ataxic, and in my con¬
sulting practice the non-ataxic cases distinctly outnumber the
ataxic.” The latter fact is probably due to the greater
number of anomalous and difficult cases that come under the
notice of a consultant as a speciality. “ Leimbach found
74*75 per cent, ataxic.”
The various forms of crisis are described, the nutritive
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371
changes, and the joint and bone affections. Among the
phenomena connected with the special senses the occasional
occurrence of loss of smell and of taste is noted as well as deaf¬
ness. Paraesthesia (hallucinations) of hearing, smell, and
taste are mentioned; the first are vague (rushing of waters,
humming of a kettle, ringing of bells, and the like); the
others do not appear to be commonly well defined, but are,
Mobius notes, always disagreeable. The old observation is
confirmed that a certain weakmindedness with some degree
of euphoria is not rare in tabes.
The next chapter deals with the anatomy of tabes. “ It is
beyond doubt that the death of c the noble parts/ of the
parenchyma, is the first change, and that the morbid condi¬
tion of the connective tissue and the blood-vessels is secon¬
dary/ 1 While we agree with the view here supported, we
think this statement is too unqualified, having regard to the
opinions of such observers as Obersteiner, who, with Redlich,
holds that the essential lesion consists in a chronic inflam¬
matory process in the meninges with hyperplasia of the
connective tissue. Nageotte, again, holds that a meso- and
peri-neuritis in that portion of the posterior roots which lies
between the spinal ganglia and the entrance into the arach¬
noidal sac is the essential cause of tabes. “ In tabes the
first seat of disease, excepting certain spots in tho brain, is
the fibres issuing from the spinal ganglia and running into
the posterior columns of the cord, the fibres of the posterior
roots. . . . According to the ideas now prevailing, cell and
fibre is one living entity, and this entity is either sick or
sound. From our point of view, however, the question in
tabes is of a primary independent affection of the nerve-
fibres. 11 The most interesting subject in connection with the
pathological anatomy of tabes is no doubt that which is here
ninted at. According to Marinesco, tabes is a degeneration
of the centripetal protoneuron. Goldscheider agrees with
this view, saying that a poison circulating in the blood
changes the neuron as a whole and in its entirety. Similarly,
Rosin calls tabes neither a disease of brain nor cord, but a
degeneration of the first neuron of the sensory tract (direct
sensory neuron of Kolliker; sensory neuron of the first order
of WaJdeyer).
We have already indicated the views of our author as to the
cause of tabes, to which he devotes a chapter. He points out,
truly enough, that the notion of a constant syphilitic origin is
gaining ground. Though our own experience coincides with
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[April,
his, we think that he dismisses somewhat too lightly what is to
be said on the other side. Arguing against the existence of
an ergotine tabes (and here again we are with him), he says
that in the entire held of pathology there exists no proof that
two different poisons can produce precisely the same morbid
state, at least when the morbid state is so distinctive as that of
tabes. On the other hand, there is no more remarkable dis¬
covery in modern pathology than the fact that certain disease-
producing organisms will only act in the presence of others
which are either themselves harmless, or harmful in a less
degree and in a different manner. This discovery will pro¬
bably eventually throw great light on the formerly inexpli¬
cable complexity of causes of disease, supplying the tertium
quid that seems so often to be wanting.
A short chapter is given on the diagnosis of tabes, but this
subject has been already anticipated in the excellent clinical
description.
A chapter on prognosis follows, which is somewhat longer
than, but much to the same effect as the celebrated chapter
on the snakes of Iceland.
Twenty-one pages are devoted to the chapter on treatment.
Little that is new is suggested. The suspension method is
dismissed along with every other general treatment as hardly
worth discussing, the treatment of individual symptoms re¬
ceiving more attention. For lighting pains antipyrin, antife-
brin, phenacetin, and salipyrin are recommended ; for bladder
trouble nux vomica, which we used to hear condemned on
“ physiological ” grounds.
The book concludes with a collection of some fifty-five
clinical cases serving as examples of the states described.
These, like the rest of the author’s clinical work, are of
•excellent quality.
PART III.—PSYCHOLOGICAL RETROSPECT.
RETROSPECT OF PHYSIOLOGICAL PSYCHOLOGY.
By Havelock Ellis,
The Psychology of Religion .—Considering the importance of the
religious emotions not only for the alienist, but in life generally, it
is very remarkable that religion has hitherto been almost abso-
Digitized by L^OOQle
1898 .] Physiological Psychology Retrospect . 373
lutely neglected by psychologists. Thanks mainly to the energy
of that most fruitful school of psychologists grouped around the
inspiring personality of Professor Starley Hall at Clark University,
this omission is now in process of rectification. I have before me
four valuable and interesting studies on this subject by two
Fellows in Psychology at Clark University, as well as a series of
papers by Mr. Rutgers Marshall, who is well known in another
connection.
Mr. J. H. Leuba’s “ Studies in the Psychology of Religious
Phenomena” ( Amer . Joum. of Psychology , vol. vii, No. 3, 1896)
deal with the general manifestations of conversion and the re¬
ligious life. A leading point in bis exposition, and one that is
clearly of great importance for the right comprehension of religious
phenomena, is his insistence upon “ the absolute divorce which
must be recognised between intellectual beliefs and religion;”
intellectual beliefs are the most evanescent elements in religion.
He defines religion as “ the conglomerate of desires and emotion®
springing from the sense of sin and its release.” The fact that
conversion has no necessary intellectual element is shown by the
frequency with which, on the evidence of religious workers here
quoted, it may take place even in states bordering on delirium
tremens. “ Take my own case,” to cite one testimony, “ a big
bloated drunkard, had fifty-three drinks the day before 1 was con¬
verted—most of them brandy cocktails,—and before me I saw my
Lord crucified. I was converted.” It is noteworthy that many such
conversions are, as was this case, permanent. The author has accu¬
mulated a number of detailed histories of conversion, and his paper
is mainly made up of a searching and instructive analysis of them.
He breaks up “ conversion ” into the following elements :—(1)
Sense of sin, which is “ made up essentially of general physical
discomforts due to unhealthy living (the yearning of the flesh
after righteousness) and of conflicting moral tendencies, whose
painfulness has also its physical basis.” (2) Self-surrender,
which is the turning-point. (3) Faith ; the author emphasises the
fact that faith in anything may be effectual; “it is a gross error
to imagine that the chief practical value of the faith state is its
power to stamp with the seal of reality certain theological concep¬
tions. On the contrary, its value lies solely in the fact that it is
the psychic correlate of a biological growth reducing contending
desires to one direction.” (4) Justification, which is really the
relaxation of the tense emotions. (5) Joy. (6) Appearance of
newness. The paper is full of suggestive and sympathetic ob¬
servations on religious phenomena, and it is well explained how
a psychic development, which is really the natural and inevitable
outcome of the organism, comes to be regarded as sometimes arbi¬
trarily inspired by divine influence from without into a merely
passive subject.
In a subsequent paper (“ The Psycho-physiology of the Moral
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874 Physiological Psychology Retrospect. [April,
Imperative,” Amer . Joum. Psych vol. viii. No. 4, 1897) the same
author attempts to analyse on a biological basis the phenomena of
the moral ought. He finds that in typical oases of moral impera¬
tive experiences there are three successive processes, or “ move¬
ments ” of the reflex arc type: the first two involuntary, but
antagonistic to each other; the third reflective. “ The cognition
of moral rightness is the psychic side of certain particular pro¬
cesses of the reflex arc type.” The moral imperative, being thus
conditioned by a reflective, purely cerebro-spinal process, contains
neither direct sensations from the external world nor sensations
from the internal organs. “ Consequently it must feel as a disincar-
nated experience, as a disembodied unlocalised manifestation of
spiritual life.” Thus the body is, as it were, left out of the moral
imperative, and “the crusade of the ethico-religious consciousness
is a war of the cerebro-spinal Self against the cerebro-sympathetic
Self.” Tbe defect of this paper of Professor Leuba’s is a certain
lack of facts and documents.
Certainly no such reproach can be brought against Mr. Star-
buck’s studies of the same and similar phenomena, which are
somewhat later in date (“ A Study of Conversion,” and “ Some
Aspects of Religious Growth,” Amer. Joum. Psych., 1897). These
are packed throughout with facts, figures, documents, and gene¬
ralisations illustrated by charts, and while Mr. Starbuck has fewer
suggestive observations to make, his results, in so far as they are
placed on a wide basis of facts collected with much industry and
energy, perhaps have greater scientific validity; in the main they
confirm Professor Leuba’s conclusions.
Mr. Starbuck issued a questionnaire , and by Professor Stanley
Hill’s influence, the assistance of many teachers, Ac., he obtained
several hundred replies. He starts by regarding conversion as a
more or less normal process, having a physiological basis, and
rooted in the first place in puberty, being thus a function of
growth ; and he finds that the years of greatest frequency of con¬
versions correspond with the years of greatest bodily growth;
in both males and females the charts accompanying the paper
show that while the greatest annual increase in weight is for boys
the age of sixteen, and for girls thirteen, the greatest number of
conversions is for boys at fifteen, and for girls from twelve to
thirteen. There is also a correspondence between the periods of
most frequent conversions and puberty in both sexes, the average
age of female conversions, 13*8 years, differing only by a small
fraction from the age of most frequent accession of puberty, as
shown by 4000 cases.
It thus appears that there may be a normal age for conversion
at about the beginning of adolescence, and the author refers to
the initiation ceremonies so common throughout the world on the
advent of puberty.
After the first climax in the frequency of conversions at puberty
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375
1898.] Physiological Psychology Retrospect .
there is in both sexes a rapid fall, with a second, but in both
sexes somewhat lower climax in boys at eighteen and in girls at
sixteen ; as this is separated from the earlier rise by, in both sexes,
a period of three years, it evidently follows according to some law.
The author considers that there is at this time a normal period of
intellectual awakening following the physical and emotional dis¬
turbance at puberty.
The author analyses in detail the elements of conversion from
the histories before him. There is little evidence of conscious
exercise of the will. In the early “ conviction ” period of conver¬
sion, conscious following out of teaching is only mentioned in 7
per cent, of the cases, and the response to moral ideas in only 20
per cent., while external forces were recognised in 40 per cent.
An apparently spontaneous awakening is the most prominent
factor, and increases the evidence that the process is automatic.
The unconscious automatic element is especially marked in the
female cases, the conscious element being entirely absent in only 2
per cent, of the males as against 19 per cent, of the females, while
the conscious element is equal to the unconscious in only 19
per cent, of the females as against 36 per cent, of the males. Con¬
version is thus largely a process of “ unconscious cerebra¬
tion.” From the social and biological side the author describes it
as primarily an “ unselfing an awakening to the larger facts of the
world. Hence it is that conversion coincides with puberty, which
is a physiological awakening to the sexual existence of other
persons.
Starbuck finds, however, that the most interesting period from
the point of view of religious development is not so much puberty
as adolescence. Analysing more minutely a larger number of
cases in his second paper, the author finds that there is often more
than one period of awakening or religious stress in the same
individual. The charts show on this basis in boys a minor
rise in the curve at twelve, a steep climax at sixteen, and a third
minor rise at nineteen* while for girls the corresponding ages are
eleven, fifteen, and eighteen. A period of “ storm and stress ” is
found to be extremely common, since it occurs in 52 per cent, of
males and 7(1 per cent, females, beginning between sixteen and
seventeen in boys and between thirteen and fourteen in girls, and
lasting on an average in the former five and a half years, and in
the latter three years. Its manifestations in the two sexes are
widely different. In the girls it is shown by brooding, morbid
sensitiveness and fears, the feeling of imcompleteness, and a
struggle after the ideal. The boys work out their ideals from the
intellectual side, with a predominance of constructive and rational
elements. In the females there are often imperfect physical condi¬
tions and bad health. At the age of eighteen in males and fifteen
to sixteen in females begins a period of religious doubt, much
more marked in males, for only 10 per cent, of the females as
xl iv. 25
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376 Physiological Psychology Retrospect. [April,
against 37 per cent, of the males have an unemotional period of
doubt, so that adolescence is for the female primarily a period of
storm and stress, and for the male primarily a period of doubt.
On the whole, two thirds of both sexes tend at some period to rebel
against conventional religion. Between twenty and thirty, and on
the average at the age of twenty-four in both sexes, follows a period
of reconstruction. The great frequency of doubt and storm and
stress suggests to the author that these experiences may be the
result racially of a survival of the fittest in which the fittest is he
who wrestles in youth with the inextricable mesh of impulses that
spring up, and even pauses in despair while the deeper forces
of his nature are working themselves out into clearness and
harmony.”
Mr. Rutgers Marshall’s papers (“ The Function of Religious Ex¬
pression,” Mind , 1897) are on somewhat different lines, being on
the whole almost as much sociological as psychological, and having
little basis of fresh concrete fact; but they agree with those already
summarised in maintaining that religious phenomena have a real
basis in the organism, and perform a beueticial social function.
Thus he believes that religion acts beneficially by emphasising
instinct and repressing the over-influence of variations from typical
forms of action. The most interesting point in his exposition is
probably the very great importance and the very beneficial influence
which he attributes to religious hallucinations. They act, he
believes, by emphasising and sanctifyiug, as if with the authority
of some external and higher power, the restraining voice of the
social instincts within men. When states of ecstasy and catalepsy
are present these religious effects are, of course, emphasised still
further. But even “when hallucination is not accompanied by
such morbid conditions, we nevertheless have of necessity a
repression of reaction to environmental stimuli, and a concentration
of thought upon states of purely subjective origin.” Even when
processes, which when carried to extreme produce hallucinations,
are not carried to extreme, mental states similar to those accom¬
panying hallucinations will obtain ; “ consequently if any benefit
were ever connected with the attainment of these hallucinations,
the same benefit in less degree would be likely to be gained by
the person who followed the practices which often lead to
hallucinations,” whether or not he succeeded. Thus the “still
small voice of conscience ” is not altogether a metaphor.
By analysing various of the leading manifestations or expres¬
sions of religion, Marshall finds that they tend to produce the
suppression of individualistic reaction, leading us to listen to the
guiding voices within us, and that if carried to extremes they
mostly tend to the production of true hallucinations. The pheno¬
mena he thus deals with are (1) seclusion, (2) fasting, and (3)
torture; (4) initiatory rites; (5) prayer—not productive of hallu¬
cinations, but subsidiary, since leading to an attitude in which the
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377
1898.] Physiological Psychology Retrospect .
inner voice may best be heard; (6) sacrifice—also useful in estab¬
lishing an attitude of mental submission and subordination; (7)
celibacy ; and (8) pilgrimages. Marshall finds that these religious
customs “are all tools, so to speak, which nature has used to
enforce restraint; and I wish to emphasise the fact that this
restraint is of the very core and essence of religious functioning.”
Altogether a very acute and suggestive study, and useful in
reminding those of us whose familiarity with morbid mental phe¬
nomena is apt to breed contempt, that such phenomena have played
a lofty and perhaps even useful part in the moral evolution of the
race.
Researches upon School Children. —Dr. Allen Gilbert, well known
in connection with experiments on loss of sleep, has recently been
appointed Assistant Professor of Psychology at the University of
Iowa; and in collaboration with Professor Patrick he has just issued
from the University vol. i (1897) of a series of Studies in Psycho¬
logy (similar to those issued by Dr. Scripture from Yale), which
will be of considerable value should the high level of the first
volume be maintained.
The chief study in this first volume is by Dr. Gilbert himself,
“ Researches upon School Children and College Students,” in con¬
tinuation of similar researches already published in the Yale
Studies. The data were in this case taken from Iowa, and the in¬
vestigation has occupied two years. The subjects were nearly
1500 in number, and were fairly equally distributed as regards sex
and age between six years and nineteen years. The tests cover
(1) pulse before and after the series of tests ; (2) pain threshold;
(3) strength of lift with wrist; (4) strength of lift with arms;
(5) estimation of length by arm movement; (6) estimation of
length with the eye; (7) lung capacity; (8) weight; (9) height;
(10) voluntary motor ability ; (11) fatigue. The results are made
clear by twenty-seven charts, boys and girls being in every case
shown separately. Reference may be made to a few of these
results. The tests for the pain threshold were notable on account
of the care with which certain fallacies, usually neglected, were
avoided. The apparatus, which the authors call the balance algo-
meter, was constructed from a balance scale with an arrangement
on one scalepan so adjusted as to push the finger-nail against a
stationary bracket when the opposite scale was pressed down. It
was found that there is a definite point at which pressure on the
nail becomes pain. Care was taken to measure the time with a
metronome, while the fact that pressure was brought to bear on the
nail instead of on the flesh of the finger obviates the errors due to
callosity of the finger. Boys are less sensitive to the test than
girls throughout, and, as a rule, there is a gradual decrease of
sensibility from six to nineteen. Girls reach nearly the minimum
of sensibility by the time they are thirteen, while for the boys that
age marks the point at which the most rapid falling off in 6ensi-
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378 Physiological Psychology Retrospect. [April,
tiveness seems to begin, and at nineteen there is a very consider¬
able difference between the sexes.
As regards wrist-lift, the same dividing point in the rapidity of
development was found at fourteen in both sexes, boys having a
greater strength than girls at all ages, but by the age of nineteen
a boy being able to lift twice as much as a girl. Much the same
result was found as regards the power of lifting with the arms.
The accuracy with which space is judged in terras of movement
by the arm with closed eyes, after having first been estimated by
the eve, increases with age. The tendency is nearly always to
under-estimate the distance. Boys are less accurate than girls from
six to ten years of age, after that boys are more accurate. The esti¬
mation of length by sight (the subject being asked to estimate in
inches the distance of two lines) increases very rapidly from six to
eleven, more rapidly in boys than in girls. Boys are throughout
more accurate than girls, except at the ages of six and fourteen.
Up to the age of fifteen the distance is always judged shorter than
it really is ; between fifteen and sixteen is the most accurate age ;
after that there is a tendency to over-estimate the distance, this
being due to an attempt to measure the space inch by inch instead
of as a whole.
In height and weight the boys, according to the normal rule,
take the lead until the age of eleven, when the order is reversed until
the age of fourteen ; the boys then again take the lead. In volun¬
tary motor ability (the number of taps on a key finger-board made
in five seconds) the girls come first from six to nine; from that
age onwards the boys tap faster. Fatigue in tapping decreases
with age, and in the girls less than in the boys.
The pulse-rate was, as a rule, raised after the tests, as would be
expected. Except at the age of six the boy’s pulse is slower than
the girl’s till between ten and eleven, faster from then till between
thii teeu and fourteen, and then slower again. “ The data point
very distinctly to an acceleration of the pulse during the age of
puberty for both sexes, both in the curves for normal pulse and
pulse subsequent to fatigue. The effect of puberty seems more
marked for boys than for girls.”
One of the chief aims of these tests was to discover their
relationship to mental ability. The record cards for each case,
after the tests were completed, were sent to the teachers to be
marked (1) bright, (2) average, or (3) dull; so far as pos¬
sible mere examination standards being avoided. For most of
the tests it was found that there was no relationship to mental
ability. Certain points came out, however, in regard to some of
the tests. The bright subjects are generally better able to estimate
length by sight than the others. In opposition to Porter, there
was no reason to suppose the tall and heavy children the brightest,
from ten to fourteeu the dull ehildreu being much the heavier.
During the age of rapid growth (ten to fifteen) the dull children
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1898.]
. Physiological Psychology Retrospect .
379
have also the largest lung capacity, but before and after there is
no such distinction. Bright subjects tap much faster than dull
ones; they also lose more in the rate of tapping, owing to the fatigue
induced.
On the whole, Dr. Gilbert has made a careful and valuable con¬
tribution to the psychology of childhood and youth, a subject
which, as we are beginning to recognise, is important from more
than one point of view.
Involuntary Movement .—This subject, which had previously
attracted the attention of Strieker, Lehmann, Fer6, and Jastrow,
has recently been studied on a large scale, and with considerable
precision, in the Psychological Laboratory of Leland Stanford,
jun., University, California, by Milo Asem Tucker ( Amer . Journ .
Psychology , vol. viii, No. 3, 1897). The apparatus used was
practically the same as Jastrow’s automatograph, which has
been described in this Betrospect in previous years, and the experi¬
ments were made on over 1000 adults and children, who were
always ignorant of the precise object of the experiments. The
movements were generally unconscious, and only those that could
fairly be called involuntary were counted.
Jastrow had reached the conclusion that there is a tendency to
move towards a stationary object on which the attention is
directed. He had not, however, determined what was the spon¬
taneous tendency of the hands to move in any direction. Tucker
find8 that there is a normal physiological tendency for the hands
and arras resting in frout of the body to move inward towards the
median plane of the body, and that there is no certainty that when
we see an object at rest we tend to move towards it, the idea of
motion being necessary to cause movement in that direction.
Tucker admits, however, that his experiments “ would indicate
that the whole body moves when we think, though of course
almost imperceptibly,” and even refers, as a further illustration,
to the tendency of the amateur bicyclist to be drawn towards
a stationary obstacle in his path. In adults the majority of
spontaneous movements of the hand (the mind being kept
occupied) were forward, in children backward; there were few
differences between the right and left hands. Adults are much
more direct in their movements than children. No sex differences
were discovered.
In testing the influence of motion on involuntary muscular
movements of the hand a bottle was drawn along by a string. It
was found that 88 per cent, adults and 81 per cent, children
imitate the movement. After seeing the moving object the subject
was asked to close the eyes and think of the moving object; in
nearly every case the motion was imitated. In some cases the
whole body was called into corresponding action.
On the whole these experiments go to support the views
(hitherto resting on a very small basis of fact) of F6r6 and
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Google
380
Physiological Psychology Retrospect . [April,
Lehmann. A number of interesting traces from the automato-
graph accompany the paper.
A somewhat allied investigation has recently been carried on in
Harvard, under the superintendence of Professor Delabarre, by
Mr. Dearborn and Mr. Spindler (“ Involuntary Motor Reaction to
Pleasant and Unpleasant Stimuli,” Psychological Review , Sep¬
tember, 1897). Miinsterberg believes that stimuli which cause
action of the extensor muscles are as a rule agreeable, while
stimuli which cause action of the flexors are as a rule disagreeable.
The object of this investigation was to test the validity of
Munsterberg’s view.
The emotional stimuli chiefly used were odours, and, to a less
extent, sounds and variously coloured lights. The subjects were
numerous, and the stimuli were repeated several times with each
subject; it was sought to give as purely painful or pleasurable an
effect as possible. The odours employed (in the order of agree¬
ableness to the majority of subjects) were oil of bergamot, can de
Cologne , heliotrope, methyl acetate, oil of cloves, tincture of musk,
ethyl iodide, spirits of turpentine, xylol, eugeuol, oil of eucalyptus,
iodoform, cider vinegar, bisulphide of carbon, ethyl bomeol and
camphor, sulphuric ether, toluidin, allyl alcohol, tincture of
asafoetida, diamylamine, acetic acid, ammonium valerianate. A
few subjects found none of these odours painful, and for these
ammonia was substituted for a real odour; the hands and head
vere chosen for reaction. According to Munsterberg’s theory the
lands should relax and the head drop back under agreeable
stimulation, while disagreeable stimuli should cause the hands to
contract and the head to drop forward. A pasteboard cap was
fitted tightly to the head and connected with a Marey's tambour,
and a sponge and india-rubber bulb was held in the left hand, a
somewhat different apparatus being applied to the second and
third fingers of the right hand. There were 764 reactions to
stimuli; in 253 cases stimuli were applied without any motor
reaction.
Under pleasant stimulation there were 67 per cent, of movements
of extension and 32 per cent, of flexion, a proportion of more than
two to one: the hands and head did not necessarily move together.
“ The left hand seems much more sensitive and more given to
expressing motor reaction than the right; and as our subjects were
mostly right-handed, it would seem justifiable to infer from this
that the right hand is more civilised and more under control and
less naively expressive than the left.” (In Tucker’s experiments
there was a very slightly greater range of involuntary movement in
the left hand.) The percentage of no reactions is much less for
the left hand, and there was also a greater proportion of extensions,
as compared to flexions, in the left hand’s reactions. The tendency
of the head to extend was in some degree counterbalanced by a
tendency to move towards the pleasant stimulus.
Digitized by L^ooQle
1898.]
Physiological Psychology Retrospect .
381
In the same way, under unpleasant stimulation, the tendency of
the head to droop forward was to a considerable degree balanced,
by a tendency to draw back from the unpleasant stimulus, though
flexion still predominated. In the hands flexion was more marked,
78 per cent, of the movements of the left hand and 69 per cent, of
the movements of the right hand being flexions. The left hand
here, again, showed a greater readiness to respond.
Under indifferent stimuli the left hand still reacted more than
the right. Here flexion and extension were nearly equal, with a
slight balance in favour of extension.
Various temperamental differences were observed. On the whole,
these interesting experiments distinctly confirm Munsterberg’s
views.
The Physiology of Exaltation and Depression .—Dr. G. Dumas,
whose investigations of emotional states in insanity are well known,
has lately endeavoured to carry further the work of Johnson
Smyth (published in this Journal) with regard to the state of the
blood in insanity (“ Recherches experimentales sur 1’Excitation et
la Depression,*’ Revue Philosophique , June, 1897). While accept¬
ing Johnson Smyth’s general result that the number of corpuscles
in the insane is always below the normal, Dumas criticises the
method of averages employed by that investigator, pointing out
that the number of corpuscles varies with age, temperament, time
of day, &c.; and also that every form of insanity includes minor
divisions. He has himself always followed an individual method,—
that is to say, instead of comparing one individual with another he
compares him with himself; instead of counting the corpuscles of
several subjects who seem to be in a similar condition, he counts
the corpuscles of the same subject in different states of exaltation
and depression, thus comparing the individual only with his own
average. To illustrate the importance of this he refers to a general
paralytic whose pulse, in a state of depression, he was surprised to
find at 90; but a few days later, when in a state of exaltation, the
same patient’s pulse was 120, so that this pulse in depression,
though apparently fast, was really slowed.
Dumas starts from the physiological fact that vaso-dilatation is
accompanied by a decrease of corpuscles, and vaso-contraction by
an increase. If, as Lange believes, exaltation is accompanied by
vaso-dilatation, and depression by vaso-contraction, there ought in
the same individual to be more corpuscles during depression than
during exaltation. Dumas proceeded to verify this hypothesis
(using Hagen’s instrument) on cases of circular insanity.
The first was a woman 33 years of age, with alternate periods of
excitement lasting twelve days, and depression lasting on an
average sixteen. Twenty experiments failed to give the expected
results ; on the contrary, the average during depression was some¬
what lower than during exaltation. He then decided to make daily
examinations, and this was done during two months with instruc-
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382
■Physiological Psychology Retrospect. [April,
tive results. It became clear that a period of exaltation was always
initiated by a decrease of corpuscles (so that the psychic change
could even be foretold before the patient herself was aware of it),
and that a period of depression was initiated by a rise in the
number of corpuscles. But these rises and fails were never main¬
tained beyond tbe first day, being then slowlv reversed. Thus the
average during each period altogether failed to indicate the con¬
ditions which ushered in that period.
The next subject was a man 37 years of age, who had at first been
regarded as a melancholiac, but was now found to be a geueral
paralytic. He presented curious daily alternations of exaltation
and depression, each lasting twenty-four hours. In this case it
was found that there was a sudden increase of corpuscles accom¬
panying depression, and a sudden decrease accompanying excite¬
ment. appearing with great regularity, and on account of the
brevity of the period not followed by any reaction.
In order to verify these observations on a normal subject, Dumas
carried on a series of experiments on himself. He is always
physically and mentally depressed on awakening in tbe morning,
with cold hands, pulse at 54, and low tension, requiring tonics to
work, while in the eveniug the hands are almost feverishly hot aud
the pulse tension high. He invariably found that the corpuscles
were increased in the morning, the average difference being as
much as 850,000.
It will be seen that on the whole this investigation conhrms the
The Psychology of Laughter .—Professor Stanley Hall, whose
interestiug study of fears among normal children and adults was
noticed in the Retrospect last year, has now carried out a similar
study on the phenomena of laughter (G. S. Hall and Arthur Allin,
“ The Psychology of Tickling, Laughing, and the Comic,” Amer.
Joum. Psych ., vol. ix, No. 1, 1897). A very full and elaborate
syllabus of questions—the precise answering of which, it may
seriously be said, would be scarcely a laughing matter—was issued,
and answers received from or concerning nearly 3000 people. It
is on these answers that this study of the phenomena of tickling
and laughing—their manifestation, causes, and significance—is
founded. The description of the phenomena and their varieties is
very detailed ; in seventy-one cases laughter begins with the eyes,
in fifty-one with the mouth. As to body movements, about two-
thirds assert that the shoulders, one-third that the diaphragm first
moves. In exceptional cases there is no feature or movement that
may not be the first symptom or aura of a laugh. Tbe description
of the various convulsive and uncontrollable muscular phenomena
of laughter leads to the conclusion that, “on the whole, the laugh
is not unlike an epilepsy, from the aura, at which stage it may be
checked, to the subsequent exhaustion.” Laughter is connected
Digitized by Le
1898.] Physiological Psychology Retrospect. 383
with the remission of arterial tension ; the authors suggest that the
characteristic attitude of the laugher favours this process.
Mauy instances are giveu of those paradoxical cases in which grief
ea uses laughter, and reference made to the case of the frontier
man who, returning home to find his wife and childr^i murdered
by Indians, burst out laughing until he died from a ruptured
blood-vessel. An uncontrollable tendency to laugh wheu grieved,
or in the presence of grief, is fairly common among young girls.
The authors consider that the net of physical tickling is
fundamental to a proper understanding of laughter, and their
returns cover the phenomena of tickling Various facts are brought
forward in support of this position, especially the actions of children,
and their “ deep impulse to fuss with the skin.” The strange sen¬
sitiveness to minimal tactile impressions all over the skin, which
has never been explained, and which reverses the psycho-physic
law, the authors are inclined to regard as very primitive, repre¬
senting “ the very oldest structure of psychic life in the soul,” and
being reminiscent of “ the primal vigour and spontaneity of the
dawn of psychic life, and especially of sight and hearing.” They
also refer to the great influence which parasites have probably had,
and to the connection between ticklishness and the sexual emotions.
(Vasey maintained that children would never learn to laugh if
they were not. physically tickled, especially in forbidden places.)
The paper is full of admirable suggestions which cannot be sum¬
marised without injustice, and the authors conclude with the broad
statement, “ While we cannot agree with Hughlings Jackson’s con¬
ception of fear as broken-down anger, it is possible that aesthetic
pleasures generally, genetically considered, and even some of the
joys of religion and virtue, are laughter diffused, tempered, pro¬
perly alloyed with pain, and minted for general circulation through
all our psychic activities.”
The Origin of Number-forms .—The “number-form,” as first
named and described by Galton, is related to the same group of
phenomena as coloured hearing, and its character is such that
when a number is thought of it invariably appears to the
mind’s eye in the same place in a visual diagram, which is usually
an irregular composition of lines. It has lately been investigated
afresh by Mr. D. E. Phillips, of Clark University, whose inquiries
extended to 974 school children of Worcester, Mass., and 343 mis¬
cellaneous adults, the sexes being about equally divided (“Genesis
of Number-forms,” Amer. Joum . of Psychology , vol. viii, No. 4,
1897). Nearly 7 per cent, of the males and nearly 8 per cent, of
the females were found to have such number-forms, and thirty-five
of these forms are diagrammatically represented. The number-
form appears very early; of 280 persons who answered the question
as to when the form first appeared, 241 could not remember when
it did not exist, and most of the remainder placed it at a very early
age. Phillips even finds, to his surprise, that there is some reason
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384
Physiological Psychology Retrospect . [April,
to believe that the form appears before the power to recognise
written or printed figures; at the same time a period of gradual
formation and development is often evident. Unlike Galton, he
does not find the number-form specially common among imagina¬
tive persons.
The author attempts to suggest an explanation of the origin of
these forms. It appears certain, he says, that sucli visual dia¬
grams are only less ordinary examples from a much wider field of
mental phenomena. He finds that most people who deny that
they have any number-form (210 of 250 adults examined) will
still discover that they “ have a feeling that numbers in some way
recede from them.” Nearly all persons, he believes, possess some
idea of extension of numbers, more or less definite. We see here
the dominance of the eye over the other senses. The saying of
Sylvester is recalled, “ Every time I go deep enough I find a geo¬
metrical bottom.” The explanation of the genesis of the number-
form is to be found in the motor and space element in thought.
Researches on Reaction-time .—The fourth volume (for 1896,
but not issued until February, 1898) of Dr. Scripture’s Studies
from the Yale Psychological Laboratory , contains two interesting
investigations on reaction-time. One, by Dr. Scripture himself,
deals with various experimental modifications of reaction-time.
Thus the influence of a constant electric current through the head
was investigated. The city supply was used as a source of current;
it was passed through an Edelmann milliainperemeter. The tests
for the effects of the current were, for simple reaction-time, pres¬
sure on knob, when shutter of Scripture’s pendulum chronoscope
exposed a coloured disc; for complex reaction-time one of two
colours was exposed, the subject being required to react only to
one. Experiments on five subjects showed almost constant
quickening of both simple and complex times under the stimulus
of the electric current. It was also the general testimony of the
subjects that there was a decided feeling of refreshment after the
experiment; only one subject, to whom a high current of nine
milliamperes was used, complained of vertigo, double vision, and
peculiar metallic taste;
The influence of visual fatigue was also investigated, the fatigue
being produced by a small Geissler tube connected with a spark-coil
in the adjoining room. The experiments were continued for a long
time, records being taken a number of times at the beginning, and
then a number of times at tbe end. The room was dark and
silent. Observation was made not only on the reaction-time, but
also (though the subject was unaware of this) on the time of hold¬
ing down the key. Reaction-time and holding-down time were
both increased, and the subject felt a strong sense of contraction
between the eyes, and the necessity for great effort in fixing atten¬
tion on the tube. One eye was then bandaged, in order to some
extent to eliminate convergence, and the subjective effects were
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Physiological Psychology Retrospect .
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increased, the subject feeling stiff, fatigued, and as if floating away
or dropping to sleep, thus closely approaching the hypnotic state.
Then the room was lighted up to eliminate accommodation, the
result apparently showing that fatigue of attention alone pro¬
duces very little lengthening, though the holding-down time is
lengthened, showing a tendency to fall asleep. The total results
seem to show that fatigue in reaction-time increases with com¬
plexity of the adjustments required for perceiving the stimulus,
most fatigue being produced when attention, convergence, and
accommodation were all involved. The tendency of the subject to
fall into a state of doze, as indicated by the holding-down time,
depends on repetition of the stimulus (? fatigue of attention) as
well as fatigue from the adjustments. These results bear on the
common methods of hypnosis.
In another series of experiments, carried out on cats, comparison
was made between simple reaction-time and direct stimulation of
the cortex. We may notice first the remarkably quick reaction of
the cat to moderate electric shock (the cat registering reaction by
breaking circuit through withdrawing leg or head) ; for the right
fore-foot it was as quick as 41 a -; in a dog twice as large it was
89 (7, while in human beings it is rarely less than 100 a■. A large
cat was quicker than a small cat, but in both the hind foot was
slower than the fore-foot, a result analogous to that found in man.
Under ether (before operation) there was no reaction, except for
the retrahens aurem muscle; the temporal muscle, when exposed,
responded. The reactions produced by direct stimulation of the
cortex were very slow, this retardation being evidently due to
ether. Scripture considers that there is a large field for experi¬
ments on animals, and that the methods of experimental psy¬
chology will lead to a new quantitative science of comparative
psychology.
The same volume contains a study by Dr. A. G. Nadler on
Reaction-time in Abnormal Conditions of the Nervous System/’
which may also be summarised in this connection. Four types of
diseased nervous system were selected: neuritis, hysteria, locomotor
ataxy and allied conditions, alcoholism. Over fifty subjects, taken
from the University Clinic, were examined for simple and complex
reaction, tested as in the study already referred to. In classifying
the results the median was used instead of the average.
In the neuritis group—local neuroses of branches of the brachial
plexus due to traumatic or toxic causes—it was found, as might be
anticipated, that the reaction-time was materially lengthened, and
that when one arm only was affected reaction was longer in the
diseased arm.
In the group of locomotor ataxy and multiple neuritis simple
reaction-time was markedly long, longer in those affected by multiple
neuritis than in the tabetic patients. Thought-times were long
also, but more so in the tabetic cases. There was an astonishing
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regularity of simple reactions in the locomotor ataxy cases, as
shown by smallness of mean variations, and this the author regards
as inexplicable.
The alcoholic cases were men who had drunk enormously during
their lives, who had just been on a “ bout ” for some days, and
were on the verge of delirium tremens. Their minds, however,
were clear and active; they were acutely anxious about their con¬
dition, unable to sleep, and utterly worn out. It is, however, rather
surprising to find that the simple reaction-times in this group were
even shorter than in any series of experiments performed on
healthy persons at Yale; the complex times, however, were longer.
After treatment there was a general decrease, making simple
reaction-time less than the normal, and complex time about normal.
“These results,” Nadler remarks, “appear to show that the effect
of the alcoholic toxine upon the individual is to heighten the
power to perform simple regular movements, but that when a judg¬
ment is needed the individual is at a disadvantage.”
In the hysteria group the reaction-times were very erratic; that,
indeed, was their chief feature, for while the median for simple
reaction-time was almost normal, the mean variation was extremely
large. Complex time was much above normal; the subjects had
great difficulty in concentrating their attention, and were con¬
stantly forgetting what they were attempting to do. One subject
could not refrain from reacting to every fall of the shutter, re¬
gardless of the colour it showed, so that no record could be
obtained from her.
AMERICAN RETROSPECT.
By Dr. C. Hubert Bond.
Cerebral Diplegia of the Family Type. —Under this name Dr. F.
X. Dereum describes ( Journ. Nerv. and Ment. Disease, July, 1897)
an affection attacking three children out of a family of four. Each
of the three affected children was born apparently healthy, and
developed normally up to a certain period,—sixteen months in
the case of the eldest, to four years in the next, and to two years
in the third. Cessation of normal development in the first child
followed upon a severe general convulsion, upon an attack of
measles hi the case of the other two. Each then became dull and
stupid, the eldest now being quite idiotic, and each became the
subject of marked spastic diplegia and epilepsy, the latter assuming
the character of petit mal. All three children now present the
tumid, sodden features so often associated with epilepsy. The
reflexes are exaggerated wherever the contractures and rigidity do
not interfere with their being tested. In neither case was there
nystagmus, but in the eldest, athetoid movements of the hands may
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American Retrospect .
387
be sometimes noticed. The remaining child, the second in age,
now nine and a half years old, possesses good physical health, and
his intelligence is up to the average, even somewhat above it, but
it is noteworthy that he has not been attacked by any of the exan¬
themata, .nor has he had auy serious illness. As regards the
family history, that on the father’s side was negative, and this is
emphasised by the fact that the mother of these children was his
third wife, and that his numerous progeny by the first and second
wives were all normal. But there is a history of the child of one
of the paternal aunts of the mother being paralysed—she thinks
in a manner similar to that of her own children. Thus it would
appear that these children present a feebleness of development on
the part of the neurons of the motor area; and that, while they
possessed the power of developing in a normal manner so long as
not subjected to any malific influence, their vulnerability was so
great that they underwent degenerative changes from very slight
causes. To a certain extent these cases may be , regarded as
analogues of Friedreich’s ataxia.
Varieties of Brain-cell Degeneration. —In the Joum. of Nerv.
and Ment. Disease , August, 1897, is an account of a paper
by Dr. C. L. Dana, embodying the results of two years*
study of anatomical changes in the brain-cells in acute
alcoholism. Ten cases are reported, and Nissl’s stain was
the chief method employed. What was known as acute alcoholic
meningitis would appear not to be really a meningitis at all, despite
the fact of a distinct clinical course of meningitis, nor usually
would the microscope show any migration of leucocytes or evidence
of encephalitis. Alcoholic meningitis is not primarily a vascular
disorder, but a slow poisoning, and therefore required a study of
the nerve-cell. He would combat the statement made by some,
that it was not possible to make any differentiation of cell-
degenerations according to the pathological irritant concerned.
Death from sunstroke with pyrexia and acute delirium yielded
a distinct form, namely, sudden and general pigmentation,
especially of the larger cells; while another and distinct form,
involving the smaller cells as well, could be found in pernicious
anaemia. He would describe three varieties of cell-degeneration:
(1) intense pigmentation of the larger cells chiefly, with degenera¬
tion of the cytoplasm ; (2) a general cell-atrophy of the body and
nucleus; and (3) a good deal of change in the cell-body, with
many neuroglia nuclei in the pericellular spaces. No definite type
of cell-degeneration, he said, could be made out in alcoholic cases,
probably because the mode of death was by auto-toxsemia and
pyrexia.
Hydrocephalus in Adult Life. —A report, by Dr. M. Prince, of
three cases—two followed by autopsy—together with a summary
of the chief facts known of the subject (gathered mainly from
Quincke’s monographs), appears in the August number of the
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American Retrospect.
[April,
Journ. of Nerv. and Ment. Disease. The writer believes that the
disease occurs much more frequently than it is diagnosed. Men¬
tion is made of the vagueness and uncertainty which at present sur¬
round the subject, and of the inexact picture that is usually
given of the affection. That it is of an inflammatory nature is a
question much open to doubt. His first case was that of a woman,
in whom the symptoms came on apparently in direct relation to
severe injury to the head; but it should be stated that before this
she had had “ freaks of leaving home suddenly without apparent
reason, and returning after some time.” In analysing her sym¬
ptoms he divides them into general —irregular fever, slight chills,
headache, vomiting, stupor, delirium ; and local —cervical rigidity,
tenderness and pain, paralysis of the right, third, and sixth
nerves, paralysis of both pupils, retracted abdomen, mild rigidity
of the biceps muscle of both arms, localised spasms, temporary
weakness of the right seventh nerve. The local symptoms were
not manifest until the fourth week, and up to that time the case
was not necessarily cerebral. Special emphasis is laid upon the
great variability in the intensity of the general symptoms. An
abscess, possibly in the cerebellum or temporo-sphenoidal lobe,
was diagnosed and explored for. Death occurred the third day
after the operation.
At the autopsy the skull was free from injury, while the brain
at the vertex showed flattening of the convolutions with complete
obliteration of the sulci, and was abnormally elastic. The vessels
at the base were normal, but here there was au excess of cerebro¬
spinal fluid ; there was no pus anywhere. The lateral ventricles
were dilated to treble their usual size with clear fluid, and their
ependyma was pale, velvety, and sodden. In the second case, a
pronounced neurasthenic, the symptoms followed upon her second
confinement. Of these the most prominent were “ delirium,
stupor, coma, and dementia,—the last simulating, as was thought
at one time, general paralysis ; chills and fever at first, later
normal and subnormal temperature, rapid, followed by slow pulse ;
abdominal pain and tenderness and cervical pains ; severe head¬
ache (she at one time said, “ I believe my head will burst”);
nausea and vomiting ; optic neuritis ; muscular weakness, but no
paralysis or anaesthesia.” Changes in intensity of many of these
symptoms were again noticed ; some would disappear and reappear.
After death the brain presented much the same appearances as in
the previous case, but it was the fourth ventricle that showed the
greatest distension. The ependyma, however, was smooth and shiny,
and microscopically yielded no changes except a slight increase of
the neuroglia beneath it, and no inflammatory appearances. The
third case had a very sudden onset, and there was nothing with
which it could definitely be connected. She gradually recovered,
and therefore the positive evidence in the two prior cases is lacking,
but it seemed to the writer that no other diagnosis was possible.
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1898.]
American Retrospect.
389
The fundamental conception, be says, would seem, then, to be that
a meningitis, especially an ependymitis, may give rise to a simple
serous effusion as well as a purulent one. It may occur at all
ages, aud trauma, mental strain, alcoholism, otitis media, and
acute infectious diseases may be regarded as the chief causes. It
may be acute or chronic,—the former simulating tubercular menin¬
gitis, while the latter is frequently confounded with the presence
of a tumour. The morbid anatomy is mostly limited to the accu¬
mulation within the ventricles of clear fluid, containing little or
no albumen or cellular elements, resulting sometimes in enormous
distension of the ventricles, flattening of the convolutions, and
obliteration of the sulci. The sudden development and the vari¬
ability of tension, he says, are rendered intelligible by Quincke’s
analogy, where he likens the affection to angio-neurotic acute
oedema of the skin.
Katatonia. —A paper read by Dr. F. Peterson, and based upon
four examples of this disease, is reported in the Journ. ofNerv. and
Ment. Disease , September, 1897. He pointed out how contradictory
are the descriptions of the affection : some hold that it is a clinical
entity, some describe it as a variety of melancholia, while others
would term it as a form of alternating insanity, others yet again
as a species of hysteria. His conclusions were—“ (1) That kata¬
tonia is not a distinct form of insanity; (2) that it has no true
cyclical character in its manifestations, and hence cannot be classed
as a form of circular insanity; (3) it is simply a type of melan¬
cholia, and it is therefore not desirable to retain the name.”
Katatonic melancholia would be a conveniently descriptive term.
Its prognosis, in his opinion, was graver than in any other form of
melancholia.
THERAPEUTIC RETROSPECT.
By Dr. Harrington Sainsbury.
8permin(PoehVs). Deutsche med. Wochenschr., October 7th, 1897.
—Twocasesof tabes, treated with injections of Poehl’s spermin,
are recorded by Dr. M. Werbitzky from Professor PopofFs Clinique
in St. Petersburg. The first case is most typical of tabes. It
occurred in a soldier of 60 years of age, and as a result of the
injections, ten in all, very marked improvement set in. The im¬
provement was noted in the gait and posture, as also in the pains,
and in the skin perception of sensations—tactile, electric, and other.
The second case, not so typical, received fourteen injections. In
him it was' noted that there was improvement in the sense of well¬
being, in the sensitiveness of the skin to stimuli of all kinds, in the
ataxy, and in the muscular power. The amount of the injections is
unfortunately not stated.
Anesine , a new substitute for Cocaine. Deutsch . med. Wochen-
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Therapeutic Retrospect.
[April,
8chr. t September 2nd, 1897.—Dr. V. Vamossv draws attention
to a new compound, trichlor-pseudo-butylalcohol, alias acetone-
chloroform. He points out that whilst c »caine is of the greatest
value as a local anaesthetic, it possesses general poisonous action,
and local after-effects which are by no means desirable ; hence
the introduction of such substitutes as tropacocaine, eucaine,
holocaiue, but all these come very far behind cocaiue as local
benumbers, and, moreover, they are poisonous, though to a less
extent. Of anesine Dr. Yamossy employs, as highest strength, a
1 to 2 per cent, solution, and this, from experiments upon animals,
as also from results obtained by his colleagues in medicine, surgery,
and dentistry, ho fiuds to be a very decided anaesthetic. In degree
of action it about corresponds with a 2 per cent, solution of cocaine,
but it cannot compare with the higher solution strengths of cocaine
on account of its own insolubility. In surgery the drug was em¬
ployed always hypodermically, and in quantities which ranged
between 1 to 10 Pravtiz syringefuls of the above solution, yet in
no case were any toxic symptoms observed. Its harmlessness is
insisted upon also by the workers in the throat and nose depart¬
ment, also in the ophthalmic and dental departments. Among
minor advantages it may be mentioned that anesine does not cause
salivation when painted on the throat, an effect which often proves
very troublesome when cocaine is used. Anesine may be obtained
from the chemical manufactory of F. Hoffmann, La Roche, et Cie.,
in Bale.
Kryofin. Deutsche med. Wochenschr ., November 4tli, 1897.
Beilage.—Dr. Schreiber describes, under the above name, the
characters and action of a new antipyretic and analgesic. In com¬
position it is a benzene derivative, and it approaches closely to
phenacetine in its composition; in place of the acetic grouping we
have a corresponding one of me thy 1-gly collie acid.
Kryofin is soluble in 52 parts of boiling water, in 600 parts of
cold water; it dissolves in alcohol, ether, chloroform, fixed oils,
and in glycerine.
Uj'on animals the effects of kryofin in toxic dose are paralytic,
and, in addition, the respiration and pulse rates are much reduced
in frequency ; the kidneys have not appeared to suffer. In man,
though very large doses up to 80 graius were in general borne
without unpleasant sensations, yet occasionally doses over 15
grains would cause a cyanosis, with retarded breathing and pulse
rates, the effects lasting perhaps for hours.
The dosage recommended is 0*5—1 gramme; at the most 2
grammes (30 grains) were administered in the twenty-four hours.
As an antipyretic Kryofin gave fairly definite results, but
secondary effects were not wanting. In one case a profuse sweating,
in another case severe collapse (both of these cases were of advanced
phthisis). In other cases the patients would sometimes complain
of feeling ill.
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Therapeutic Retrospect .
391
Kryofin proved its powers in headaches, even in those of uraemia
and of cerebral syphilis with periostitis, but it did not seem to
possess any advantage over antipyrin.
On the whole, as far as present experiments have gone there
seems to be no distinct reason why it should supersede antipyrin
and phenacetine.
Phesin and Cosaprin. —Two new drugs, derivatives respectively
of phenacetin and antifebrin, are reported under the above names
by Drs. v. Yamossy and Fenyvessy in the Therapeutisch. Monatsh.,
August, 1897. Their experience is at present confined to the action
upon auimals, but the drugs are upon trial clinically in some of the
hospital wards in Budapest. At this stage of proceedings the in¬
vestigators draw attention to the marked antipyreticuction of both
preparations, which action suggests that they might well be used
as substitutes for phenacetin aud antifebrin. They further point
to the following advantages which the drugs present, viz.: (1) Their
ready solubility, which permits of a readier administration by the
mouth, and their use, if need be, hypodermically. (2) Their speedy
action—they take effect very quickly. (3) Their relative inno¬
cuousness. As a disadvantage they state that the effect is rela¬
tively transitory; this, however, they suggest might be got over
by a more frequent smaller dosage. Drugs of this class, as we
know, combine antipyretic with analgesic effects, and they are
mentioned here for this reason.
Lactophenin. Therap. Monatshefte , September, 1897.—Dr. Wefers
reports a case of poisoning by lactophenin. A vigorous young lady
received 7£ grains of lactophenin on account of headache (she
had on previous occasions taken 12 grains of phenacetin with
success, and without any bad effects) ; about twenty minutes after¬
wards she suddenly ceased speaking in the midst of conversation,
looked bewildered, and grew very red in the face. She gave no
immediate respouse when addressed, then said that she had expe¬
rienced so severe an attack of giddiness that she could hardly
keep upright; the pulse was quickened, intermittent, of moderate
tension.
Graves' Disease , Treatment of. Wiener medizinische Wochenschr. f
1897, September 4th, p. 1672.—At the Kongress fur innere
Medizin, held in Berlin in June of last year, Dr. Eulenburg, deal¬
ing with Graves’ disease, drew attention to the symptomatic growth
of this disease from that earlier stage when palpitation, thyroid
enlargement, and exophthalmos summed up its clinical aspects.
The addition of the eye symptoms of v. Graefe, Stellwag, and
Moebius, of Marie’s tremor, of the diminished resistance of the
skin to the galvanic current, described first by Romain, Vigouroux,
and Charcot, of the alimentary form of glycosuria, frequent, as
shown by Chrostek, and lastly, of the large group of symptoms
which belong to the neurasthenic or neurotic type,—these additions
have served to build up a disease of considerable complexity.
xliv. 26
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Therapeutic Retrospect.
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Three theories have arisen to explain the symptoms, viz. the
hsemogenic, the nervous, and the thyroid secretion hypotheses.
Not one of these covers the ground quite satisfactorily, and we
find that methods of treatment based on each one of these theories,
or on a combination of more than one, sometimes succeed, some¬
times fail.
Thus the hsemogenic theory finds its corroboration in the ad¬
mitted occasional success of tonics and of medicines regarded as
builders up of the blood. Here also belong certain dietetic and
climatic treatments (in particular prolonged stay at high altitudes,
even during the winter); also hydropathic methods of cure.
The neurogenic theory is indicated by the value of electric treat¬
ment, and more recently by the success obtained by psychical
methods.
The more modern “ thyreogenic” theory has led up to thy-
rectomy and the use of thyroid preparations. Concerning these
last, Dr. Eulenburg says that the best that can be said of the use
of thyroid preparations is that if given circumspectly they do not
appear to do harm. Of the operation of thyrectomy he says that,
in spite of its laudation by many surgeons, it may in the great
majority of cases be entirely dispensed with, and that it should be
reserved for those cases which exceptionally threaten by their
severe local effects.
Tuberculin TR. Preliminary reports on the use of Tuberculin TR.,
by Jaroslar Bukovsky. Wiener medizinische Wochenschr.j October
2nd, 1897.—The writer refers to nineteen cases of tuberculosis in all
(lupus scrofuloderma, multiple tuberculosis, including one case of
infiltration of one apex), treated with Koch’s new tuberculin. The
results obtained cannot be said to be very encouraging; true,
sufficient time has not yet passed for a complete testing, but some
positive observations have been made. Thus, in general, the
effect upon the nutrition was unfavourable, a loss of weight being
recorded in the majority of cases in spite of a full dietary,—a loss
of eleven pounds occurred in one case. The local effects in
superficial lesions did not exceed the local effects of the older form
of tuberculin. As to immunity conferred by TR. the evidence was
inconclusive, but in one case in which the course of TR. had been
completed it was found that the patient gave a very marked
reaction to small doses of the older tuberculin. Aud in another
case, in which a lupous patient was about to be discharged, the
tuberculous foci having all disappeared and given place to scar
tissue, whilst still under the treatment with tuberculin TR., a relapse
took place in the scar tissue in the form of miliary foci .
Schnabl. (Wien. med. Wochenschr ., October 16th, 1897) does not
report favourably of the use of the new tuberculin; he records
fever, loss of weight, and night sweats as apparently following upon
the injections, and he was unable to reach the upper limits of
Koch’s doses, because of the impaired state of health.
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Therapeutic, Retrospect.
393
Disinfection of Dwelling-rooms and Larger Spaces. —This subject
has an interest for all those who have to control large institutions
into which, in spite of every care, infection is liable to find entrance.
It will therefore commend itself to the superintendents of asylums.
Dr. H. Aronson brings before us a new disinfectant in the shape
of formalin. This in the solid form as pastilles is very portable,
and by the aid of a suitable heating apparatus may be readily
volatilised, and carried in the form of fumes to all parts of the
chamber to be disinfected. The disinfectant has proved its powers
upon staphylococci, streptococci, Bacillus pyocyaneus , typhoid and
diphtheria bacilli, the bacilli of anthrax and of tubercle. With
the very uncertain results which sulphur accomplishes, even when
consumed in fullest quantity, we shall welcome this addition to
our available list of disinfectants. Formalin has no damaging
effect on clothes and furniture (consult Zeitschr . /. Hyg. u. lnfec -
tionsJcr.y Bd. xxv, quoted from Wien. med. Wochenschr. t October
23rd, 1897).
Treatment of Insomnia. —An interesting discussion upon this
subject took place at the Montreal meeting of the British Medical
Association last autumn (see Brit Med. Joum October 2nd, 1897).
The subject was dealt with from its medical and physiological
aspects, German See’s classification of insomnia being adopted by
Professor C. K. Clarke, viz. 1, dolorous; 2, digestive; 3, cardiac and
dyspnceal; 4, cerebro-spinal and neurotic; 5, psychic; 6, the
insomnia of physical fatigue; 7, genito-urinary; 8, febrile; 9,
toxic. He also adopted Howell’s theory of sleep as due to—
(1) A diminution of cortical irritability, the result of fatigue.
(2) A voluntary withdrawal of sensory and mental stimuli in
the preparations for sleep.
(3) A lowered blood-pressure within the cranium due to the
dilatation of the vessels of the skin (Howell), or of those in the
splanchnic area (Hill) ; this latter, i. e. the physiological basis of
sleep, was discussed chiefly by Professor Webb Wilcox.
On all hands it was admitted that insomnia required very
cautious and well-considered treatment, and that the recourse to
drugs was the last step to be taken. Passing to the use of drugs,
Professor Wilcox made special mention of pellotin, the alkaloid
derived from the Anhalonium Williamsii , a species of cactus found
in Mexico. The dose of the chloride of pellotin, a very soluble
salt, given hypodermically, is, according to Pilcz, £ gr.; according
to Jolly the dose may be raised with advantage to one grain.
Few by-effects have been recorded, but these include heaviness of
head, giddiness, some slowing of the pulse, and sometimes rest¬
lessness before the drug takes effect. After-effects seem to be
lacking at present, and the sleep obtained is said to be very
refreshing.
Professor Wilcox, after a survey of the list of hypnotics at our
disposal, summed up in favour of four, viz. paraldehyde, chloral-
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Therapeutic Retrospect.
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amide, pellotin, trional. He places them in the above order of
•potency. Judged by rapidity of action he ranges them thus 2
pellotin, paraldehyde, chloralamide, trional; by duration of effect
thus: trional, chloralamide, pellotin, paraldehyde; by habituation
thus: pellotin (slight), trional, chloralamide, paraldehyde; by
safety thus: chloralamide, pellotin, paraldehyde, trional.
McPhedran, of Toronto, dwelt rather upon the dangers result¬
ing from the use of hypnotics, but he mentioned paraldehyde as a
comparatively safe drug.
Dr. Ferguson, of the Western University, commenting on
bromides as drugs which permit sleep rather than euforce it,
confesses his belief in the superior virtues of the potassium salt,
the comparative depressant effect of which, as taught, he holds to
be theoretic, and not to obtain for ordinary doses.
Donald, MacAlister, of Cambridge, referred to liis experience in
the treatment of insomnia among young students of both sexes,
and urged the importance of the air-bath, also of a modification of
the cold pack or drip sheet, and such like measures. Where these
failed he said stimulation rather than sedative action was often
called for, and that strychnine was often of great value in such
cases, ^ grain of the hydrochlorate at bedtime being often
an efficient hypnotic. Occasionally a cup of strong coffee would
serve. The only other drug used regularly in the treatment of
this class of insomnia was sulphate of magnesium. If his hand
was forced. Dr. MacAlister had recourse to the bromides or to
chloralamide, which he very carefully did not prescribe in writing.
Dr. Learned, of Northampton, Mass., described a series of pos¬
tures to be assumed in regular sequence in bed, liorA, somni. The
postures were such as to involve considerable fatigue to the muscles
used in maintaining the positions, and they were accompanied by a
slow regular breathing of six or eight respirations per minute.
Each enforced posture would last during ten to twenty respira¬
tions. In his method the slow, regular counting of the respira¬
tions formed one factor, upon which he laid stress, mind and
muscle both contributing towards the result; he also insisted upon
there being no intervals, no vacations between the postures as¬
sumed. The value of Dr. Learned’s contribution is that it has
received the sanction of his own experience.
Dr. Whitla thought the danger of chloral had been much
exaggerated, and he urged, rightly, that it was fallacious to com¬
pare its statistics on a vast scale with the statistics of the more
recent and insufficiently tried drugs. Alcohol in his opinion was
perhaps the best of all hypnotics but for its habit-danger.
Dr. Leech, the president, summed up an interesting discussion.
Scopolamine as a Calmative in Insanity .—Much confusion has
existed and still exists in the nomenclature of the alkaloids of the
group Atropaceae, which includes the important drugs belladonna-
hyoscyamus, stramonium. Having become familiar with the alka-
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Therapeutic Retrospect,
395
loid hyoscine, from Hyoscyamus niger , we have recently been
taught that its proper name should be scopolamine, the name
being derived from the Scopola carniolica , native of Austria, from
which this alkaloid is also obtainable. The question is not of very
serious import, for, as Martindale and Westcott state, it is “from a
therapeutic point of view an alteration of name ” only. Accept¬
ing the newer nomenclature, we learn that Dr. S. Tomasini has
recently employed the hydrobromate and sulphate of scopolamine
with equally good results as sedatives in maniacal cases and
periodical insanity. He injects the salts hypodermically in doses
of T | T5 —grain. The injections were not painful, nor did they
give rise to any local reaction. Marked dilatation of the pupils
occurred after the injections, but no nausea or other toxic effect is
mentioned; the sleep which was obtained is stated to have been
quiet and physiological in character. A drawback is to be noted
in the readiness with which habituation obtains, the dosage calling
for rapid increase.—( Amer . Journ. of Med. Sci. y September, 1897,
from the Riforma medica.)
The Wet Pack in the Insomnia of Neurasthenics. —Dr. G. Richard
recommends a modification of the ordinary wet pack in the shape
of flannel roller bandages, which are dipped in water before
bandaging The application of a double spica to neck and
shoulders and'thighs, with the plain spiral to the thorax and
abdomen, is, however, a complicated proceeding when compared
with such measures as the drip sheet or the plain pack ; and
though doubtless good results are obtainable by this method, are
these in any way better than those obtained by a simpler
procedure ? According to Dr. Weir Mitchell the “drip sheet ” of
hydropathic establishments (which is something quite different
from the wet sheet pack) is a remedy past praise in many forms
of insomnia, and there is no doubt that we do not in general
utilise to their full the virtues of water applications in the treat¬
ment of this most obstinate affection, the sleeplessness of the
neurasthenic. Dr. Richard records his experience in the Revue
Therapeutique, No. 6, 1897. (See Amer. Joum. of Med. Science ,
September, 1897.)
FRENCH RETROSPECT.
By Dr. Macevoy.
Note on a Case of Epileptic Jaundice. —F6re believes, judging
from the dearth of references to it in medical literature, and re¬
viewing his own extensive experience, that the occurrence of jaun¬
dice after epileptic attacks is rare, and therefore records a case
which he has observed in “Le Progrfcs Medical” (1897, No. 24).
Mdme. B—, aged 49 years, of a “ nervous ” family, had eclampsia
during her first confinement at the age of twenty-one years, and
began to suffer from epileptic fits at the age of forty-seven years.
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French Retrospect.
[April,
Her first attack occurred a fortnight after a shock due to being
caught in a storm, which also caused arrest of menses. She did
not pass urine during her attack; but on awakening, the urine first
passed was observed to be dark brown; a little later, jaundice of
conjunctiva and skin was noticed. The signs of obstructive jaun¬
dice persisted for eight days, accompanied with itching and a
slow pulse (28 per minute on second day). For the next three
months she had fits every fortnight, always during the night,
each one followed by more or less jaundice. The urine first passed
after each fit presented a constant appearance.
After a time the patient was treated with bromides, and the
interval between the fits was decidedly lengthened (e. g. six
months) ; but there was no diminution in their intensity, and each
fit was followed by jaundice.
Between the attacks examination revealed no sign of disease of
the liver, and her digestion was good. After one of the fits, when
she passed water unusually early, at an interval of one and a half
hours, the presence of bile was easily detected.
Fere believes the explanation of the production of the jaundice
is most likely that suggested by Potain in the case of “ emotional
jaundice ” (from fright, anger, &c.). A dilatation of the abdominal
vessels takes place; and pressure diminishing in these vessels, while
the internal pressure of the hepatic vessels is # unaltered, the
passage of the biliary elements by osmosis or otherwise from the
biliary ducts to the blood-vessels becomes easy.
Fer£ leaves out of consideration the slight yellowish tinge which
is noticed before and after fits in the eyes of epileptics subject to
gastric troubles, when talking of jaundice after epilepsy; these
cases are quite different from the above.
Suggestion in Warfare. —M. Felix Regnault (Revue Scimtifique ,
1896, No. 25), in an interesting article extracted from his work
“ Hypnotisme, Religion,” reviews the experience of several cam¬
paigns, principally those in which the French have been engaged
during the present century, with the object of showing the mar¬
vellous influence of suggestion on the troops engaged in warfare.
“ A lost battle is a battle which is believed to be lostand
analysing the various elements of a fight, one sees that a defeat is
moral and not material,—that is, not dependent on the number of
the slain, but on the moral condition of the survivors; and the author
instances battles won by Napoleon through obstinacy in not
leaving the field after severe initial losses, and persuading his
troops that victory was at hand. The power which Napoleon pos¬
sessed in such a high degree—the supreme quality of a general—
that of imparting confidence of victory to his soldiers, is, of course,
in the nature of suggestion. Arcole, Eylau, Arcis-sur-Aube, &c.,
illustrate the results of this powerful influence.
Cavalry charges have no value beyond the moral impression
which they produce ; but their efEect on occasion in suggesting fear
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French Retrospect .
397
with the enemy has led, as Regnault shows, to almost incredible
victories. This same suggestion provoked by panic has again and
again brought about defeat, even of the best troops (Mans, 1870,
Saint-Privat, &c.).
Numerous instances of shameful capitulations mentioned by
Begnault illustrate in a remarkable manner the moral effect of
certain defeats, i. e. they result from suggestions of fear, of
cowardice.
The advantages of attack over defence, as suggesting superior
moral confidence, are therefore undoubted in warfare; and in this
connection we are reminded of the short, sharp work of troops in
late wars contrasted with the prolonged duration of wars before
this century. To-day, ceaseless attack without respite in order
to demoralise the enemy, to rob him of his courage, leads to
success. Want of confidence of the French generals in 1870, with
its suggestive effect on the soldiers, led to an attitude of defence,
and therefore defeat, says Regnault.
From his study Regnault draws conclusions which are appli¬
cable to the present time. Forts, camions, guns, &c., all the engines
of war are being perfected; but is sufficient attention being paid to
the moral factor V And yet, as he remarks, this is everything when
we are dealing with millions of men suddenly dragged from their
hearths and full of fear. In these more enlightened days one
suggestion may turn out to be of great importance; the nation who
goes to war persuaded that her rights have been assailed, that to
surrender would mean dishonour, would start with a great advan¬
tage. To successfully suggest to an intelligent people that they
are fighting for their rights, for a good cause, will be a powerful
factor in ensuring victory, and should be the aim of any statesman
who premeditates war.
Apoplectiform and Epileptiform Attacks in General Paralytics .—
In reviewing various theories which have in succession been
suggested to explain the occurrence of apoplectiform and epilepti¬
form attacks in general paralysis, Professor Pierret, of Lyons (Le
Progres Medical , 1896, !No. 40), thinks that one which deserves a
certain amount of attention is the inflammatory, especially for those
cases which are accompanied with a rise of temperature. Unfor¬
tunately, he says, microscopic examination does not support this
contention, inasmuch as we do not find lesions in cases which die
immediately after a series of epileptiform attacks differing from
those found in ordinary cases of general paralysis (without such
attacks). On the other hand, the temperature may be subnormal
in some cases—perhaps a more valid argument than the preceding
against the view that the attacks are inflammatory. No solid
support is forthcoming in favour of the view that oedema is the
cause ; it is so frequently found in the brain of general paralytics
in all stages, and is probably compensatory. He is much more
inclined to attribute them to errors of nutrition with stasis of
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398 French Retrospect . [April,
toxic products, which affect those cells which are still able to
react.
When the kidneys are diseased, and there is retention of urine,
the possibility of their uraemic origin must not be lost sight of;
but as it is not uncommon to look far and wide for things close at
hand, he believes that constipation, indigestion, the use of meat in
a state of incipient decomposition, may cause certain attacks—
probably by absorption of toxic products, as has been shown to
be likely in the genesis of some cases of puerperal mania ( e.g . by
A. Campbell Clarke, Journal of Mental Science, 1886-7).
The epileptiform attacks of general paralysis are not always as
sudden in their onset as is generally believed. There are often
premonitory signs. When, for example, says Dr. Pierret, they
are related to digestive troubles, they are preceded and perhaps
foretold by a gradual elevation of temperature.
An Extraordinary Child. —M. Carl Stumpf, of Berlin (Revue
Scientifique , No. 11, 1897) gives an account of his study of an
interesting child of 4 years, son of a butcher of Brunswick, who
two years ago attracted a good deal of attention in Berlin. Of
fair general development, the shape of the head, which is elongated
and promiuent in the occipital region, at once strikes the observer.
On account of his restlessness, and the difficulty of attempting
methodical experiments with him, Professor Stumpf was content
with observing the spontaneous manifestations of his marvellous
faculties. An extraordinary memory of events relating to history
and biography, &c., was noticed ; he knows the dates of birth and
death of the numerous German emperors since Charlemagne, of a
number of generals, poets, philosophers, often including the day
and place of their birth. He answered all kinds of questions
concerning the Thirty years* and Seven years’ wars—battles of
these wars, &c. Not only is his memory distinguished by rapidity
and duration of impressions, but a certain similarity is sufficient
for their reproduction, so that he easily reads all kinds of hand¬
writings, and is enabled to complete words written in abbreviation.
He exhibits well the part which is played in rapid reading by the
mental perception of the subject-matter long before the text has
been read out; that is, the ideas arising from words alone impress
the mind, obliterating the form, and hence mistakes in spelling
and such like are quite overlooked in the rapid reading. With this
child it seems probable that visual images play an important part
in the development of his wonderful memory ; but one must not
forget also the part played by muscular sensations arising from the
emission of words. Music and arithmetic interest him not. He
cannot distinguish differences of pitch in various notes, and has no
notion of addition or subtraction. He cannot write, and is appa¬
rently not anxious to learn to do so.
Professor Stumpf looks upon his memory as not purely mechani¬
cal, but depending on a decided co-operation of the intellect. In
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French Retrospect .
399
common with Placzek and other savants who have studied his
case, he believes that the child is highly intelligent and morally
healthy.
The Action of the Thyroid Gland on Growth and Obesity. —Dr.
Bourneville (Le Progres Medical , February 1st, 1896) gives the
notes of six cases of idiocy (three of which were cretins) treated
with thyroid extract, especially in relation to the effect on growth
and obesity. The emaciation and increase in height observed in
the three cretins led to its trial on three dwarfs, with the same
results, except in the case of one patient, aged 28 years, where no
alteration in height occurred and his weight increased. Reference
is made by Dr. Bonrneville to similar observations made recently
by Dr. E. Hertoghe, of Antwerp. Comparing the increase in
height of his cases while under treatment (Dr. Hertoghe deals
especially with cretins) with the increase which takes place
normally in ordinary idiots, the difference is most marked.
With regard to emaciation, it is noticeable that after a certain
time patients cease to Lose weight even while under treatment,
and weight is regained when the treatment is suspended ; hence
the necessity of resuming it after a temporary rest.
Finally, in six cases of retarded growth (not cretins) observed
.by Dr. Hertoghe, and said to be due to chronic albuminuria (two
cases), to rickets (two), to early menstruation (one), and to con¬
genital debility (one), the same increase in height is noticed while
the patients were taking thyroid gland.
The Function of the Lenticular Nucleus. —Drs. Tonnel and
Raviart publish a very interesting case of softening, limited to
the internal segment of the right lenticular nucleus, which seems
to throw a good deal of light on the function of the lenticular
nucleus ( L'jEcho Medical du Nord y 1897, No. 12).
F—, aged 45, was under observation- from 1890 to 1897, and
successively developed marked motor and mental symptoms
culminating in the following: —sensory troubles on the right side,
labio-glosso-laryngeal palsy, flaccid paralysis, more and more
marked in the lower limbs, progressive paresis of upper limbs
passing on to absolute paralysis on the right side, and progressive
mental impairment ending in “ mental confusion ” or stupor. The
autopsy revealed an area of softening localised to the internal
segment of the right lenticular nucleus, without involvement of
the internal capsule.
The authors, reviewing the literature of cases bearing on this,
compare notes, and suggest that the important function of the
lenticular nucleus is as a superior reflex centre, the action of which
is more marked according as the will intervenes less—intermediary,
therefore, !>etween the reflex function of the medulla and the
volition of the intellectual zones of Flechsig.
Their general conclusions are that the lenticular nucleus is
before all—(1) a channel of passage for certain cortical motor
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Google
400 French Retrospect. [April,
fibres ; (2) the site of origin of descending cylindraxils, condensed
in one fasciculus in the internal segment, spread in a fan through
the middle segment and the external segment, where are situated
their cells of origin ; (3) the point of destination of sensory fibres.
Physiologically its function is especially that of a centre of
co-ordinate movements, the execution of which is determined by
peripheral stimuli, or as a result of a voluntary stimulus originating
in a projection-sphere (cortical) ; on the other hand, from a
psychical point of view some importance must be attached to the
lenticular nucleus.
Hypnotic Suggestion .—In Revue de Psychiatrie (1897, Nos. 6
and 7) Professor Joffroy, a propos of the treatment of a
case of infantile hysteria, makes some very interesting remarks
concerning hypuotic suggestion. In view of the fact that this
treatment has been especially advocated by French physicians, it
is particularly important to hear the opinion of so good an autho¬
rity as Professor Joffroy. Suggestion, as we know, may take place
during hypnotic sleep and in the waking state; shall we try the
former? Such is not his advice, as therapeutic hypnotism is
susceptible of serious drawbacks, of which several are emphasised.
We may not succeed in hypnotising patients; or after perseverance
we may succeed, but only aggravate the hysterical symptoms.
“ Beware of patients who are difficult to hypnotise; better a
thousand times leave them alone.” On the other hand, your
patient may be easily hypnotised ; but this does not mean that
suggestions, especially therapeutic suggestions, will be carried out.
Again, there are some patients whom you easily send to sleep; you
thereupon make suggestions, but hours and hours pass before you
succeed in waking them from their lethargy. Others (and the case
of a morphinomaniac in point is mentioned by Joffroy) after one
or more attempts at hypnotism develop a mania for being
hypnotised; every one hypnotises them; it suffices to look at
them fixedly for a moment, and they “ drop off; ” life becomes
unbearable.
Professor Joffroy’s advice is, therefore, to try hypnotism only in
those cases which are serious, and in which there is, so to speak,
nothing to lose. Here hypnotic suggestion may give marvellous
results, as in a case of his own, a patient suffering with hysterical
arthralgia with severe pains, inability to do anything, and in whom
arthrotomy had been proposed. Suggestion during the waking
state and during hypnotic sleep brought about a complete cure in
one “ seance.”
Suggestions during the waking state, which of course are daily
made by all practitioners consciously or unconsciously, are on quite
a different footing, and are often most beneficial.
While hypnotic suggestion may be exceptionally advisable in
hysterical cases, Joffroy looks upon as an absolute contra-indication
the fact that a patient is suffering from non-hysterical manifesta-
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French Retrospect.
401
tions ; for it is not efficacious, he says, especially iu epilepsy and in
the various forms of insanity.
In conclusion, u the indications for hypnotism may be resumed
in one word: very serious and very tenacious form of hysteria,
where the condition of affairs is so deplorable that we have nothing
to lose, but on the other hand we may stand to win everything.”
“ Such is my way of thinking on this important question ; it is
in accordance with the teaching of Charcot and of most of his
pupils; and especially with that of Professor Pitres.”
Therapeutics of Suggestion and Auto-suggestion. —After the
opinion expressed by Professor Joffroy it is of interest to read
what Dr. Dumontpallier, member of the Academie de Medecine of
Paris, says on the subject of suggestion. In Revue de VHypnotisme
(1896, No. 4) Dr. Dumontpallier relates the case of a lady aged
37 years, who suffered for some months after childbirth of paresis
of the lower limbs, with gastric troubles and obstinate constipation,
and applied to him for relief because he had cured a friend of hers
of paraplegia which had lasted several years. On examination
no stigmata of hysteria were found, but decided evidence of neuras¬
thenia. Incidentally the patient remarked that she often felt a
tendency to sleep when she fixed a brilliant object.
The patient was told that she would be able to go down the
stairs of her house the next day, would drive to the doctor’s house
and ascend the three flights of stairs leading to his consulting-
room ; and it so happened. Hypnotic sleep was induced by fixation
of a brilliant object and suggestions made. The next day there
was marked improvement in all her symptoms, and in three weeks
she was practically well.
Iu cases of this kind, which depend upon a psychical cause for
their origin, this treatment is strongly advocated. “ Who shall
decide when doctors disagree ? ”
The Description of a Cigarette. —Among other experiments made
by A. Binet, in order to study the higher intellectual faculties, an
interesting one is detailed in the Revue de Psychiatrie (1897, No. 9).
Three different groups of individuals were selected as subjects
of the experiment: (a) seven old boys of an elementary school (aged
13—20 years) ; (/3) five pupils of a class of elementary mathema¬
tics ; (y) six pupils and assistants in the laboratory of psychology
(aged 30—35 years). The experiment was as follows :—A pen and
paper were given to each, and they were seated before an object
which they were asked to describe. “ A small object, such as a
pen-holder, a knife, &c., will be placed before you, and remain
before your eyes. You understand, you are not asked to draw it,
but only to give a description of it in words. Here is the object.”
This object was a cigarette. Five minutes was the time allotted
for the task, but in a few cases, where the number of lines of
description was deemed insufficient, the time was prolonged by a
few minutes.
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402
. French Retrospect.
[April,
A number of characteristic descriptions are given, and from the
general tendency exhibited, or the intellectual direction of the
subject shown in his description, Binet arranges them into types:
1. Descriptive or Graphic Type. —Minute and dry observations,
without reasoning or conjecture, without imagination or emo¬
tionalism,
2. Observant Type. —Observations and tendency to judge, to
conjecture, to interpret what is perceived. This mental type has
already been commented upon by Miss Bryant.
3. Erudite Type. —Memory and erudition exemplified. The
subject mentions what he knows, what he lias learnt concerning
cigarettes in general. The result is quite impersonal, and borders
on the common, the stereotyped.
4. Imaginative and Poetical Type. —This is a more complex
type, and would perhaps bear subdivision. It illustrates a neglect
of observation, the predominance of the imagination, of personal
recollections, of emotionalism. Bad taste and bathos may be
found in this type.
Without laying much stress on his results, or endeavouring to
draw definite conclusions from this and other similar experiments,
Binet concludes that from the experimental study of the higher
intellectual faculties we may observe the existence of four or five
definite mental types—the descriptive, the observant, the erudite,
the emotional, and the idealistic.
Obsession of Blushing (Ereuthophobia). —Drs. A. Pitres and E. Regis
(.Archives de Neurologie, 1897, No. 13) distinguish three kinds or
degrees of morbid blushing, as regards the moral effect produced
by the blushing, (a) Simple ereuthosis, including individuals who
present an extreme readiness to blush, but are not concerned, or
only momentarily troubled, on this account. ( b ) Emotional ereu¬
thosis. In this class we fiud subjects who, besides blushing readily
on the slightest provocation, are concerned about it, and evince a
desire to be rid of this weakness. This anxiety does not, however,
amount to an obsession. Cases are given to illustrate this group,
(c) Obsessive ereuthosis or ereuthophobia. Here we are dealing
with cases in whom the mental preoccupation on account of the
blushing constitutes a true obsession—a painful and tenacious
phobia. Nine cases have been observed by Pitres and Regis during
receut years, and from an analysis of them they are able to define
the principal characteristics of this obsession. All the cases but
one were men of a neurotic type. The attacks of blushing appeared
in all under very similar conditions, and were similarly influenced
(by weather, observation, &c.). During the interval between the
paroxysms there is a constant dread of blushing, a constant self-
analysis to explain this peculiarity. In order to conceal their weak¬
ness patients resort to all kinds of devices ; some take to alcohol.
Full notes of two cases are given.
Psychologically this obsession seems to offer a favourable field for
Digitized by L^OOQle
1898.] French Retro&pect . 403
the study of the relations between fixed ideas and emotions, and
of the nature of the emotion. From the recent investigations of
Lange, Ribot, Ac., we are prepared to believe that the role of the
emotion in certain psychopathic states is much more important than
has been hitherto held; and although the attention of our two
authors was not directed especially to the condition of the vaso¬
motor reflexes of their patients at the time they were under obser¬
vation, nor to some other points of interest in this connection, they
nevertheless draw attention to certain deductions from these cases
which are of great psychological importance.
(1) The order of succession in the phenomena observed in cases
of morbid blushing is invariably the following:—(a) An excessive
tendency to blush, followed by (/3) a feeling of confusion coming
on at a later date, and then (y) a fixed idea, which comes as a com¬
plication. That is, (a) a vaso-motor phenomenon ; (/3) an emo¬
tional phenomenon; (y) an intellectual phenomenon. If, on the
other hand, we consider the disease from the point of view of
the increasing gravity of its various forms, we notice the same
dissociation of the three elements, and in the same order.
(1) In simple ereuthosis—an excessive tendency to blush (in¬
nate or acquired) without morbid emotion and without fixed idea
—the disease is reduced to the vaso-motor element.
(2) Emotional ereuthosis is a tendency to blush with morbid
emotion and without fixed idea; i.e. the disease with its two
elements, vaso-motor and affective.
(3) Ereutliophobia—tendency to blush with morbid emotion
and with fixed idea; i.e. the disease complete with its three ele¬
ments, vaso-motor, affective, intellectual.
One fact, however, seems to militate against the priority and the
absolute preponderance of the affective element in ereuthophobia:
it is that the blushing attacks are generally brought about by the
idea of blushing, according to the almost invariable testimony of
the patients; i.e. the intellectual element precedes the emotion.
This, however, as the authors show, is probably only a hasty con¬
clusion drawn from a superficial analysis of the facts.
A study of the influence of atmospheric conditions on the attacks
of blushing, a careful examination of the phenomena which occur
when attacks are suddenly brought about, &c., lead to the con¬
clusion that the idea is not the precursor of the emotional crisis.
The authors’ final words on this subject are, “ We believe that
we are justified in saying that in the obsession of blushing, as in
many other phobias doubtlessly, the fundamental and constant
phenomenon is the emotion.”
Loss of Consciousness in Hysterical Attacks. —After referring to a
widely spread notion that consciousness is never lost in hysterical
attacks, Dr. A. Pitres, in a small monograph (“ De la perte de
connaissance dans les attaques d’hysterie ; ” Paris, Masson et Cie.,
&Jiteurs), gives the results of his researches into the mental state
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404
French Retrospect.
[April,
of patients during hysterical paroxysms. At the outset he lays
stress on the importance of distinguishing, in what is called
vaguely loss of consciousnes, or “losing the senses/’ phenomena of
consciousness and phenomena of memory ; and on the necessity of
studying the state of the consciousness and of the memory in each
of the three periods or phases of a regular hysterical attack, as
well as in each form of irregular or incomplete attack.
The laws which preside over the retention or the loss of con¬
sciousness in hysterical attacks are found to be complex, but Dr.
Pitres believes that they may be summed up in the following
propositions:
1. In the pre-convulsive stage of complete and regular hysterical
attacks, and in incomplete attacks solely characterised by pheno¬
mena which habitually belong to this stage (attacks of sobbing,
spasms, pandiculation, &c.), consciousness and memory are entirely
preserved.
2. In the convulsive stage of regular attacks, and in the incom¬
plete attacks constituted by tonic and clonic convulsions of the
epileptoid type, consciousness and memory are totally abolished.
In incomplete or irregular attacks where clonic convulsions appear
at the outset, patients may retain enough intellectual lucidity to
be able to notice what goes on around them, and to answer ques¬
tions put to them. But, in spite of this apparent persistence of
consciousness, they are not able to realise that they are convulsed,
and do not remember, when the attack is over, that they have had
spasmodic, involuntary movements.
3. In the post-convulsive stage of regular attacks, and in
attacks solely represented by hypnotic phenomena (attacks of
sleep, of catalepsy, of lethargy, of delusions, &c.), consciousness
and memory behave exactly as in cases in which these phenomena do
not represent attacks or stages of hysteria; that is to say, that
with the exception of a few rare varieties (deep lethargy, acute
maniacal delirium, &c.) consciousness is preserved during the
hypnotic stage; and the memory of what has occurred, though
abolished in the normal state (awakening), is susceptible of being
revived completely in subsequent hypnotic states, either spontaneous
or induced.
On the Pathogeny of Joint-troubles and Spontaneous Fractures of
Bones in Locomotor Ataxy. —In Archives cliniques de Bordeaux
(1896, No. 11) Drs. Pitres and G. Carriere give a detailed account
of the history and post-mortem examination of a patient suffering
from locomotor ataxy, which bears upon the pathogeny of the
joint and bone affections in this disease. Two theories have been
suggested to explain these affections : one refers the trophic lesions
of bones and articulations to an atrophy of the cells in the anterior
horns of the spinal cord; the second refers them to inflammatory
or degenerative lesions of peripheral nerves.
Pitres and Carri&re’s case is that of a man aged 58 years, with a
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1898.]
French Retrospect .
405
history of alcoholism and sexual excess. At the age of twenty-six
he had his first gastric crisis; at the age of twenty-eight, soft
chancres, scabies, and a second gastric crisis; at thirty, anaesthesia
of the big toe, numbness in left foot, lightning pains; at thirty-
three, inco-ordination of legs, shedding of big toe-nails ; at thirty-
five, confirmed ataxy, troubles in micturition; at thirty-eight,
spontaneous fracture of the tenth right rib; at forty-two, arthro¬
pathy of the left knee (“ Charcot’s joint ”).
Between 1881 and 1895, progressive aggravation of symptoms.
Death on July 10th, 1895, in a condition of marasmus, after a
severe and prolonged gastric crisis.
At the autopsy, and as a result of careful histological examination,
were found: systematic sclerosis of posterior columns along the
whole length of the cord ; normal appearance of cells in the anterior
cornua, and of antero-lateral columns; advanced atrophy of posterior
nerve-roots; diffuse lesions of ulnar nerves, intercostal nerves, aud
nerves of lower limbs, more marked than elsewhere in the filaments
distributed to the left knee-joint (the seat of arthropathy), and in
those of the tenth intercostal nerve on the right side (corresponding
to the broken rib). Anterior nerve-roots normal.
The description of the nervous filaments supplying the articula¬
tion of the left knee, for instance, is: “only a few fibres are to be
seen here and there with a recognisable myelin sheath. The nerve-
fibres are for the most part reduced to empty sheaths, or to sheaths
containing here and there fusiform masses of granular protoplasm.”
Be viewing the literature of the subject, our authors find that in
four cases, more or less convincing, alterations in the anterior
cornua of the spinal cord are described in locomotor ataxy, against
seventeen cases in which microscopic examination has failed to
reveal any appreciable alteration in the anterior cornua.
In favour of the neuritic theory of arthropathies, they find eleven
observations detailing the results of careful examination of the
nerves supplying the diseased articulations, in each of which these
nerves have been found more or less diseased (references given).
In only two cases, concerning which scant information has been
supplied, these alterations have not been found. So that the
authors conclude that tabetic arthropathy in all probability depends
upon alterations in the nerves supplying the articulations involved.
As regards the causation of the bone affections in locomotor
ataxy, we have up to the present but limited contributions to the
study of the subject. Only five published cases bear on this point.
In three, including the case of Pitres and Carriere, there are
positive indications that these fractures are due to disease of
nerves supplying the bones. In two cases no mention is made of
the condition of the nerves particularly in question ; but in one of
these it is definitely stated that the anterior cornua were healthy.
Here also, therefore, the evidence so far is more strongly in favour
of the neuritic theory than the myelopathic.
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[April
THE PROGRESS OF PSYCHIATRY IN 1897.
AMERICA.
By Dr. H. M. Bannister.
The statement made a year ago in reference to the condition and
progress of American psychiatry is equally applicable at the
present time; there have been no startliug novelties or events,
but there have also been no backward steps, at least as regards the
country as a whole, in which it may be said there has been a con¬
tinuous though gradual advance. There have been, it is true, the
expected political changes, but many of these were for the better;
while some, it may be, have been for the worse. It is a great
misfortune that politicians in some parts of this country still
consider public charities as political spoils, in so far as the emolu¬
ments of their administration are concerned, and that some of
them have disgraced themselves by introducing the spoil system
where it had not previously existed, and thus have demoralised the
public service in these institutions. The past year, though it fol¬
lowed one of the most exciting political campaigns in our history,
has not been especially notable in this respect, and there have been
signs of improvement even in quarters where it was hardly expected.
It may not be in the immediate future, but the time will certainly
come, and that before many years, when this at present the greatest
hindrance to progress in American hospitals for the insane will be
a thing of the past in every part of our country.
A year ago 1 referred to the increasing interest in pathological
work as evidenced by the founding of laboratories for this pur¬
pose in different parts of the country. This interest has not
decreased, but is extending, and one of its latest manifestations is
the inauguration of a plan, much like that already adopted in
New York, in the State of Michigan. This commonwealth pos¬
sesses in connection with its State university one of the best
equipped and most efficient physiological and pathological labora¬
tories in the United States, and the proposition is to utilise its
advantages, each of the state hospitals contributing its portion to
the salary of the specialist who will do their work. The plan has
the advantage of economy, as the cost to each institution is small,
and there will be no fitting up of quarters or expensive apparatus
to procure; and it has the still further advantage of the best sur¬
roundings and atmosphere of scientific research, which, it must be
confessed, are not always so well insured in all hospitals for the
insane. It is quite possible that some former attempts at patho¬
logical work in asylums have been ineffective for this very reason;
the workers were not sufficiently in touch with what had been or
was being done elsewhere, however well equipped with appliances
or skilled in microscopic technique they may have been. There
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1898.] American Retrospect. 407
will be no deficiencies in these regards in the New York State
Laboratory or the University of Michigan. There is still another
advantage in having the pathological work for all the institutions
done under critical supervision at one central point, and this is not an
unimportant, one; it makes possible a comparison of the methods
of clinical study in each separate institution, and ought to stimulate
a healthy competition in this respect. Pathological findings are of
comparatively little value except as interpreting clinical observa¬
tions ; and, as an eminent naturalist has remarked, it is just as scien¬
tific to make observations with our unaided but educated and pro¬
perly guided senses as it is to observe through a tube furnished
with lenses. To many, however, and to some who ought to know
better, there is a sort of impressiveness about the brass and glass
and general paraphernalia of microscopic work that gives it a sort
of factitious importance as compared with other less showy but not
less really scientific work in a hospital for the insane.
That there is an increasing interest in clinical studies of the
insane is shown by the efforts constantly made to assimilate the
treatment of acute cases, at least io general hospital methods. In
this connection also may be mentioned the psychological laboratories
at Waverley aud Kankakee, the latter in charge of Professor W.
A. Krobn, late of the State University of Illinois. It has as yet
published no results of its operations, but there is no reason why
whatever is possible in the way of good work in this special depart¬
ment should not be done. Kankakee, with over 2000 patients, and
affording every type of mental aberration, ought to furnish an
especially favourable field for the study of pathological psychology
by modern objective methods.
It is probably well known to European alienists that the popula¬
tion of American asylums includes a large proportion of non-native
inmates; but few, it is likely, realise the extent of the burden thus
imposed upon our charities. The State of Massachusetts alone is
stated to have deported to their native countries 520 alien insane
and paupers at its expense last year,—this, of course, not including
naturalised foreign-born who had gained a residence, or those
turned back by the United States immigration inspectors. While
the great mass of the foreign-born inmates of our institutions—and
these form in some sections nearly or quite 50 per cent, of the
whole—are legitimately there, having broken down mentally after
they had gained a residence, there is in nearly every large asylum a
number who are known or strongly suspected to have been assisted
emigrants, and in many cases asylum iumates before coming to this
country. I have personally known three cases of this character
from a single limited district in a European state in one asylum.
This condition of affairs has led to legislation in the State legisla¬
tures, and is one of the motives, it may be, of the stricter immigra¬
tion laws now pending in the National Congress. Probably the
seaboard States suffer most, and in this connection an inquiry into
xliv. 27
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408 American Retrospect . [April,
the relative degeneracy of the younger class of criminals in New
York and Illinois, by Dr. E. S. Talbot, is of interest. The paper
was offered at the last meeting of the American Medical Associa¬
tion, and was based ou a series of observations and measurements
of the inmates of the State Reformatories at Elmira and Pontiac
respectively. The proportion of foreign-born in these two reforma¬
tories was about the same in both, and the figures of Irish and
German nationalities were large. The statistics brought out the
rather striking fact that while all or nearly all the inmates
examined were physical degenerates as compared with the average
population, those of the eastern institutions were decidedly more
markedly such than those of the Illinois Reformatory, and that
this difference was as pronounced in the different nationalities as
in the inmates taken as a whole. Dr. Talbot endeavours to
account for this by the fact that New York has for a long time
maintained institutions for defective immigrants, and that these
have had a tendency to concentrate this class within its limits.
The inferiority, however, existed in the native-born as well, and to
make this reason apply to them we have to assume that practically
all the native offenders of this class must at least have had recent
ancestors of foreign birth. This is probably hardly true of such a
proportion as would be required, and it seems probable that other
reasons, as yet not given, must exist. The fact, however, is an in¬
teresting one, and goes to show how, besides its native product, the
country is overloaded with alien defectives. While the writer was
connected with one of the large State hospitals of Illinois, the one
county in its district that was almost exclusively populated with
the original Anglo-American stock never kept its quota over half
filled ; while the others, similarly situated but with a large foreign
element, were always demanding space.
It is not altogether pleasant to anticipate the founding of new
Jukes families, or such as that recently described by Kierman, the
record of which, according to the Lancet , exceeded Zola’s most
daring imagination, and which was the outcome of one or two
defective immigrant importations. That we have survived them
in the past is, perhaps, a comfortable assurance for the future;
but, as shown m the Jukes family, they are expensive and incon¬
venient.
The care of the chronic insane is a subject that is always to the
fore in the older States of the Union. Within the past three or
four years Massachusetts and Pennsylvania have built asylums for
this class, and one has been started in Illinois; but this last,
according to recent reports, is not likely to be available for use for
some time on account of defects in construction, &c. The Wis¬
consin system of so-called county asylums is claimed by its advo¬
cates to best meet the needs, but it is hardly an ideal plan, though
inexpensive, and an improvement on the almshouses it supplanted.
According to the Hon. Clarence Snyden, Special Agent for the
Digitized by t^ooQle
1898.] American Retrospect . 409
Inspection of Charitable, &c., Institutions, Wisconsin supports in
these establishments nearly 3000 chronic lunatics, at a cost of about
$88 a year apiece. New York adopts the plan of State care for all,
and has about 20,000 inmates in her hospitals for the insane. The
boarding-out plan has been tried to a limited extent in Massa¬
chusetts, apparently without striking success thus far. Dr. Moul¬
ton’s reply to Sir Arthur Mitchell’s criticisms of the Beport of the
Massachusetts Commissioners states, I think, some of the difficul¬
ties in carrying out this method in this country fairly, and, as the
statement of one acquainted with the ground, is worthy of
credence. He might, however, have said more and made his case
still stronger. Until the country has become much older, and has
a larger settled rural population of a certain social class than it
now possesses, it is doubtful whether the boarding-out plan will be
anywhere general or remarkably successful.
The after-care of the insaue is another subject that is exciting
attention, and has been taken up the past year not only by the
Medico-Psychological Association, but also by the American
Neurological Association, which includes in its membership a
number of alienists as well as neurologists. At its last meeting
this body received a report of a committee appointed to consider
the subject, which included recommendations that the Association
take further active measures to aid in the foundation of organisa¬
tions for assistance of the convalescent insane. As a preliminary,
however, it was held that there should be a more universal recog¬
nition of the necessity of separate hospital treatment of insanity
in its acute and active stage, and special provision for the treatment
of the acute insane in public hospitals before burdening the tax¬
payers with the cost of convalescent homes. This, of course, will
not interfere with voluntary endeavours in this direction, and it is
not understood that they were discouraged or not advocated by
the recommendations, whether the hospital reform is or is not
immediately achieved.
Two events of psychiatric interest during the past year were the
transfer of the Journal of Insanity, the organ of the Medico-
Psychological Association, to Baltimore, where it is now issued
from the scholarly precincts of the Johns Hopkins Press. It has
been completely changed in appearance, and otherwise improved.
The other event is the publication of Dr. Kellogg’s book on Mental
Diseases, which is the most extensive work of its kind that has as
yet appeared as a native product in this country, and as America
has not been very prolific in psychiatric text-books its publication
is the more noteworthy. It is to be hoped it will meet with
deserved success.
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410
[April,
FRANCE.
By Beni Semelaigne.
Diagnosis of General Paralysis .—At the Congress of French
alienists held in Toulouse last August, Arnaud of Vanves
presented an interesting report on the diagnosis of general paralysis.
According to him there is no pathognomonic sign of this disease ;
the diagnosis must be grounded on an union of physical and
psychical symptoms, i. e. on the one side generalised and progressive
dementia, on another disorders of speech, oculo-motor symptoms,
psycho-motor ataxy, and cerebral disorders. General paralysis is
most uncommon after fifty-five. Arterio-sclerosis might assume the
clinical aspect of this disease, or be associated with and modify its
features. If one finds a genuine hemiplegia, the diagnosis of
general paralysis is doubtful; or if the patient is an habitual
drunkard, if the disease is consecutive on an infection or intoxica¬
tion, and above all if the evolution has been rapid, it is necessary
to wait, and to study the progress of the disorder before asserting
a final diagnosis.
JEtiology of General Paralysis .—According to Christian of
Charenton there is no proof that the origin of general paralysis is
syphilitic. In some countries where syphilis is very common, as
among the Arabs of Algeria, general paralysis is almost unknown.
Even if a general paralytic is syphilitic, it is not thereby certain
that syphilis is the cause. Besides, specific treatment is of no
value.
Carrier and Carle of Lyons report two cases of general paralysis
in females. The first patient, affected by hereditary syphilis,
presented the symptoms of general paralysis at the age of eighteen,
and the disease rapidly progressed. The second showed, during the
evolution of an evident cerebral syphilis (pronounced cephalalgia,
spasmodic hemiplegia, and dissociated paralysis of the ocular
muscles), the genuine symptoms of general paralysis at the age of
forty-two.
Regis of Bordeaux considers general paralysis as a post-infectious
disease, generally following syphilis, and sometimes but not so
often acute illness. Besides the general paralysis, he admits that
the alterations of cerebral syphilis could produce symptoms nearly
the same; it is a syphilitica pseudo-paralysis.
According to Paul Gamier of Paris, syphilis only prepares a
favourable soil for general paralysis ; alcoholism does the same. To
produce the genuine disease, some other cause must intervene,
such as surmerage, venereal excesses, &c.
Petrucci of Angers thinks that we must interrogate pathological
anatomy to interpret clinical facts. He recognises (1) a poisonous
origin, such as alcoholism, syphilis, saturnism, infectious states;
(2) disorders of the white substance or of the nervous filaments.
Digitized by t^ooQle
1898.] French Retrospect* 411
with primitive and predominant phenomena of ophthalmoplegia;
(3) primary disorders of the grey substance, the patient presenting
a peculiar aspect of dementia, but without delirious concepts;
(4) commencing in pathological alterations of membranes of the
brain, such as thickening, blood-coloured or lactescent suffu¬
sions, neo-meuibranes, &c.
Mariet and Vires of Montpellier noted in 174 cases of general
paralysis that the causes capable of being quoted separate
into two groups. First group: tuberculous heredity, mental and
nervous heredity, acute infections, excesses of every kind, trau¬
matism, moral causes. Second group: cerebral heredity, arthritic
heredity, alcoholic heredity, personal alcoholism. The causes of
the first group, even when associated together, exceptionally tend
to general paralysis, and they must be associated with some of the
causes of the second group, which are the special and genuiue
causes of general paralysis. According to Mariet and Vires,
syphilis does not determine true general paralysis. The true
causes act either by creating the disease or by preparing a favourable
soil for the growth of the causes of the first group, which in
another case become predominant. Accordingly general paralysis
is not the result of one. but of multiple causes. Arthritic heredity
acts by determining an anticipated senility, i.e. degeneration and
inflammation of the tissues. Cerebral heredity determines on one
part a tendency to diffuse inflammation of the vascular system of
Dervous centres, or on the other part a less organic resistance of
the nervous cells. Alcoholic heredity and personal alcoholism act
either as arthritic heredity or as cerebral heredity. So the excesses
of every kind—the overstraiu of the brain, the infections, Ac.—
consume the cells and congest the nervous system. Accordingly
one finds degeneration everywhere.
Obsession and Imperative Ideas .—According to Pitres and Regis
of Bordeaux, emotion is the fundamental element of the states of
obsession.
Vallon of Villejuif, and Marie of Dun-sur-Auron, think the
obsessions are excitations not reaching the totality of the nervous
centres, but partially irradiating to a limited place. The secondary
disorders so provoked are more or less inteuse as irradiation is
limited to such or such determined place. Intensity and limita¬
tion of disorders produce an automatism more or less imperious
and anxious. The authors divide obsessions into emotional, hallu¬
cinatory, impulsive, intellectual, with possibility of various com¬
binations.
Self-accusing Persecution .—Vallon reports the case of a girl of
twenty-one who confessed to having been guilty of concealment of
pregnancy and murder. She furnished exact particulars of hiding
the infant’s body in the ground, &c. On the legal investigation no
dead body could* be discovered. Doubts arose, and inquiry proved
that the letter of confession had been written by the alleged
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412
French Retrospect.
[April,
Criminal who, during a period of eight years, had been prosecuted
and sentenced some ten times for robbery, injuries to policemen,
begging, &c. Medical examination showed that the woman was
nearly imbecile, and very dangerous. She was sent to an asylum.
On the Use of Serum in Nervous and Mental Diseases. —Mariet
and Vires have used either the serum of an insane person on the
point of recovery, with which they inject a patient affected with
the same variety of mental disorder; or artificial serum, which
they inject pure or mixed with a medical substance; or pure
serum taken from rabbit’s or dog’s blood. Serum of human blood
seems to have produced a slight and short acalmy. Injections of
artificial serum were of no appreciable value. The pure animal
serums seem more useful for the depressed forms of mental dis¬
ease. The use of these was followed by a notable physical
improvement.
BELGIUM.
By Dr. Jules Morel.
Psychological Methods for the Examination of the Insane. —Dr.
Sommer, Professor of Psychiatry in Giessen, desires the adoption
of rational methods for the examination of the insane, and in
order to obtaiu these results he tries to determine the knowledge
of the patient by means that allow of the measurement and
analysis of some of the phenomena. For instance, perception of
sight is reproduced and analysed by optical, photographic, stereo¬
scopic, and cinematographic processes. The motor senses, e. g. the
reflexes, may be fixed and measured by appropriate apparatus, and
the same may be done for voice production by means of the phono¬
graph. Next to these elementary, motor, and vocal acts, it is also
very important to take notice of and fix in a durable manner the
nature of the psychical processes of the patient, for the sake
of diagnosis and prognosis. The usual subjective method is
replaced by a more exact one, in order to determine the exact
measurement of certain phenomena of mental diseases, and to
explore the reactions of a patient always subjected to the same
stimulus—in other words, psycho-physical reaction. The old
descriptions of these diseases are subject to so many variations
that they need to be scientifically developed by physiological factors,
e. g .—
1. The competency of the patient to solve the four elementary
rules of arithmetic.
2. His competency to solve various problems.
3. The time taken for their solution, i. e. the duration of the
psycho-physical reaction.
4. By noting down the concomitant phenomena which allow us
to draw conclusions as to the mode of the psychical process.
Digitized by L^ooQle
1898.] Belgian Retrospect, 413
In accordance with this scheme Sommer made a series of inves-
tigations, and in comparing the results he discussed certain
important indications for diagnosis.
1. Normal type. An attendant examined for six minutes made
three mistakes in the easy exercises (multiplication), while the more
difficult exercises (subtraction and division) were done easily. The
psychical capacity, therefore, increases with the effort required.
2. An imbecile acquainted only with the most simple processes.
In arithmetic she could only multiply by ten. She could do nothing
else. Her multiplication does not seem to be a real ciphering, but
rather a repetition of words learnt by heart.
3. Imbecile of a medium degree, with very marked lapses of
memory, required half an hour to answer the questions of the
author’s scheme, and in this time made twenty-six mistakes. She
had no notion of division. Instead of dividing the numbers she
added them.
4. Epileptic, well educated, has had epilepsy since her twelfth
year, with occasional epileptic mania. The patient answered in a
well-defined automatic way all the questions by the word “ nine.”
Consequently there is a loss of the faculty of ciphering, with
automatic phenomena.
5. Epileptic with intermittent mania. There are periodical
oscillations in the faculty of ciphering. At the first examination
she calculated without a fault the exercises of multiplication,
addition, and subtraction. The day following her ciphering
knowledge greatly diminished for multiplication, the reaction time
very long, and with false results ; for addition the results false, and
she did not answer tbe subtraction exercises. This examination
was made thirteen hours after an epileptic fit. In a third trial
ciphering was possible again, the patient could sum up everything
asked; the answers in multiplication were incomplete.
6. This case resembles the foregoing one. The first examination
in multiplication showed a loss of every notion of ciphering. The
patient repeated some answers automatically. For the first
question the word “ three ” is repeated at different times, then the
word “once.” The other questions were answered either by
repeating the whole question, or by repeating the last word, e.g,
“Three multiplied by ten?” Answer, “Three multiplied by is
five.” “ Four multiplied by six ? ” Answer, “ Is six.” Four
days afterwards the patient could solve certain sums in multiplica¬
tion, and even in addition. In the third trial, made the day
following, the patient showed phenomena of total automatism, e.g,
“ Two multiplied by four ? ” Answer, “ Is four.” “ Two multi¬
plied by six ? ” Answer, “ Is six.” In a fourth experiment the
patient seemed more lucid, but made mistakes after a few questions,
consequently showing periodical oscillations, combined with auto¬
matic phenomena—an important combination for the differential
diagnosis of epilepsy.
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414
Belgian Retrospect.
[April,
By the foregoing processes we can study a given function,
namely ciphering, and by a comparison of the results a series
of important postulates can be made. The scheme permits
of the solution of the following questions:—1. Has the patient
received education at school ? 2. Is he suffering from congenital
imbecility ? 3. Does he exhibit slowuess of mentalisatiou in the
course of psychical processes ? 4. Do symptoms or phenomena of
automatism exist ? 5. Is the disease continuous, intermittent, or
periodical ?
Dt. Sommer has formulated many other schemes for the study
of innervation, the processes of association, the faculty of orienta¬
tion, <fcc., which may lead to the solution of doubtful points of
psycho- pathology.
Du Patronage familial des Alienas d Liemeux en 1897.—Dr.
Deperon describes the new Walloon colony. It was inaugurated
in 1884, and is managed in tbe same manner as that of Gheel,
Liemeux, has a territory of 6325 hectares, with a population of
2500 inhabitants, and at tbe present time can receive 1000 patients.
Dr. Deperon hopes that later on, when the buildings exist in a
sufficient number, the colony will be enabled to receive 2000
patients. The number at the end of December was 419. There
were several escapes, but, with the exception of eight, all were re¬
covered in one or two days.
Official Classification of Mental Diseases. — Professor Francotte,
after a close study of the classification of mental diseases, still
maintains the classification of the International Congress of 1889 in
Paris, with this difference, that he desires to add the “ Delire G6n6-
ralise,” which is the 41 Confusion Mentale” of the French, the
“ Verwirrtheit” of the Germans, and the “Amentia” of Meynert.
He prefers to substitute the term “Paranoia” for “ Folie Syste¬
matise progressive,” or “ Delire Chronique ” of Magnun. Next
to Moral Insauity he places the “ Parapsychies ” a new word given
by Dornblutt to specify “ Desequilibration Mentale,” i. e. consti¬
tutional anomalies and eccentricities of all sorts ; and “ Folie
Degenerative propreinent dite,” i. e. mental diseases specially
characterised by phobias, either intellectual obsessions or impulses.
I believe that in the future there will be no difficulty in admitting
the “ Delire Generalise; ” but I think that there is as yet no suffi¬
cient reason to separate neurasthenic insanity from the neurotic
insanities (epilepsy and hysteria), many cases of hysterical insanity
being similar to those mental troubles characterised by phobias,
obsessions, &c. It is at present very difficult to settle the boun¬
daries of this pathological form of insanity.
Abnormal Children and their Education. —Dr. John Demoor,
Physician to the Special School for Education of Abnormal
Children in Brussels, has written an excellent paper on this
important question, in which he proves himself well acquainted with
the views of Baldwin, Boumeville, Fernwald, Hammarberg, Perek,
Digitized by LjOoqL e
1898.] Belgian Retrospect . 415
Seguin, Shuttleworth, Sollier, Yoisin, &c. He studies tbe relation
between idiocy and its causes, and consequently its symptoms,
and concludes, as Hammarberg has already demonstrated, that
every idiot constitutes a special type. He shows the difference
between the intellectual development of the normal child and that
of the idiot, some of whose different sensations are growing and
improving, whilst others are absent or rudimentary. Those
differences have to be examined, registered and considered from
a therapeutic point of view. The author also refers to the
discoveries of Hammarberg, both macro- and microscopic, and to
the work of Flechsig, and rightly conies to the conclusion that idiots
should not be inmates of lunatic asylums, but of special schools,
considering the brilliant results obtained in the special schools in
England, the United States, Scandinavia, and France.
As regards treatment, he is of opinion that little can be done in
the way of surgical treatment, but much may be expected of
rational teaching. He reviews what has been attained by physical
and intellectual education, and is of opinion that both should be
combined with social education. He advises when to begin the
education, states what results are to be obtained by the exercise
of the different senses, and what may be expected after a certain
number of years’ work. Next to Sollier’s work (The Psychology of
the Idiot ) that of Dr. J. Demoor deserves to be known by every one
who takes the education of the idiot into consideration.
The Nursing of the Insane. —The question of attendants was again
brought before the Societe de M^decine Mentale, although the
discussions have lasted since 1894, and the conclusions were
approved of in other countries after one or two meetings. The
necessity of teaching attendants being evident, we are still awaiting
results; and we shall have to wait somewhat longer, as the greater
number of the Belgian asylums belong to proprietors who, directly
or indirectly, superintend their own institutions, while the phy¬
sicians have no authority over the attendants, who are appointed
by most of the proprietors without the advice of their physicians,
who ignore the qualities of the attendants. Some of tbe principal
proprietors have been informed of the necessity for instructing
their attendants, but they will remain indifferent as long as they
are not obliged to alter their way of nursing the insane. Dr. Maere,
physician to one of the numerous asylums superintended by the
Brothers of Charity, did not hesitate to say, “ We have to deplore
the instability of our attendants. It is useless to give professional
teaching, for we should have to begin teaching again the day the
attendants leave the asylum. We must try to avoid these frequent
changes in the staff of the attendants.” And Dr. Lentz added that
at the present moment the difficulties were insurmountable.
Provision 1 for the Insane in Belgium. —Dr. Peeters insists on the
necessity for a better classification of the insane in Belgium. Some
patients whose mental state is incompatible with the usual condi-
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416 Belgian Retrospect. [April,
tions of the insane in Gheel are, notwithstanding, sent to that
colony by superintendents of asylums, while others fit for the
colony remain in the institution; and others again are sent
direct, whether tit or not. Dr. Peeters makes comparison with
what is more logically done in other countries, and especially in
Scotland. Dr. Peeters would like to see the rules existing for
Scotland adopted in Belgium, but I fear that he will not have his
wish fulfilled for many years, although j agree with him.
Belgian Asylums and the Belgian Government .—One of the
members of Parliament availed himself of the last official report
to give his views concerning the situation of affairs, t. e. that the
private asylums are far inferior to the public as regards scientific
organisation and medical service, besides being superintended by
incompetent men who are mercenarily inclined. Following the
Belgian law the medical staff is appointed by Government, but
as the proprietor may present his candidates, they are always
appointed. Any doctor, whether he has studied mental disease or
not, can become physician to a lunatic asylum. Moreover in most
asylums, as the doctors are paid according to the number of
patients, they are allowed to engage in private practice. The
Minister of Justice pointed out that although some alienists are
really working as alienists, many are quite indifferent to their
asylums and to the progress of mental diseases. Dr. Lentz stated
at a meeting of the Societe de Medeciue Men tale that six of the
largest private asylums, containing the greatest number of lunatics
in the country, had twelve physicians during thirty years, and not
one of these had done any scientific work whatever, whilst the
majority of the papers published in the Bulletin were contributed
by doctors of public asylums. It was resolved in Parliament to
adopt the conclusions arrived at last year at one of the meetings of
the Societe de M6decine Mentale:
1. For medical students a compulsory course of clinical psy¬
chiatric instruction in the four Belgian universities.
2. An increased rate of salaries in asylums, the salaries to be
fixed and in proportion to the number of patients.
3. In large asylums the doctor should not be allowed to engage
in general practice.
4. Inspection of all asylums by a board composed of alienists.
Special attention was also given to the education of idiots and
the formation of classes for feeble-minded children.
The same questions were brought before the Senate by his
Excellency M. Lejeune, Minister of State, ex-Minister of Justice.
He also showed the necessity of appointing only competent alienists
to the asylums, and warmly recommended the teaching of psy*
chiatry in the universities.
Two Cases of DSlire GenSralisd (Verwirrtheit, Confusion
Mentale).—In order to prove the necessity for introducing this
morbid form of insanity into the actual classification of mental
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.Belgian Retrospect .
417
diseases. Professor Francotte describes two cases. There is loss
or diminution of the consciousness, consequently the patient has no
notion of time, place, or persons. Ideation is more or less affected
because of the absence of conscious attention. The speech is
unconnected, mixed with nonseuse, or actually incoherent, i. e . the
words do not represent ideas. The patient being in a dreamy
state, he may have delusions or hallucinations.
Reflexes in General Paralysis .—Regarding the comparative evo¬
lutions of the cremasteric, pharyngeal, and patellar affections of the
reflexes in the same patient at the three periods of progressive
paralysis, Dr. Marandon de Montyel in two different papers has
described these troubles in progressive paralysis. He has found
important modifications in one, two, or three reflexes. These
modifications may be permanent or temporary. The conclusions
of the author are numerous. From a practical point of view there
is nothing to aid in the diagnosis or prognosis of the disease.
The Provision and Classification of the Insane in Foreign
Countries. —Dr. Peeters describes what has been done concerning
home treatment in Dalldorf since 1884, in Luchtpringe by Dr.
Alt, in Bunzlau, near Breslau, in Dun-sur-Auran (France), in
Russia, and in the State of Massachusetts. His paper is only a
sketch of what has been accomplished. Many smaller colonies
exist, and many are annexed to public asylums. However, the
report of Dr. Peeters is sufficient to prove that much more can be
done in nearly every country.
ITALY.
By Professor Bianchi .
Dr. Cesare Colucci has published an interesting work entitled
A Contribution to the Pathological Histology of the Nerve-ceU in
certain Mental Disorders (from the Clinical Institute of Professor
Bianchi). It contains the result of the examination of four cases
of epileptic dementia, and of five cases of progressive paralysis. In
order to exclude the doubt that certain alterations in the .cells
might be post-mortem changes, the author refers to certain re¬
searches made by him upon nerve tissue at various stages after
death, from which it appears that such changes consist in a diffuse
granular disintegration, especially of the elements of the second
and fourth cortical layer, With Marches method these cadaveric
changes are found to consist especially in the formation of large
black droplets originating from nerve-fibres; or there is a diffuse
black coloration of the whole cell body.
The author passes on to discuss the various methods of staining
most suitable to the varied constitution of the cell, and to the
nature of the change it presents. As regards hardening reagents,
reference is made to alcohol, sublimate, picric acid, pyridin, chromic
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41 S Italian Retrospect. [April,
acid, osmic acid,formaldehyde, formalin, Ac.; and as regards stains,
to the coloration methods of Nissl, Heidenhain, Delalield, Paladino,
Golgi, Ac. When it is feasible the author prefers direct colora¬
tion of the tissue by methylene blue or other aniline dyes. In
connection with methods, he refers to his modification for neutral¬
ising balsams which are acid ; this consists in the addition of
neutral carbonate of soda or potash, the only carbonates which
neutralise balsam and at the same time leave it soluble in xylol.
The cell alterations upon which the author especially insists are
the following:—(a) The formation of yellow globules , otherwise
known as 44 pigmentary atrophy ” and 44 fatty degeneration.” The
yellow granules which result give various histo-cbemical reactions,
which do sometimes correspond to those which result in fatty
degeneration. The cell protoplasm is principally involved, being
generally iuvaded, and replaced by yellow granules; ultimately the
nucleus is iuvolved. In advanced stages there is fatty meta¬
morphosis. But the chief characteristic of this form of degenera¬
tion is its limitation to distinct zones of'the protoplasmic substance,
which may be significant from the point of view of the function of
the nervous elements. The products of degeneration are created
and undergo disintegration in situ. (b) Granular disintegration .
According to the various modes of dissolution of the fibrillar
substance and of Nissl’s bodies (which the author regards as
structures supplementary to the nerve-cells), many forms of dis¬
integration are described, of which the significance varies. The
peripheral bodies of Nissl present the greater resistance in chronic
processes; they participate m the changes of the chromatic substance
and of the fi brill® in varying fashion. The participation of the
nucleus in the degeneration is always of grave significance, it being
the most resistent structure. ( c ) The changes in the cell-processes
were investigated by the methods of Golgi and Nissl; the author
considers these changes iu their relation to those of the fibrillar
substance of the cell protoplasm, and also from the standpoint of
the different structure of the processes. He describes various
alterations, such as transverse segmentation, irregular and bead¬
like swellings, Ac. ( d ) An alteration of the nucleus, whereby a
homogeneous appearance is produced. The author describes this
change in degrees and forms more complex than those referred to
by Sarbb; the nucleus is described as exhibiting curious forms.
(e) Simple atrophy consists in partial or total diminution of the
cell. (/) Degenerative hypertrophy , considered as affecting the
prolongations of the cell or the cell protoplasm ; it may be partial
or total; Nisei’s bodies bear a prominent part in it. ((/) Necrosis ,
a form attended by coagulation, is described as the most impor¬
tant. This may show itself from the first, or secondary to regres¬
sive processes already developed. Though the forms of necrosis
•are diverse, all are of an acute nature; all the cell constituents
participate. The process would seem often to be dependent upon
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1898.]
Italian Retrospect .
419
vascular disorders. ( h ) Tbe last chapter refers to vacuolaiion,
which is described as due to various causes. Yacuolation is most
marked in Nissl’s bodies. Various general pathological conditions
close this chapter.
Dr. R. Colella has made a study of The Senile Psychoses. He
treats at the outset of senility and of the phenomena which
characterise it, of intellectual longevity, of premature mental en-
feeblement, of the frequent transition into deineutia. The psychi¬
cal and somatic symptoms are described in detail; the course, dura¬
tion, with the mode of termination and treatment of the conditions
described are given. A chapter is devoted to pathological ana¬
tomy, based in part on the author’s own observations. Ho passes
on to discuss senile dementia with delirium , which is described as
a complication of simple dementia, there being Ruperadded to the
latter delirious ideas (delusions) of every description (hypochon¬
driacal beliefs, ideas of persecution, ideas of exaltation, &c.). Such
delusions may represent every form of mental disease, but dif¬
ferentiation is possible by the presence of special features to
which the author draws attention. Sixteen clinical observations
complete the study, illustrating the different morbid types of
senile psychoses. The principal conclusions arrived at by the
author are—(1) The successive destruction of the centres and of
the cerebral association systems causes, between ideas and judg¬
ment, a loss of equilibrium favourable to the development of
erroneous interpretations, which reflect themselves now upon the
patient’s physical state, now upon his surroundings, now upon his
personality. (2) The delirious (delusional) state of senile de¬
mentia may simulate every form of mental disease. The delusions
are always numerous, mobile, and fugacious. Hallucinations are
frequent, especially those of hearing and vision. Agitation is
especially nocturnal. Simple dementia remains, although the
delusions may disappear. (3) Psychoses do not supervene in
senility, except upon a suitable basis, which is commonly furnished
by heredity.
Dr. A. di Luxenberger furnishes a contribution to the Patkolo -
logical Anatomy of Nervous Shock , based upon observation of the
changes produced in the central nervous system as a result of
violent blows on the head in experimental animals. He establishes
that the circumscribed lesious cousecutive to injury of the nervous
system are due to two factors—contusion from contre-coup, and
to shock transmitted to the cerebro-spinal fluid. The alterations
of the ganglion-cells, which are found beneath the seat of injury,
or in the region corresponding to the contre-coup , are represented
by a peculiar polarisation of the chromatic substance of the cells.
The displacement of tbe cerebro-spinal fluid may induce laceration
of the spinal cord, and at the site of greatest laceration even
sclerotic areas may be found. Tbe circulatory mechanism of the
central nervous system frequently responds to the injury by ex-
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420 Italian Retrospect. [April,
hibiting dilation of capillaries and veins. When the injury is
succeeded by a coudition of cachexia the cell-changes may be very
advanced, and resemble perfectly those found in grave cerebral
processes, such as progressive paralysis.
G. Dotto and E. Pusatesi have published a work Upon Changes
in the Elements of the Cortex Cerebri Secondary to Intra-cerebral
Haemorrhagic Foci , and upon the Connection between the Island of
Reil and the External Capsule in Man. Their researches were
carried out upon various zones of the cortex cerebri of a man aged
40, dead two months after the recurrence of cerebral haemorrhage
on the right side. There was a haemorrhagic focus of the size of a
large nut, involving the external capsule for a short portion of its
extent, and a considerable part of the putamen, the globus palli-
dus, and the internal capsule. The stainiug methods employed
were those of Golgi and Nissl, and safranin and thionin were also
used. The changes met with, variable in extent and in degree in
the different nervous elements, may be summed up as consisting
in secondary atrophy of the cerebral cortex of the hemisphere in¬
volved. The presence of the like alterations in the elements of
the cortex of the island of Reil led the authors to suppose that the
latter had connections in man with the external capsule.
In a work by Dr. G. Angiolella, the results of the histological
examination of the Cerebral Cortex of a Criminal Paranoiac are
given. Various parts of the cortex were examined; the frontal,
parietal, temporal, and occipital lobes. The author places in two
categories the alterations met with. The first class comprises in¬
flammatory phenomena (increase of connective tissue about the
vessels, dictation of perivascular lymph-spaces) and degenerative
states (pigmentary change and vacuolation of the nervous cells,
varicose atrophy of the nerve-fibres), due partly to old age, partly
to dementia. In the second are placed anomalies which the author
considers congenital, similar to those already found by Roncaroni
in the cerebral cortex of criminals and epileptics. These anomalies
consist in the total defect (mancanza totale) and atrophy of the
deep granular layer, in the predominance of the large pyramidal
cells throughout the cortex, and in the presence of nerve-cells in the
white substance in a larger proportion than that met with in
normal brains. They are in general more evident in the frontal
and temporal lobes, less in the parietal, and still less in the occi¬
pital. The author agrees with Roncaroni in according to this
structural anomaly (sic) of the cortex the significance of a degene¬
rative stigma, in considering it as an indication of that general
lack of equilibrium in development of the entire organism, and of
the nervous system in particular, which is the basis of psycho¬
somatic degeneration.
R. Tambroni and G. Obici, taking as their text observations
made upon Two Cases of Tumour of the Frontal Lobes , discuss fully
the various points upon which to form a diagnosis. They call
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1898.] Italian Retrospect. 421
attention especially to a somatic symptom described by Biancbi,
who found it constantly in bis experiments upon the frontal lobes
in dogs and apes, and also observed it in a case of tumour of these
lobes which came under his care. This consists in mydriasis on
the side opposite the lesion. To it the authors attach great value,
together with the psychical and somatic symptoms (as, for instance,
olfactory disturbances); it may be of much assistance in diagnosis
in difficult cases. A point brought out by the authors is that it
would not be unreasonable to refer the pupillary disturbances of
general paralysis to lesions of the cortex of the frontal lobes when
these disturbances are more particularly combined with psychical
changes.
Dr. D. Lo Monaco has made a study of the Physiology of the
Optic Thalami, experimenting on dogs. He divides into four
stages, variable in duration, the course of the abnormal phenomena
exhibited by animals subjected to extirpation of an optic thalamus.
In the first traumatic and irritative effects mask those ascribable
to the suspension of the function of the ablated parts. The second
is the stage of restitution of the general state, the nutritional con¬
dition of the animal. However, there are to be observed on the
side opposite the lesion transitory disturbances of vision (blindness)
and deficiency of muscular force. There are besides disturbances
of tactile sensibility and of sensibility to pain, which are not always
localised solely on the side opposite the lesion. The third stage is
characterised by a condition of complete well-being—as far as can
be judged—of the animal; the most minute examination fails to
reveal any alteration. In the fourth stage grave dystrophic phe¬
nomena present themselves, which become aggravated until death
results.
The conception brought forward by Lombroso, and now generally
accepted, of the analogy between criminals and epileptics has
induced Dr. E. di Arcangelis to look for the Stigmata of Epilepsy in
Insane Criminals. The basis of this study was constituted by 200
criminals affected by various psychopathies. The chief fact resulting
from the anthropological and functional examination of these
subjects is the presence of asymmetry, more commonly on the left
side, which is also without doubt the most characteristic feature
of the epileptic organisation. The author has, moreover, been
able to establish that all the stigmata of epileptics are met with in
insane criminals, not, however, with the frequency with which they
occur in epileptics. From this point of view he divides the various
stigmata into two great categories; in the one are grouped all the
characteristics common to epileptics and to criminals, whilst in
the other are placed those by which the latter are distinguished
from the former.
. M. L. Patrizii has made a study of the Vascular Reflexes in the
Limbs and Brain of Man , availing himself of the plethysmographic
method. His investigations were made upon two boys of about
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422
Italian Retrospect.
[April,
thirteen years of age, when awake aud asleep, and with various
stimuli (sensitive, sensorial, or psychical). The results are sum¬
marised as follows:
(1) The vascular reflexes in man follow the fundamental laws of
localisation and irradiatiou.
(2) The localised vascular reflex is accomplished in a less time
than the radiate vascular reflex.
(3) The brain exercises an undoubted influence upon the reflex
activity of the cord, even in respect to the reflex movements of
blood-vessels.
(4) The time of the vascular reflex in the waking condition, and
in response to sensory stimuli, is, for the arm, about three seconds,
for the leg about five seconds.
(5) The vascular reflex of the brain for sensorial stimuli has a
latency not less than that of the brachial reflex for the same
stimulus.
(6) Sleep produces a great retardation in the period of dura¬
tion of the vascular reflex, which diminishes as one passes from
brain to arm, and is inappreciable in the vessels of the leg.
(7) The movement of blood in the brain in sleep, secondary
to excitation is, without doubt, reflex.
(8) The vascular reflex in the limbs, secondary to sensorial and
psychical stimuli, are accomplished more slowly than is the reflex
from sensitive excitation.
(9) There is a period of vascular reaction for each sense stimu¬
lated .
(10) Certain sensorial excitations have a greater power of in¬
ducing vaso-motor reactions than others.
GERMANY.
By Dr. Bresler.
As in most other countries, our profession aud our science does
not advance without many struggles. We are engaged with a
certain class of calumniators who are dazed by preconceived
opinions, iguorance, and even hatred. While their misrepresenta¬
tions are usually absurdly wrong, and may therefore be borne with
patience, the beginning of last year brought forth a very serious
question in parliament. One of the deputies, in sustaining a
motion to the effect that the regulations regarding the admission
of insane patients into asylums are insufficient, said that a number
of cases had occurred showing that they had been relegated to
inhuman treatment in asylums, by brutal and frivolous removal
to these institutions. He also attacked the members of our
specialty.
At the annual meeting of the German Alienists held in Sep¬
tember, 1897, the following resolution was proposed by Dr, Jolly „
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German Retrospect.
423
and unanimously carried by tbe members present: “Thatthe asso¬
ciation regrets to notice that in the session of Parliament held on
16th January, 1897, a criticism, not in accordance with fact, had
been made on the conditions existing in G-ernian asylums, and that
this criticism had remained uncontradicted on the part of the
Government. The association formerly recommended, and again
thinks it a duty to advise that the most important reform would
be the establishment of independent boards directly subordinated
to the Ministry, and presided over by an alienist.”
In order to improve matters in lunatic asylums, and render sucb
attacks impossible in the future, the association at the same meet¬
ing, recognising the necessity for efficient training of attendants,
resolved to offer a prize of 500 marks for the best Handbook for
Attendants. Unfortunately a motion for proper training of, and
granting diplomas to attendants was not carried.
Dr. Hoppe reported on the treatment of the insane without
seclusion and drugs. During the last three years, out of 400 male
patients, seclusion was only used by him in six incurable cases,
and he believes that under more favourable circumstances he
could have dispensed with it in those six cases. Drugs he believes
to be useless, and he further recommeuds that alcohol be removed
from the diet of the patients, and lemonades, fruits, &c., be sub¬
stituted, citing the example of English asylums, and especially in
London, which in 1890 removed their private brewhouses. His
views were upheld by the majority of the meml>er8.
Dr. Alt said it was now the general course in Germany to
abolish the use of seclusion as far as possible, it being done away
with altogether in some asylums.
There have been no acts of any importance referring to lunatics
passed during the year now ended. Besides the seven smaller and
local associations of alienists and that above mentioned, a new one
was founded last year by Flechsig and Hitzig. It is entitled the
Association of Alienists of Middle Germany (Saxony and Thu¬
ringia). Such societies certainly afford the best means for success¬
fully combating the attacks of ignorance, and for improving the
condition of the insane. This must be worked out by ourselves.
We must purge tbe service of existing unsuitable methods. That
cannot be done by those who rank themselves as our enemies.
During the past year Professors Schiller and Fisher have pub¬
lished a collection of treatises on pedagogical psychology and
physiology in the form of a journal, which will apply the results
of physiology of the brain, and of physiological psychology to
schools and education.
Another similar journal, edited by Truper, has been already
noticed on page 357 of last volume of Journal of Mental Science.
In April, 1897, Dr. Konrad Alt (Uchtspringe) inaugurated Die
Irrenpflege , a monthly journal for the use of attendants. It is
full of general information, and has been largely used. Such a
xliv. 28
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424 German Retrospect. [April,
journal is worthy of support. It is intended to promote the
welfare of attendants by instruction, advice, and encouragement,
and it specially deals with freedom of treatment in colonies and
private care. As each craft has its own special journal, it is
apparent that the attendants on the insane should find a periodical
devoted to their best interests. I have now before me the first ten
numbers, complete to this date, and there can be no doubt that the
Irrenpflege has so far accomplished its intention as declared in the
opening statement of the editor.
In mentioning that there is a proposal on the part of the pro¬
vincial authorities to increase the salaries of asylum officials, I am
at the end of this letter, for most of the important literary works
have been already noticed in the Journal of Mental Science , with
the exception of the “Atlas of the Brain,” by C. Wernicke. It
consists of a series of photographic plates of sections of the brain,
which have teen stained by Pal’s modification of Weigert’s
method, and which are intended to demonstrate the normal
anatomy and the pathology of the brain. This standard work
is the result of much care and perseverance, and should commend
itself to all those desirous of furthering their study in this direction.
In the region of research, Nissl, in an article in Allg. Zeit -
schrift fur Psychiatrie entitled “ The Hypothesis of the Specific
Functions of the Nerve-cells, and Studies in the Anatomy and
Histo-pathology of the N6rve-cells,” gives the result of his
experiments on the effect of toxins on the cortical nerve-cells of
animals poisoned with lead, arsenic, phosphorus, silver, morphia,
nicotine, trional, strychnine, toxins of tetanus, alcohol, and vera-
tria. He used his own method of fixation and staining of sections,
and found that the cells are altered in a determined specific
manner by the action of the poison. His experiments have the value
of a physiological reaction. He does not compare the pathological
with the normal cell, but has introduced a new definition, “ the equi¬
valent figure,” of the nerve-cell. This is the microscopic figure of
the nerve-cell of an animal killed in a certain manner, which
regularly takes place under certain conditions. These equivalent
figures serve to control the figures of the poisoned cells. Explana¬
tory tables and photographs accompany the paper.
The progress of clinical knowledge has not kept pace with the
great labour bestowed upon anatomical studies. It would seem
that the favourite problem at present is the anatomical sub¬
stratum of mental diseases, which is so vigorously searched for in
the nerve-cells.
HOLLAND.
By Dr. F. M. Cowan.
Asylums are not popular institutions, and every now and then a
virulent article appears in the newspapers, inveighing against gross
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1898.] Dutch Retrospect . 425
abuses and shameful practices by which men of perfectly healthy
minds are designated insane by doctors, and may even be shut up for
life. Such a case occurred a short time ago. A merchant suffering
from delusions of persecution was admitted into the Meerenberg
asylum. He kept complaining and insisting upon being discharged.
An acquaintance of his wrote to the patient’s wife, and did what
he could to prevail upon her to take her husband home. Finding all
his endeavours vain in that quarter, he wrote to a member of the
second Chamber. The consequence was that the matter was
brought under the notice of the Government. The honourable
member, without seeing the patient, made the diagnosis of his
perfect mental health after reading a couple of letters which had
been sent him, and after seeing that the case-book recorded that
Mr. K. was not violent, and took daily walks Addressing the
minister, he said, “ Can there be stronger evidence that here we
have a man detained in an asylum who‘should be at large? ”
The discussions which followed were absurd, and clearly showed
what an amount of nonsense honourable members may utter when
they flounder out of their depth, and discuss matters which
they know nothing about. The conclusion they arrived at was
that the formalities required for admission into asylums were not
stringent enough. Now, although it was generally thought by
alienists that a great deal of precious time was lost owing to the
different formalities already required, it may be expected that one
day or other new measures will be introduced which, in the long
run, will no more satisfy the malcontents than those which now
exist, and which may seriously damage the mentally diseased.
Deliberante eenatu perit Saguntum was true in a certain sense here;
the patient died of consumption, and put a temporary stop to the
matter. As one of the supporters of the motion has since come
into office as a Cabinet minister, it is unfortunately probable that
we shall hear more of this. One of the most grossly mismanaged
asylums has fortunately been suppressed,—at least, it will be so
some months hence ,viz. the asylum at Dordrecht. The governors of
this institution had made it a veritable Black Hole. By their stupid
management not only were two patients sadly burnt in a single
room, built according to their own ideas, but it was found that to
make the asylum a profitable business the patients were stinted
in their food. The senior physician, disgusted by these shameful
proceedings, resigned his position, but did not attain his otium cum
dignitate without any further tribulations. When he complained
that orders given by him were countermanded by the governors,
the chairman of this honourable board called upon him and
dastardly attacked him with a stick, badly cutting the doctor
across the face, and giving him a number of bruises. Most fortu¬
nately the criminal bungling of a lot of pettifogging creatures will
now be stopped. In fact, so thoroughly are the authorities
convinced that the asylum has a bad reputation that the burgo-
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Dutch Retrospect.
[April,
master, when he proposed to suppress it, gave as a reason that
after what had occurred no physician of self-respect would take
the place of superintendent. An endeavour to obtain an inquiry
into the state of matters was resisted by one of the aldermen, the
architect of the single room I mentioned above, formerly one of
the governors, who thought an inquiry would be a proof of distrust
in these worthy persons. It is a sadjbing that the law which was
considered too stringent by several people should be impotent to
stop such proceedings, and sad it is that the Psychological Society
did not raise a single protest against a state of things which it
must disapprove of. As it is, the society now appears to agree
with the governors, and to approve their line of action.
A new asylum has been built near Leyden ; it is built on the
cottage system ; the grounds were formerly a country seat, and are
finely wooded.
DENMARK.
By Dr. A. Friis.
During the last year there has been no change of importance in
the care of the insane of Denmark. In this country there are five
large asylums, viz. the St. Hans’ Hospital for the city of Copen¬
hagen, and the four State asylums at Vordingborg, Middelfart,
Aarhus, and Yiborg. The last mentioned is only for incurables;
the others both for curable and incurable patients. Besides these
there are a few small provincial asylums designed only for pro¬
visional care and for the incurable. At the beginning of the year
there were, according to the Asylum Reports for 1896,2939 lunatics
under care in the large asylums, viz. in St. Hans’ Hospital, 1019;
in the asylums at Vordingborg, Middelfart, and Aarhus respec¬
tively 470, 572, and 539; in the Viborg Asylum, 339. During
1896, 802 cases were admitted, 653 discharged or died. Of those
admitted, 25 per cent, were suffering from melancholia, 20 per
cent, from mania, 17 per cent, from paranoia, 36 per cent, from
dementia., and 2 per cent, from idiocy. In the State asylums
there has for some time been need for room, especially for in¬
curables ; and the Department of Justice, which has the supervision
of the lunatic asylums, has therefore appointed a commission, con¬
sisting of the medical superintendents of the above-named asylums
and the Dean of the Royal College of Health, to inquire into this
and other questions concerning the insane.
The low number of idiots in the lunatic asylums of the State is
owing to the fact that these patients are not admitted. In Den¬
mark there are, therefore, two special asylums for idiots and
imbeciles of all kinds, adults and children, viz. the Keller Asylums
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1898.]
Danish Retrospect .
427
Gamle Bakkebus—Ebberoedgaard, each with about. 600 patients,
of whom about 200 are children undergoing school training. The
asylums are situate in and near to Copenhagen (the schools in the
city), and are private institutions subsidised by the Government.
Though the asylum of Ebberoedgaard is only about six years old,
and has more than 400 patients, there is already a great need for
places, especially for the helpless. It is therefore in contemplation
to enlarge one of the asylums; at the same time that the Keller
asylums, which now are spread over a great extent, are to be con¬
gregated in a new asylum, built in the province of Jylland.
For the care of the epileptics no special provision has hitherto
been made in Denmark. Those of them who are insane or
feeble-minded, and therefore dangerous or very troublesome, have
been admitted into the asylums for lunatics or idiots; while the
rest, to the detriment of themselves and others, when they have
not been under private care, have been obliged to drag out their
existence in poor- or work-houses. In 1896 the committee for the
lunatic asylum at Yiborg, therefore, made a proposal to the Jus¬
ticiary Department for enlarging this asylum, and at the same time
uniting it with au asylum for epileptics. In spite of the reasons in
favour of establishing such an institution, and in spite of the fact
that the project was recommended by the highest medical autho¬
rity in this country (the Royal College of Health), the matter made
no progress, the Minister of Justice resolving that the establish¬
ment of asylums for epileptics, at all events for a long time, could
not be regarded as a duty of the State. Yet it is to be hoped that
the commission for the care of lunatics will take also this matter
up, and that the minister will change his mind. For the present
it has been tried by private means to start two small colonies, and
the medical superintendent of the Yiborg Asylum, Dr. Hallager,
has brought out a popular, well-written book On the Treatment of
Epilepsy and Epileptics , with the intention of instructing the
public in the matter.
It has, however, already caused a collection of statistical data
concerning epileptics. Dr. Hallager has made a careful enumeration
of epileptics in the district in which his asylum is situated, and by
comparing it with the statistics of the number of young men who
are found incapable of being soldiers by reason of epilepsy, and with
the few existing statistics of epileptics from other countries, he has
found out that there must be about 3000 epileptics in Denmark, or
about 1*4 per mille of the population, the number of the inhabitants
being about 2,200,000. How many of these require care in an
asylum it is, of course, difficult to say, but it will surely be a
rather large proportion if all claims are to be met. For instance,
about seven hundred nre under public care, but only between four
and five hundred under constant medical supervision in asylums
or hospitals.
In his book, De la Nature de VEpilepsie, published in Paris, 1897,
Digitized by AjOoqL e
428
Danish Retrospect.
[April,
Dr. Hallager, who has specially studied epilepsy, communicates
his views on the morbid physiology of epileptics. He concludes
that the fits are owing to a sudden ansemia of tbe brain, and this
anmmia is always the result of a reflex constriction of the vessels
through the vaso-motor centre, which is irritated either from the
cortex cerebri or the peripheral parts of the body ; only when the
irritation is owing to physiological processes (or latent lesions) we
call the epilepsy idiopathic. The form of the fit is determined
by the degree of irritability of other centres put in activity, so
that the same ansemia which in one individual only causes “ petit
mal,” in another with irritable motor ceutres will be the cause of
a fit of “ grand mal.” In the same manner the aura and the
post-epileptic phenomena depend on the condition of the different
centres or organs ; the post-epileptic mental condition depends
partly on the form and intensity of the fit, partly on the pre¬
disposition of the individual (i. e. his cortical centres).
Dr. D. E. Jacobsou has published his observations on The
Pathogenesis of Delirium Tremens. He seems inclined to regard
this mental state as the result of an autotoxic infection in a
chronic alcoholic. The reasons he gives for his theory, which is
based on a careful investigation of about 250 cases, seem to be
very convincing. He denies, on the contrary, the existence of the
so-called delirium tremens traumaticum, and supposes that the
traumatic lesion as a rule is consequent to the delirium, and not the
reverse.
NOEWAY.
By Dr. Holmboe , translated by Dr. Lindell.
Dr. Lindell in 1890 sent an account of the provision for the insane
in Norway to Dr. Hack Tuke’s Dictionary of Psychological Medicine.
Since that time our Lunacy law of 1848 has been amended by
the law of 1891. According to this law, four-tenths of the ex¬
penses for the maintenance of the insane poor, which expenses
were formerly charged entirely upon the respective towns and coun¬
ties, are now to be refunded by the Government, but only in the
case of pauper lunatics in need of special treatment. The neces¬
sity for this special treatment is to be decided by the county phy¬
sicians (“ Amtslsege ”) of whom there is one for each county.
This Government grant applies to pauper lunatics in asylums, and
also to those who are cared for in private houses. The law, there¬
fore, has compelled the miuistry of justice to increase the general
control of the insane in private houses, and to order the district
physicians to carefully supervise these patients.
A comparison between the census of 1891 and of 1865 shows
Digitized by L^ooQle
1898.]
429
Norwegian Retrospect.
that the number of insane has increased absolutely as well as pro¬
portionally to the population, as may be seen from the following
table:
1865.
1891.
Idiots . .
... 2039 ...
... 2431
Acquired mental diseases
... 3156 ...
... 5318
Total...
... 5195 ...
... 7749
Proportionate to the population—
1865.
1891.
Idiots.
... 1*835 ...
... 1*823
Acquired mental diseases
... 1*539 ...
... 1*376
Total ...
... 1*327 ...
... 1*258
This increase partly depends upon more careful investigation,
but it is too great to be entirely owing to that, especially as regards
acquired mental diseases.
Insanity is now as before more prevalent in the southern parts
of the country. The want of accommodation is more and more
felt, although during these latter years great sacrifices have been
made both by the Government and by certain cities to meet the
difficulty.
Since 1890 a new municipal asylum has been opened at Bergen,
on the estate of Newengaarden. It accommodates at present 224
patients. The State Asylum at Rot void is enlarged by the addi¬
tion of a new wing and a farm for fifteen patients. The com¬
munal asylum atTrondhjem and the private asylum at Moellendal
have also been somewhat enlarged. On the other hand, the old
and inconvenient communal asylum at Stavanger has been closed.
The Storthing (Parliament) granted in 1894 the necessary means
to build an asylum for the most northern parts of the country on
the estate Roewvik at Bodoe. The buildings are far advanced to¬
wards completion, but they are in such a remote part of the country
that many difficulties have been encountered, so that the asylum
probably will not be finished for many years. It is being con¬
structed to accommodate 230 patients.
Furthermore, a very favourable reform has been introduced in
our lunacy system. In 1894 the Storthing authorised the recon¬
struction of an unused building at the prison in Trondhjem as a
lunatic department for insane convicts and criminal lunatics, who
on account of their moral degeneration and their dangerous ten¬
dencies are considered unfit to be cared for in ordinary asylums.
The ordinary institutions are thus relieved of their most dangerous
and most offensive patients, and consequently a more free treat¬
ment of the other patients has become possible.
The total accommodation in the asylums of Norway was 1328
in 1890, and is at present 1549. Notwithstanding the increased
Digitized by AjOOQle
430 Norwegian Retrospect . [April,
asylum accommodation, the insufficiency is still very inconvenient.
Very many, especially incurable cases, whose condition demands
asylum care, continue in private houses, sometimes under very un¬
favourable circumstances.
The number of establishments for idiots is the same as in 1890,
viz. three. One of them has been bought by the Government, and
it is under consideration to purchase both the others.
Clinical lectures on psychology have been delivered since 1896
in the University of Kristiania by a specially appointed psycho¬
logist. Examination in this science is still not required for medical
graduation.
SWEDEN.
By Dr. Lindell.
The first lunacy law of 1858 was repealed, and after careful
revision replaced by the Royal Ordinance of 1883, which still is
in force. British psychologists will find a very complete description
of it in the Reports on the Working of the Lunacy Laws Abroad
(1885), except that Supplements A and B were modified and
improved in 1894.
In consequence of a trifling informality on the admission of a
patient into a private asylum, a Royal Committee was appointed in
1894. It consisted of five members, only one being a psychologist,
who were to revise the law and to draw up a proposal for neces¬
sary amendments. The result was in 1896 laid before the Eccle¬
siastical Department as a proposal for a new lunacy law, but in
spite of various proposed improvements it was found such that
the psychologists requested to give their opinion had declared
unanimously against the proposal, as being essentially a change
for the worse. As it has not yet been finally debated, it will be
more convenient to postpone a minute account until the result is
known. However, it may be stated as evident testimony of the
power of the present law to secure legal protection for the insane, as
to their admission into, treatment in, and discharge from public
and private lunatic asylums, that the Committee, after investigat¬
ing the few cases—less than ten in a total of 10,000 admissions—
of alleged unlawful detention in asylums, were convinced that in
reality no one had been unlawfully admitted into a Swedish lunatic
asylum.
The increase in the number of the officially known insane until
1890, when the last census was made, may be shown in a tabular
form thus:
Digitized by
1898.]
Swedish Retrospect .
431
K umber of
Ratio (per 10,000).
Year*.
Population.
1
!
Lunatic*.
Idiot*.
LuiiHtics to
population.
'Idiot* to
population.
1860 .
3,859,728
5000
2500
13
6*48
1870 .
4,168,525
5750
3240
14
7*79
1880 .
4,565 668
7229
4227
15*83
9*26
1890 .
4,784,981
8703
7619
18*19
15*92
Owing to deficiency in the reported statistics by the clergy the
cited figures must be considered rather too small. However, one
must regard them as evidence that insanity is considerably increas¬
ing in Sweden. Nevertheless the excellent report by the Scottish
Commissioners in Lunacy in 1895, contradicting the alleged in¬
creasing prevalence of insanity in Scotland, may certainly prove
applicable to Sweden.
Great efforts have been made during the last decennium to
meet the continually increasing want of lunacy accommodation,
and the Riks-dag (Parliament) has with praiseworthy generosity
supplied the necessary means. Thus older asylums have been
enlarged, and new asylums erected. The accommodation in the
State asylums during the years 1862—1896 has been quadrupled,
viz. from 1074 to 4259 beds.
As many of the State asylums are open for patients of the
wealthier classes (in all 126 beds) for an extra fee, there are only
three small private asylums, which accommodate in all forty-two
1 unatics.
The accommodation at the different State asylums was at the
end of 1896 as follows :—In the asylum situated at Stockholm,
270 beds ; TJpsala, 446 ; Nykoeping, 140 ; Yadstena, 784; Vexioe,
222; Yisby, 32; Malmoe, 175 ; Lund, 1190; Gothenburg, 175;
Kristinehamn, 300; Hernoesand, 225 ; Piteaa, 300 : total, 4259.
In connection with the asylum at Upsala a number of detached
blocks for 800 incurable patients are being erected, besides which
small enlargements of the asylums at Gothenburg, Kristinehamn,
and Nykoeping are in progress. Finally a plan is submitted for
building a new asylum for about 1000 patients, the position of
which presumably will be at Restad, about three miles south from
the town of Yenersborg.
For persons with congenital insanity (including idiocy) there is
the following special accommodation :—Nineteen training schools
(for imbecile children) with 532 beds; six work-homes, with
92; nine idiot establishments (asylums), with 146 : total, 770
beds.
Most of these institutions receive subsidies both from the
Government and from the respective County Councils (Landsting).
Digitized by {jOOQle
432 Swedish Retrospect . [April,
218 adult idiots with dangerous tendencies were (1896) cared for
in the lunatic asylums.
Except as above described, insane persons at the end of 1896
were cared for:—In union workhouses, 1127 lunatics, 688 idiots;
in ordinary hospitals, provisionally, 56 lunatics, 16 idiots. The rest
were at home or treated as single patients.
PART IV.—NOTES AND NEWS.
MEDICO-PSYCHOLOGICAL ASSOCIATION OP GREAT BRITAIN
AND IRELAND.
GENERAL MEETING.
A General Meeting was held by the courtesy of Dr. W. S. Kay at the West
Riding Asylum, Wadsley, Sheffield, on 16th February, 1898, under the Presi¬
dency of Dr. T. W. McDowall. The following members were present:—H.
Rayner, J. Carlyle Johnstone, James Beveridge Spence (Registrar), E. B.
Whitcombe, Fletcher Beach, T. Stewart Adair, David Bower, M. B. Ray, Harry
A. Benham, Crochley Clapham, D. Yellowlees, Evan Powell, Chas. E. Hetherington,
J. A. Campbell, A. R. Urquhart, J. Holmes, T. W. McDowall (President),
S. Edgerley, Bedford Pierce, Henry J. Mackenzie, Richard Legge, M. D.
Macleod, J. R. Macphail, Robert Jones (Secretary), Rothsay C. Stewart, Keith
Campbell, William C. Sullivan, Margaret C. Dewar, Walter S. Kay, Stuart Isacke,
Arthur Finegan, H. Hayes Newington (Treasurer), and J. R. Whitwell.
The President :—Gentlemen, before we enter on the reading of the papers
to be brought before us, I have to suggest to you the propriety of forwarding
a vote of sympathy to the sons of Dr. John A. Wallis, lately deceased. He
was personally acquainted with many of us in this room. We all respected
him as an old friend, and we all liked him in his official capacity as a Com¬
missioner of Lunacy. I think it would be exceedingly becoming of us to show
our regard for him, both personally and officially, and to send through Dr. John
Merson, his most intimate friend, a message of sympathy with his sons in their
bereavement. I think you will agree to this unanimously, and instruct Dr.
Jones to do as I have suggested.
The vote of condolence was seconded and carried unanimously.
The following candidates were elected Ordinary Members :—Anderson, John
Sewell, M.R.C.S.Eug., L.R.C.P.Loud., Assistant Medical Officer, Hull City
Asylum, Willerby, near Hull. Proposed by John Morson, S. Edgerley, and J. G.
McDowall. Boyle, Alice Helen Ann, M.D.Brux., L.R.C.P.Edin., L.R.C.S.Edin.,
L.F.P.S.Glasgow, 3 Palmeira Terrace, Hove, Brighton—late Assistant Medical
Officer, London County Asylum, Claybury. Proposed by Robert Jones, Emily
Dove, and Margaret Orange. Dyer, Sydney Reginald, M.D.Brux., M.R.C.S.,
L.R.C.P.Lond., D.P.H.Eng., Barrister-at-Law, Middle Temple; Deputy Medical
Officer, H.M. Prison, Wandsworth; and 13, Dorlcote Road, Wandsworth
Common, S.W. Proposed by David Nicolson, James Scott, and J. J. Pitcairn.
Goldie-Scot, Thomas, M.B., C.M.Edin., M.R.C.S.Eng., L.R.C.P.Lond., Assistant
Medical Officer, Warneford Asylum, Oxford. Proposed by James Neil, J.
Bywater Ward, and Heurtly Sankey. Greenwood, H. Harold, M.R.C.S.Eng.,
,L.R.C.P.Lond., Assistant Medical Officer, Derby County Asylum, Mickleover,
Digitized by LjOOQLe
1898.]
Notes and News.
438
Derby. Proposed by Richard Legge, S. Rutherford Macphail, and F. K.
Dickson. Jones, W. Ernest, M.R C.S.Eng., L.R.C.P.Lond., Assistant Medical
Officer, Leicestershire and Rutland Asylum. Proposed by Dr. Rothsay Stewart,
Dr. J. E. M. Finch, and Dr. H. M. Baker. Pasmore, Edwin Stephen, M.D.Lond.,
M.R.C.P.Lond., Assistant Medical Officer, London County Asylum, Banstead. Pro¬
posed by T. Claye Shaw, George H. Savage, and Robert Jones. Piper,
Francis Parris, M.B.Lond., M.R.C.S.Eng., L.R.C.P.Lond., Assistant Medical
Officer, London County Asylum, Clay bury, Woodford Bridge, Essex. Proposed
by T. E. K. Stansfield, F. R. P. Taylor, and Robert Jones. Todd, Percy
Everard, M.B., C.M.Edin., Acting Medical Superintendent, Port Alfred Asylum,
Cape Colony, South Africa. Proposed by W. J. Dodds, T. Duncan Greenlees,
and T. W. Me Do wall.
Crochley Clapham, M.D., Physician to the Royal Hospital, and Lecturer on
Clinical Medicine, University College, Sheffield, read a “ Note on the Com¬
parative Intellectual Value of the Anterior and Posterior Cerebral Lobes ** (see
page 290.
W. C. Sullivan, M.D., Stewart Scholar, Royal University, Ireland, Deputy
Medical Officer, H.M. Prison, Liverpool, read a paper on 4< Alcoholism and
Suicide ” (see page 259).
A. Keith Campbell, M.B., C.M., lately Assistant Medical Officer, Murray’s Royal
Asylum, Perth, read “ Notes of a Case of Heematoporphyrinuria ” (see page 305).
Bedford Pierce, M.D.Lond., The Retreat, York, read “Notes of an Unusual Case
of Poisoning,” published at page 313.
Dr. Kay kindly invited the members of the Association to lunch at the
Asylum, and subsequently afforded facilities for its inspection. The members
dined together after the meeting in Sheffield.
SOUTH-WESTERN DIVISION.
discussion ok db. goodall’s fapbb (see page 235).
The Chaibman said they were all very much obliged to Dr. Bullen for
reading Dr. Goodall’s able contribution. It was a very suggestive paper—
suggestive of a great amount of added labour by Assistant Medical Officers.
Dr. Stbwabt said, as an old Assistant Medical Officer of very large
County Asylums, he quite sympathised with the remarks of the Chairman as
to the added labour which anything of this kind would involve. He also
quite fell in with Dr. Goodall’s feeling in the Lint which he threw out as
to the unnecessary amount of what was really only clerical work that was cast
upon assistant medical officers. Throwing such duties upon scientific men
took away the greater part of the time that might otherwise be devoted to
such fascinating work us Dr. Goodall had alluded to in his paper. He used
the word fascinating because he—a mere tyro in the subject—had enjoyed
nothing more during, the little time he had been able to devote to anything
of the kind than the subject of authropology. A very important statement
in Dr. Goodall’s paper was to the effect that normal standards would be
required for various districts, and most people would think that it would
be a useful thing for anyone who started these anthropoinetrical observations
that they should have standards. The circumstance was very marked that in
various districts of the country there were certain varieties and types more
observed than in others; and it would be necessary, therefore, for each
person to obtain the type and standard applying to that particular district.
Dr. Stewart went on to speak of the interesting field which lay open to
those taking up the subject, and said he could commend to anyone wishing
a little interesting divertissement to take it up in connection with their own
children and their own friends. The instruments required were not expensive
Digitized by {jOOQle
434 Notes and News . [April,
and Dr. Goodall would be, he was sure, delighted to assist in every way he
possibly could.
Dr. Dbas remarked that Dr. Goodall did not propose that a committee
should be appointed to consider the desirability of carrying on anthropometrical
observations.
The Chairman said he thought Dr. Goodall rather proposed that the subject
should be taken up individually by anyone having leisure. It struck him that
the matter of obtaining the standard would be a very difficult one.
Dr. Macdonald said they all very much regretted that Dr. Goodall was not
present. He especially regretted it because at Moscow he had the pleasure of
talking to him a lot about this subject, and he promised to show them on that
occasion certain diagrams to illustrate his paper. Dr. Goodall had become an
absolute enthusiast in this matter; in fact, he was perfectly mad over it.
(Laughter.) One, however, must, he thought, pause for a moment to consider
whether a man of Dr. Goodall’s great ability would needlessly and wastefully
give up his time to a subject of such an intricate and difficult nature unless he
firmly believed there was something in it. (Hear, hear.) Therefore, although
it might seem rather difficult for any of them to promise adherence to it, or say
they would follow in his footsteps and try to move on the same lines, yet at the
same time he did feel strongly that anything that might tend to elucidate many
of the difficult problems iu connection with that large element of asylum popula¬
tion, the mentally defective, would, he was sure, one day bear good fruit. (Hear,
hear.) He believed that in the recent numl>er of their journal there was a con¬
tribution by Dr. Goodall, and it only proved, as had been proved over and
over again, that it was the busy man, the hard-working man, perhaps the over¬
worked man, who did the good solid work. (Hear, hear.) It was not the man
with most leisure who did the most work.
SCOTTISH DIVISION.
A meeting of the Scottish Division was held in the Hall of the Faculty of
Physicians and Surgeons, Glasgow, on 10th March. 1898.
Dr. T. W. McDowall, President of the Association, occupied the chair, and
there were also present Drs. Carswell, Hotchkis, Ireland, Carlyle Johnstone,
Hamilton Marr, Mitchell, Richard, Alexander Robertson, Turnbull (Secretary),
Urquhart, Watson, and Yellowlees, with Mr. James R. Motion, Inspector of
Barony Parish, as a guest.
Xbw Members.
The following candidates were elected ordinary members: —William Arnott
Parker, M.B., C.M.Glasg., Assistant Physician, G&rtloch Asylum, Gartcosh,
proposed by Drs.Oswald, Yellowlees, and Hotchkis; Stanley L. Dobie, Surgeon-
Lieut.-Col. I.M.S., retired, L.R.C.P.Edin., M.R.C.S.Eng., L.S.A.Lond., Dunain
Park, near Inverness, proposed by Drs. Keay, Urquhart, and Turnbull; Charles
Percivale Bligh Wall, M.B., Ch.B.Edin.," Assistant Medical Officer, District
Asylum, Inverness, proposed by Drs. Keay, Middlemass, and Bruce.
Dr. Carswell read a paper on the Relation of Imbecile Children to Pauper
Lunacy, which, with the relative discussion, will appear in the next number of
the Journal.
Nomination op Divisional Secretary.
Dr. Yellowlees moved that Dr. Turnbull be nominated for the Divisional
Secretaryship, and that the name of Dr. Carlyle Johnstone be suggested for
election to the Council in room of the Scottish member who falls to retire at next
annual meeting. This was unanimously agreed to.
Digitized by {jOOQle
1898.]
Notes and News.
435
Expenses of Genebal and Divisional Secbetabifs.
Dr. Cablyle Johnstone said that he rose to move the motion relative to this
subject in the absence of Dr. Campbell Clark. He thought the general principle
would appeal to them all, and he did not require to say much in favour of it; but
apparently they would require to modify the terms of the motion, and If the
meeting would agree to that, he thought, in the first place, that instead of
saying the Divisional Secretaries, they should say “ the General and Divisional
Secretaries.” In the second place, it would be better to guard against any undue
extravagance by limiting the expenses a little more strictly. He hoped that the
motion would be carried unanimously, and would only say in favour of the motion
that at present the Secretaries gave up a great deal of their time and expended
a great deal of energy and trouble, and they got no return for it except their
thanks. The hardship was that they were penalised for sacrificing themselves
for the members of the Association ; and to have to pay all their expenses them-
selves was not right, especially as the Association was perfectly able to pay these
expenses. He understood that it was a flourishing Association, and if this could
not be afforded, other expenses might be cut down. This was a debt of honour
which the Association should pay in the first instance. He therefore begged to
move the motion as altered :—“ This meeting resolves that it be a recommendation,
to the Council of the Association that the General and Divisional Secretaries have
their travelling expenses paid in officially attending the annual meeting of the
Association and the meetings of their division.”
Dr. Ybllowlees seconded the motion with pleasure. He thought that it was
on the lines of other societies, that this was a just debt, and that they ought to-
pay it.
Dr. Ubquhabt said he would suggest a slight amendment, the motion to con¬
clude with the words, “ meetings within their divisions.” At present they bad
divisional meetings in the various districts into which the country had been
mapped out. The general meetings had formerly been convened principally in
London, but of late years they had been drawn out of London into the various
districts, to the benefit of tbe Association and the manifest convenience of the
whole body of members. He thought that it was necessary that the Secretaries
should attend these general meetings so far as possible. At the next general
meeting (for instance) most important business relative to the conduct of the
association would be dealt with. They expected that Dr. Carlyle Johnstone
would attend the general meetings. If not, he would be inevitably knocked off
the Council, and it would be a hardship if he had to go all the way to London on
every occasion, while London men had only to go next door. It was a still
greater hardship for their local Secretaries, who were more permanently connected
with the Council. It was as much the business of the Divisional Secretary to
attend the general meetings when these were within his own division as any
other meeting in that division. He had formerly proposed that the Secretariea
should have their travelling expenses paid as soon as the funds of tbe Association
permitted, but was met with a non-possumus.
Dr. Cablyle Johnstone aud Dr. Ybllowlees having agreed to tbe altera¬
tion proposed by Dr. Urquhart, Dr. Tubnbull said that he did not think it was so
hard on the Divisional Secretary to pay his expenses in his own division,
because he ought to do that as a loyal ordinary member of the Association, but
it was of great importance that he should attend the Council meetings which
were held at the same time and place as the general meetings of the Association.
He believed that it really would be of more use if one put it this way ; that the
Divisional Secretaries should have their expenses paid in attending those
general meetings of the Association at which Council meetings were also held,
because it was in that way they could more efficiently help in carrying on the
business of the Association. He would give up the claim for expenses at
divisional meetings. There were three general meetings in the year, and at:
Digitized by
436
Notes and News.
[April,
these a great deal of administrative work was done; and sometimes it was very
necessary that the Scottish Secretary, for instance, should appear at a Council
meeting for the transaction of Scottish business. If he went up to a general
meeting to do that he must pay all his expenses himself unless they made a
rule to cover such cases.
Dr. Carlyle Johnstone agreed fully with Dr. Turnbull's view, and only
moved the amended motion because Dr. Yellowlees had so advised.
Df. Turnbull said that if the Secretary’s expenses to the annual and
divisional meetings wore paid, the division could more reasonably expect him to
attend Council meetings when necessary, even though his expenses there were
not refunded.
Dr. Yellowlees said that they had a representative member of Council, who
was expected to attend the general meetings on their behalf.
Dr. Ireland said he liked the original motion of Dr. Carlyle Johnstone a great
deal better than the amended motion. Gentlemen laid stress upon Scotland being
represented. What the exact value of that was he did not know, hut he supposed it
would be very difficult to say at whut particular meeting it would require to be
represented. It might be required at any meeting. He did not think that the
limitation looked very well, although it might save a few shillings. He would
propose the original motion on the billet.
No seconder was found to Dr. Ireland’s motion.
Dr. Carlyle Johnstone then moved his motion as amended :—“ That this
meeting resolves that it be a recommendation to the Council of the Association
that the travelling expenses of the General Secretary in officially attending the
meetings of the Association other than divisional meetings be paid by the Asso¬
ciation, and that the expenses of the Divisional Secretaries be paid when attend¬
ing the annual meeting and the meetings of the Association held within their
respective divisions.”
Dr. Yellowlees seconded; and on the motion being put to the meeting it
was unanimously agreed to.
Fatal Accidents Inquiry (Scotland) Act.
Dr. Mitchell stated that he had just had a case at Rosslynlee of an inquiry
before a Sheriff and jury, under the Fatal Accidents (Scotland) Act, a bank of
earth having fallen on a patient, and he wished to know whether that Act was
applicable to asylums. Those present at the time of the accident had to go into
the witness-box and give information about the occurrence; and the jury returned
a verdict in accordance with the evidence.
Dr. Turnbull thdught it would be desirable to know whether all accidents in
asylums came under this Act, or whether the Act applied at all to any accidents
in asylums, and if so to what class of accidents. A fatal accident might occur
in the ward, and he did not know whether it came under the Fatal Accident
(Scotland) Act.
Dr. Yellowlees said it was a very important question. He had no idea that
asylums should come under that Act, and he thought they should resist it as far
as possible. He did not think any accident was a thing to be inquired into
unless where a man was arrested and dealt with in the ordinary course of law.
When a fatal accident occurred between one patient and another, it did not seem
to him that the matter should be one of public investigation.
Dr. Urquhabt said it was their duty, in the first place, to intimate every fatal
accident to the Procurator Fiscal, and if the Procurator Fiscal decided that he
would hold an inquiry before the Sheriff, it would be rather difficult for them to
avoid it. They should know where they stood, and have opinion of counsel
on the subject. They could not vote money at that meeting, however. The Act
was generally held to have been unnecessary and futile.
The President asked if it would not he better to have a small committee to
see whether this came within the Act.
Dr. Yellowlees said that the Procurator Fiscal was practically omnipotent
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*s to the course he chose to take, and it was quite right that the responsibility
should rest upon him; but he did not think that official would have any
further duty than to report the case and its accidental character to the Crown
Authorities, and he would expect in reply the order “No further inquiry necessary/’
He did not think that such a case would be regarded as coming under the Fatal
Accident (Scotland) Act, which it seemed to him had its scope only as between
•employer and employed. He did, not think that they should have interference,
•or rather publicity of that kind if it could be possibly avoided.
Dr. Carlyle Johnstone said that he understood that Dr. Keay of Inverness
had a case of the very same kind quite recently, and that he had persuaded
the Procurator Fiscal with difficulty not to adopt the procedure of this new
Act. Dr. Mitchell’s case was advertised in the newspapers, and a public inquiiy
was held before the Sheriff in the ordinary way.
Dr. Hamilton Marr suggested that it might be desirable to write to tbe
Lord Advocate asking about this matter. The conditions were not changed in
asylums. The Act applied between employer and employed.
The President thought they should consult some competent legal person as
to the terms of the Act, because it was very unlikely that the Crown officers
would do anything for which they would be found in fault, and if they had the
right to hold an inquiry nothing further could be said.
Dr. Turnbull suggested that this matter might be put on the agenda paper
of the next meeting for further consideration, and this was agreed to.
Amended Regulations fob Nursing Certificate.
The President said that the next business was the m\journed consideration
of the Report by the Educational Committee on the amended regulations for the
Nursing Certificate.
Dr. Turnbull said there only remained one difficult point'. The last discussion
stopped short at that part of the report which dealt with the constitution of the
■ examining body, about which there was a great difference of opinion. The
recommendation of the Educational Committee was that the written answers
should be examined by two examiners in nursing appointed by the Council for
that purpose, and he believed that it was intended to have only two examiners
for the whole country. He had a letter from Dr. M'Pherson, who intended to
move the following motion :—“ That a board of examiners be appointed in each
division to examine all the written papers, and to examine each candidate vivd
voce” He (Dr. M'Pherson) would be willing to modify that motion to some
extent if necessary, but he positively could not agree to the proposal of the
Educational Committee.
Dr. Watson thought that there was also a proposal made that there should be
two for each division of the country—Scotland, England, and Ireland.
Dr. Ybllowlees said that he was clearly of opinion that they ought to have
a larger examining board than two for setting questions and examining papers.
He proposed that the Board should contain representatives from each division of
the Association, that they should set the questions for the whole country. And
that they should examine and adjudicate upon the written answers. He did not
see how they could alter the local examinations. He thought that the vivd voce
examination must be conducted, for practical reasons, as it was conducted now.
If strangers could be got to do it, it would be better. Tbe visitor was called the
assessor in the old regulations, but properly it was he who should examine the
candidates in the practical or vivd voce part while the superintendent was present
but did not taking any active part. As for the written examinations, he thought
they certainly ought to be examined by the man who set the questions, he not
knowing the names of the people who were being examined. He did not propose
that every member of the Board should examine all the papers, but that they could
divide the papers among them. Each division could nominate two members of tbe
examining board, and they could examine the papers from another division than
.their own. He thought there should be no possibility of favouritism, and that
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the examiner* should not even know from what asylum the papers came. There
were three divisions in Englaud, one in Scotland, and one in Ireland, and that
could give them an examining board or council of ten. He did not think it was
fair so to burden two men. if there were a council of ten they would keep the
arrangements right.
Dr. Tubnbull said he seconded that with great pleasure, more especially as
he had himself suggested it in conversation with another member. The only
point he would refer to in Dr. Yellowlees* remarks was that he thought that the
examiners should examine the papers from their own division, beeause if there
was any difficulty in any case they could more easily get at the candidate.
Dr. Yellowlebs was strongly of opinion that they should not get at the
person, that the examination of the papers should be independent of the person
who wrote them. The only doubt he had about it was whether ten was not too
large a number.
The Pbbsidbnt said it was moved that there should be two representatives
from each division of the Association for the inspection of the written papers and
the setting of the questions—the practical part to be taken as before, the
assessor examining in the Superintendent’s presence.
Dr. Yellowlbe8 did not see how, in the face of the multitude of people, they
could improve ou that. They could not expect the members of the Board to
go round the country to all the different asylums. The fees should also be in*
creased, so that those who examined the papers should get some remuneration for
their services.
Dr. Tubnbull said that that came on a little later, and he had no doubt that
they would agree with the Educational Committee, who thought that the addi¬
tional fee was necessary.
The motion, on being put to the meeting, was unanimously agreed to
A vote of thanks to the President for his conduct in the Chair terminated the
proceedings.
RECENT MEDICO LEGAL CASES.
Rbpobtbd bt Db. Mebcieb.
[The Editors request that members will oblige by sending full newspaper
reports of all cases of interest as published by the local press at the time of the
assizes.]
Reg. v. Prince.
The cause cSlebre of this quarter was the trial of Richard Arthur Prince, an
actor, for the murder of the popular actor known as William Terriss. The case
attracted a great deal of attention in consequence of the circumstances of the'
crime, but is of no great medical or legal interest. The prisoner waited for Mr.
Terriss at the door of the Adelphi Theatre, and as the latter was stooping dowu
to insert the key in the lock the prisoner stabbed him twice iu the back. The
deceased turned round, and the prisoner stabbed him to the heart. It was
proved that the prisoner was extremely poor: that he had many times applied
for, and received, assistance from the Actors' Benevolent Fund, and that he had
received this money on the recommendation of the deceased. The managers of
the fund at length refused to assist him further, and the prisoner appears to
have attributed this refusal to the influence of the deceased. It was proved that
for many years the prisoner had suffered from delusions of persecution, and that
he had very often accused different persons of “blackmailing" him; that
he had complained that a Mr. Arthur, manager of a theatre, had been “black¬
mailing" him for ten years, that he had complained that actors generally had
“ blackmailed" him; that the men where he worked had been sent by Mr.
Arthur to blackmail him ; that he had complained that his tea was poisoned.
After his arrest for the murder the prisoner repeatedly stated that the deceased
had blackmailed him for ten years.
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Dr. Bastian stated that he had examined the prisoner at the request of the
Treasury, and that the prisoner’s mind appeared to be saturated with delusions
of persecution. Prisoner's act in killing Mr. Terriss was the result of those
delusions. He did not think that the prisoner was capable of exercising
self-control at the time. The judge: Would it mako any difference in witness's
opinion if he thought that prisoner had premeditated the act ? Witness: No,
because insane persons do premeditate. “ I am perfectly certain that the
prisoner was insane." Prisoner knew that he was making an assault on Mr.
Terriss, but he did not know the quality of the act.
Dr. Hyslop of Bethlera and Dr. Scott of Holloway Gaol gave similar evidence.
The learned judge told the jury that there was no doubt that the prisoner
committed the act, and there was also evidence that it was premeditated, but
premeditation did not prevent a man's being so insane as to be irresponsible at
law. The judge then referred to the well-known rule of law, and said that it
was clear, according to law, that a person might be insane to a certain extent,
and yet be responsible. The mere fact of insanity was not enough to make a
person irresponsible.— Guilty, but insane.—Central Criminal Conrt, January 13,
1898 (Mr. Justice Channell). — Times, January 14.
The usual latitude was permitted to the medical witnesses, who were allowed
to give evidence of their opinion of the state of mind of the prisoner at the time
of crime. The judge summed up in the strict terms of the answers in the
McNaghten case, but plainly intimated to the jury that they were at liberty to
find the prisoner insane.
Reg. v. Cross.
Prisoner, a coal merchant, aged 22, was indicted for the attempted murder of
Annie Drury. Prisoner, disguised with a handkerchief over his face, with two
holes cut in it for vision, went to the house at which Mrs. Drury was staying.
He had a revolver in one hand, and in the other a dagger made out of the tine
of a pitchfork fixed in a wooden haft. He fired the revolver at one of the
women in the house, and stabbed another several times. Subsequently he came
undisguised to the house in which they had taken refuge, and talked about the
outrage, saying that the man who committed it ought to be caught. The plea
of insanity was set up, but no details are given in the report. The jury found
the prisoner guilty, but recommended him to mercy on the ground that he was
of weak mind, although not insane.—Norwich Assizes, February 26, 1898
(Mr. Justice Grautham).— Times , February 27.
Another instance of the growing practice of taking into consideration a mental
state which, while not involving complete irresponsibility, is yet a reason for
mitigation of punishment. In this case, by inflicting only twelve months'
imprisonment, the judge appears to have given effect to the plea.
Barnett v. Blagg and others.
This was one of the rare cases in which a will is upset on the ground of
insanity. The testator was proved to have suffered from delusions of persecu¬
tion, which gave rise to a groundless and intense feeling of hostility towards, his
father, brother, and sister, whom he excluded from benefit by bis will. Sir F.
Jeune, sitting without a jn*y, pronounced against the will.— Times , December
9,1897.
THE INSANE POOR IN PRIVATE DWELLINGS IN
MASSACHUSETTS.
BT SIB ARTHUR MITCHELL, K.C.B., M.D., LL.D.,
' Ex-Commissioner in Lunacy of Scotland .
[In view of the fact that the State of Massachusetts has the near prospect of
getting a new Lunacy Law, Sir Arthur Mitchell thought it might be
useful to make an effort to secure good provisions in that law, especially in
XLiy. 29
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Notes and News.
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respect of the care of a certain class of lunatics in private dwellings, and
with that object wrote as follows on those parts of the Eighteenth Annual
Report of the State Board of Lunacy and Charity (January, 1897) which
deal with the boarded-out insane. The remarks, from which we take these
extracts, appeared originally in the Boston Medical and Surgical Journal of
November 4th, 1897.—Ed.]
The boarding-out of the insane poor began in Massachusetts in August, 1885,
under the provisions of an Act approved in that year.
The number of patients boarded out on the 30th of September of each of the
eleven years is as follows:
1886,34; 1887,73; 1888,80; 1889,110; 1890,148; 1891,155; 1892,175;
1893, 164; 1894, 158; 1895, 142; 1896,129.
These figures show a slow but steady growth of the number of the boarded-
out during the first seven years, but during the last four years there is a
steady decline, though it is said that there has been “ the same effort to place
patients out.” According to the Report, “the lack of material alone has
prevented the advance of the system.” There is room, however, for doubting
the accuracy of this opinion. Other causes of failure have been in operation,
and these must be considered in forming an estimate of the result of the
experiment, which, as the Report says, we may fairly expect to be able to do
from a knowledge of what has happened during the eleven years of its
working.
I. Mental and Bodily Condition op Patients placed in Pbivate
Dwellings.
(1) “ Persons of the quiet and chronic class.” Page 84.
(2) “ Chronic cases of good physical health and quiet and tidy habits.”
Page 85.
(3) “ Entirely tractable.” Page 86.
(4) “Simply requiring to be comfortably clothed, housed, and fed.”
Page 86.
In Scotland patients provided for in private dwellings are certified to be
(1) incurable, (2) harmless, and (3) not in need of such special nursing as cannot
easily be found out of institutions. This is regarded as enough. As a permanent
provision is contemplated, incurability is assumed to be a feature of the patient's
condition. Of course, patients may sometimes be erroneously certified to be
incurable, and recoveries among them may therefore occur. Transferences
from asylum care to private care, made for the purpose of completing or
confirming convalescence, are not regarded as a mode of providing for the
insane, but as a means of treatment; they are of a temporary character, and
are called Liberations on Probation.
II. Advantages to Patients op Cabb in Pbivate Dwellings.
(1) The '* patient enjoys home comforts and pleasures, and a measurable
return to his former habits of life.” Page 85.
(2) “ The flickering remnants of mental activity are stimulated by the
presence of old familiar habits, and the patient is happier than in the
hospital.” Page 85.
This accords exactly with forty years’ Scottish experience. If it is true of
any single patient that his happiness and enjoyment can be thus increased, the
State has no right to deprive him of that blessing, even if it cost a little
more, instead of a good deal less. Admittedly , some lunatics do enjoy life
more out of asylums than in them—in their old familiar roughish environments
than in the great formal day-rooms and dormitories of a public institution,
with the irksome discipline and methods which must and always do exist
there. If there are, as is admitted , some patients who can be thus benefited,
it becomes a duty to ascertain how many there are, and, with that in view, to
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441
ask ourselves whether long connection with asylums does not tend to make us
bad judges of what patients among the incurable could with advantage live
under private care in natural non-institutional surroundings.
III. Character op Families in which Patients should be placed, and
A8YLUM TbAINING OP GUARDIAN8.
(1) “In families without young children, and one or both of whose
heads have had hospital trainiug.” Page 85.
(2) In families in which “ enough of the hospital system appears to
help ordinary family government.” Page 85.
In the experience of Scotland the presence of young children in the homes
of the guardians is often a decided advantage to the patients. It is a
common experience to find a boarded-out lunatic an excellent and trustworthy
nurse.
Asylum-trained guardians do not ordinarily prove so satisfactory as persons
who have no special training, but who have shown good common sense and
kind-heartedness in their relations to their children, relatives, and neighbours.
There is nothing which is so much disliked in Scotland as the appearance in the
homes of the boarded-out of any trace of asylum methods of management.
Every effort is made to render the life of such patients a true home and family
life—the patients being as nearly as possible members of the family in which
they live. This is generally found to be quite possible; and the patients share
the interests, the pleasures, and the sorrows of their guardians.
IV. Dipficulty in securing without Delay in Case op Illness the
Cabe which can be at once obtained in Asylums.
(I) There is a “ difficulty of securing in case of illness the same care that
can be obtained without the slightest delay in the hospital.” Page 88.
It is difficult to believe that this is seriously advanced as an obstacle in the
way of boarding-out suitable patients.
The care referred to is evidently medical care. The guardians may fall ill as
well as the boarders, and there would be no greater difficulty in obtaining the
attention of a medical man in the one event than in the other. It is no hardship
that the guardians and patients should be on an equality in this matter. A
residence would not, of course, be chosen because it was far from a doctor, nor,
when such a residence was selected as in many respects suitable, would, a
specially delicate patient be placed in it; but, in a general sense, there is
nothing in the condition of suitable patients to prevent their living in the cir¬
cumstances in which people of their class usually live.
V. Risk op Guardians doing their Work for the sake op Gain.
(1) There is a risk that persons will “take patients for the sake of gain.”
Page 86.
(2) In agreeing to receive boarders “ the motive of personal gain neces¬
sarily exists to some extent.” Page 87.
No one could have expected that persons would receive insane boarders into
their families without the hope of some advantage from doing so. Indeed,
they ought not to do so without that hope. They ought to he sufficiently
remunerated. Proper payment tends to secure good work in this as in other
things. It is not a work of charity, though kindliness should appear in it, and
he required. The word gain has associations which give it an unpleasant ring :
but the motive of gain or advantage is quite a proper motive, and in good
administration there is fto difficulty in preventing abuses and excessive gains.
VI. Risks to the Young Persons pbom Association with the Insane.
(1) “ The companionship of a person afflicted with insanity is extremely
unsuitable for young and unformed minds, and is sometimes even attended
with dangerous results.” Page 86.
(2) “The influence on children is far from good.” Page 89.
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Notes and News.
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No evidence of such injurious influence has presented .itself in Scotland. It
must be remembered that the insane who are under private care are believed to
be incurable and harmless, and are often feeble in body as well as in mind. They
are objects of sympathy, and the young as well as the old are led to treat them
with kindness and consideration. In this direction there is an educational ad¬
vantage to the young from having two or three imbeciles boarded in a village, in
whose well-being the State shows an active and kindly interest. The real nature
of the sad condition of such persons comes to be understood, and sentiments like
the following become more common:
“ An' is there ane amang ye but your best wi* them wad share ?
Ye mauna scaith the feckless, they’re God’s peculiar care.”
It is difficult to disprove an assertion like that contained in these quotations.
It is mere assertion, however, and on its side is unsupported by proof; and, so
far as the experience of forty years’ work in Scotland goes, there is no evidence
of any such injury to the young.
VTI. Thb Risk op Overworking Pateents in Private Dwellings.
(1) There is a “ danger that too much work may be imposed ” on them.
Page 87.
(2) There is a risk of the “ imposition of tasks too severe for strength.”
Page 87.
Of course, such a danger must exist. The risk, however, is not great. And it
will not be difficult under a good administration to make arrangements which
will render the risk exceedingly small. The existence of this, as of any other
risk, ought not to be ignored, but it will not be found to be of such magnitude
as to constitute any obstacle to the development of the system of boarding-out
the incurable and harmless insane poor with guardians or caretakers selected
from the people either of New England or of Old Scotland.
VIII. Patients in Families lose the Amusements of Patients in
Asylums.
“ Patients in families are necessarily deprived of almost all the advant&gea
of social life, the amusements and entertainments which form so large a
feature of the ordinary hospital routine.” Page 87.
The dances, theatrical performances, concerts, and games of asylum life
become proper, or rather necessary, as a relief to the dull monotony and Youtine
of that life, and are needed for patients, officers, and attendants alike. But going
back to family life is a going back to true social pleasures and enjoyments.
These are longed for by asylum inmates just in proportion to the power they have
of longing for anything. No sane person would exchange them for asylum
dances and concerts. The thousand and one familiar things constantly going on
around patients in families constitute a far greater source of enjoyment than the
scenic and got-up entertainments of asylums, and All their lives with truer
delights. Of course, all this involves the ability to give to boarded-out patients
a life closely approaching to real family life,—that is, the ability to place them
with guardians or caretakers wlio will make them as far as possible members of
their families. That this is possible has been abundantly proved, and the happi¬
ness of many of the insane poor has in that way been much increased.
IX. Private Care best suited por Convalescents.
(1) Care in private dwellings “seems to apply most happily to those who
are on the road to recovery”; they are “convalescent homes for them”;
“ several patients entirely recovered in this way, whose recovery would have
been doubtful, or very much delayed, had they remained in the hospital.”
Page 88.
(2) “ Convalescent cases receive the most benefit ” under private care;
“for them the system is best suited.” Page 89.
There is a complete misunderstanding here of what is properly enough called
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the system of boarding-out. It is a method of providing for the care of the
incurable and harmless, and it concerns itself with arrangements and conditions
which are expected to be lasting.
Of course, recoveries are often hastened and confirmed by removing patients,
who are improving, from asylums to care in their own homes, or in the homes of
persons not related to them, and every good lunacy law should make it easy to
liberate patients on probation for some definite period with this good end in
view.
But it is an altogether different feature of the lunacy* administration of a
country which proposes to provide for a considerable number of harmless and
incurable lunatics in private dwellings, instead of leaving them in asylums.
The number of pauper lunatics in Scotland satisfactorily provided for in private
dwellings is 23 per cent, of all the pauper lunatics in the country. Scotland is
nearly twice as populous as Massachusetts, and the proportion of the insane to
the population is nearly the same.
In further reference to this point, it seems proper to ask whether convalescent
insane patients are more fit than others to be exposed to the risks of being under
the care of persons without hospital training, of being without the means of
instantly having a doctor, of being kept for gain, of being overworked, &e.; and
also, whether they would not injure young persons associating with them, and
would not suffer from the loss of hospital entertainments and hospital social life.
X. Strain on Guardians op Attendance on Patients Boarded with
THEM.
(1) The guardians or caretakers may tire “of the strain which this con¬
stant and unremitting attendance occasions.” Page 86.
(2) “They can never leave home together without first securing some
reliable neighbour to take charge in their absence.” Page 86.
If suitable patients are selected for care in private dwellings, there will not be
any such “constant and unremitting attendance” as to cause any strain which
will be a subject of complaint. It may be otherwise, of course, if the patients
are badly chosen. The presence of an insane member in a family will, no doubt,
sometimes—perhaps often—make it as difficult for both guardians if there are
two; or for the single guardian if there is only one, to leave home as if there
were young children in the family. But it will not be moro difficult; and the
parents of children, if they are sensible and respectable people, do not complain
of having to keep at home, or of their not being as free to move about as if there
were no children under their care.
XI. Women shrink prom Association with Persons of Impaired
Intellect.
“ Most women shrink from near association with persons of impaired
intellect.” Page 89.
This is a very surprising statement. It is not true of the women of Scotland.
They are as capable and fearless as they are kind in nursing persons of impaired
intellect. They often devote themselves most lovingly and intelligently to the
care of a helpless imbecile or dement.
It is not easy to believe that what is said here of Scottish women could not be
said with as much truth of the women of Massachusetts.
XII. The Demand for Insane Boarders exceeds the Supply.
(1) It is “ a significant fact that the demand for insane boarders invariably
exceeds the supply.” Page 81.
(2) The “ demand for patients is always greater than the supply.”
Page 89.
These are most important statements, and show the possibility of making
care in private dwellings a part of any whole scheme for providing for the
insane poor, if well-directed efforts are earnestly and continuously made. This,
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of coarse, assumes that the proportion of incnrable and harmless patients in the
whole body of the insane poor does not differ radically from the proportion in
Scotland; and there is nothing to show that any such difference exists.
XIII. Boabding-out is Objectionable as leading to the Removal
from Asylums of Useful and Profitable Workers.
(1) “The boarded-out are those easiest to care for in the hospital.”
Page 88.
(2) “The number of paid employes in our hospitals is so small that much
of the work must be done by patients, with the result not only of con¬
siderable saving to the State, but of being a wise adjunct to the treatment
of the patients. Thus the greatest number eligible for boarding-out are
either quiet patients, doing no work, and requiring the minimum of
hospital care, or else chronic cases, helpful to themselves and others,
whose departure reduces the working force of the hospital.” Page 88.
This view of the question is full of error. On the threshold it ignores the
obligation of the State to do for the insane poor what is best for them, and to
make their life as happy as it can be made. As regaids a certain number of
them—not inconsiderable—it may be safely said that every person having
special experience in the care of the insane holds that they are happier out of,
than in, asylums. All physicians act on that view, and so do all laymen.
Every insane person is not sent to an asylum. Only those are sent who, in
addition to being insane, require care and treatment in institutions. It is recog¬
nised on all hands that it would not be right to subject some insane persons to
the loss of liberty and the irksome discipline which asylum life necessarily
involves. If, then, it is not right to send to asylums persons in certain states of
insanity, it is clearly wrong to continue to detain persons in asylums, who after
a longer or shorter residence there, have passed into corresponding states of
insanity. Whatever the number of these persons is—whether it is large or
small—they ought not to be kept in asylums when they have ceased to need
such detention, and when they can he provided for otherwise in a way which
adds to their happiness. This should be a guiding view in State lunacy adminis¬
tration, even if the other way of providing for such persons led to some increase
. of cost. But it so happens that it diminishes cost and leads to saving.
It is not easy to believe that any one would seriously hold that it was right to
keep persons in an asylum because they worked well and profitably—were good
laundresses, were useful in the kitcheu, gardened well, were good musicians, or
were serviceable in other ways. This would be almost equivalent to holding
that it would be proper to detain patients unnecessarily in asylums for gain to
the asylum authorities,—that is, for gain to the State.
But it is desirable to point out that the removal of quiet patients who are good
workers, and are able to be helpful to themselves and others, has not the effects
which it is here alleged to have. This has been abundantly proved. When such
patients are removed, this is what happens: it is found that there are other
patients who can be induced to work. The set of good workers being sufficient
in number, no serious effort is made to lead non-workers to become workers.
They are not wanted, and a refusal to work is too easily accepted as a thing that
cannot be got over.
In this way the removal of the incurable and harmless does good to those who
are left, and tends to increase the number of recoveries.
XIV. Overseers of the Poor hinder the Growth of the System of
Boarding-out.
(1) Before removing patients to private care, the “ consent of the over¬
seers of the poor must first be obtained,” and they “ prefer to care for them
in their own almshouses.” This is “ a serious obstacle to the success of the
system.” Page 89,
(2) During the year ending March 31,1896, u 86 persons were discharged
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to the overseers of the poor, most of whom were eligible for boarding in
families/' Page 89.
(8) " Were small towns forbidden by law to make their almshouses
receptacles for the insane, the number of those boarded out would be largely
increased." Page 89.
All this points to the necessity of fresh legislation.
(1) All the insane poor, however provided for , should be as much under the
care of the State as those of them who are in asylums.
(2) No almshouse should be allowed to receive insane inmates which is not
licensed to do so by some State authority—the licence being granted on well-
considered conditions.
ASYLUM NEWS.
Derbyshire .— The Committee asked for power to extend the present county
asylum at Mickleover so as to provide for 750 patients, as against 600 at present.
This would involve an outlay of £21,000. During the discussion several speakers
suggested the desirability of erecting a new asylum in the northern part of the
county, which was very favourably regarded by those present.
Lancashire .—At the annual meeting of the Lancashire Asylums Board the
Chairman moved the adoption of the Report of the Committee of Winwick
Asylum, which stated that the tender of Messrs. Robert Neill and Sons for the
erection of the new asylum for Winwick for the sum of £253,000 had been
approved. The patients' blocks will be completed in about two and a half years,
and the whole building in three and a half years. The report was confirmed.
The Clerk read the following resolution from the Preston guardians:— u That
the asylum authorities be asked to put pressure upon all unions to make room
for chronic harmless cases.'' Sir J. T. Hibbert said thnt if chronic harmless
cases were put into the workhouses the guardians would not receive the 4s. grant
for their maintenance. The County Councils Association were about to promote
a Bill in Parliament to enable the union authorities to receive the grant for
chronic harmless cases that were kept in the workhouses, just as they did for
pauper lunatics in ssylums. (Hear, hear.) Alderman Hulton said he had heard
the statement of Sir John Hibbert with great pleasure. He hoped it would be a
condition that only those patients who had been subject to probationary treat¬
ment in the asylum would be allowed to remain in workhouses. Sir John Hibbert
said that would be so/
Mr. S. S. Brown (Pemberton) moved —“ That this Board doth hereby undertake
to remove the temporary buildings, to be erected in connection with the annexe
at Rainhill Asylum, on the completion of the new asylum at Winwick, unless the
sanction of the Secretary of State to their being used after the completion of
such asylum be obtained.'' The resolution was passed. Mr. Brown also moved,
“ That a sum not exceeding £10,500 be granted out of the Asylums Fund for the
erection of the temporary buildings at Rainhill." The motion having been
seconded, Mr. Hoyle said he was very glad to hear that additional accommodation
was to be provided. They were receiving censure from all parts. Only the other
day the Coroner of Liverpool made some very strong remarks on the matter.
Alderman Hulton said it seemed a great waste of money to spend £10,500 in
buildings that would have to be done away with. Mr. Turner said they might
be able to use them as permanent buildings, subject to obtaining the approval of
the Secretary of State. Mr. Kenyon said he hoped they would not have to be
swept away. They would need them and the new asylum as well. The resolution
was adopted.
West Riding .—In order to meet the need created by an increase of insanity
in the West Riding of late years, the Asylums Committee of the County Council
are making preparations for the erection of an additional asylum capable of accom¬
modating about 2000 patients. It was shown that whereas in 1887 there were
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Notes and News.
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only 2951 patients in the two asylums then open for the receipt of patients
(Wakefield and Wadsley), in 1896, ten years later, the three asylums at Wake¬
field, Wadsley, and Menston contaiued no fewer than 4152 insane persons.
These figures are exclusive of out-county and private patients. Then, in addition,
there were 1060 lunatics in the workhouses of the Riding in 1887, and 928 in
1896. To put it in another way, the returns for 1887 showed an increase of 105
in the asylums as compared with the previous year, wheroas in 1896 an increase
of 226 was recorded. If sixteen additional patients in the workhouses be included
in the latter figure, the gross increase for 1896 will be seen to have been 242.
The average of increases for the past ten years does not, it is true, give quite so
startling a result, hut an aggregate annual increase in asylums of 130 is calcu¬
lated, nevertheless, to afford food for serious reflection. In the same report the
Committee estimated that at the end of last year the total available accommoda¬
tion at their three asylums (after deducting out-county patients) was as follows:
—Wakefield, 18; Wadsley, 21; Menston, 191: total, 230.. The hospital for
acute cases now in course of erection at Wakefield would, it was stated,
afford provision for 200 more, whilst by the removal of 147 persons to the pro¬
posed new private asylum room would be made for a further 100. At the most
liberal computation, however, there could only be said to be places for 530 new
patients in the asylums at the end of last year, and at the present rapid rate of
increase all three institutions may be expected to be crowded within the next
three or four years.
The scheme for the erection of the asylum for private patients is now under
the consideration of the county council. It is intended to build it at Scalebor
Park in the Wharfe valley, for the accommodation of about 170 persons.
Besides the main building, separate villas, containing about twenty patients
each, will be eventually added, so that the total number of beds will amount to
350. It is to be hoped that the rate of award will be kept within moderate
limits, so that the poorer class will not be rejected from a hospital built at the
expense of the ratepayers.
Radnor .—At the quarterly meeting of the Radnorshire County Council held
on January 24th, the Visiting Committee of the Radnor and Brecon Joint
Counties Asylum reported that the plans of the new asylum would be ready by
September, when building would be commenced. The committee suggested that
they should be authorised to continue the boarding-out arrangement at
Abergaveuny pending the erection of the new asylum. The report was adopted.
£120,000 will be required for the new asylum.
Somerset .—At the meeting of the Somerset County Couucil held last week it
was reported that £154,000 had been spent on the Cotford Asylum up to the
present, and it was estimated that the total cost would be about £170,000.
The number of patients at Wells Asylum was stated to be 293 males and 505
females; total, 798. Cotford Asylum has 188 males and 122 females;
total, 310.
Warwick .—An epidemic has recently occurred at the Warwick Asylum which
has taxed the resources of the institution to the utmost, and caused a great deal
of local excitement, no doubt largely due to the fact that the disease w'as described
as due to ptomaine poisoning. One attendant died. The coroner held an inquest,
and sent the abdominal viscera to Dr. Stephenson for analysis, the inquiry being
adjourned for four weeks. At the adjourned inquiry Dr. Stephenson appeared,
and stated that he had examined all the viscera, but found no trace of poison
whatever. Out of 29 ounces of matter he extracted -fa part of a grain of
basic material; with this he injected a mouse, but failed to cause the little
animal any inconvenience. The jury thereupon brought in a verdict of death
from natural causes.
1 described the outbreak as one of an influenzal type, with marked abdominal
symptoms. It was highly infectious, and spread with alarming rapidity. Between
the 13th and 21st January there were fourteen cases ; from the 22nd to the 27th
inclusive 120; and between January 27th and February 12th forty. In addition
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to this number my colleagues attended upwards of thirty cases occurring among
the families of artisans living outside the asylum.
Fifty-seven attendants, thirty-eight artisans, and nearly one hundred of the
patients were under treatment. 1 had a slight attack myself, both assistant
medical officers, engineer, storekeeper, housekeeper, farm bailiff, and head
laundress being also sufferers to a greater or less degree. I called in extra
medical assistance and engaged four trained nurses, who looked after a large
number of cases in the infectious hospital.
The disease was generally very sudden in its onset, sometimes being preceded
by rigors. The most prominent symptoms were vomiting, diarrhoeu, pains in
back and limbs, high temperature, reaching 103° and 104° in a few hours, a crisis
often accompanied by profuse perspiration; while among other symptoms may
be noted coryza, pains at the back of the eyeballs, headache, sleeplessness, slight
delirium, and transitory hallucinations. The vomited matter generally contained
bile, and a marked icteric tinge was often present. A slight desquamation was
noticed in many cases where the temperature was high. The average duration
of fever was about seven days, the patients being very prostrate and weak, and
in some convalescence was very protracted, pains in the limbs, general weakness,
and tendency to neuralgia retarding recovery. In some cases diarrhoea was
entirely absent, the disease being of the ordinary type. [Communicated by
Dr. Miller.l
RESIGNATIONS.
We regret to notice that, on account of ill-health, Dr. Greene has resigned his
position as Medical Superintendent of the Berry VVood Asylum, Northampton ;
but it is some consolation to know that his services have been highly appreciated
by the Committee, and that they have set forth the facts and their conclusions
in a succinct and well-reasoned document.
The Committee states that “Dr. Greene was appointed in 1878 to the office
which he has since held with such distinction to himself and advantage to the
county of Northampton. At that time the total number of patients in the
asylum was 523, and the cost of maintenance per head per week was 10s. 6d.
Since his appointment there has been an increase in the number of patients to
900. In addition to this it must be borne in mind that by gradually decreasing
stages the cost of maintenance of patients per head per week has been materially
reduced from the above-mentioned sum of 10s. 6d. to the sum at which it now
stands of 7s. 6d. Taking the present number of patients as a fair Average, this
is equal to an annual saving of £5460. The Committee have thus been enabled
by the excellence of the management to return to the county a sum of money in
aid of the rates, which at the close of 1896 (and which has since been added to)
amounted to no less a sum than £9803, while at the same time the Committee
had in hand a balance at the bank to the credit of the Building and Repairs
Fund Account of £4741 10s. 4d. There can be no question that the Committee
have mainly to thank Dr. Greene for the administration which has led to such a
conspicuous financial success. The above resume of the results of Dr. Greene’s
service cannot be concluded without reference to another matter. For nearly
twenty years, although many additions to the asylum and asylum buildings have
been made, and notably a Fever and Infectious Diseases Hospital, a children’s 1
block (costing about £3500) and about fifteen residences for the staff have been
built, and also a well (costing about £3000) has been provided, and sundry pur¬
chases of land have been made, without the county being called upon to pay any
sum towards the same j moreover not one penny has ever been expended by the
Committee on Architect’s fees, Dr. Greene having prepared the designs and super¬
intended the buildings entirely by himself. He has also so managed that no
demand has ever been made upon the county rate for maintenance and repairs.
Dr. Greene has now, on account of ill-health, tendered his resignation to the
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Notes and News.
[April,
Committee, who are by the Act bound to give him a superannuation allowance
based on his present salary and emoluments. Dr. Greene, previous to his
appointment at Berry Wood, was for upwards of ten years a medical officer in an
asylum ; since that time he has for nineteen years and a half been Superintendent
of Berry Wood Asylum. To the great regret of the Committee, it has now
become their duty to consider what should be the amount of the superannuation
allowance to be granted to Dr. Greene, on the basis of the scheme settled by the
County Council in the year 1890. The Committee have unanimously decided to
grant a superannuation allowance of £850 per annum.'*
Although the County Council were not unanimous in regard to the amount of
the pension granted, there were apparently but three dissentients. The very
handsome remarks made by those who had long experience of Dr. Greene's
services amply compensate for this very small fly in the ointment. We join with
the Committee in their expression of cordial thanks and approval on his retiring
from public life.
We regret to note from the same report that Dr. S. A. E. Strahan has
resigned his position as Assistant Medical Officer, and that his length of service
did not entitle him to any retiring allowance. It is to be hoped that Dr. Strahan
will continue his work in reference to mental diseases, and that he will not be
lost to our specialty.
It should also be recorded that Mr. Mitchell, the head attendant of the same
asylum, tendered liis resignation after nearly twenty years* service, and was
granted a superannuation allowance of £80 per annum.
THE AFTER-CARE ASSOCIATION.
Sir William Broadbent kindly permitted the annual meeting of the After-
Care Association to be held at his house on 31st January, and took the chair
himself. He made a few introductory remarks. The report was read by the
secretary, and Dr. Savage, the Archdeacon of Westminster, Dr. White, and
the Rev. E. S. Hilliard respectively moved, seconded, and supported the adoption
of the report. The election of the officers and council was proposed by Mr.
Deputy White and seconded by Dr. Norman Kerr, and carried unanimously, and
the meeting closed with a vote of thanks to the Chairman and Lady Broadbent,
w'bich was proposed by Dr. Rayner und seconded by the Rev. Henry Hawkins,
the originator of the Association. Two facts were universally acknowledged by
the speakers: one that the year ending December 31st, 1897, has been the
most prosperous and useful in the history of the Association; the other that
the difficulties in providing employment for convalescents from mental disease are
far in excess of those connected with any other form of redemption work.
People more willingly employ the criminal discharged from prison than a cured
lunatic. The need of the help granted by the Association is intense, and the
form of help most beneficial is that which enables the patient to recover his
strength in a convalescent home, and then gives him work. As one speaker
remarked, “it is enough to drive anyone mad again to be discharged from the
asylum, where he has had every comfort, to face the world penniless, dependent
on his own exertions, and yet to have the door of so many occupations shut in
his face on account of the nature of his recent illness." During the last
twelve months 147 cases passed before the council, and the maintenance
fund reached £561, a higher sura than it has ever done. The boarding
out of convalescents in cottage homes in the country has been carried out
with increasing success, and there is need of additional homes for this
purpose. Higher rates are now paid per week for each boarder, and this has
proved a wise expenditure. The Council has decided to appoint local secretaries,
and a number of ladies and gentlemen have signified their willingness to act as
such. This will save considerably in postage and working expenses. More
convenient offices have been secured in the Church House, and efforts are being
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Notes and News,
449
made to make the work of the Association more widely known, and thus secure
a larger number of subscribers. During the proceedings Dr. Mocatta promised
a donation of £25 if a sum of £1000 was raised by other benefactions. The Rev.
H. Hawkins closed the meeting with a sketch of the origin and growth of the
Association, mentioning in the course of his remarks that the French society for
the 6ame object is far ahead of ours.
INFLUENZA AND ISOLATION.
The epidemic of influenza raises a question of vital importance. Is it possible
by isolation to save the risk of infection P It seems to us that the Collective
Investigation Committee might obtain an authoritative answer. The recru¬
descence of this plague year after year has opened a wide field of experience,
and still opinion seems to be contradictory and chaotic. Isolated papers and
letters, records in asylum case-books, and annual reports should be analysed and
brought into focus.
FATIGUE IN SCHOOLS.
Mosso has pointed out that the fatigue curve was characteristic for each
person, and that the amount of work done by a muscle could be expressed in
terms of work as kilogrammetres ; he showed, too, that mental fatigue, in so far
as it affected the general nutrition of the body, could also be estimated in
kilogrammetres. Acting on this suggestion. Dr. Kemsies has lately employed
the ergograph systematically for a year in two large schools in Berlin. Curves
were taken before and after lessons, and the particular lesson was noted. The
general result of these experiments was that the pupils showed greatest fatigue
after gymnastics. With regard to mental exercises, mathematics headed the
list; then came foreign languages, religion, and history ; natural history showed
least fatigue. A specimen of a day^s experiments is as follows:—After nine hours’
sleep, 5657 kilogrammetres; after one hour lecture, afternoon, 4086 kilo¬
grammetres; after walk and bath, 5282 kilogrammetres; after evening lesson,
4094 kilogrammetres. The fatigue passes off again after two hours from its
commencement if the lesson has been changed.
MESCAL.
Mr. Havelock Ellis has, in the Contemporary Review, lately recorded the
effects of mescal (Anhelonium Lewinii) upou two poets, an artist and himself, as
Dr. Weir Mitchell did so fully in the British Medical Journal of December,
1896. The colour sense in the insane is not infrequently affected painfully or
agreeably. It is common to hear complaints that everything looks black or grey
in melancholia, and sometimes red is predominant in the ideas and conversation.
We are not aware that mescal has been given in these conditions.
WANDERING LUNATICS.
The city coroner of Liverpool, Mr. Sampson, has lately drawn attention to the
fact that there is no suitable provision for dealing with persons suffering from
the milder forms of mental aberration, and who, while they show no definite
marks of insanity, are unable to give any satisfactory account of themselves, and
are clearly in a condition in which insane impulses might at any time arise with
grave danger either to themselves or to others. Such persons are frequently
found by the police wandering at large, and are then conveyed to the bridewell
and examined by a medical man. If they are found to be unable to take care of
themselves, and yet the medical man does not feel justified in certifying then and
there that they are insane, it is manifest that, in the interests both of the suf¬
ferers themselves and of the public, they should be retained in some suitable
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Notes and News.
[April,
place until the cause and nature of the mental aberration can be ascertained.
Until recently no serious difficulty in dealing with such cases has arisen, since
they have been received into the workhouse on a doctor’s note, and there dealt
with as the occasion demanded. Latterly, however, the authorities of Mill Road
Infirmary have declined to receive them, owing, it is stated, to there being no
accommodation in the workhouse for the alleged lunatics;' and there has been no
alternative but to take them back to the bridewell, where there is no proper
provision for attending to them, and to bring them before the presiding magis¬
trate the following day. As these persons are not charged with any offeuce for
which they can be committed to goal, there is no alternative but to discharge
them.
It is high time that reception houses for all cases of supposed insanity were
established in the great centres of population. The Barony Parish df Glasgow
has set apart observation wards in the ordinary poorhouse to meet this difficulty,
and we understand that good results have been obtained there, not only for the
individuals, but also for the ratepayers.
LABORATORY OF THE SCOTTISH ASYLUMS.
The first annual report deals with a period of seven weeks. Four assistant
medical officers had received a course of instruction, and reports had been made
on material from six cases. The superintendent has entered on his duties with
great zeal and ability, and has visited four asylums for the purpose of advising,
besides aiding in research. The work in hand has been very varied, and
Dr. Robertson is at present engaged in the study of the changes affecting the
nerve cells in insanity. He states that the premises are well suited for the
purpose. No doubt his report for next year will bear evidence of much good
work accomplished in the same spirit as he has begun.
THE CASE OF REV. H. J. DODSWELL.
It is reported that the Home Secretary has decided not to interfere in this
case. A petition was lately presented for Mr. Dodswell’s release, on the grounds
that the maximum punishment for the offence of which he was convicted had
long since expired, and that if he was still considered insane he should now be
detained in a private, not a criminal asylum. We heartily approve of the Home
Secretary’s decision.
FRAGILITY OF BONES IN THE INSANE.
A patient in the Cork Asylum lately died, after it was found that several of
his ribs had been fractured. Dr. Oscar Woods caused an expert examination of
the bones to be made, with the result that they were proved to be excessively
degenerated and fragile. It would seem that such observations should put an
end to the loose statements occasionally made in a contrary sense.
THE RISKS OF ASYLUM LIFE.
Dr. J. A. Campbell lately addressed a letter to the Lancet, in which he showed
how many hardships are endured by those engaged in the treatment of bodily
and mental disease. He traced the life-history of a medical man through his
training to practice, and alluded to the risk of infection at post-mortem exami¬
nations or in fever wards. He specially drew attention to the services reudered
by army surgeons and their inadequate recognition, and stated that he had asked
for particulars as to injuries, Ac., from forty-five English asylums in 1897.
Dr. Campbell found that several medical officers had been seriously attacked.
Lately two have had to retire owing to the results of injuries inflicted by patients.
He referred to the murder of Commissioner Lutwidge, the narrow escape of
Dr. Wiglesworth, and the injury to Dr. Merson. We congratulate Dr. Campbell
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Notes and News.
451
on having survived after having been attacked by a patient, scythe in hand, by a
patient with a knife, and by a patient with a stone, in the course of his thirty-
two years* service; and join with him in believing that if the public were aware
of such facts they would be more liberal in dealing with asylum officials.
A QUESTION OF CONVENIENCE.
Dr. J. A. Campbell also suggests that some arrangement should be made to
economise time and effort by fixing the meetings of Council of the Medico-
Psychological Association for the same week as the Council of the British Medical
Association, especially as the first-named are now often held in London. This
suggestion deserves the most careful consideration, and it will no doubt be laid
before the Association at no distant date.
SANITARY APPLIANCES.
Mr. John Lanyon, of Belfast, who has attained eminence in his profession as
an architect, and whose plans for asylums have been so favourably commented
upon, has sent us drawings and model of an “ Anti-fouling and Contagion Wnter-
closet,** which is a new pattern of the ordinary “ wash-down.** Mr. Lanyon has
designed this sanitary appliance with full knowledge of the requirements of
public buildings, and it is largely in use in mills, warehouses, Ac. Messrs.
Shanks and Company, Barrhead ; and Messrs. Johnson Brothers, Trent Pottery,
Hanley, are the makers.
Mr. Lanyon has also designed a slow combustion stove, which shows three
bright fires, burns the impure air of the room, and distributes fresh heated air.
It has been tested by the Army Medical Staff in Belfast, and favourably
commented on.
A new waterproof fabric has been placed upon the market by the Pegamoid
Company, 144, Queen Victoria Street, London, E.C. It has many advantages,
and should have a careful trial in asylums.
COMPLIMENTARY.
We observe that Professor Ludwig Meyer of Gottingen attained his seventieth
birthday on the 27th December last. We heartily join in the congratulations
with which the event was greeted by his many friends. The name of Conolly
was brought into prominence on the occasion, for Professor Meyer has devoted
his long official life to a consistent effort to work on the principles Conolly laid
down, and to induce his colleagues to adopt his practice.
We have also to congratulate Dr. G. Marriott Cooke on his promotion to
Whitehall. Dr. Cooke had the advantage of serving under the late Dr. Sherlock,
and has maintained the Worcester Asylum at a high level of excellence. He has
taken an active interest in the affairs of the Medico-Psychological Association,
and his many friends, especially those of our specialty, have every confidence in
Dr. Cooke’s ability and desire to forward the best interests of the insane and those
responsible for their welfare.
Another honour has been done to a distinguished member of our department
of medicine. Sir John Batty Tuke has been raised to the knighthood in recog¬
nition of his long and brilliant services. We wish him many and happy days,
and look forward with much interest to the Address on Psychological Medicine
which he is to deliver at the Edinburgh meeting of the British Medical
Association.
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Notes and News.
[April,
<&bfttiarp.
JOHN AUGUSTUS WALLIS.
We regret to have to record the death of Dr. John Augustus Wallis, one of
the English Commissioners in Lunacy, which took place on the 30th December
last. He had not been in robust health for some time. During the last year or
two he had experienced several rather alarming attacks of heart failure, and had
often expressed to his friends the opinion that be should not live long. Some
months before his death he had consulted an eminent London physician, whose
opinion had somewhat reassured him as to the state of his heart, and for a time
he was much better. A few weeks before his death, however, he had a return of
the symptoms, and on one or two occasions had attacks of an anginous cha¬
racter. At the time of his death he was staying at the house of his mother-in-
law in Hull, and on the morning of December 30th, not feeling so well, he
remained fn bed, and was visited by a medical friend, who prescribed for him,
but did not regard his condition as immediately dangerous, and there was
nothiug to suggest the somewhat sudden and unexpected termination. He was
getting out of bed about noon, when he dropped down and expired from heart
failure.
The deceased gentleman was a native of Cornwall, and received his early edu¬
cation at Falmouth. Subsequently his family removed to the south of Ireland,
and he was sent to school in Belgium, where he remained for some years, acquir¬
ing a familiar knowledge of the French language, which he spoke throughout
life with the ease and fluency of a native. He studied medicine in Dublin, and
obtained the diplomas of L.R.C.S.I. and L.R.C.P.E. in 1866. Subsequently
he became a graduate of the University of Aberdeen, where he took the degrees
of M.B. and C.M. in 1875, and that of M.D. in 1883.
After qualifying in medicine he engaged for a short time in general practice,
but in 1867 he was appointed assistant medical officer at the Durham County
Asylum, and from that time he devoted himself to the study and treatment of
insanity. He remained at the Durham Asylum for nearly seven years, and
after leaving he travelled on the Continent and in the United States for the pur¬
pose of studying the condition of the insane, and the various provisions made
for their care and treatment. On his return to England he became attached to
the West Riding Asylum at Wakefield, then under the superintendence of Dr.
(now Sir James) Crichton Browne. After a short residence there he was ap¬
pointed in 1875 superintendent of the Hull Borough Asylum, which was at that
time an old building situated inside the boundaries of the city, and very ill-
adapted to its purpose. From the time of his appointment Dr. Wallis never
ceased to urge upon the authorities the necessity of making some better provi¬
sions for the care of their insane patients, and at length he had the satisfaction
of seeing a site for a new asylum purchased, and plans put in hand. The pre¬
sent building was subsequently erected from designs prepared by a local architect
under his directions.
In 1878 he was appointed Superintendent of the Lancashire County Asylum at
Whittingham, where he had greater scope for the display of his practical know¬
ledge of asylum construction, and of the needs of the insane. For fifteen years he
continued at the head of this large establishment, and under his management
many important additions and improvements were effected. At his instigation
the Lancashire Asylums Board determined to erect a special hospital for the
treatment of recent cases at Whittingham, and plans for such a building had
been prepared under his direction, when he was appointed a Commissioner in
Lunacy on the resignation of Mr. Cleaton in 1894.
Dr. Wallis was a man of undoubted ability, and, though not a voluminous
writer, he made some practical and thoughtful contributions to medical literature.
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Notes and News .
453
He was the first to call attention to the value of chloral in the treatment of
epilepsy, and wrote an able paper on the subject in the West Riding Asylum
Reports. He made a special study of the housing of the insane, and was
anxious to see more thorough provision made for the early treatment of recent
cases. He was the author of a valuable article on “ The Treatment of Recent
Cases of Insanity in Special Hospitals/’ contributed to this Journal in 1894.
He was a man of broad sympathies and of benevolent disposition, generous, and
kind-hearted almost to a fault, ever ready to encourage and assist those who
needed sympathy or help. His old colleagues, and many others who knew
him well, can recall many acts of practical sympathy and kindness towards
those with whom he whs brought into contact. As a superintendent he was
eminently successful. His genuine kindness of heart and sympathetic manner
endeared him to his patients, and his relations with those under his authority
were always of the happiest kind. He took great interest in the welfare of
attendants and nurses, many of whom have cause to remember him with gratitude.
In private life he was a great favourite, being the life and soul of the circles
in which he moved. Of late years, however, he went very little into society,
leading, apart from his official duties, a somewhat retired life, and devoting
himself to the supervision of his sons’ education.
He married, in 1879, Louise, youngest daughter of the late T. W. Pearson, of
Hull. His wife predeceased him about five years ago, but he leaves a family of
four sons, to whom his comparatively early death will be an irreparable loss.
RINGROSE ATKINS.
By the demise, on the 4th of February, of Dr. Ringrose Atkins, Medical Superin¬
tendent of the Waterford District Asylum, at the early age of forty-seven, a
striking personality has passed from amongst us. The call was startling in its
suddenness, and many friends were hardly aware of his illness when the tidings
of its fatal termination reached them. On Tuesday, the 1st, he began to feel the
premonitory distress of the illness which was to carry him off so swiftly, notwith¬
standing which he went out in the afternoon to visit a lady. While in her house
he was seized with more acute symptoms of the malady, and only reached'home
with difficulty. On Friday morning, after two days of intense suffering, he
breathed his last, death being due to perforation from acute appendicitis,
associated with the passage of a renal calculus.
A wave of genuine sorrow spread over all classes in the city of Waterford when
the sad news became known. For Atkins was no ordinary man. His was a
character rich, unique, and rare. In him intellectual talents of a high order
were united to a sympathetic nature, generous feelings, and nobility of soul.
And all were freely placed at the disposal of his fellow-men without distinction,
high-born and humble, rich and poor. Wherever his help was needed that help
was given ; first of all to those who were his special charge, for towards the
insane he always had a feeling of kindliest interest, which even in maimed and
shattered minds struck an answering chord, as was shown by the greeting of
welcome he used to receive as he passed on his daily round through the wards.
He never wearied in his efforts to cure or alleviate, and devoted a large portion
of his time to entertaining his patients with his interesting lantern lectures,
seaside excursions, and amusements of various kinds. And while, as he always
did, making his patients the subjects of scientific observation, he never forgot
that he was dealing with human souls. Outside his asylum work he was a leader
in every good cause, and his labours in connection with the Young Men’s Christian
Association, of which he was President, and in furtherance of the cause of
temperance, will not soon be forgotten.
Dr. Atkins sprang from a well-known Cork family, which contributed many
members to the medical profession, including his paternal grandfather, his brother.
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Notes and News.
[April,
Dr. T. G. Atkins, a lending physician and surgeon in his native city, and other rela¬
tives. His father, .William Atkius, whs a leading architect in Cork, and also an
artist, hnving studied in the various Continental schools, it was he who instructed
young Atkins in early life, and from him, uo doubt, he both inherited and acquired
his artistic tastes, and bis love for and knowledge of architecture. Oue of the
earliest reminiscences of his childish taleut was his painting a diorama of
Switzerland, and lecturing on it, when he was only ten years old. His acquaint¬
ance with architecture he turned to good account in his asylum, as all structural
operations he kept under his direct supervision, and was fond of saying he liked
to know how every brick was laid. From his father also he probably inherited
his love of travel, amounting in his case almost to a passion, which, happily, he
was able to indulge to no ordinary degree. Of science he was not one whit less
enamoured than of art; science and art, like twin sisters, seeming to have almost
equal claims on his homage and affection. To these endowments he added a
quite exceptional manual dexterity, coupled with mechanical skill, which found
abundant room for exercise in the surgical part of his professional work, and in
the operations connected with histology and photography, in both of which he
was an adept. Inspiring all these natural gifts was a spirit of iudomitable
industry, which never flagged up to the closing hours of his busy life.
Educated in Queen's College, Cork, after a distinguished course he graduated
in the Queen's University with nonours, winning the gold medal for experimental
physics at the early age of seventeen. He took the M.A. degree in 1871, and
those of M.D. and M.Ch. in 1873. He obtained his first experience in lunacy
practice as assistant medical officer in Cork Asylum, and in 1878 he was appointed
Medical Superintendent of the Waterford District Asylum, which post lie held
till his death. During this prolonged period his relations with his patients, his
Board of Governors, and the public were of the happiest kind. From an early
stage in his career he was busy with pen and pencil, writing articles which he
illustrated with his own drawings, which were of such exceptional merit as to
draw from no less an authority than the illustrious Charcot words of generous
commendation. Among his contributions to medical literature may be mentioned
his Pathological Illustrations of Localisation of the Motor Functions of the
Brain, and his papers on Arterio-capillary Fibrosis, On Morbid Changes in
the Blood Vessels and the Nerve Elements of the Brain of the Insane, and the
Morbid Histology of the Spinal Cord in Insanity. His articles reviewing the
progress of nervous and mental disease, which regularly appeared in the Dublin
Journal of Medical Science , showed a wide acquaintance with the literature of
his speciality both at home and abroad. He was a Fellow of the Academy
of Medicine and a member of the Medico-Psychological Association since
1875. He also assisted Dr. Macnaughton Jones in founding the premier
branch of the British Medical Association in Ireland, and in conjunction with
him worked hard to make the Cork meeting of the Association a success.
To spend eveu one hour with Atkins was a liberal education. His thoughts
sped swiftly on winged words. Whether forming one of an audience, or, more
delightful still, chatting on into the small hours of the morning, one could only
feel amazed at the wealth of bis information, hs he poured forth out of the
treasure-house of his marvellous memory things new and old. New—for he
kept himself well abreast of the most recent discoveries of science, which he
could discuss with an ease and grasp unusual in one who lived so far apart
from the great centres of thought; old—for he never was happier than
when he was studying, photographing, or describing to friend or audience
the ancient relics of hoary antiquity. In every tour he made there was an
earnest purpose to fulfil. To enlarge his knowledge, and gain fresh insight
into the habits and customs, the architecture, the geological features, the
historical associations of the countries he visited, was to him a definite aim. His
lectures on such subjects were remarkable for the phenomenal memory which
they displayed, and the absence of the slightest falter or hesitation. They were
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1898.]
Notes and News,
455
invariably illustrated by bis own exquisite lantern slides, which, as regards
technical excellence, were perfect, but had, in addition, an artistic quality which
is only rarely noticeable in the work of the professional photographer, and which
gave them a peculiar charm. He was an ardent Egyptologist; in fact, it was
one of his special studies, and his photographs of the interiors of some of the
pyramids, and of hieroglyph and cuneiform inscriptions, are probably some of
the best that exist anywhere. His enthusiasm for this branch of archeology
nearly cost him his life on one occasion, when he was all but smothered while
exploring the recesses of a pyramid in order to photograph it by magnesium
light, a suffocative attack, to which he was at times subject, having come on
just at the wrong moment.
There was one other feature in Atkins’ many-sided character which must not
be omitted from this imperfect sketch, as it coloured his whole life. He was a
profoundly religious man. The combination of an ardent love for science with
strong religious convictions is not a very common phenomenon in these days.
And, perhaps, of all the sciences, psychology least of any tends to encourage
stability of belifef. Faraday, we know, kept his science and his religion apart.
Conscious of the difficulty of reconciling things which often seem hopelessly in¬
compatible, he, as it were, assumed a different mental posture, according as he
was engaged with one or the other, and thus, no doubt, escaped mental conflict.
With Atkins it was wholly different. In him religion and science were inti¬
mately interwoven, and though the former was never aggressively thrust into pro¬
minence, it could be seen that it underlay his whole life and conduct. He never
seemed to be troubled with doubts or difficulties; possibly he may have had some—
who is there that has none—but they did not come to the surface. An explana¬
tion of this, perhaps, may be found in the fact that, if we may judge from bis
writings, his attention was directed rather to the neurological than the psycho¬
logical aspects of insanity. His mind was so constantly engaged with such
concrete subjects as neuro-pathology, clinical observations, asylum administration,
&c., his hobbies also being of a practical sort, that he probably gave but little
time to the consideration of purely abstract problems, those “obstinate question¬
ings ” which have vexed the souls of many, and in not a few have made shipwreck
of their faith. His was the large and liberal and eminently practical Christianity
which embraces all mankind, and sympathy with suffering of any and every kind
was the key-note of his being—a sympathy which always had some outlet in
action, whether in administering relief with skilful hands to bodily suffering, or
on his knees at the bedside assuaging mental anguish with words of consolation,
and binding up the broken heart.
The following tribute from one of those best qualified to speak on this subject
may fittingly conclude this outline:—" I did not like the man, I loved him; for
his genuine nature, his childlike mind, his great culture. He was a truly disin¬
genuous soul, affectionate, true, sympathetic; a delightful companion, a charm¬
ing conversationalist. His was the versatile sort of brain. Yet there was both
quantity and quality. 1 knew him as the enthusiastic pupil, the ardent and
indefatigable worker, the impulsively warm friend, the keen scientist. I knew
him through a period of cloud and sorrow, and his Christian and forgiving
spirit. To none a resentful thought, to none a harmful act. One is tempted
with Arnold to exclaim, * Oh, strong soul, by what shore tarriest thou now ? *
Surely to thee it is given to help,.to comfort, to strengthen ; and not for ever
blotted out is the bright intellect that we knew, and the loving soul that we
have lost.”
A character deep but translucent; a life simple yet full, not without an element
of grandeur. Like the sun of a tropical day our friend has suddenly, alas!
passed beyond our visual horizon, and has, we fain would hope, reached the clear
daylight of a higher existence, a larger life. The memory of him will not die.
On those who mourn his loss—and they are many—there lingers a warm sunset
radiance, the afterglow of a noble life, cheering, brightening, elevating, casting
the backward reflection of a tender glory over the path he trod, that path of the
xliv. 30
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456 Notes and News. [April,
just which, we are told, is as “ a shining light, that sbineth more and more unto
the perfect day.”
Sic iiur ad astra.
ERNEST HART.
We deeply regret to chronicle the death of Mr. Ernest Hart. Although his
own personal interest lay chiefly in matters connected with Public Health, and
his editorial duties led him into every department of Medicine, he was ever
alive to the claims of our specialty. In bis official capacity as editor of the
British Medical Journal , and as Chairman of the Parliamentary Bills Com¬
mittee of the British Medical Association, he was always accessible and willing to
lend us a helping hand. Mr. Hart’s energy and enterprise were unbounded; his
determination to leave the world better than he found it was worthy of all
praise. We might object to certain incidents in his career and certain
methods in his working; hut when the measure of his achievements is reckoned,
his mistakes are obliterated by a sense of his personal worth, and the loss which
the medical profession has sustained by his death.
THE LIBRARY.
The Library Committee asks for the following to complete sets, viz.—
Reports of the Commissioners in Lunacy for England and Wales for the
years 1847, *48, *49, ’64, and *74.
Reports of the Scottish Commissioners , Nos. 3, 4, 6, 8, 10, 11, 13,18.
American Journal of Insanity for the year 1886.
Archives de Neurologie for the years 1874-5-6-7, and 1887.
V Encephale, from 1888.
Allgemeine Zeitschriftfur Psychiatrie. Complete set wanted.
Annales Medico-Psychologique , 1864-5-6.
NOTICES BY THE REGISTRAR.
At the examination for the certificate in Psychological Medicine held on
December 16th, 1897, the following candidates were successful:
Examined at Bethlehem Royal Hospital, London. —Oscar Bernard Goldschmidt,
William John Handheld Haslett, Robert Hughes, George McGregor.
Examined at the Royal Asylum, Morningside, Edinburgh. —Charles Cromhall
Easterbrook, G. Landsborough Findlay, Donald A. Macvean.
Examined at the District Asylum, Cork. —Lucia Strangman.
The following is a list of the questions which appeared on the paper: ■
1. How would you treat persistent insomnia (a) in passive melancholia; (5) in
melancholia with excessive bodily movement; (c) in acute mania? 2. What
forms of mental disease are associated with a previous history of syphilis ? How
far do you consider general paralysis of the insane to be due to syphilis ? 3.
Enumerate the principal varieties of mental disease arising from alcoholic excess,
and give the distinguishing physical symptoms of each variety. 4. Give
examples of mental and physical causes of refusal of food, the prognosis in each,
and the indications for treatment. 5. Distinguish between idiocy, imbecility,
dementia, and stupor, and give the best recognised classification of idiocy. 6.
Compare the changes in the brain cells which have been described as charac¬
teristic respectively of paretic, senile, and alcoholic dementia. To which
conjecture as to the mode of origin of these respective changes do you incline,
and why ?
The next examination will be held in July, 1898.
Digitized by LjOOQle
1898.] Notes and News. 45/
The examination for the Gaskell Prize will take place at Betblem Hospital in
the same month. ,
The exact dates for these examinations have not yet been fixed, but will be
advertised in the medical papers in due course. #
Competitors for the Bronze Medal and Prize of Ten Guineas must send in
their essays to the President before 30th May, 1898.
The following candidates were successful at the November examination for
the Nursing Certificate in addition to those published in the Joubnal for January,
1898 *
Valkenherg Asylum, South Africa.—Female : Ellen Kenny.
Port Alfred Asylum , South Africa.—Females: Fanny Maud Barnes, Louisa
Annie Jane Evans, Edith Adoliue Woods. Male: Valentine Muller.
Note.
As the names of some of the persons to whom the Nursing Certificate has been
granted by the Association have been removed from the Register, Employers are
requested to refer to the Registrar in order to ascertain if a particular name is
still on the Roll of the Association. In all inquiries the number of the Certi¬
ficate should bo given.
For further particulars respecting the various examinations of the Association
apply to the Registrar, Dr. Spence, Burntwood Asylum, near Lichfield.
NOTICES OF MEETINGS.
MEDICO-PSYCHOLOGICAL ASSOCIATION.
The Annual Meeting of the Association will take place in Edinburgh,
under the presidency of Dr. Urquhart, towards the end of July, and as the
Aunual Meeting of the British Medical Association is also to be held in
Edinburgh, it is considered that probably Thursday or Friday (or both), July
21st and 22nd, may be the most convenient dates, so as to enable members
to attend both congresses.
As the success of the meeting depends upon the contributions of individual
members, it is desirable that notices of discussions, exhibits, or papers to be
read, be received at an early date, in order that the necessary arrangements may
be made, and that facilities may be afforded to members seeking accommoda¬
tion in Kdinburgh during the meeting.
Notices of papers to be read or of intention to be present should therefore
be sent as soon as possible to Dr. Turnbull, Hon. Secretary for Scotland,
District Asylum, Cupar—Fife.
General Meeting.— The next General Meeting will be held at the rooms of
the Association, 11, Chandos Street, Cavendish Square, London, W., on Thursday,
May 12th, at 4 p.m., under the presidency of Dr. T. W. McDownll.
South-Western Division. —The Spring Meeting will be held in the County
Asylum, Littlemore, Oxford, on Tuesday, the 19th April, 1898. The proposed
alterations in the nursing regulations and the question of assured pensions will
bo discussed. Dr. Sankey will show cases, Drs. Noott and Blachford will con¬
tribute papers.
South-Eastern Division. —The next meeting will be held at the Wandsworth
Asylum on the second or third Wednesday in April, 1898.
Northern and Midland Division.— The next meeting will be held in May,
1898.
BBITISH MEDICAL ASSOCIATION.
The sixty-sixth Annual Meeting will be held at Edinburgh from the 26th till
the 29th July, 1898, under the presidency of Sir Thomas Grainger Stewart.
Section of Psychology President, Thomas Smith Clouston, M.D. Vice-Presi-
Digitized by
458
Notes and News.
[April,
dents, William Wotherspoon Ireland, M.D., H. F. Hayes Newington, M.R.C.S.,
Joseph Wiglesworth, M.l). Honorary Secretaries, John Macpherson, M.D.,
Stirling District Asylum, Larbert, Stirlingshire; George M. Robertson, M.B.,
District Asylum, Murthly, Perth.
THE NINTH INTERNATIONAL CONGRESS OF HYGIENE AND DEMOGRAPHY
will assemble at Madrid from the 10th till the 17th April, 1898, under tbe
presidency of Professor Julian Calleja, of Madrid. The General Secretary is
Dr. Amalio Gimeno, of Madrid.
APPOINTMENTS.
Braine-Hartnbll, G. M. P., M.R.C.S., L.R.C.P., has been appointed Medical
Superintendent of the Worcester County and City Lunatic Asylum.
Bubb, William, M.R.C.S., L.K.C.P., has been appointed Deputy Superin-
tendeut and Senior Assistant Medical Officer of the Worcester Couuty and City
Lunatic Asylum.
Campbell, Robert B., M.B., C.M., has been appointed Senior Assistant
Physician of the Montrose Royal Asylum.
Cooke, E. Marriott, M.B.Lond., M.R.C.S., has been appointed Commissioner
in Lunacy, vice J. A. Wallis, M.D., deceased.
Elkins, F. A., M.D., has been appointed Medical Superintendent of the
Leavesden Asylum, King’s Langley, Herts.
Lord, J. H., M.B., C.M., has been appointed Assistant Medical Officer of the
London County Asylum, Hanwell.
Middle mass, J., M.B., C.M., F.R.C.P.E., has been appointed Medical Superin¬
tendent of the Sunderland Borough Asylum.
Pulford, Herbert, M.A., M.B., B.C.Cantab., has been appointed Second
Assistant Medical Officer of the Worcester County and City Lunatic Asylum.
ERRATUM.
January number, page 140 —for Clonmel read Downpatrick.
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THE JOURNAL OE MENTAL SCIENCE.
[Published by Authority of the Medico-Psychological Association
of Great Britain and Ireland.']
No. 186. NE M 1K8 ’ JULY, 1898. Yol.XLIY.
PART I.—ORIGINAL ARTICLES.
Insanity in Children.*— By Fletcher Beach, M.B., F.R.C.P.
Lond., Physician to the West End Hospital for Nervous
Diseases; formerly Medical Superintendent of the
Darenth Schools for Imbecile Children.
Although ancient writers have given short descriptions of
mental diseases affecting children, it was not until the
commencement of this century that the subject began to
attract attention. Since then Esquirol, Guislain, Delasiauve,
and others have written on the matter, and in 1856 Le
Paulmier, in a thesis, gave the most complete description of
the affection which had previously been published. Numerous
authors in England, Germany, and France have since 1856
written on the subject, but still there seems to be a good
deal of want of knowledge regarding the mental affections of
children.
The young child is a creature of emotion and of lively
imagination, and he usually has a good memory, but it is
often difficult to fix his attention for a long time on a subject,
and he lacks reason and reflection. As a matter of fact, the
child is guided in his conduct by instinct or by sentiment,
but his sentiments are usually fickle and changeable. Up to
seven years of age mania is comparatively rare, and when it
exists shows itself chiefly under the form of a maniacal
excitement or delirium, frequently coming on with febrile
attacks. The moral sense becomes early depraved, and if
the affections are not well developed, it later becomes true
insanity. As the child grows up the bad inclinations become
stronger, and when puberty comes on there is a furious out-
# Read at the South-Eastern Division at Northampton, October 13th, 1897.
XL1V. 31
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460 Insanity in Children , [July,
burst, and a slight cause will be sufficient to excite the
patient to commit homicide.
What are the causes which produce these troubles in
infancy and childhood ? Want of time will only allow me to
touch upon a few of them.
The first and most important is that of heredity . Esquirol
is of opinion that of all diseases insanity is the most
hereditary, and other psychologists have confirmed his
observations, and some have even exceeded him in their
estimates of the number of cases in which insanity is due to
hereditary taint.
We must also take into account the metamorphoses or
transformations of heredity. Dr. Moreau, of Tours, has
made an extensive study of the subject, and in his “ Psycho¬
logic morbide ” he gives several cases of the transformation
of heredity taken from pathology and history. “We must
not,” he says, “ look for a return of identical phenomena in
each generation. ... A family whose head has died insane or
epileptic does not of necessity consist of lunatics or
epileptics; but the children may be idiots, paralytics, or
scrofulous. What the father transmits to the children is not
insanity, but a vicious constitution which will manifest itself
under various forms, in epilepsy, hysteria, scrofula, and
rickets.” He goes on to say, “ Just as real insanity may be
hereditarily reproduced, only under the form of eccentricity;
... so a state of simple eccentricity in the parents may in the
children be the origin of insanity.” As an instance of this he
gives the family history of a boy aged ten years.
Paternal line .—Grandfather intemperate and immoral,
notwithstanding his advanced age. Grandmother very
nervous, lively, peevish, jealous.
Maternal line .—Grandfather intelligent, without energy,
easily influenced by the first comer, and by his eccentricities
excites the laughter and jests of his neighbours. Grand¬
mother very obstinate, imperious, extremely violent. Towards
the end of her life she delighted in ill-using persons and
things. Father.—Feeble in character, proud, subject to fits
of violence, ideas vague and slow of development, intem¬
perate. Mother.—Very intelligent, meek, hard-working.
Brothers and sisters of the patient. —The eldest whimsical,
uncommunicative, of slight intelligence, simple-minded.
2nd.—The patient.
3rd.—Very simple in character, her simplicity contrasting
strongly with the wickedness of most members of the family.
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1898.]
by Fletcher Beach, M.B.
461
4th.—Of the same character as the patient, but he has not
yet had fits of violence.
5th.—An intelligent girl, but eccentric in her tastes.
The patient’s intelligence was well developed. One day
he went into a vineyard to steal some grapes. Surprised
by the field keeper, he was taken before the proprietor,
whose remonstrances made such an effect on his mind that
from this time he showed symptoms of insanity. He ran
quite naked through the streets, armed with a stick with
which he struck children without any reason. He was sent
to school, but was so lazy that he was sent home again.
Next ho was sent to a home, whence he escaped, his arrival
at his parents’ house being announced by the burning of a
straw rick to which he had set fire.
The faculty of imitation plays an important part, especially
when the imitator is a neurotic person. In this case there is,
one might say, a ground prepared to receive the impression.
There is an instance on record, many years ago, at the time
when a number of children were taking their first communion,
of one of them being attacked with convulsions, and in less
than half an hour all, or almost all, were attacked with
similar convulsions. This faculty of imitation is so imperious
in certain individuals that they cannot see any action, or
hear of one, without being disposed to imitate it. The most
formidable imitations are those of suicide and homicide.
A boy aged fourteen years was of a lively and happy disposi¬
tion. On the day on which he died he was happy and con¬
tented. Some days before he had attended the funoral of a
playfellow who had committed suicide, and he was heard to say
playfully, “ I must kill myself too.” He came some time
afterwards to the place where his friend had committed
suicide. The sight of a cord, the suitability of the place,
struck him, and he realised the idea which he had previously
expressed.
Prosper Lucas relates the case of a child of from six to
eight years of age, who had choked his youngest brother.
The father and mother surprised the boy in the act. The
child threw himself into their arms crying, and said that he
had only done it in imitation of the devil whom he had seen
strangle Punch.
There is no doubt that the great publicity now given in
the newspapers to murder is the cause of many similar
crimes. A person with a weak or ill-balanced mind sees in
the newspapers reports as to the health of the murderer, his
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Insanity in Children,
[July,
conduct and behaviour, and endeavours to acquire notoriety
by committing a similar crime. A severe shock or fright is
well known to be the cause of convulsions, and it may also
originate a mental affection. Chorea is often produced by a
severe fright. Esquirol mentions the case of a young girl, aged
eight years, who saw her father murdered. Since then she
had often suffered from violent terror; at the age of fourteen
the menses appeared, but only irregularly; she became
maniacal, and wished to fight everybody. The sight of a
weapon, a knife, or of many men assembled together was
sufficient to excite in her the most violent fury.
Excess in study is a very active cause. The late Dr. Hack
Tuke read a paper entitled “ Intemperance in Study ” at the
annual meeting of the British Medical Association, held at
Cork in 1879, in which he pointed out that brain-fag, mental
excitement, depression of spirits (sometimes suicide), epilepsy,
and chorea were produced by over-study. In these days,
when so much attention is paid to exercise and athletics in
schools, at first sight one would think that this statement
could not be true, but he mentioned a case of mania from
this cause which came under his notice, and which had to be
confined to an asylum, and he had seen several cases of
suicidal melancholia brought on by overwork. As he truly
said, “no doubt worry has a great deal to do with the pro¬
duction of the disease, but the real cause is that the school¬
boy has to master too many subjects in too short a time.”
Many of these cases are kept at home and seen in con¬
sultation practice, and therefore do not appear in lunacy
statistics.
The establishment of puberty plays a very important part;
as Esquirol says, “ the troubles of menstruation are one of
the most frequent causes of insanity.” In ancient times
Hippocrates noticed that puberty was often the cause of
mental disorder. He mentions the case of a young girl
whose “visionsorder her to jump, to throw herself into wells,
to strangle herself; . . . when there are no visions there is a
certain pleasure which makes her long for death as something
good.” No doubt there is an hereditary tendency to insanity
in these cases, for, as we all know, menstruation is established
without much trouble in the great majority of the human
race. Rousseau has pointed out the normal and morbid
phenomena which take place at the moment of transition
from infancy to adolescence. The establishment of puberty
can, he says, “ provoke accidents capable of being translated
Digitized by ^ooQle
1898.]
by Fletcher Beach, M.B.
463
into all forms and all degrees of neuroses, from spasm and
convulsion up to delirium, and even stupor.” According to
him mania is more frequent than melancholia at this epoch.
“ The young boys,” he says, “ are generally loquacious,
endowed with remarkable activity; they are fond of boasting
and bravado; they wish to undertake everything, they com¬
mence many things, but accomplish nothing. The delirium
of young girls is less brilliant; they are gay, frolicsome, and
eager to fix attention on themselves; their mobility is
excessive, and they pass with surprising facility from ex¬
travagant laughter to most abundant tears.” He is of
opinion that when melancholia does supervene the religious
and erotic forms are the most common at puberty.
Masturbation is an important factor. Very often this
pernicious habit is due to instruction by a nurse of vicious
principles. An instance is on record of a young girl, twelve
years of age, who was initiated by a servant into this odious
practice, and she then taught her brother. They were
separated, and the girl sent to a convent, the boy to school,
but they later led a most dissolute life. While still young
the boy blew out his brains.
In some cases the habit is due to a vicious boy introducing
it among his schoolfellows. Very often masturbation is
denoted by a blue circle round the eyelids, a weakening of
the senses, especially of sight, and of the digestive organs, a
feeling of lassitude, emaciation, and feeble circulation.
These symptoms are followed by nervous affections, epilepsy,
and finally, mental disease. Many of my out-patients at the
West End Hospital come to me suffering from utter prostra¬
tion and nervous weakness as the result of this practice, and
more than one has threatened to commit suicide. In all
these children there is a change of character; there is a
disappearance of the joyfulness which is one of the principal
attributes of youth, and the propensity is often the cause of
atrocious perversion of the affective faculties. Sensibility is
profoundly injured, and hence melancholia is the form which
most commonly occurs as a result of this practice.
Intoxication by alcohol is occasionally a cause, and Magnan
describes children, aged nine and thirteen, who were afflicted
with the vice of drunkenness. Gemme quotes a series of
cases of delirium tremens in children. The parents were
drunkards, and supplied liquor to their offspring. Four
children suffered from epilepsy in consequence of excess of
drink, but true delirium tremens occurred in many cases. In
Digitized by
464
Insanity in Children ,
[July,
one instance, hallucinations, excitement, confusion, and
insomnia existed in a child aged five years, who had been
given brandy daily for two years by her father, a glass
of Hungarian wine daily by the mother, and in the evening
the child drank beer with the father, who kept a public^
house.
Intoxication by drugs, such as belladonna and stramonium,
from children eating the berries, and producing in some
cases hallucinations of sight, in others furious delirium, are
on record, but it is not necessary further to allude to the
subject.
Acute affections , such as meningitis, acute hydrocephalus,
scarlet fever, pneumonia, typhoid fever, are frequent causes
of mental disease. As far as meningitis is concerned there is
nothing surprising in this, for there is often direct irritation
of the cerebral substance. “If,” as Broussais says, “the
meningitis is slight, the delirium will be acute and noisy;
but if the lesion is profound, and injures the substance of
the brain, not only perversion but suppression of the
cerebral functions follows, viz. stupor, coma, and paralysis.
Delasiauve attended a girl aged six years for this affection;
before the attack she was intellectual and vivacious, but
afterwards she became gloomy, and was subject to whimsical
desires and hysterical caprices.
As regards scarlet fever , independently of the delirium
which sometimes comes on in the course of the fever—a de¬
lirium characterised by hallucinations and a kind of anxious
melancholy,—many authors have observed that psychical
troubles sometimes occur after the fever is over. One in¬
stance will suffice. Dr. Wick attended a very young man
who had a severe attack of scarlet fever. Scarcely had the
fever ceased, and at a time when everything pointed to a
rapid convalescence, the patient presented mental troubles—
delirium with hallucinations, agitation, insomnia, and delirium
of speech. He remained in this condition for a week, but
after strong doses of chloral he recovered, after being two
months ill.
During the course of typhoid fever the cerebral faculties are
often weakened, so that the children when convalescent have
forgotten much of what they had learnt, and learn new sub¬
jects with difficulty. In some children this intellectual weak¬
ness is very marked, and presents all the characteristics of
dementia. Marce relates the case of a girl aged thirteen
years, who was very intelligent, but at the end of a severe
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465
attack of typhoid fever she became quite idiotic. Her speech
was drawling and silly; she addressed everybody with childish
questions, weeping at the time, forgot the names of those
around her, and became unclean in her habits. Instead of
dementia, maniacal delirium, with or without hallucinations,
is sometimes produced, or the delirium may be partial, and
present all the symptoms of monomania. In other cases the
monomania is more complete, and often characterised by
ambitious ideas; hallucinations and attacks of epilepsy also
occur.
As regards the age at which insanity is noticed, Dr.
Berkham has collected particulars of forty-seven cases. They
are as follow :—
1 child at
1 „
2 children at
3 „
3
5
9 months old.
2^ years old.
3 *
5
6
7 to 7£ „
4 children at 8 years old.
4 » 9 „
10 „ 10 to lOfc years old.
10 „ 11 years old.
4 12 „
Paroxysms of fury and passion strongly resembling mania
are often seen in mere infants, but according to the table
above given, proclivity to insanity seems to increase with the
age of the children. Of thirteen cases that have been under
my care, one case occurred at nine years, and two at ten years;
the others showed mental disease at the age of twelve years
and upwards.
As regards sex , twenty of the forty-seven cases were boys
and fourteen girls; the sex of the others was not stated. Of
the thirteen cases which I have seen, eight were boys and five
girls. 80 far as my information at present goes, it seems,
then, that more boys than girls are affected with insanity.
As far as age is concerned, there is no doubt that up to
seven years of age convulsions and arrest of intelligence are
most commonly observed, although, as I mentioned in a
former part of this paper, delirium is often seen as the result
of febrile affections. From seven to fourteen years of age
true mania and melancholia are most frequent, while hysteria
shows itself very often as soon as the menses appear.
Among the psychical diseases met with dementia is fre¬
quently observed. Acute dementia, which is the most common
form, frequently occurs between the ages of ten and sixteen,
and differs from senile dementia “in that it seems to depend
on the imperfect nutrition of the nervous system, and is gene¬
rally curable by generous diet and other means that supply
materials for construction.”
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Insanity in Children ,
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Burrows relates the case of a boy who, up to twelve years
of age, " had evinced all the capacity and activity usual to
his years. At this period some change was observed in his
disposition and habits. He became negligent and irascible,
fond of amusements below his age, and if opposed fell into
silly passions. What he desired he cared not how he obtained.
At length slight symptoms like chorea came on. When
aged fourteen years,” he says, "he (the patient) was brought
to London for my advice. He appeared then to be a stout
lad with a healthy complexion. The conformation of his
head was good. The expression of his countenance denoted
a degree of vacuity. He hesitated in his speech a little, and
then uttered his words suddenly. He desired almost every¬
thing he saw, and attempted to gain it with force and violence,
and if restrained broke into furious passions. He had lost
all knowledge of the classics, and only amused himself with
childish books and pictures. A year afterwards his tutor
wrote to me that he was gradually becoming worse; his
senses were more impaired, his movements were more re¬
stricted ; in short, he was quite in a state of vacuity.”
Juvenile dementia, as a result of inherited syphilis, is
occasionally met with. Mental deficiency is noticed at the
age of the second dentition, and from this time gradual
degeneration ensues, with sometimes paralytic and epileptic
seizures, and death occurs in three or four years. I had a
well-marked case under my care, in which after death the
brain was found to be small in size, and there was thickening
of the membranes and diminished calibre of the cerebral
arteries.
Monomania , or delusional insanity , which " consists in an
exaltation or undue predominance of some one faculty, and
characterised by some particular illusion or erroneous con¬
viction impressed upon the understanding,” is commonly met
with. The patient suffers from delusions and hallucinations.
I had a case under my care at Darenth, a girl aged twelve
years, who was full of religious delusions. As far as halluci¬
nations are concerned, Moreau is of opinion that while those
of the adult may be gay or sad in character, in children they
are in ninety-nine times out of a hundred sad. The hallucina¬
tions of sight consist of armed men who menace the child, of
red or black devils, of corpses dressed up, and so on. Those of
hearing are usually terrifying in their character. The child
not only sees but hears people say, "I am going to cut your
neck,” "Be quick or I shall knock you down,” "If you
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467
move you will die,” and similar sentences, which frighten
him. Many cases are on record, but the following is a good
example. A child aged seven years, after hearing some
stories told by her nurse, had hallucinations of sight. She
saw one evening on the wall opposite to her bed a great red
man. At her cries they ran to her, and pointing to the
figure with her finger, she said, “ Do you see him on the wall ?
he is looking at me.” This condition persisted for a long
time.
Theomania, demonomania, kleptomania, pyromania, and
dipsomania occur in children, but it is not necessary to discuss
these affections now.
Erotomania has been observed in early life. The expres¬
sion of the face and the gestures have an amorous languor,
but as a rule the children so affected are chaste. For the most
part the disease lasts for a short time, but individuals pre¬
disposed to insanity often fall into so much physical and
moral languor as to constitute what the French call “ amorous
cachexia.” Esquirol describes such a case :—“ The eyes are
lively and animated, the look passionate, the talk tender, but
erotomaniacs do not become indecent. They forget them¬
selves; they devote to the object of their love a£ pure and
secret worship; they become slaves, and execute his orders
with a childish fidelity. . . . The facial aspect is dejected,
the complexion pale, the character altered, sleep and appetite
disappear, and they become restless, dreamers, desperate,
irritable, angry, and so ou. The return of the beloved object
makes them drunk with joy, and the happiness which they
enjoy breaks forth in themselves, and is communicated to
every one around them. . . . Night and day they are pursued
by the same ideas, the same affections. . . . They desert their
parents and friends, scorn fortune, despise social propriety,
and are capable of the most extraordinary, difficult, painful,
and eccentric actions.”
Far more important is nymphomania and satyriasis , due no
doubt to the influence of heredity and exaltation of the
general sensibility. Instances are on record in which the
affections have been seen at a very early age; satyriasis
has occurred in boys only three years old, and in girls cases
of pregnancy have been observed at nine years of age.
Buchan states that the first symptoms of nymphomania have
been observed in a girl three years old, who was in the habit
of throwing herself into the most indecent attitudes, and
indulging in the most licentious movements.
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468
Insanity in Children,
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I have already spoken of homicidal mania as the result of
imitation; but there is no doubt that the influence of heredity
and an overpowering impulse must also be taken into account.
Homicidal mania has been observed at a very early age.
Esquirol relates the case of a child aged four years, in whom
the instinct to murder revealed itself suddenly; he armed
himself with a knife, and stooping over the cradle of a baby
ten months old, cut its nose and made horrible gashes on the
body. Quite lately the newspapers have contained an account
of a boy seven years old who was returned for trial at the
assizes for the murder of his brother, aged six months. I do
not know whether the trial has yet come on, but in this case
there is no doubt the influence of heredity is very marked.
The mother had been confined in an asylum two years ago,
and all her children were weak-minded.
Melancholia appears incompatible with early life, but the
buoyancy and gladness of childhood may give place to
despondency and despair. It may be sudden or insidious in
its attack ; a primary disorder, or the sequel of some other
form of insanity. There are two forms: the first, a pure
abstract indefinable depression ; the second, a despondent
condition, having relation to religious matters or a future
state. In the case of a boy aged sixteen years, who was
under my care at Darenth, the parents were nervous, ex¬
citable, irritable, and subject to nightmare. The boy was
born under the stress of hard work (the mother was a teacher
of music). When fifteen years old he came home for his
holidays, not knowing that his grandfather was dead. The
news, the mother said, “ worked upon him.” Here we have
the influence of heredity and a shock. Five days afterwards
he awoke, after going- to bed, and shrieked out that he was
dying. He saw visions, became melancholy, and swam long
distances in the ornamental water, Regent’s Park, at night.
He was restless and careless of consequences. When ad¬
mitted he was bright and good-tempered, and very fond of
reading. At the end of two years he commenced to have fits
of depression, which after a time came on more frequently,
and he remained in the same condition when I left four
years ago.
As to suicide in early life, there are numerous instances.
In these cases heredity exerts a great influence, but very
often there is an overpowering impulse, or terror produced by
certain hallucinations will cause the child to commit suicide.
The fear of reprimand or bad treatment is a frequent cause
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469
1898.] by Fletcher Beach, M.B.
of suicide, as are also self-love and disappointment at not
obtaining a high position in school. Falret mentions a case
in which a child aged twelve years committed suicide be¬
cause she was twelfth in her place in class. Soultz relates
the case of. a child aged twelve years who committed the
act in order to escape the tediousness of having to go to
school. Seizing a knife from the table, he buried it deep in
his chest three times. Unfortunately, suicide in children
seems to be increasing; in France there have been 482
during sixteen years, and in Russia 57 during ten years. I
have no statistics at present with regard to England.
Mania is characterised by a general delirium, with loqua¬
city, incoherence, intellectual excitement, and delirious con¬
ceptions. The movements are violent and incessant. The
children cry, run about, laugh, sing, break and destroy
things, undress themselves, and do everything without any
aim or design. The muscular strength seems to be increased,
and one sees young children overcome obstacles and lift
heavy things with extraordinary facility. In this form of
mental affection delusions are more frequent than hallucina¬
tions. Of the thirteen cases which have been under my care
no less that nine suffered from mania, and in five of these it
came on after attacks of epilepsy. The following is a repre¬
sentative case :—W. A. R—, aged twelve years on admission,
was a fairly nourished boy, of dark complexion and engaging
disposition, but of excitable temperament. There was a
history of phthisis on the father’s side of the family. The
case was a congenital one, and was supposed to be due to
the mother being insulted by. a man when three months
pregnant. The child had always been on the move since
birth, but had become more restless lately. He had fits of
screaming a fortnight before admission. He was the only
child. On admission he was noticed to speak in a short,
sharp manner, and give incoherent answers to questions. His
attention could only be arrested for a very short time. He
was constantly moving about, and became violent after states
of excitement. He was very mischievous. He had no epileptic
fits, but violent screaming attacks. In one of these maniacal
states he threw his trousers into the fire, broke some basins,
and threw two chamber-pots at the head of some helpless
imbecile children near him. When asked about it, he said
he did it, but gave no reason.
Kelp gives the case of a boy, aged thirteen years, who
suffered from folie circulaire. He was a dull child, and had
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470 Insanity in Children , [July*
been so often punished at school, on account of his slow pro¬
gress, that he became deeply melancholy and tried to kill
himself. The melancholia alteruated with mania, in which
he whistled and sang day and night, tore his clothes, and was
filthy in his habits. A case of this kind is rare, he says, at
such an age.
Choreamania consists chiefly of capriciousness, irritability,
and a great tendency to sudden emotional disturbances.
Hallucinations, illusions, and a maniacal delirium may also
occur. I have seen one such case myself. Leidesdorf has
directed attention to the resemblance of choreic to toxic
insanity, as supporting the view that chorea may be of
infectious origin. There is no doubt that it is due to a blood
state, but what this is we are at present unable to say. In
the ninth volume of the Psychological Journal a case of
choreamania is related, in which a boy ten years of age
lifted an adder, supposing it to be a stick, and was so much
alarmed, though perfectly uninjured, that mania, accom¬
panied by involuntary and grotesque attitudes and gesticula¬
tions, was induced.
Moral insanity is of frequent occurrence in childhood, and
I have seen several cases, though in America it seems to be
of more frequent occurrence than in England. The intel¬
lectual faculties are unimpaired, and the child is usually
sharp and clever, but morally he is a thief, a liar, full of
cunning, horribly cruel, and often of immoral tendencies.
When remonstrated with he will express contrition and
promise amendment, but these promises are soon forgotten,
and a fresh outbreak occurs. Mayo relates the case of a boy
of fair talents and considerable intelligence, but of the most
singularly vicious, unruly, wayward, and depraved character.
Under all means had recourse to for his reformation he had
been alike intractable. He was selfish, violent, delighted in
mischief, had drawn a knife on one of his tutors, exposed his
person, and gave way to every degrading vice.
Hysteria has been frequently noticed. Tables have been
published of the various ages at which it most frequently
occurs, and from a study of these it seems that hysteria
rarely appears before the age of six or seven years. As in
the adult, so in the child, it presents the convulsive and non-
convulsive forms. Rarely there is a convulsive attack ; more
commonly it commences with intellectual disorders, and
various troubles of sensation and movement. Usually those
affected have a lively appearance, keen imagination and intel-
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by Fletcher Beach, M.B.
471
ligence, and seek to draw attention to themselves by exag¬
gerating their sufferings. These cases are extremely impres¬
sionable, and laugh and cry on the slightest provocation.
The will is weak. Hysteria is more common in girls than
boys, but when the latter suffer from the affection they
become timid, and blush and lower their eyes when spoken
to. They will not play with boys of their own age, but
prefer the games of little girls, such as playing with a
doll, &c.
Recently Dr. Wiglesworth has described two cases of
degenerative cerebral disease in children, presenting sym¬
ptoms resembling those of general 'paralysis . Lack of time,
however, prevents me from describing them. The diagnosis
of most of these forms of mental disease is easy. The chief
difficulty arises in distinguishing mania from the delirium
which appears in the course of acute diseases. Acute menin¬
gitis may be mistaken for mania, and vice versa. But in
meningitis the pulse is full and strong, and the temperature
raised. There is headache, vomiting, and convulsions. The
pupils are contracted, and strabismus will often be observed.
In mania the pulse is only slightly quickened, notwithstand¬
ing the violence of the delirium, and there is no vomiting nor
convulsions.
Asthenic pneumonia and typhoid fever are sometimes ac¬
companied by violent delirium which masks the essential
symptoms of the disease, but the delirium of these diseases is
always preceded by a long or short febrile period; while in
mania the febrile period only becomes developed at the time
when delirium is at its highest point of intensity.
As regards prognosis , the presence or absence of hereditary
predisposition will help us to decide whether the patient will
recover, or if he recovers whether there is likely to be a
relapse. Generally one may say that if a child has an attack
of mania, melancholia, or other mental affection, and there is
no history of hereditary predisposition or masturbation, the
prognosis will be favourable ; on the other hand, if heredity is
well marked and masturbation is much practised, the pro¬
gnosis will be bad, especially as regards the future. An ex¬
ception must be made in the cases of juvenile dementia the
result of hereditary syphilis, moral insanity, general paralysis,
and usually by nymphomania and satyriasis. In these cases
the prognosis is always bad.
As to treatment , opium is rarely necessary; when sedatives
are required, a warm bath daily will be found useful, and
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472
Insanity in Children ,
[July,
when there is intense delirium we can add to this the appli¬
cation of cold to the head ; in other cases a wet pack will be
preferable. The administration of bromide of sodium in
doses, according to the age of the child, will act as a calming
agent, especially in cases of epileptic mania. In cases where
there is much sleeplessness trional in doses of from 3 to 8
grains may be given for a few nights. A tonic treatment is
to be aimed at in order to restore the strength of the patient,
and in those who masturbate the administration of quinine
and camphor will be found convenient. Cod-liver oil and
extract of malt will help to reduce any emaciation which may
be present. Care must of course be taken to keep the
bowels well open. Open-air exercise is to be employed in
all cases, but gymnastics should be made use of as a recrea¬
tion in cases of melancholia, and as a regulator of movements
in choreic insanity. In some cases it will be necessary to
stop all intellectual occupation ; in others to encourage it,
and also make the child interested in the general affairs of
life; in the higher classes the study of painting, literature,
and the modem languages, and employment in carpentering
and gardening for the boys, and fancy work for the girls,
will materially aid the cure. One of the most important
parts, if not the most important, of the treatment is the sepa¬
ration of the child from his friends; among strangers he will
be obliged to conform to the rules of the house, and carry out
the treatment which has been ordered. Visits from friends
should be permitted rarely at first, and regarded as a favour
or reward for good behaviour. Under these circumstances
amelioration will proceed much more rapidly.
With regard to moral insanity, Dr. Jules Morel, who has
seen a good many children suffering from it in Belgium,
advocates special institutions for them. I am of his opinion,
and think they should be put into institutions in which they
should undergo industrial training, and be kept under control
during the period of their lives. If allowed to be without
control they are sure to commit some act which will bring
them in contact with the law. The result of this will be that
they will most probably be sent to prison, which is not the
proper place for them.
The prevention of insanity in childhood is most important.
Life in the open air, work in a garden or on a farm, recrea¬
tion of all sorts, absence of forced prolonged intellectual
labour, and the suppression of excessive emotion are the
chief hygienic indications in those predisposed to insanity.
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by Fletcher Beach, M.B.
473
To strengthen the body first is the main point, and having
laid a good foundation, we can then proceed to educate the
mind. In many cases the opposite view has been held, and
children’s minds have been pushed on with no regard to
their physical condition, and insanity or severe nervous
disease is the result. I see children of this kind every year.
Fortunately of late various societies have sprung up, whose
objects are to study the development of the mind of the
child and endeavour to guard against over-pressure, and I
hope that in time greater attention will be paid to education
in relation to the child’s mental condition.
I must apologise for only being able to give you a short
sketch of what I consider is a very important subject, but
want of time has prevented me from going more fully into
the matter.
Discussion.
The Chairman thanked Dr. Fletcher Beach for his interesting paper. It
dealt with many important points, and one especially he liad brought under
their notice, that of over-education of children. Dr. McDowall said in his
asylum experience lie had very little personal knowledge of insane children, as
they seldom found their way into a county asylum. The youngest cases he had
known were of adolescent general paralysis, and he had had several of those well-
marked cases, boys and girls of thirteen and fourteen who had died from
general paralysis due to congenital syphilis. He had known of cases where
hereditary influence was much marked on both sides.
Dr. Shuttleworth said that the distinction between insane children and
those properly designated idiots and imbeciles was of much importance in prac¬
tice. In his opinion, the former were out of place in institutions organised for
the training of imbeciles; for they were not amenable to disciplinary influences
efficacious for the latter, to whom, moreover, they set a bad example apt to be
imitated. He well remembered the trouble caused at the Royal Albert Asylum
by the admission of three insane children, two sisters and a brother, who proved
by their moral perversity and occasional maniacal outbursts that they were
patients more fitted for a lunatic asylum than for a training institution for
mentally deficient children. In a case in which he had recently been consulted
in a higher rank of life, there was (in a girl of twelve) moral perversion with
sexual precocity manifested by masturbation and other abominable practices, and
but slight intellectual defect, though there was reason to believe that the mental
abnormality was congenital. There was a neurotic heredity on one side and a
phthisical on the other, a family history which he thought not uncommon with
the juvenile insane. He had been interested in what had fallen from Dr. Beach
as to the characteristics of insanity in children. Children are more or less crea¬
tures of emotion. The formation of ideas was a matter of gradual organisation
in the growing child. Fixed delusions were uncommon in children, for their
normal ideas were not fixed but transient. Of course, amidst monotonous sur¬
roundings there might be predominance of one idea, as in the case of a child
constantly harping on the word u window,” the only bright spot in its cellar
dwelling. Homicidal tendencies were most common at the adolescent period;
they were not always the outcome of insanity so much as of moral imbecility,—
that is to say, a simpleness of mind leading to deeds of violence through mere
imitativeness. Hence the need of caution as to the reading of sensational litera¬
ture by youths of weak mind. Much might be said as to injurious modes of
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Insanity in Children.
[July,
education. Precocious children were sometimes rendered insane by their talents
being too early brought into prominence. Such children often broke down and
became insane before they arrived at adult age. The more cases of general
paralysis in children were inquired into and the antecedents found out the more
likely they would be to find a history of inherited syphilis.
Dr. Jones said he was expecting to hear more about insanity in children before
the age of puberty. It would be interesting to find out whether what happened
in the adult happened in the early youth of the child. He would like to know
when moral perversity began. Over-education in children was certainly a
subject worthy of great consideration.
Dr. Ohtterson Wood, speaking as a hospital practitioner, spoke of the
question of masturbation, and said he saw the results of it over and over again
in their out-patient department. There was a great alteration in the habits
and manners of children who were allowed to practise the habit unchecked.
Numerous cases of epilepsy were undoubtedly due to the practice of self-abuse.
Dr. Boycott said Dr. Beach had not told them the age at which insanity
showed itself in children. As far as he could see, insanity in children showed
itself as they grew up. When the child began to talk they would expect to see
signs of hereditary insanity develop, but it seems to take years to develop.
Dr. Thomson said Dr. Savage had written that insanity in children was n
tendency, and not an entity of itself. He thought it was when that tendency
was diverted actually into insanity. That tendency he said might remain
throughout life if there was nothing to set it all right, so to speak.
Dr. Beach said moral sense was greatly due to the education of the child.
No doubt, as Dr. Jones had said, there was something in the environments or
surroundings of the child. Insanity did not show itself much in very young
children, and the older the child grew was hereditary insanity likely to show
itself. Tendency no doubt w'as a strong factor in the introduction of disease of
all kinds. He alluded to the question of degeneration, and said an American
doctor was in England making a study of the degeneration of the English race,
and according to him that was very marked.
The Care and Education of Weak-minded and Imbecile
Children in Relation to Pauper Lunacy .* By John Cars¬
well, L.R.C.P.E., &c., Certifying Physician in Lunacy,
Barony Parish, Glasgow; and Lecturer on Mental Dis¬
eases, Anderson’s College, Medical School, Glasgow.
The care, training, and education of physically and men¬
tally defective children is now an accepted public duty
undertaken by the State at the public cost, to the extent at
least of providing the necessary schools and institutions, and
other needful arrangements. Blind and deaf and dumb
children are provided for by legislation, which was passed as
the result of the facts of the case relating to the special
needs of those children having become apparent by the
general enforcement of compulsory education. Imbecile and
idiot children have also been provided for by laws passed
* Read at the Spring Meeting of the Scottish Division.
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1898.]
John Carswell, L.R.C.P.
475
during recent years ; but inasmuch as all the laws relating to
those classes of children are either Lunacy Statutes, or have
as their object to make provision for weak-mindedness
viewed as a special or modified form of insanity, they have
been found to be inadequate for providing the necessary
facilities for the proper care and education of children of
defective intellect, but devoid of those insane character¬
istics which distinguish true imbecility and idiocy. The
probable reason for this hiatus in the legal provision for the
education of weak-minded children, is that it has hitherto
been assumed that a child who is not a certifiable imbecile is
capable of being taught in an ordinary school. That such
is a mistaken view many who have had experience among
children of defective intelligence have recognised, and the
Committee on Defective and Epileptic Children, whose report
has just been published, recognise the distinction between
the two classes of feeble-minded children and base their
recommendations upon it. Indeed, the Committee was
appointed to consider the case of such children, because
it was found in practice that many children of school age
were unable to profit by the instruction of ordinary schools,
and yet were not imbeciles or idiots, and the reference
to the Committee was limited to that class of children. The
Committee say in their report, “ the word e feeble-minded 9
as used in the report denotes only those children who are
not imbecile, and who cannot properly be taught in ordinary
elementary schools by ordinary methods.” It is clear that
if legislative sanction is given to the recommendations of
the Committee, a great benefit will be conferred upon non¬
imbecile feeble-minded children, and upon their parents; and
an important step in advance will also be taken in the direction
of making more reasonable use of existing facilities for the
care and training of imbeciles and idiots.
In England provision for the training and education of
imbeciles and idiots exists separately from that provided
for lunatics; while in Scotland imbeciles and idiots are
dealt with under the Lunacy Statutes alone. In Scotland
the training and education of imbeciles is provided for partly
by voluntary charity and partly by Poor-law authorities.
When the Scotch Lunacy Acts were passed the duty of
providing education for imbeciles was not directly placed
upon the Poor-law authorities; but without direct legal
enactment parishes have assumed that obligation, and that
course has been found in practice to be but the natural
xliv. 32
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476 Weak-minded and Imbecile Children , [July,
development of the purposes of the Lunacy Statutes in rela¬
tion to pauper lunacy in general, and imbecile and idiot chil¬
dren in particular. Not only children of weak minds, who
on other grounds have become chargeable to the parish, are
placed upon the lunacy roll, but the children of able-bodied
people, whose only claim to relief under the Poor law is the
imbecility of their children, are admitted to relief.
In other words, pauper lunacy is accepted by all the autho¬
rities concerned in the administration of the Poor law and the
Lunacy laws to include imbecile and idiot children. Now it
is important to remember that this is so, because imbecile
and idiot children are placed in the same category as lunatics,
the provisions applicable to lunatics being made applicable to
them. Pauper imbecile and idiot children in training schools
are pauper lunatics, although they do not appear upon the
General Board’s register of lunatics.*
Under the “Instructions to Inspectors of Poor” issued by
the General Board of Commissioners in Lunaey for Scotland
(1895), the procedure for dealing with applications made to
the Inspector of Poor on behalf of imbecile children is the
same as that for ordinary lunatics, except that imbeciles are
not committed to training schools under a Sheriff's order.
That is to say, the same obligation rests upon Inspectors of
Poor to provide for the proper care and training of imbecile
children as in the case of ordinary lunatics. A man who is
relieved by the parish of the financial burden of maintaining
his wife in an asylum, and also of au imbecile child in a
training school, receives such relief in both cases under the
same statutes; and in all respects, except that the child
is not committed under a sheriffs order, and that its name
does not appear upon the register of lunatics kept by the
Lunacy Commissioners, but upon a separate register, both
wife and child are provided for by the parish as pauper
lunatics.
Adequate provision has existed for many years in Scotland
for the proper housing and treatment of ordinary pauper
lunatics, and as there has been but little private and voluntary
charitable relief of lunacy, the full burden of pauper lunacy
has been borne by parishes. But it has been different with
imbecility occurring among the children of the same class of
* The inmates of training schools for imbeciles are recorded in a separate
book, and not being on the Board’s General Register of Lunatics are not
included in the General Board’s annual return ot‘ the number of registered
lunatics.
Digitized by LjOOQLe
by John Carswell, L.R.C.P.
477
1898.]
the community who have been relieved by the parish rates of
the burden of ordinary lunacy. Private voluntary charity,
aided by profits accruing from private patients, has to a con¬
siderable extent made the necessary provision for the im¬
becile children of poor people. But there has occurred
during recent years, owing to circumstances which need not
at present be referred to, a considerable increase in the
number of imbecile children for whom their parents desire
institution care and training, an increase which private
charity could not be expected to wholly provide for. The
parishes have maintained those children, finding accommoda¬
tion in the existing institutions, and paying rates of board
rather higher than those paid for ordinary lunatics in district
asylums. This method of providing for pauper imbecile
children tends towards an increase of the number so main¬
tained, because voluntary charity ceases when legal provision
is found ready at hand to take its place.
When the Glasgow School Board recently directed atten¬
tion to the cases of imbecile children found among the non-
attenders at school, the financial considerations involved in
providing institution care for those children did not arise,
because the School Board very properly considered that the
Poor-law authorities were bound to grant the necessary
assistance towards maintenance in training schools.
In the foregoing observations I have endeavoured to in¬
dicate the following positions as justified by a review of all
the circumstances relating to the care, training, and educa¬
tion of feeble-minded and imbecile children.
1. That simple feeble-mindedness can be distinguished
from true imbecility, and that children suffering from such
deficiency should not be classed with imbeciles and idiots,
and should not be provided for in the same institutions.
2. That children suffering from simple feeble-mindedness
belong to the category of sane persons, and should be pro¬
vided for in special classes, or otherwise, under the control
and at the cost of the educational authorities, as suggested
by the Committee on the Education of Epileptic and Defective
Children.
3. That imbecile and idiot children belong to the category
of insane persons, and are suitably provided for by the Lunacy
authorities at the cost of the Poor-law authorities in the cases
of children of poor people.
4. That in Scotland separate statutory provision for im¬
beciles and idiots does not exist and has been unnecessary!
Digitized by LjOOQle
478
Weak-minded and Imbecile Children ,
[July,
they being considered to be lunatics within the meaning of
the Lunacy Statutes, and that benefit to the children has re¬
sulted from their being so regarded.
The views now indicated present the requirements of the
problem of providing suitably for all forms of mental de¬
ficiency among children in a simpler form than it has hitherto
assumed. Because if the educational authorities undertake
the duty of providing adequately for the education of weak-
minded children down to the level of the distinctly imbecile
and idiot class, there will no longer exist any adequate reason
for separating imbecile and idiot institutions from asylums,
except in so far as different sections of an asylum having
various objects to serve require to be separated for purposes
of efficiency.
In further discussion of the subject, I* propose to relate the
circumstances of the Barony Parish of Glasgow in relation
to this question, and to show how the principles just stated
may be applicable to a large city parish.
For many years the parish council has maintained a con¬
siderable number of imbecile and idiot children, some in
training schools, others boarded with parents and guardians ;
and when school age was passed, those children who con¬
tinued to require institution care have been removed to the
asylum at Woodilee under the usual certificates and sheriff’s
order, so that Woodilee has had to serve for those adult
imbeciles the purpose of a custodial asylum. Many children
who would otherwise have been chargeable to the parish
have been provided for in training schools at the cost of
voluntary charity, and many more have remained at home
under the care of their parents without assistance from the
parish.
A year or two ago the School Board specially investigated
the cases of children not attending school on account of
mental defect, and they decided to instruct the parents of
those children who could not afford to pay for their mainte¬
nance in a traiuing school to apply to the Inspector of Poor
for the necessary assistance.
The Barony Parish Council were fortunate in having upon
the Council Dr. Wilson Bruce, whose experience as Medical
Officer to the Glasgow School Board, and also to the Juvenile
Delinquency Board, gave him authority to speak with a know¬
ledge of the necessities of the case which was invaluable in
the discussion of proposals intended to meet all the require¬
ments.
Digitized by CjOoqL e
1898.]
by John Carswell, L.R.C.P.
479
It became the duty of the responsible medical officers* of
the Parish Council to carefully consider the existing system
for providing for imbecile children, with the object of
advising the Council upon all the facts relating thereto, so
that an intelligent policy might be adopted in view of the
considerable increase of public burdens contemplated.
The question to be considered was: What have been the
educational and other results of the training in imbecile
institutions to the children who have been chargeable to this
parish ? And in view of the conclusions formed from such
consideration of past experience, we had to consider what
would be the best course to follow in making further
provision for the additional number of cases waiting for
disposal.
The feeling we had was that as regards care in management
and nursing, and well-directed successful efforts to secure the
comfort, happiness, and general well-being of the children in
Larbert and Baldovan Training Schools, nothing was left to
be desired. But we were bound to go further, and ask, What
has the parish gained by its expenditure in training those
children ? Has it been relieved to any extent of the ultimate
burden of maintaining those children when they reached
adult life? We were conscious that the prevailing public
spirit of benevolence justified the expenditure hitherto
incurred for imbecile children, but we also felt that only
good could come from a discriminating application of that
sentiment to the subject in hand.
In order to estimate the training or educational benefit
received by the children chargeable to Barony who had been
resident in Larbert Schools, we reviewed the progressive
history of the children chargeable to the parish under training
there in 1887, tracing them till 1897.
The following table shows the result of that inquiry.
# In tliis inquiry Dr. Hamilton Marr, of Woodilee Asylum, was associated
with me.
Digitized by k jOOQle
480
Weak-minded and Imbecile Children,
[July,
Table showing progressive history of fourteen children under
training in Larbert Institution in 1887.
No. of Imbecile* chargeable in Larbert at 15th May, 1887,14.
How disposed of since.
Ykak.
By death.
| Removed to Asylum.
Boarded with Guardians.
Off roll;
sent to
mother.
Still
chargeable.
Since
died.
Still
chargeable.
8ince
died.
Subsequently
removed to'
Asylum.
1888 . .
1
1
i
1889 . .
...
2
4
1
1890 . .
2
1
1
1691 . .
2
0 3 ©
@ • «
1892 . .
1
1893 . .
...
— •
1894 . .
1
1
1895 . .
• ••
...
i
1896 . .
• ••
...
...
1
i
1897 . .
...
•••
...
!
1
5
4
... j 4 ... ...
1
Total ........ 14
Similar inquiries over other periods would, we believe,
show similar results. It is clear that Larbert Institution,
from the point of view of the Barony cases, cannot bear to be
judged by a high standard of advantages gained as regards
ultimate permanent benefit. And yet it is barely conceivable
that Larbert Institution could be administered, or the
children more carefully taught, or with more discernment
of their individual characteristics and capacities, than has
been the case during the years under review.
The general result of our inquiries showed—
1. That fully 50 per cent, of the children chargeable to the
parish under training in imbecile schools were deriving no
benefit from those specially equipped schools that could not
be equally well secured in a custodial asylum, under the
management of the parish council, as a department of their
lunatic asylum, but separate as regards building. It has to
be remembered that the asylum grounds extend to over 400
acres.
2. That even of those children whose habits had been
improved and intelligence brightened by training, none had
Digitized by L^ooQle
1898.]
481
by John Carswell, L.R.C.P.
reached such standard of manual efficiency or mental capacity
as fitted it to be discharged recovered. This fact pointed to
the need for custodial asylum care for such cases when they
reached adult life, and were no longer suited for the training
school. It is generally agreed, I think, that such parrot-like
trained patients are not suited for the ordinary wards of a
curative asylum.
3. Relating to that branch of our inquiry appertaining to
the new applicants, who had been intimated to the Inspector
of Poor by the School Board, we found that with the excep¬
tion of two or three, who were to be tried in ordinary schools,
special attention being given to them, they were all suffering
from similar forms of mental defect as those whose progres¬
sive history in imbecile institutions we had traced, and there¬
fore similar results might be anticipated in their cases.
In view of the results of our inquiries, the idea of setting
up a custodial asylum for imbeciles and idiots in the asylum
grounds at Woodilee had much to commend it. Like all other
ideas, it has a history, which has been well stated in a report
which Mr. James R. Motion, clerk to the Barony Parish
Council, prepared and presented to his Council, from which
the following is taken :
l< Before approaching the subject matter of the report, I
desire to furnish the Asylum Committee and the Council
with a short history of the evolution of this important ques¬
tion, and its relation to Poor Law administration.
“ In the first place, it is the duty of the Parish Council to
provide for the care and treatment of imbecile children, for
whom application is made by their parents or guardians, by
removal either to the asylum, an imbecile institution, board¬
ing in the country, or by placing them on the out-door roll.
In the first three modes, parents who are able are liable to
contribute to their maintenance as the relief committee may
determine; while in the latter class, the out-door relief
granted is in the form of an aliment allowed to the guardian
where the income is too low to afford proper maintenance
and nourishment.
“ In 1881 the Asylum Committee had then under considera¬
tion the question of accommodating such children at Fauld-
head in their own grounds ; but, after mature consideration,
it was decided to board them in Larbert Institution. The
number then chargeable was six.
“ Again in 1889 the matter was under discussion, with the
view of purchasing Craigenbay Cottages, and utilising them
Digitized by CjOoqL e
482 Weak-minded and Imbecile Children, [July*
for fche reception of such patients, but the Committee declined
then to entertain the proposal.
“ Now, in consequence of the action of the Glasgow School
Board, in tracing large numbers of children who are not
educable, and bringing the cases under the notice of the
parish councils, the question of the care and treatment of this
class of poor children has assumed much larger proportions.
The School Board has no motive in pressing this matter upon
the notice of the different parishes but the necessity of having
the children properly cared for; and as the parents them¬
selves are the proper parties to make the necessary applica¬
tions, it must be assumed that sooner or later this parish
must provide for the care of the children resident therein. It
is necessary, therefore, that the Council should consider the
means to be taken to meet these applications, either by
providing for them in the grounds of Woodilee or in the
existing training institutions.
“It appears there are thirty-six children in Barony dis¬
covered by the School Board, of whom eighteen require care
and treatment in an institution, and ten left with their parents,
alimented by the parish. Of the former number eight have
already been removed to Baldovan, leaving ten still to come
up for consideration before the relief committee.
“Baldovan Institution, near Dundee, has accommodation
for 100 pases, the number on the register at 31st December,
1895, being seventy-eight, but it is now understood to be full.
The cost to the parish per head per annum is £25, including
clothing, &c.
“ Larbert Institution is licensed for 230 children, while, as
a matter of fact, they had at close of last report, on 31st
December, 1896, 271, and the report shows the institution to
be overcrowded. The inclusive cost per head per annum is
£30, as against £25 in Baldovan.
“ There is, besides, the larger question of the policy of the
Council having the care and treatment of all their insane
poor under their own control in their own institution, with
their present highly-equipped staff and appliances.
“The necessity for the Council taking up these children,
and dealing with their applications in a favorable light, is
absolutely necessary when the conditions under which they
live at present are considered; and there is no other authority
but the parish charged with that duty. It is simply appalling
to contemplate the conditions under which a large number of
these poor children at present exist, and something must be
Digitized by
483
1898.], by John Carswell, L.R.C.P.
done by either of the above courses. The Committee will be
able to consider from this report which is best in the interests
of the children and the parish, both from a financial and
administrative stand point.
Following upon those inquiries, and the consideration given
to the whole subject, a definite proposal was submitted for the
consideration of the Lunacy Commissioners to the effect that
sanction should be given for the erection of a cottage within
the asylum grounds for the care of the uneducable class of
imbeciles or idiots. It is not contemplated to provide for all
cases of imbecility, but only for children who require care
and nursing, and who are unable to appreciate the simplest
pedagogic instruction. It became, therefore, necessary to
classify imbeciles into educable and non-educable; but our
attempts to get a working definition of those terms were not
fortunate, and naturally some difference of opinion occurred
as between the views of the Lunacy Commissioners and our
own views as to the cases that ought to be included, under
the one head or the other.
The Commissioners rightly viewed with disfavour any in¬
terpretation of the term “ uneducable imbecile,” which would,
in their opinion, result in a loose practice as regards the
disposal of imbecile children, whereby some who might be
capable of deriving benefit from training would be deprived
of that advantage. To meet that risk, it is proposed to send
all imbeciles, except the most hopeless idiots, to a training
school for a probationary period of not less than six months.
While safeguarding the interests of the educable imbecile,
the Commissioners favorably entertained the proposal for
separate housing of the uneducable class of imbeciles.
In the opinion of the Commissioners, “ idiots merely re¬
quiring nursing are not suitable inmates for training schools,
and for such of them as cannot be provided for under private
care, the Board would gladly see special provision made in
ordinary asylums.” As the result of their consideration of
the proposed scheme, the Commissioners have now sanctioned
the erection of a cottage for the accommodation of thirty
children of the class just described. By sanctioning the
erection of this establishment the Commissioners have en¬
couraged what will be generally admitted to be a movement
in the right direction, and it may safely be expected that
experience in the working out of the scheme will indicate the
limits of the terms educable and uneducable as applied to
imbeciles.
Digitized by L^ooQle
484
Weak-minded and Imbecile Children ,
[July,
If the suggestions of the Departmental Committee on the
education of mentally defective and epileptic children are
embodied in legislation, and the educational authorities be¬
come responsible for the care of all mentally deficient children
above the level of the imbecile class ; and if the Lunacy and
Poor-law authorities undertake the duty of providing for all
imbeciles and idiots, adults as well as children, in a manner
suited alike to the special needs of those children and to
considerations of economy of public expenditure, a step in
advance will be taken in the public provision for the mentally
defective.
Discussion on Dr. Ireland's paper , printed in January number , 1898, p. 45.
Dr. Carswell said that lie had been interested in the idea of a custodial asylum.
That seemed a different idea from what we followed here, because, as every
superintendent knew, they got patients who had been trained or had been
resident in imbecile institutions, for whom, at the end of their period of resi¬
dence, no adequate provision could be made at home, and they had to be sent
ou as certificated lunatics to the asylum. It raised the question whether
these imbeciles should be kept separately in custodial institutions from ordinary
lunatics. He might say that in the Barony Parish they had had this question
raised in a very definite and urgent form, for this reason, that the School
Board uf Glasgow had found in the course of their investigations that a con¬
siderable number of imbecile children were at home nneared lor, and they
considered it to be a public duty to call upon the parish to provide for the care
of these children. That raised the whole question of the method that they
adopted for these children, and so far as steps had been taken, the direction
that was likely to be followed was that an institution would be built on the
grounds of the pnrochial asylum for the care and nursing of non-educable
children, while the educable children would l e left in such institutions as
Larbert, Baldovan, and others. He thought it whs obvious that if that policy was
carried out not only by one parish, but by all parishes, such institutions as
Larbert and Baldovan would become real training schools, because they would
be relieved of the nou-educable children ; and that being so, what would happen
further would be this, that the constituency—if he might use that word in this
connection—from which children requiring admission to imbecile institutions
were drawn would become extended. The presence of the nou-educable children
in these institutions to a certain extent limited the class of children, but once
these were all away it would become a more desirable place not only for those
who were recoguised as imbecile children, but for backward children, mid the
school boards would induce guardians and philauthiophts generally to withdraw'
from ordinary schools backward children and get them sent to such an institution.
Dr. Ireland had a considerable suspicion about these backward children. He
had gone to several schools, but he fouud that there was a very broad distinction
made between them and imbecile children. All those who were imbecile were
very soon pushed out of ordinary schools, and he thought it would be an outrage
to those backward children if they were sent in among imbecile children. Many
children were bright enough in the playgrouud, although they were stupid at their
lessons. He understood that the school"board of Birmingham was makiug
inquiries similar to the Glasgow Barony Parish, and lie hoped that they w’ould
erect an institution of their own and keep it separate from such institutions as
Larbert and Baldovan.
The Chairman (Dr. Urquhart) said that as Dr. Carswell had this matter at
Digitized by k jOOQle
1898.]
by John Carswell, L.R.C.P.
485
heart, and as Glasgow was going to move, it became a question whether they should
not consider the whole subject more carefully and more deliberately thau could
be done that afternoon.
Dr. Yellowlees thought that they musk be agreed as to the undesirability of
having those children who were no longer fit to be retained in school as imbe¬
ciles intruded upon them in asylum wards. He thought every one was quite clear
that that was not the place for them, und that they were apt to learn habits which
were not to their advantage; but if they began to differentiate between idiots
and imbeciles, and those who required education and those who required merely
custody, did they not open up a very wMde question ? He had been preaching
the need of custodial as contrasted with curative institutions, and this was iu the
direction of what lie believed to be right. He thought it was a misfortune that
asylums should be added to because chronic patients accumulated, when they
might with far greater economy be transferred to a custodial institution which
might be common to several districts, and leave the curative asylum to do its work
with a smaller number of patients.
Dr. MacPherson said he understood tliHt the Barony scheme was pretty well
advanced, ami that they had gone the length of w riting a report; and he thought
that Dr. Carswell might write a paper on the subject, to he brought up at the
next meeting in Glasgow.
Dr. Carswell said that lie might do so if it was the desire to hear the subject
discussed at the meeting in March.
The Chairman said that by that time they would also have an opportunity of
reading Dr. Ireland’s paper with every care quietly at home.
Discussion on Dr. Curs well's Paper.
Dr. Cabswkll said that before reading this paper he had taken the liberty of
inviting Mr. Motion, Inspector of Poor for the Barony Parochial Board, who had
taken an intelligent interest in this question for many years. There was now
some prospect of some steps being taken, and he had thought it proper Mr. Motion
should be present.
Dr. Turnbull intimated that Dr. R. Wilson Bruce, Chairman of the Asylum
Committee of the Barony Parish, who had been invited to the meeting, was
unable to attend on account of professional duties.
The President said that in thanking Dr. Carswell for this interesting paper,
he would suggest that along with the discussion of his paper they might take
the general discussion of Dr. Ireland’s, which whs read at their last divisional
meeting. They would be glad to hear Mr. Motion.
Mr. Motion said that he really could not add anything to what Dr. Carswell
had so well said, especially as his sentiments had been quoted in that report;
but he would merely wish to say that the original proposal was made by a
distinguished predecessor of his, Mr. Beattie, in 1881.
The President asked Mr. Motion at what age children would be removed
w'hen they were sent to this home or school.
Dr. Carswell said that they had not got the length of considering that point,
but he supposed that the natural development of it would be that, they would have
a custodial institution for adult imbeciles associated with the children’s custodial
institution, and that they would keep all such cases outside the ordinary asylum
wards.
The President said that as the boys and girls grew up they became adult
imbeciles.
Dr. Carswell said that when that came about they would probably have a
sufficient number of them to get the sanction of the Board of Lunacy to erect
another place for them.
Digitized by
486
Weak-minded and Imbecile Children , [July,
Mr. Motion. —Or simply transfer them into the ordinary wards.
Dr. Cabswell thought that the natural development would be the other way,
and he thought it whs desirable to relieve the asylum of all such cases.
Dr. Alexander Robertson said he would like to make a few remarks prior
to Dr. Ireland, from whom they expected the most information on a question of
that kind. It was quite evident thut this subject had increased in importance
lately compared to what it nsed to have. Previous to the action of the school
board in Glasgow it really was a comparatively small question, as Dr. Carswell
in the latter part of his paper had said, and scarcely suggested the idea of a sepa¬
ration of the classes ; bnt now both in the Barony and also in the city parish of
Glasgow it had become really of considerable importance even from an economic
point of view. In that aspect he was not particularly prepared to look at it
just now ; but with regard to the advantage to the children he quite approved,
and thought that it was a right distinction to draw with regard to them,
that in respect to idiots and the lower class of imbeciles they must distinguish
between those that might derive benefit from residence in a special training
school and those that were practically non-educable. He thought, therefore,
that there was room for both institutions. In institutions such as Lnrbert,
where great attention was given to training, he could speak of cases which had
been sent there where very marked benefit whs obtained from the training* He
did not know that he could speak to a solitary case where a child was trained to
a condition so as to be able to support himself or herself, but still the benefit by
special education was very decided, and it became a question if that class were
sent into an institution of a more custodial character whether that great gain to
the individual would not be lost. He gathered from the remarks in the paper by
Dr. Carswell that it was fully intended to differentiate between the two. That
being so, he could not help thinking that it was a very right and proper step to
take; and now the question from the economic point of view had increased so
largely, and therefore there was really room for a special place for keeping them
comfortable and right. Where else conld they have a better place than simply in
the grounds of an asylum, where there would be the supervision of the medical
superiutendeiit,and the care with which the treatment of that class was carried out.
He thought that was the distinction which they must keep clearly in view, to be
very careful to distinguish between the two classes, and to continue to send those
cases that could be benefited, or in any way likely to he benefited, to institutions
where they had special facilities of training. There was another poiut of view,
however, even in regard to the cases that were sent there. There came a time
when further benefit did not seem to be derived from continuous attention.
Then why should they pay the very considerable charges if the improvement had
ceased ? Why not take them away ? He did not say let them be taken to this
custodial institution, but possibly let them be boarded out in private homes.
Dr. Cabswell said that they did that.
Dr. Robertson said that they would, therefore, relieve the parish from some
of the expense. The question was a very large one in connection with that
class, and it must be very pleasing to them to see that so much public attention
was being given in England to this subject of what was the proper thing to do
with those who were mentally defective, and the recognition of the physiological
fact that there was a class neither idiot nor distinctly imbecile, but still, as this
Departmental Committee to which Dr. Carswell had referred called them, feeble¬
minded. Formerly all such cases were in common schools, and were subjected up
to the present time to much unnecessary hardship, where perhaps a teacher who
was not aware what was the exact condition gave a slow boy or girl a box on the
ear, whereas the child ought not to be expected to learn his or her lessons in the
same way as the majority of those present. The recognition of this fact, that
there was a class of that kind who were not up to the standard, but who were
yet not idiots or imbeciles, appeared to him as a very important step for the
probable production of a method which was really very much wanted.
Dr. Ireland said he had listened with great attention and pleasure to Dr.
Digitized by {jOOQle
1898.]
by -John Carswell, L.R.C.P.
487
Carswell’s paper, on which he had expended a great deal of thought founded
upon previous observations. He wus not quite sure whether he could gather
together all the points to which Hr. Carswell had referred, so as to give his own
opinion on them all. As they had a paper that entered on a number
of points which had been controverted, it would be impossible for him
to do so, and if he attempted to do so he would only tire them ; but he would
make some remarks on some points that were new. Dr. Carswell had laid great
stress upon the report of a committee which had ’been appointed about a year
ago, and which consisted of several gentlemen of great experience in the treat¬
ment of idiots and imbeciles, and of two or three ladies engaged in charitable
undertakings who had acquired considerable experience. He had got a copy of
the report of the committee. That committee had consulted a great number of
people, and had got their opinions reported and printed in a pretty big volume
at the national expense. They all knew that the appointmeut of a committee
was a common wav in the House of Commons in order to get rid of a trouble¬
some inquiry, and it was generally understood that very few people read the
report, but somehow or other the matter came to an end. He would like to read
through that blue-book, and read the evidence before he accepted the evidence
for notions which had converted Dr. Carswell. They had there quite a new’
definition of the word 4 * imbecile,” and he thought they had quite enough to do to
provide for the imbeciles without attempting a new definition of them. They now'
had the feeble-minded, who in Scotland might comprise about 5000 children
who w'ere to be thrown upon the funds of charity, or of the Poor Law, but at any
rate this was a proposal which he thought should be gravely considered. He
thought it was Dr. Warner who commenced the discovery of the feeble-minded
in schools. He himself had gone with Dr. Yellowdees and inspected some schools
in Glasgow; and then he went to the Hoard school in PreKtoupans, where he
w'as a member of the School Board, and could examine the children at his
leisure. He was much puzzled to find this feeble-minded class, but he found
that there was a hroad distinction between an idiot or imbecile and a dunce.
A child might be very bad at his lessons, but on the playground, or looking for
birds* nests, or going out in the boats he was a boy who could learn easily, and
surpass the other children who w’ere better at reading and writing. It might
be that there w'as an intermediate stage, so that they could go through feeble¬
mindedness, stupidity, and dulness up to genius. In large towns like London
there might be a larger number of such deficient children, but he must say
he had considerable hesitation about it. He was not prepared to speak to the
report, and he might yet be convinced by it, but there were some other objections
that were taken at the time, namely, that people in Scotland were proud,
sensitive, and cautious, and there would be very considerable opposition if they
classed children as feeble-minded, and sent them to particular schools. He was
not sure whether it would work as well as in England. He had seen these
feeble-minded children in Bergen and in Bremen. In Bremen they were all
idiots or imbeciles. They were very well educated. He noticed that Dr. Carswell
did not define what was the distinction between a feeble-minded and an imbecile
child. The Americans were heirs of the English language as well as ourselves,
and they had taken the word feeble-minded and applied 'it to idiots and
imbeciles too; it there included all classes. A feeble-minded person was
an idiot in the American speech, if not in the English language. The
Board of Lunacy from the beginning had allowed all the children sent
to the Larbert Institution to be certified by the medical superintendents
as imbeciles. That was enough, but when the 4s. grant was made he poiuted
out that it would be a disadvantage to the Institution if this was not given to
the children sent by the parishes as boarders, and they required for this purpose
that they should be certified as unsound of mind. Why should they not be
certified as idiots instead of unsound of mind, which meant something different
from an idiot and an imbecile, but it was mentioned in the Act as something
different. They evidently used it in the sense of non compos mentis, using a word
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Weak-minded and Imbecile Children
[July,
which was sufficient to include all classes. He thought that Dr. Carswell used
the word lunatic iu reference to persons who were not lunatics. He (Dr.
Ireland) imagined that a lunatic was a person who was sometimes insane and
sometimes not, as distinguished from a person who from natural incapacity was
always unfit to manage his own affairs. He did not think there was the slightest
use of confounding these definitions.
Dr. Carswell said that the English Lunacy Commissioners separated them ;
he did not separate them. He did not distinguish between the idiot and the
lunatic.
Dr. Ireland said that he was sorry if he had misconceived Dr. Carswell’s
meaning. Dr. Carswell liad entered into the question at considerable length as
to what should be done with these idiots and the large number who were thrown
upon the different parishes. He must say that his views differed to a
certain extent from the Barony Parish Council. He knew that that
Council liad always taken an intelligent interest in the care of idiots and
imbeciles. He remembered that Mr. Mitchell, an old member of the School
Board, got a list of seventy children who might be benefited by special training,
and proposed that the Barony Parish should set up an asylum of their own.
That met with the decided disapproval of the Directors of the Larbert Institution,
and they did all they could to pour cold water on it. That was not on his
advice, because he knew that they did not provide for one third of those presented
for application, and he did not think it was proper for men called philanthropists
to vote against providing accommodation for the whole of them. However, his
views on the subject might be gathered from the paper he had read to them
about the Danish asylums. In Denmark they had no Lunacy Acts at all, and they
had been allowed to work out their views with perfect freedom. What they
arrived at was that there should be an asylum for the uneducable, who could
receive so little benefit from education that they might be called idiots. No
doubt the late Dr. Seguin began the education of the insane, and he would not
despair of any idiot; hut, still, the amount of time and trouble necessary was so
great that practically he might be said lo have abandoned it. They required
medical care and relief, and should on this account receive asylum treatment
of some kind. The idiot was distinct from other children, and he was
always subject to bad health and nervous diseases which required treatment,
and the mortality was usually about nine or ten times as great eveu in the best of
asylums as compared with that of ordinary children. An asylum of that kind
should be both a home and a hospital. Then the second department he would
have would be an educational one, in which medical treatment and educational
pedagogic treatment should go hand in hand. These children should be taught
to use their hands and acquire good habits, and as much school teaching as they
actually could take in. He thought that this had scarcely been done in this
country for a good many years back. The third asylum, which was the most
necessary of all, was the custodial one. When he was at Larbert there was an
election system, and after five years the beneficiaries were pushed out to
make room for others. If the parents were alive the children were sent
back, and if dead they generally found their way into lunatic asylums.
He had pointed out the miseries that these children suffered, and the
bad habits they were taught, and he believed that there was no necessity
of insisting upon these before an audience of that kind. In Larbert they
only provided for children up to eighteen years of age, and after that there
was no provision. They were sent into lunatic asylums, anywhere so that paro¬
chial authorities could manage to get rid of them. They had great hopes that
the Barony Parish would take this into consideration, and might provide three
asylums or an asylum in three different departments, one for uneducable, one for
those who could be educated and trained from their youth, and thirdly, a
custodial asylum for those whose education was over, including those for whom
education had been of little benefit. In that asylum he thought that a consider¬
able portion of their board might be defrayed by their doing some work. As to
Digitized by
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489
1898.] by John Carswell, L.R.C.P.
the trade they should be taught in the educational institution, he did not
think that idiots and imbeciles, however well trained, could go into the market
and look for work, or into a joiner’s shop and hold their own. Eveu supposing
they could work they could uot spend their wages. At the same time, if
they were in an institution such as they found in Norway and Denmark, he
thought that a considerable portion of the expense of supporting them could
be saved.
Dr. Yellowlbes said that he had felt very greatly interested in this ques¬
tion, and he greatly appreciated the importance of the subject and the spirit
with which the Barony Parish Council had entered upon it. He did not
admire quite so much the definition which that Committee had given them, and
while it might be sufficiently useful for practical purposes, it was by no means a
scientific one. They were told of feeble-minded people and imbeciles, and the
difference between them was that the feeble-minded people had no insane
characteristics, whereas the imbecile children had insane characteristics. It
seemed to him that that was a kind of definition which put the difficulty a little
further back. What constituted insane characteristics ? There was no absolute
line to be drawn. For example, there was temper. When was the temper of a
weak-minded child an insane manifestation, and when was it mere irritability ?
The whole thing resolved itself practically; and he suggested that one
division might serve as well as any other, but it was by no means a division by
such a line as the Committee seemed to have drawn. He thought they must
recognise that. Neither was the further division, of educable or uneducable an
exact or safe division, because what was education ? It might be a triumph of
education in some of the children that they were able to button their clothes or
go to the water-closet, whereas others were susceptible of school learning, so
that educable and uneducable was not a very exact division, and it just came
back to the practical question as to those who were able to attend an ordinary
school for ordinary training. They were so far able to guide themselves that they
required no other special care. 'There was no exact line. For the parish a verjf
important practical division was this, the possibility of that patient—because they
were patients—becoming ultimately self-sustaining. That was the practical point
of view from which the parish looked, and ought to look, at such a case, as well as
the benevolent one. He was sorry to agree very much with what Dr. Carswell had
told them as to the results of training in that particular direction. He had
never yet seen any result that he could rejoice in to the great benefit of the
individual, and he had never seen any person turned out from a training
institution who was a self-sustaininsr man, able to go about the world and guide
himself in it; and yet that was the practical test by which parochial benefit
towards these people and parochial action towards them must be largely guided.
Therefore he thought it was entirely a wise and proper and right thing that
these children, who were so little susceptible of education and so little susceptible
of permanent benefit, should be cared for in special institutions from the public
funds; and moreover, when they reached the stage at which they were not looked
upon as children, but adults, they should still be cared for in separate institutions,
and not in asylums. He thought that the Barony Parish was doing an admirable
thing, but should it not be a much wider thing, and be a better thing that such
an institution should be a Scottish institution, and that the parish councils
should provide a separate institution for weak-minded people or defective people,
whether they were children or adults P No doubt the Barony Parish had such a
tremendous population to provide for that they might do it separately, but even
a vast parish like the Barony could only find thirty just now. They knew that
these were bad lives in the sense of longevity, and it was a question whether
such an institution should not be a separate institution altogether, and one
which could be developed to any extent, and which would contain both an
educational portion and a custodial portion, and an adult custodial portion—the
three requirements which Dr. Ireland had just alluded to. He thought the
matter a very important one, because every parish had more or less the very
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490
July,
Weak-minded and Imbecile Children ,
same difficulties as the Barony Parish had now so bravely met. He supposed
that it was quite understood that the patieuts who were placed iu that buildiog
would be certified.
Dr. Carswell said they were—at least, they were under the sheriffs’
order.
Dr. Yellowlees said he did not think he had anything more to say except that
he was glad that this question had received such prominence, and he thought that
the thauks of the Association were due to Dr. Carswell tor bring the matter
before them.
Dr. Hamilton Mabb said he regretted that Dr. Blair, the Medical Superin¬
tendent at Woodilee, was unable to be present through illness in his family,
because he would have been able to throw some light on the scheme. There was
certainly at first some misgiving iu the minds of the officials of the asylum as to
the erection of an imbecile institution in the grounds of the asylum. It was
thought that an institution of that kind should not be associated with an insti¬
tution whose aims were that it should be wholly curative, but that misgiving
had completely disappeared under the strongly expressed idea of the Barony
Parish to liave the care of all the children from their birth to their death, so to
speak, completely under their charge. There was one point that he would like
to refer to, and that was the educable and uon-educable question. No definition
had been given by Dr. Carswell, and the suggestion was put before them to go
aud visit the children in Baldovan and Larbert Institutions und decide whether
these children were educable or uon-educable,—that was to say, whether they could
be received into an institution attached to Woodilee or not—that institution being
charged with the reception of children who required nursing only, not children who
were capable of being educated or trained iu an institution such as existed at
Larbert. In setting themselves to this task they overcame the difficulty; they
fouud an intermediate class. They found that there were some children who, to alt
intents and purposes, were idiots, but who had not received the advantages of train¬
ing in any way, and who were at home aud yet might benefit by special training.
The Barony Parish had decided that in ull such cases they would give them a trial
for six months in a special training institution. They were sent there, aud on the
reports of the superintendent of the institution or on the report of the medical
man who visited the institution, they were to remain in that institution to get
the training if benefit followed. If they w r ere not benefited they had to go back.
So that no definition had been attempted, but merely an inquiry as to the proper
kind of children to put into that new institution at Woodilee Asylum. It might
be interesting to point out that w’liile this institution was within the grounds of
the asylum, to all intents and purposes it would be quite detached from the asylum.
The building was to be erected within the asylum grounds, and to be managed by
the medical superintendent of the asylum, but all the internal management would
take place within the buildiug itseli. Tne officials, nurses, aud so on would live
on the premises.
Dr. Ibeland said that he might point out that in England idiots had been
entirely separated from lunatics. By the Idiot Act institutions for this class
were treated, as that was considered a great advantage, quite different from the
lunatic asylums, although they were inspected by the Commissioners of Lunacy.
Dr. Yellowlees said he thought that was within the metropolitan area
alone.
Dr. Ireland said it applied to the whole of England. The Commissioners of
Lunacy gave a licence, but they could not revoke it; they could only make a
recommendation. These institutions were managed by directors.
The President asked if Dr. Ireland w as now talking of places like Earlswood
and Lancaster.
Dr. Ireland stated that that was so; they had to be certified as idiots, and
they were placed in the same class as lunatics. Naturally they did not require
such a classification. They had a separate class. Parents objected to have
their children certified. They were put under the Lunacy Acts, and there was a
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by John Carswell, L.R.C.P.
491
difficulty with them that they could not certify that they would recover. When
they were certified there they were all their lives, whereas an ordinary lunatic
could get out on the statement of the medical superintendent. As a person
never recovered from idiocy, he was under the Lunacy Act all his life.
Dr. Cabswell, in reply, said that he had to thank them for the very patient
hearing that they had given him in reading a longer paper than be intended to
write, and he had to thank them for the very friendly manner in which his re¬
marks had been received. Some points had been suggested in the course of the
discussion that would suitably form a subject for a detailed discussion, but of
course that was impossible, but he would just like to point out to Dr. Yellowlees
that the phrase “ insane characteristics ” was not his. He did not claim the credit
or discredit of it. The phrase was given to them by the Board. They had this
from the Commissioners, that with regard to children of a certain class certain
difficulties would not occur—that is, with regard to children who though of
defective mind were more or less intelligent and devoid of insane characteristics.
Their business was to go about discovering children that had insane characteristics
and were also uneducable, in order to satisfy the conditions of the Commissioners
before they would set up the new institution. The whole thing was surrounded
by difficulties so long as the question remained in the stage of mere discussion;
but when they got down to practical methods he of ten thought that a layman had
an advantage over a medical man, as the layman came in and adopted them when
they were discussing them. As to the doubt that had been expressed about the
existence of a feeble-minded class of persons who as children could not be taught
in ordinary schools, and who came to be wastrels and defectives, paupers and so
forth, and never became lunatics, he did not think that he would be justified in
saying that his experience did not bring ample testimony of the existence of such
a class. He welcomed this new definition or this specific acknowledgment of
the existence of a class of people who wanted twopence in the shilling in relation
to imbecility, because he thought he saw in it a hope of the treatment of mental
deficiency as related to moral deficiency, and the larger question as to how best
to deal with the vagrant and wastrel, and the defective. No doubt it was the
fact of the existence of that class that led to the appointment of the committee,
because it stated that a reference to the committee expressly excluded the case of
lunatics, and only considered the child deficients, who were not idiots or imbeciles.
He thought the responsibility of that large class whs acknowledged by the very
terms of the reference made to the committee. Of course, difficulties of all sorts
would be suggested, and if they were to go to England and consider these diffi¬
culties he did not know how they were to get over them, but in Scotland they
had the knack of being able to say half a dozen when it did not suit them to say
six, and he thought they could get round about difficulties in this way: that here
was a method in which imbecile and idiot children had been dealt with as lunatics
on the initiation or application of the Inspector of Poor, and in the proceedings
of the parish council qud that class they had been considered as lunatics, but had
never been treated like an ordinary lunatic in the asylum. They had been sepa¬
rately provided for, just as if there was a special Act providing for them. That
was an illustration of what he meant when he said that they did not find them¬
selves at a barred gate when they came across a difficulty such as was mentioned
by Dr. Ireland.
XLIY.
33
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492 Similarity between Epileptic and Alcoholic Insanity , [July,
Points of Similarity between Epileptic and Alcoholic Insanity .
By R. H. Noott, M.B., C.M., Senior Assistant Medical
Officer, Broadmoor Criminal Lunatic Asylum.*
Points of similarity between alcoholic and epileptic insanity
are referred to by many writers on psychology. These short
notes, which I bring before you to-day, refer to cases of
criminal acts of violence committed by epileptic and alcoholic
maniacs, and, I think, exemplify in a very striking manner
the similarity above referred to—a similarity in the mental
phenomena which preceded and which led up to the specific
acts of violence in a series of cases.
Although such similarity is noticeable between cases of
epileptic and alcoholic insanity in both their acute and
chronic forms, I confine myself to-day to the acute forms, by
which I mean the state of acute alcoholism or acute alcoholic
mania on the one hand, and the paroxysmal period of
epileptic insanity—the period in immediate relation to the
u fits ”—on the other; and I hope to be able to bring
forward evidence which suggests that there often occurs, in
cases of acute alcoholic mania, a condition identical with the
so-called condition of mental automatism which is so charac¬
teristic of the post-epileptic state, a period during which,
though “ consciousness ” may be entirely lost, the most
complicated and purposive acts may be performed, of the
circumstances of which the patieut has no trace of recollection
after the attack has passed over. In other cases the acts
committed by such patients are acts of ungovernable violence,
uncalculating and aimless.
The following short notes refer to a few fairly typical cases
of acts of violence committed by persons while in a state of
epileptic or acute alcoholic mania.
One preliminary remark I must make as regards the
subsequent loss of memory of acts committed during the
attack. It is obvious that there is in such cases a strong
motive for such absence of memory being assumed, and it is
equally obvious that it is impossible to tell with absolute
certainty whether such loss of memory is assumed or real.
In the cases that I am about to refer to, it is certain, so far
as it is possible to say so, that the loss of memory was not
assumed. I draw particular attention to this, because not
* Read at the Spring Meeting of the South-West Division.
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by R. H. Noott, M.B.
498
only is it an interesting point in considering these cases, but
also it is one of considerable medico-legal importance.
W. G—, a lad of 18 years of age, who was a cook on board
a fishing smack, killed his uncle, who was skipper of the
vessel, by stabbing him in the neck with a clasp-knife. He
had suffered from fits for many years. He had never been
known to have any quarrel with the man he killed, and the
latter had never been known to be unkind to him in any way.
One afternoon, when at sea, about an hour after having a
fit, W. G— rushed at the skipper, and stabbed him in the
neck. He was immediately secured by one of the other
hands on board, and in answer to a question as to why he
had done it, he said “ He wants to make away with the ship
and all hands ; he's Jack the Ripper." The following day he
had two fits, and was very maniacal. On recovering from
the attack he had no recollection of what had occurred on
the afternoon in question.
L. M— was employed on a farm to scare birds with a
shot-gun. Across some of the fields in which he was
employed there were footpaths. In the early part of a
certain afternoon he had a fit, and shortly afterwards two
ladies, who were quite unknown to him, walked across the
field in which he was. He shot at one of them—over sixty
shots entering her face—and fractured the skull of the other
with the butt end of the gun. In the evening he was taken
to the police station, where he had several fits. On recovery
he had no recollection of what had occurred on that after¬
noon. He still maintains that he is innocent of the crime,
and that he knows nothing about it.
W. B— murdered a fellow inmate of a workhouse. On the
day in question he had several fits, and was put to bed early
on that account, in the infirmary, the only other occupant of
which was an old imbecile, bed-ridden patient. The male
nurse, who visited the room from time to time, was attracted
by a knocking at the door, and went to see what was the
matter. Immediately he entered the room W. B— rushed at
him and struck him violently with a heavy piece of wood,
which he had taken from the foot of a spare bed in the room.
The patient was secured, and it was then found that the other
occupant of the room was lying insensible in bed, bleeding
from a severe wound on the head. W. B— was extremely
maniacal for several days, and had to be kept under restraint
during that time. On recovery he remembered nothing of
what had occurred.
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494 Similarity between Epileptic and Alcoholic Insanity , [July,
E. C—, a married woman, cut her child’s hand off under
the following circumstances. She had her four months old
infant in her arms, and being asked for some bread and
butter by another child, she proceeded to cut some. While
doing so she was seized with a fit, after which she cut the
infant’s hand off at the wrist. On recovering she recollected
nothing about the infliction of the injury, and was found by
some neighbours hugging the infant’s hand, which she had
wrapped up in a handkerchief.
The next case is one of probable “ masked epilepsy.”
J. A—, a patient in Winson Green Asylum, on the night of
his admission there, killed two of his fellow-patients and
injured a third. One of his victims, W. B—, who subsequently
succumbed to his injuries, gave the following account of what
happened. J. A— suddenly jumped out of bed, picked up a
crockery chamber utensil, and savagely attacked another
patient, smashing it over his head, and beating him about
with the broken pieces. He then rushed at W. B—, and
with the pieces of crockery beat him about the head until he
became unconscious. He subsequently attacked a third
patient, but was secured before he inflicted much injury.
A few days afterwards he was removed to Broadmoor Asylum.
On admission he could recollect nothing of what had occurred
on the evening in question. To quote his own words, he
said, “ 1 remember going to bed in a dormitory where there
were other patients, and when I woke the next morning I
found myself in a different place.” This case was reported
in the Journal of Mental Science for January, 1894. As a
rule he was a quiet and well-conducted patient, with exalted
ideas and delusions of extreme wealth. At times he destroyed
his bedding, but on every occasion, when questioned about it,
he said that he l€ had slept all night, and someone must have
come into the room and done it.” After these attacks he
had delusions of suspicion and persecution, which always
disappeared in a few days. After one of these attacks he
developed meningitis, his temperature going up to 108’4° F.
He was practically in a state corresponding to the status epi -
lepticus—minus the convulsions,—which terminated fatally.
The following notes refer to cases of acute alcoholic mania.
A. D— killed a woman aged 73 by striking her on the
head with a chair. He was living with his mother at the
time, and deceased lodged with them. Some years pre¬
viously some bricks had fallen on his head, and from that
time a very little alcohol would upset him. At the time of
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by R. H. Noott, M.B.
495
the committal of the crime he had been drinking heavily for
some days. On the previous day he had gone to a neigh¬
bour’s house, had thrown a poker at one of the occupants,
and smashed a table with the kitchen fender. He then went
into the garden and beat the wall with a piece of the table.
On the day on which the crime was committed he again went
to this house, and smashed more of the furniture. He then
returned to his own house, went upstairs to a room occupied
by the deceased, and hit her on the head several times with a
chair. That evening, when at the police station, he was
very maniacal, and had to be restrained. He continued in
this state for several days. On recovery he could remember
nothing of what had occurred during the whole of this time.
C. S— killed his child, aged six months, by smashing her
head against the fender. He had usually been a quiet,
steady, and temperate man; but for about ten days previous
to the committal of the crime he had been drinking heavily
with his brother-in-law, who had come to stay with him.
C. S— became so ill and strange in his manner that his wife
sought medical advice. In spite of strict injunctions to take
no stimulants, he continued to drink heavily, and on the
evening before the crime was committed he was very excited
and restless. He accused his wife of poisoning him, and
threatened to kill his brother-in-law. After a time he went
to sleep on a sofa. Early in the morning he again became
very excited, and his wife and brother-in-law went out for
assistance. While they were away he went upstairs and
broke all the windows; he then took the child from her bed
(a boy aged ten was sleeping in the same room), and smashed
her head against the fender. He then went out without hat,
boots, or coat, and wandered about until he met a policeman,
to whom he said, “I am-, I live in Porter Street;
I have murdered my child by dashing its head against the
wall; you will find it all right if you go and look.” For
some days afterwards he was very maniacal, and had to be
kept in a padded room. On recovery he could remember
nothing whatever of the crime. He subsequently passed into
a state of chronic mania.
T. L— killed a man in a police cell by cutting his throat
with a knife. He had been taken to the police station for
being drunk and disorderly, and was confined in a cell by
himself. Shortly afterwards another man, who was helplessly
drunk, was brought in and placed in the same cell. They
were visited regularly during the night by the constable on
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496 Similarity between Epileptic and Alcoholic Insanity, [July,
duty. On each occasion the deceased was found to be sleep¬
ing heavily, and T. L— was standing by the fireplace. At one
of the visits in the early morning the constable on duty found
the deceased lying on the floor with his throat cut, and about
twenty cuts on the face. On being asked what he had being
doing to the deceased, T. L— said, “ I thought he was going
to kill me, so I knifed him.” He was very maniacal for
several days afterwards, but on recovery remembered nothing
of what occurred in the police cell, nor could he remember
being taken there.
H. H—, a publican, shot a girl in his employment under
the following circumstances. He had been drinking heavily
for some time, and had appeared strange in his manner. On
the day in question his son saw him wandering about the
house with a gun in his hand. He seemed to think there
was a man hiding in the house, and his son heard him say,
“ Sam, come out; Sam, don’t shoot me in front of my son.”
His son tried to get the gun from him, but he would not
give it up, and said, “ Don’t take it away or somebody will
shoot me.” He then left the room, and shortly afterwards
his son heard two shots, and going upstairs found the deceased
lying on the floor, having been shot through the chest. On
recovery he had no recollection of the crime, or of what had
occurred for some hours previously to it.
G. M— killed his mother in a most brutal manner, and
before a third person, a domestic servant. He had on a
previous occasion had an attack of “ delirium tremens.” He
had been drinking heavily for several days. His mother
owned a public-house in which they lived, and on the evening
in question the house was shut up at ten o’clock as usual.
G. M— then went upstairs to a room in which his mother
and the servant were. He locked the door, and said, “ You
will have to stop up all night.” He then loaded a revolver,
rushed at his mother, and said that “ she was not his mother,
aud that they were both at the same game.” The servant
took up the poker to defend herself and the deceased, but
G. M— took it from her, and pointing the pistol at her, he
said, “ It will be your turn next, if you move you will not
live long.” He then kicked his mother in a most brutal
manner, aud continued to do so for several hours. About
three o’clock in the morning he tore off all her clothes and
roasted her body in front of the fire. From time to time he
threatened the girl in the room that he would shoot her if
she moved or screamed. He was subsequently secured and
Digitized by LjOoq Le
1898 .]
by R. H. Noott, M.B.
497
taken to the police station. On recovery he could remember
nothing that had happened on the day the crime was com¬
mitted. There was an interesting medico-legal point about
the case, as there was a possible motive for the crime. The
deceased had saved a considerable amount of money, and
G. M— was wishing to get married, and had asked his mother
to help him by advancing him some money. She had refused,
saying that she was going to be mistress in her own house
while she lived.
Gentlemen, I must ask you to kiudly pardon the elemen¬
tary nature of the following few remarks. Reference will
often be made to the writings of Hughlings Jackson on
epileptic insanities.
The first suggestion I wish to make is this : May we not
look upon acute alcoholic mania as the outcome or result of a
“ discharging lesion,” very similar to that which is the cause
of epilepsy and its allied insanities. That the epileptic fit
itself is the result of a u discharging lesion ” in the highest
centres of the brain seems to be generally acknowledged. As
regards the post-epileptic mania, some look upon it as a
continued result of the initial “ discharge,” which has spread
to other nervous tracts; while others, and Hughlings Jackson
among them, look upon it as a result not of a direct “ dis¬
charge ” in the nervous tracts concerned, but of an abnormal
physiological “ letting go ” in these tracts, due to their being
cut off from the inhibitory control of the highest centres, this
“ letting go” being due to the paralysis of the highest
centres, caused by the initial “ discharge ” — a similar
phenomenon, as Hughlings Jackson suggests, as the increased
rate of cardiac action after section of the vagus. I would
rather look upon it as a result of both these conditions, viz.
an abnormal instability or irritability of the nervous tracts
concerned, and their isolation from the protective control of
higher centres.
The condition into which the highest nerve-centres are
brought by the consumption of an extreme aud poisonous
amount of alcohol, and which results in the sudden, violent,
and often transitory mania as seen in the cases I have
quoted, occasions mental phenomena very analogous to those
observed in epileptic mania. May we not look upon these
phenomena as due to a “discharging lesiou,” a sudden
liberation of nerve energy which, commencing in the highest
centres (the “ anatomical substrata of consciousness ”) may
be either expended in these centres, or may spread to lower
Digitized by L^OOQle
498 Similarity between Epileptic and Alcoholic Insanity, [July,
levels, resulting in movements the less organised, specialised,
and automatic, or the more organised, specialised, and
automatic, according to the level to which the discharge
spreads.
Before going further I must refer to the .loss of “con¬
sciousness” accompanying the acts performed by acute
alcoholic and epileptic maniacs, whether those acts are of a
complex purposive character, or of an aimless wildly destruc¬
tive character. In some cases, as in those above quoted, the
“ loss of consciousness ” is complete; in other cases it is
only partial; that is to say, the acts performed are subse¬
quently faintly remembered as if they had happened in a
dream. As regards the relation of “consciousness” to
activities of the highest nerve-centres, the above and similar
cases illustrate very definitely, I think, the opinion of Hugh-
lings Jackson and others on the subject, viz. the doctrine of
“ concomitance,” which is stated by Hughlings Jackson in
these words : “that (1) states of consciousness (or synony¬
mously states of mind) are utterly different from nervous
states of the highest centres; (2) that the two things occur
together, for every mental state there being a correlative
nervous state; (3) that although the two things occur in
parallelism, there is no interference of one with the other.”
I now pass on to refer briefly to some points of resem¬
blance between these two classes of cases. Clinical observa¬
tion shows, I think, that, speaking generally, the slighter
fits of epilepsy are more liable to be followed by mania than
the more severe fits.
Both in epileptic and acute alcoholic mania we find
different intensities and different depths of dissolution,
resulting in correspondingly different nervous manifestations.
In some cases the initial discharge is entirely expended in
the area in which it takes place; in other cases it “ over¬
flows” into other nervous tracts. For example, in some
cases of epilepsy the initial “ discharge ” in the highest
centres (the “ anatomical substrata of consciousness, and the
re-representation of lowest levels) results in profound coma
of short duration, a temporary complete dementia. Corre¬
spondingly, in some cases of acute alcoholism a profound
coma, a temporary complete dementia, results. It may be
said that the coma in these cases cannot be allied to the coma
resulting from a severe epileptic fit because it is of so much
longer duration, and because in the case of epilepsy it is
accompanied by more or less severe convulsions. My sug-
Digitized by C^ooQle
1898.]
by R. H. Noott, M.B.
499
gestion is that in acute alcoholism the “ discharge ” is
entirely expended in the nervous tracts which subserve
" consciousness,” and does not overflow, as in epilepsy, to the
nervous tracts in the highest centres, which are the re¬
representation of the lowest levels. In this relation, however,
it is important to remember that in some cases of acute
alcoholism general convulsions of an epileptiform nature
occur.
In some cases, both of acute alcoholic and epileptic mania,
the middle level and the lower tracts of the highest level
being cut off from the protective control of the highest
centres, and being in a high state of nervous instability,
there result those blind uncalculating destructive acts of
which some of the cases I have quoted are examples. In
other cases both of epileptic and acute alcoholic mania, the
acts are of a complex and purposive character, indicating
activities of the highest sensori-motor centres. Sometimes
“ consciousness ” is entirely lost; in other cases “ partial
consciousness/’ if I may use the term, is present, but not in
such degree of activity as would enable reflection and judg¬
ment to give their “ protection ” to the activities of the cor¬
related sensori-motor tracts. In relation to this “loss of
consciousness” accompanying elaborate acts, Hughlings
Jackson says “ it may be that in dissolution the activities on
the lower level of evolution have attendant states of con¬
sciousness which in normal conditions they had not, or that
their normal slight states of consciousness become more
vivid. (The condition which I have referred to here as
“partial consciousness” is by many designated “double
consciousness.”)
In some cases the individual will at the time give expres¬
sion to delusions, hallucinations, or illusions, of which the act
is the ultimate outcome. In the study of these cases, how¬
ever, in which the highest nervous activities are concerned
independently of consciousness, one is confronted with this
difficulty—that while motor activities are open to objective
study, sensory activities being entirely subjective, one is
dependent upon information given by the patient regarding
them.
Whether expression is given to delusions, &c., or not, there
are often strong indications that the sensory nervous activities
present are correlated to the emotion of “ fear.”
Both in alcoholic and epileptic mania relief is often ex¬
perienced on the accomplishment of the act, due, as one must
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500 Similarity between Epileptic and Alcoholic Insanity . [July,
suppose, to the relief of tension in the nerve tracts concerned,
and a consequent resolution to normal stability.
The following clinical facts are also suggestive. Epilepsy
is sometimes the result of severe injury to the head, and
also of suustroke. Injuries to the head and sunstroke may
also cause a great predisposition to extreme effects of alcohol,
and also a predisposition to the maniacal type of acute
alcoholism.
In conclusion I would draw particular attention to the great
medico-legal interest and importance of the insanities which
I have brought to your notice to-day.
Discussion.
The Hon. Secretary wild he wished to thank Dr. Noott for lais able and
instructive paper, which, he was quite sure, would be read with interest by every
member of the Association. It was difficult to discuss an intricate subject of
this kind against time, for every point required to be carefully considered
before venturing on an expression of opinion, whether for or against the views
formulated by the reader of the paper. He might mention that he had recently
seen a case where the clinical symptoms were attributed to epilepsy, but it was
clearly proved that alcoholism was the cause, and not epilepsy. The man had
manifested suicidal propensities, and generally the case supports the views of
Dr. Noott. If it can be proved that in these states of alcoholism there is a
discharge similar to the Jacksonian discharge in epilepsy, then a very valuable
link will have been added to the chain of nerve pathology.
Analysis of the Causes of Insanity in One thousand Patients .
By J. V. Blachford, M.B., B.S., Senior Assistant Medical
Officer, Bristol Asylum.*
I have investigated as far as possible the causes of insanity
in the last 1014 patients admitted to the Bristol Lunatic
Asylum, 507 being males and a like number females. My
purpose has been to ascertain in what proportion of insanity
heredity was the prominent factor in causation, and what
influence was exercised by alcohol, traumatism, and certain
other agencies, where no taint of bad heredity could be found.
The present investigation has been undertaken to seek
confirmation, if any, of my opinion, that the causes of insanity
may be grouped under very few heads, as well as to try and
afford some explanation for the apparently rapid' increase of
psychoses during recent years.
Special care has been exercised to avoid accepting in¬
sufficient evidence as to hereditary predisposition, drink,
* Rend at tho meeting of the South-western Branch of the Medico-Psycho¬
logical Association held at Oxford, April 19th, 1898.
Digitized by Le
J. V. Blachford, M.B.
501
1898.]
traumatism, Ac., and it has seemed best to class separately
cases showing direct evidence of slight neurotic history, and
those in whom this is to be inferred from the occurrence of
insanity in their offspring.
Of the total 1014 cases, 230 epileptics, general paralytics,
congenital and puerpural patients have been removed to a
separate group, the remainder consisting of '370 males and
408 females. The disproportion between the sexes indicates
that puerperal insanity does not counterbalance the greater
proportion of male as compared with female general para¬
lytics.
To avoid undue confusion in dealing with numerals I shall,
in reading this paper, quote percentages only.
Of the 784 ordinary cases, sufficient evidence of hereditary
predisposition is found in nearly 30 per cent.; in about
5 per cent, a neurotic history was ascertained, or was inferred
from the insanity of offspring, and over 13 per cent, had
suffered previous attacks.
If it be allowable to consider these recurrent cases as in¬
dicating an undiscovered hereditary predisposition (for they
constitute no less than a quarter of those patients with an
ascertained neurotic heredity), the percentage of hereditary
predisposition may be materially raised.
Dr. Bevan Lewis gives an ascertained strong neurotic
heredity in 36 per cent, of recurrents.
Eliminating these, however, as an uncertain factor, a history
of insane or neurotic heritage has been definitely ascertained
in 34*6 per cent., thus constituting the greatest discoverable
predisposing cause. Nearly 11 per cent, of the 784 cases
were broken down through drink alone, without known
history of hereditary predisposition. Eighteen cases were
classed as organic insanity, and four as traumatic, forming
with the previous numbers a total of 486, or more than half
the cases under consideration. And when the large number
of patients is taken into account in which no history could
be obtained, or in which the friends have ignorantly or wilfully
withheld the same, the percentage is full of significance.
If, as is stated, mental break-down occurs at an earlier
period in the offspring than in their parents, it is surmisable
that the largest numerical difference between those suffering
first attacks who have hereditary predisposition and those
free from it would be at later periods of life, and that this
difference would diminish at earlier ages. And, so far as my
observations go, this supposition is borne out. Thus, of both
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502 Causes of Insanity in One thousand Patients , [July,
sexes in which the first attack of insanity occurred at over
sixty years of age, 7*2 percent, had hereditary predisposition,
and 18*8 per cent, were without this tendency.
In the previous half-decade 4*5 per cent, had hereditary
predisposition, and 9*5 per cent, were without, and below this
age period the difference is very slight. This equality
seems to indicate hereditary predisposition in the cases
where otherwise it was not obvious. For inasmuch as some
causes manifest themselves at particular epochs of life, more
strongly in the hereditarily degenerate, a difference between
the two classes of cases below fifty-five years of age should
be observable. In the degenerate, puberty, adolescence, and
the climacteric undoubtedly act as disturbing elements, the
two former being answerable for an early break-down where
the predisposition is marked, whilst where the instability is
slight retrograde processes of senility are required to disturb
mental equilibrium. In both sexes of those with or without
hereditary predisposition, the most common age (exclusive of
the senile epoch) for attack is from the twenty-fifth to the
thirtieth year, and the next in frequency is from the twentieth
to the twenty-fifth, followed by those from thirty to thirty-five
years of age, so that the majority of cases occur between the
ages of twenty and thirty-five, this embracing the period of life
most subjected to stress, physiological and environmental.
A rise in female numbers between forty-five and fifty years
marks the influence of the climacteric.
To summarise, these tables bear out what has been already
advanced as to the causal agents in insanity, and allow us to
infer that hereditary predisposition is the strongest of them,
whilst the evolutionary and decadent periods of life consti¬
tute more focalising influences. Also that the period of
greatest liability to insanity is between the twentieth and
thirty-fifth year, embracing as this does the influences of the
principal physiological epoch and objective encroachment.
I have also made observations in 131 female and 102 male
cases, with a view of determining any tendency on the part
of either sex to exhibit a transmitted neurosis. When this
is direct from the parents its influence appears equally potent
in the two sexes, whether the transmitter be the father or
mother.
I have reliable statistics in only thirty-five cases concerning
collateral hereditary influence, but so far as these go they
indicate that the descendant of the same sex as that of the
parent through whom it is transmitted is chiefly liable.
Digitized by t^ooQle
1898.]
by J. V. Blachford, M.B.
503
We can now consider the value of the commonly alleged
cause of insanity—alcohol. I have felt it necessary to deal
very critically with the ordinary testimony of the friends of
the patient as regards alcoholic habits, being well satisfied
of its unreliability in the majority of cases. So that I have
taken into account only those instances in which no hereditary
predisposition could be found, and in which the symptoms,
personal history, &c., pointed without doubt to alcoholic
excess. I have also eliminated those cases in which it was
not possible to decide whether alcohol was a cause or a sym¬
ptom of the insanity. There were 64 males and 22 females
whose mental disorder seemed the direct result of alcoholic
indulgence (the proportion being, as one might expect,
larger among men). These cases comprise acute mania,
melancholia, and typical amnesic and demented forms, and
constitute 8*4 per cent, of all cases.
Insanity dependent on or accompanied by hemiplegia,
growth, ataxia, bulbar paralysis, &c., constitute 18 out of the
total number, mostly males, for easily surmisable reasons.
Choreic insanity, being a strongly hereditary form, has been
excluded from this group. Traumatism accounts for but a
trifling number of cases.
Epilepsy has now to be considered; 7*7 per cent, of the
total 1014 cases were epileptics, and in 21*5 per cent, of
these hereditary predisposition was present. “ Traumatism 99
and “ drink 99 were causes alleged in a very small proportion.
The influence of the latter appears to me only trifling, espe¬
cially if we exclude those cases of convulsions occurring in
alcoholics, and which both by their clinical form and transient
duration (where the poison is discontinued) deserve to be
classed apart. Hence hereditary predisposition poses once
again as a potent cause, and the percentage just quoted is
probably under-estimated, as in the case of other varieties of
neuroses. I have arrived at the conclusion that as a general
rule epilepsy commences at an early period of life, most com¬
monly between the ages of ten and fifteen. In those cases
which occur later in life they are traceable to traumatism,
or to some toxic influence.
About 9 per cent, of the total cases were general paralytics.
Hereditary predisposition is found in 23 per cent, of these, a
sufficiently large number to indicate its influence in the pro¬
duction of this form of mental disorder. Dr. Mott has pointed
out that general paralysis is a primary neural degeneration,
an untimely decay of the most highly elaborated structures of
Digitized by LjOoq Le
504 Causes of Insanity in One thousand Patients , [July,
the cortex, and this is in harmony with the preceding suppo¬
sition. But at the same time there is evidence that extra¬
neous causes, such as stated by Dr. Clouston (hard w6rk,
alcohol, and meat eating), can of themselves act as excitants.
The disproportion between male and female patients is sug¬
gestive in this aspect. Syphilis has been another cause
advanced, both from direct evidence of it and indirect; the
indirect consisting of the assumption that as syphilis is
frequently a cause of ataxia, and the latter a not uncommon
accompaniment of general paralysis, therefore syphilis is a
factor in the production of both. My present statistics show
scanty proof of syphilis in general paralysis, but more reliable
and frequent evidence of it in ataxia.
Alcoholic excess as an extraneous cause comes into pro¬
minence in these tables—11 per cent, to 12 per cent, of the
91 cases had a distinct history of this without any discoverable
hereditary predisposition. This percentage is, admittedly, a
considerable one.
Traumatism is a not infrequently alleged cause, but I can
neither, on the one hand, find a history of such in any im¬
portant number; nor, on the other hand, does it appear
feasible to suppose that a coarse injury should be capable of
setting up so gradual and characteristic a neural degeneration
as general paralysis.
Only one case of the so-called “ developmental ” type has
been met with by me; this was, however, a marked one, and
ran its course between the ages of twenty and twenty-five
years. If such cases have any bearing, it is in favour of the
production of the early decay in general paralysis by faulty
heredity.
From these tables the age limits in general paralysis
appear as twenty-five to sixty (excepting the first-mentioned
case), and the age on attack seems to be a little higher in
women than men.
Dr. Clouston states that in the Durham Asylum, situated as
it is in a thickly populated mining district, where wages are
low, work hard, and drink plentiful and bad, the proportion
of general paralytics is one in six of all admissions; whereas in
the Edinburgh Asylum, which is differently situated, it falls
to one in seventeen; in the Bristol Asylum it is one in eleven.
In order to ascertain the life of a general paralytic after
symptoms have been established, I have investigated the
male cases included in these tables : of the fifty-seven cases
which have died here, in only four cases did it last for more than
Digitized by ^ ooqLc
J898.]
by J. V. Blachpoud, M.B.
505
five years, these being five and three quarters, six, eight, and
nine; and in the last three it is very doubtful if the informa¬
tion obtained is correct, inasmuch as it is merely stated in each
case that the wife or other informant said that the patient had
been queer four or five years before, but there is no satis¬
factory proof that the symytoms at that time had anything to
do with general paralysis.
I have separated the puerperal from the ordinary cases on
the female side, because the exciting cause is one to which
every woman is not liable, and does not obtain on the male
side. Of these there were forty-two, or 8*2 per cent., and in
this class hereditary predisposition again plays an important
part, fourteen having a definite hereditary history, while in
three a distinct neurotic history was obtained—in all 40*4
per cent., the largest proportion ascertained in any class
except the congenital. The influence of the condition as to
marriage of the patient could hardly be estimated from so
small a number, but as only two of the forty-two are recorded
as being single, it would appear that the mental anxiety and
distress accompanying pregnancy in the unmarried are not
sufficient to cause a break-down, unless acting upon a mind
already predisposed to insanity. And, as a matter of fact, in
both these cases hereditary predisposition is attributed as a
predisposing cause, in the one case the mother, and in the
other the maternal uncle having been insane; and when we
consider the amount of mental worry single women in that
condition must suffer, it throws grave doubts on such ascribed
causes as domestic trouble, loss of relatives, &c., being any¬
thing more than purely exciting causes acting on an already
unstable cortex, and once more points the chief predisposing
cause as heredity.
We now come to the last class, namely, congenital imbeciles
without epilepsy, and of these there were only eight male and
ten female. In the case of one male and six females there
was a definite history of hereditary predisposition, and in
that of one female the mother is described as neurotic, so that
the percentage of hereditary predisposition in this class is,
as we should naturally expect, higher than in any other, viz.
44‘4 per ceut. In four of the female cases it was inherited
directly from both parents, and in one of either sex directly
from one parent.
From the foregoing statistics it would appear that all forms
of insanity are strongly hereditary, the percentage being for
all cases with a definite history of hereditary predisposition
Digitized by LjOoqL e
506 Causes of Insanity in One thousand Patients . [July,
28*7 per cent., and with a strongly neurotic history 4*1 per
cent: total, 32*8 per cent.
That of all forms the congenitals hold the first place,
with 44*4 per cent., is only what is to be expected. Dr.
Clouston describes them as te nature’s ending to a bad stock.”
Puerperal insanity seems to be the next most hereditary form,
with 33*3 per cent, hereditary predisposition, and 7 per cent,
with neurotic history, these percentages having regard to
female cases only. Then follow the ordinary cases, with 29*7
hereditarily predisposed and 4*9 with a history of neurosis;
23 per cent, in general paralysis, 21*5 per cent, in epilepsy. In
the last I should think hereditary predisposition is more under¬
estimated than in any other class.
It is further interesting to note that there are more male
than female epileptics, and that as regards the general para¬
lytics the male cases are not only 'five times as numerous as
the female, but drawn as they are from an urban population,
the proportion on the male side is one in 6*6.
With regard to the ages at which mania and melancholia
respectively most commonly occur, I have appended tables
showing the frequency of their occurrence at different ages
on the male and female sides in half-decades, from which it
will be seen that while in the male cases the maniacal line
rises very suddenly between the ages of twenty and thirty-
five, and again sinks as suddenly between the thirty-fifth
and forty-fifth years, after which it varies somewhat till the
sixtieth, when it suddenly drops and scarcely rises again, the
melancholic line is more level throughout, reaching its greatest
height between the fifty-fifth and sixtieth year, and falling
rather suddenly after sixty-five ; between the ages of twenty
and forty being always below, and after forty above the
maniacal line. In the female cases the difference is not so
marked, the chief occurring between the ages of thirty and
thirty-five, after which they tend to alternate with a spurt
in favour of mania towards the end of life.*
* Discussion postponed to the next meeting of the Division.
Digitized by
ipjWAM.
V Oi
Digitized by t^ooQle
1898.]
507
Remarks on the Giant-cells of the Motor Cortex in the Insane ,
examined in a fresh state {without hardening), A Con¬
tribution to the Pathology of the Nerve-cell, By John
Turner, M.B., C.M., County Asylum, Brentwood, Essex.*
Introduction, —In these days of elaborate technique, it may
not be without interest to record a method which enables us
to demonstrate details of structure in the nerve-cells which
have been practically untampered with by hardening fluids or
other reagents.
The method consists essentially in colouring small pieces
of the fresh cortex with methylene blue, and pressing the
fragment out under a cover-glass. There are certain little
details which must be attended to, however, before the best
results can be obtained, but these are only supplementary,
and serve merely to render more clear and lasting the appear¬
ances brought out as above described.
The method is so simple, and yields such instructive results,
that I hope it may lead to a more general and systematic
examination of the brain cells, both of the insane and the
sane. It is by such means that we may hope to get a clearer
idea of the changes which occur in the nerve-cells in mental
and other disorders.
Naturally, as there is no sharp line of demarcation separat¬
ing the sane from the insane, we should expect such changes
to be largely of a quantitative rather than a qualitative
nature, and yet it would seem, according to some observers,
that because the changes met with in the brains of the insane
are often not peculiar to those mentally disordered that their
importance as factors in these latter conditions has been
over-estimated.
The method before us brings out a wealth of detail in the
interior of the nerve-cell and its processes, and it possesses
the great advantage of showing the nerve-cells of their
natural size.
The consistency of the cells can by this means be directly
estimated, and we find that in a healthy state their elasticity
and resistance to pressure are very great. It may either be in¬
creased or much diminished in morbid states.
In viewing whole cells and not merely optical sections, we
get a more correct idea of the amount of pigment they con¬
tain, and of the number of processes they give off. As many
# Read at the General Meeting, 12th May, 1898.
xliv. 34
Digitized by L^OOQle
508 Giant-cells of the Motor Cortex in the Insane , [July,
as twenty dendrites can often be counted springing from all
sides and parts of a cell.
I may add that I have obtained equally satisfactory results
from cadavers twenty-four to thirty-six hours dead as from
perfectly fresh corpses.
Procedure .—Small pieces (thin slices) of the cortex direct
from the cadaver are put to soak in a solution (watery) of
methylene blue (0*5 to 1 per cent.) for two to four hours. In
cold weather it is advisable to place the solution and contained
pieces in a warm place (on the paraffin bath). A minute
shaving is next taken from the whole depth of the surface of
the cortex and soaked in Farrant’s solution for a few minutes;
it is then placed on a slide, a cover-glass superimposed, and
slight pressure made with two mounted needles, taking care
that, although extended, the several parts keep their relative
position as far as possible. When the film is thin enough to
transmit light, place the specimen on the stage of the micro¬
scope, and continue to press it out till the cells are satisfac¬
torily isolated, or cleared from any particles obstructing their
view, watching meanwhile through a i-inch objective to see
that the cells are not damaged by the pressure.
When the film is satisfactorily spread out, pass it through
a flame till the colour just begins to run (this can be seen
under the £-inch) ; by this means the detail in the cell is ren¬
dered sharper and more distinct, then again transfer to the
microscope stage, and finally adjust the cells by due pressure.
The specimen will not be at its best till from two to four
days; by this time much of the colour has left the matrix,
and the nerve-cells stand out darkly and distinctly stained
against a more or less colourless background.
These preparations are better examined by artificial light;
they only keep, as a rule, about a fortnight to three weeks,
although occasionally a specimen keeps for years. They
can, however, be rendered permanent without any shrinking
of the cells, and with their clearness enhanced, by the
following simple means.
When the film has been mounted for a week or two, or
when it is just beginning to deteriorate, the slide is put into
warm water and left until the cover-glass can be slipped off
with a mere touch of a needle, or better by its own weight
on tilting the slide. Warm water loosens the cover-glass
quicker, and I generally find that specimens stood on their
side in a grooved porcelain dish over night to soak are ready
the next morning, but if the cover-glass is not quite loose it
Digitized by L^OOQle
1898.]
by John Turner, M.B.
509
is very unadvisable to endeavour to get it off with the slightest
force. A drop of 0*5 per cent.osmic acid is run over the film, and
immediately the slide and film are placed in a flat dish of warm
water for a minute. It is then taken out, dehydrated quickly in
alcohol, cleared in xylol, and mounted in Canada balsam.
Although by this time it may seem that the above process
is as elaborate as any hitherto used, yet we have practically
our eye on the cell from the time it leaves the brain until it
is finally mounted, and any change it might undergo during
the process could at once be detected; but such changes do not
occur. I should mention, however, that the appearances noted
in the cells in the following communication were observed in
the specimens previous to their treatment by alcohol, &c.
It is curious to note the avidity of the nerve-cells for the
stain; those which when first looked at after mounting are
only just visible, will after a few hours’ time have absorbed a
quantity of the stain from their neighbourhood, and are now
as dark as those which from the first had been in contact with
the methylene blue.
Pigment .—As is well known this deposition is generally pre¬
sent, and the term “physiological pigment” has been applied
to the small amount seen in health, which is generally situated
near the base of the cell.
Bevan Lewis* writes, “The one fact clearly established in
the history of the various psychoses is that where excessive
pigmentation of the nerve-cells is found, it is a witness to a
bygone functional hyper-activity.”
Although pigmentation may be under normal conditions in
proportion to age, this certainty is not altogether the case in the
insane. Amongst them it is common to find in the still young
or middle-aged, cells not merely containing a large quantity of
it but distended to an enormous extent. I cannot say that I
have noted excess to be peculiar to any form of mental disorder
or any age; as much is found in states of chronic melancholia,
chronic mania, or dementia as in general paralysis or acute
forms of insanity; but in all the idiots’ or imbeciles’ brains which
I have examined it has been either in small amount or absent.
In several cases of cerebral haemorrhage the pyramidal
cells of the lower part of the cortex have presented a very
extreme degree of pigmentary degeneration. In many of
them the whole of the perikaryont was replaced by yellow or
* Text-book of Mental Diseases, p. 473.
f Term used in the last edition of Foster’s Physiology to denote the body of
the cell surrounding the nucleus.
Digitized by LjOOQLe
510 Giant-cells of the Motor Cortex in the Insane , [July,
buff-coloured pigment, unaffected by osmic acid; a small
nucleus and nucleolus remained, which were generally pushed
up against the attenuated apex. These cells were much the
shape of a peg-top.
Although it is most usual for the pigment to lie at the base
or along one side of the cell, yet not unfrequently a large
mass of it is interposed between the apex and body, running
for a considerable distance up the former, and completely
isolating it from the latter. In such a case it is difficult to
see how it can avoid very seriously interfering with the cell
functions. Most frequently in these cases, beyond the deposi¬
tion of pigment, the apex contains numerous chromophilic
threads. Sometimes there are two or more distinct deposi¬
tions of pigment, one at the apex and one at the base, &c.
In some of the big distended bags seen at the base of a cell it
is possible to trace the processes through them by means of
their chromophilic material.
In the tables later on I have given roughly the amount of
pigment noted in the cells of the various cases examined.
Chromophilic material. —(1) It is chiefly about the arrange¬
ment and changes which take place, due to morbid alterations,
in the chromophilic material of the cell that I wish to speak.
I have no doubt that much of what I am about to describe
is already familiar to those who have worked with Nissl’s
method, but it must be remembered that my remarks refer
to fresh cells, which, as far as I am aware, have not been
previously studied. In a short account of this method in the
winter number of Brain (1897) I said that we had thereby
proof that the chromophilic material existed in the cell in
the form described by Nissl,—rods, spindles, &c,—and that
these structures were not artificially produced by hardening
and reagents.
Nevertheless we must not forget that we are dealing with
dead elements, and if we may trust to the appearance of the cell
stained with methylene blue by the vital method of Ehrlich,
it would appear as though the fact of dying alters very
materially the reaction of different parts of the cell to the
stain.
Thus the nerve-cells of a guinea-pig, when stained by
Ehrlich’s vital method, showed a pale undefined nucleolus, a
rather deeply stained, granular, and sharply defined round or
oval nucleus, and a pale more or less homogeneous perikaryon
and processes, and there was no indication whatsoever of chro¬
mophilic material, except in the long apices of the pyramidal
Digitized by Le
by John Turner, M.B.
oil
1898.]
cells of the cornu ammonis, where it presented a moniliform or
beaded appearance. But in cells taken from the same brain
and soaked in methylene blue, and examined fresh after
merely squeezing them out, the reaction taken on was similar to
that noticed in human cells, only the chromophilic material
was very irregularly arranged in a blotchy manner, and it
was only at the apex that there was a slight appearance of
striation.
(2) Bearing the above remarks in mind, there is no doubt
that in dead nerve-cells the chromophilic material does take
on a definite arrangement and form, which in the case of the
healthy giant-cells and pyramids is that of rods or spindles,
more or less regularly disposed, with their long axis in the
direction of the long axis of the cell. Whether a similar
arrangement exists in the other cells of the cortex is to my
mind very doubtful. Naturally in whole cells we are not
able to see the arrangement near the centre so clearly as near
the boundary and in the apex and processes, nevertheless
their general disposition is indicated, even in such places,
with sufficient clearness as to be conclusive.
To finish the description of what I take to be a normal
motor cell, as seen by this process, I may add that the
shape is irregularly angular with many processes starting
from all parts of the body, and almost invariably leaving the
cell by a fan-like extension of the protoplasm, which rapidly
thins down to the diameter of the process. The cell is darkly
stained owing to the quantity of chromophilic material, the
nucleolus round or oval, and sharply defined, is very deeply
stained, centrally situated, and surrounded by a paler zone
with no striation and an ill-defined border (the nucleus). In
the apex the chromophilic material is in the form of long,
(10 to 3Q/i), sharply-defined lines or shorter spindles. The
processes (dendrites) are scarcely coloured at all with the
exception of the chromophilic material, but can be distinctly
seen by reason of this latter, which is in the form of threads
arranged at short distances one from another at each side
and within the processes ; sometimes as many as six distinct
threads can be counted side by side in a dendrite near to the
cell body. The cell is very elastic and resistent to pressure ; it
can be pressed out, and returns again on removalof the pressure
to its original size,—indeed it is only with very considerable
force that its contour is destroyed or the processes broken off ;
these latter can be made to twist about in all directions like
the lash of a whip.
Digitized by L^ooQle
512 Giant-cells of the Motor Cortex in the Insane, [July,
More or less yellow pigment is almost invariably present,
generally in the lower part of the cell. The axon when dis¬
tinguishable contains no chromophilic threads, and by arti¬
ficial light appears of a very faint pinkish colour. It arises
from the perikaryon by a small, similarly coloured eminence,
also without chromatin (see Fig. 1).
(3) The most frequent departure from the normal is a
granular degeneration of the chromophilic material ; it breaks
up in the perikaryon into irregular granules, which sometimes
seem to aggregate together into large masses. At first the
rods and spindles in the apex and dendrites segment, still
retaining a linear arrangement, but ultimately the granules
appear quite irregularly disposed. The cell eventually ac¬
quires a more or less globular shape, and the processes become
either fewer in number, or are so fragile that they are parted
from the cell in the process of mounting, but I am inclined to
think that they do actually diminish in number, because for
one thing in cells undergoing this process of degeneration v/e
see them in all stages of attenuation.
As this change advances the perikaryon appears paler, and
the granules are smaller and fewer in number ; the nucleus is
now often distinctly visible, stained deeper than the peri¬
karyon and homogeneously, and frequently surrounded by a
cluster of chromophilic granules (see Fig. 2).
Ultimately there remains a pale skeleton or ghost-like cell of
a finely granular nature, with no trace of chromophilic material
to be seen. There is generally a small, densely-stained
nucleolus, and sometimes a nucleus is visible, but both maybe
absent. I have never yet examined films without finding some
of the cells in the above described process of degeneration, but
their proportion to normal cells seems to increase according to
the duration of the mental disorder and age of patient. As
regards the very pale, attenuated, ghost-like cells, staining
scarcely any denser than the surrounding matrix, they leave
little doubt on the mind of the observer that they ultimately
disappear altogether. One of the most marked cases pre¬
senting numbers of cells of this character that I have yet met
with was a woman aged 26, who had become mentally
deranged two years previously, after childbirth, but the sym¬
ptoms were not acute until shortly before her death. She was
only in residence here a week, and all that time was in a
stuporose condition with short intervals of excitement. There
was a strong family history of insanity, her other three sisters
having been affected, and an uncle on the father's side. I
Digitized by L^OOQle
513
1898.] by John Turner, M.B.
believe this granular degeneration has been ascribed to post¬
mortem changes, but there is very little doubt that such is not
the case. Cells from brains thirty-six hours old have shown
normal arrangement, whilst it has been often seen in very
recent specimens. Pigment is rarely in such abundance in
these degenerated as in healthy cells,—indeed at the last
stage it is almost absent.
(4) Another change is a partial or complete absence of the
chromophilic material, noted in cells which instead of
becoming attenuated and fragile, as in those previously
described, are smaller and tougher, and in which there is no
tendency for the chromophilic material to break up into
granules; that which remains is always in distinct but thin
threads, and situated at the circumference of the cell. Such
cells appear dense, and stain irregularly, some parts deeply
and others lightly, but the apex loses nearly all colour at a little
distance from the cell, and becomes ragged and indistinct.
The dendrites stain for a short distance a more uniform
dull blue than normally, and show few or no threads;
they have a marked tendency to curl round on themselves
when detached from the matrix. The nucleolus is almost
always dislodged from its normal site, and occupies a
position close up against one side of the cell, or it may
be a considerable way up in the apex, or right down
in the fan-like projection of protoplasm, from which a den¬
drite arises; it is smaller and denser than normal. Very
often the nucleus is invisible at other times the nucleolus
is surrounded by a paler zone, and in yet a few others
the nucleus is nearly as dense as the nucleolus, but
always small. Such cells may be largely occupied by pig¬
ment (Fig. 4).
Quite recently [Brit. Med. Journ ., December 25th, 1897)
Dr. L. F. Barker has published an account of certain changes
in the cells of the ventral horn, &c., in epidemic cerebro¬
spinal meningitis. He states : “ The central portion of the
cell body .... shows no well-defined Nissl bodies, but in¬
stead the protoplasm in this region stains diffusely of a pale
blue colour .... Any Nissl bodies .... are situated in
the periphery of the cells. Even where no isolated tigroid
masses can be made out the periphery of the cell usually
stains of a rather deeper blue colour. . . . The nuclei in the
cells under consideration are dislodged .... and have
come to occupy a position immediately adjacent to the
margins of the cell, often causing a distinct bulging of its
Digitized by LjOoq Le
514 Giant-cells of the Motor Cortex in the Insane, [July,
periphery* Such changes, he states, are practically
identical with those which take place in the cell body of the
neuron after solution of continuity of the axon which belongs
to it. These changes, it will be noticed, correspond closely
with those which I have just described in certain fresh cells,
and which I take to be examples of cells which are no longer
functionally active. It is probable that in these cases they
are flung out of gear from above, the interference with their
functioning being a result of a dissolution of the nervous
system, and affecting them from higher disordered centres
on the side of their apices and dendrites. At any rate, if
the result of severance of the axon produces such changes
merely by preventing the cells from functioning, I see no
reason why a similar condition of cell should not be called
forth from any cause which interferes with their activity.
I have met with such cells in widely different forms of in¬
sanity, e. g. in a female aged 26, who died after a few days’
residence here of tubercular meningitis with delirium, and
where there was no history of any insanity previous to her
bodily disease ; in a woman aged 37, who also died a few
days after admission from bronchitis, with delirium and peri¬
pheral neuritis; in certain cases of general paralysis; and
very frequently in secondary dementia. One of the most
striking examples seen was from the brain of a male aged 56,
who had been an inmate here for six years, and died of
phthisis. He was admitted suffering from acute melancholia
which passed into dementia. Two years after admission
paresis of the lower limbs was noted ; he gradually became
more feeble, and was bedridden for a year before he died.
(5) The last change to be described appears to me to be a
particularly interesting one. I have only seen it in five cases.
The chromophilic material is completely absent from the cell
and its processes. They both stain of a uniform dull blue
colour, and afford a very striking contrast to the appearances
seen in normal cells, especially as regards the processes, which
are in no wise attenuated. The nucleolus is almost invariably
central and large, and surrounded by a pale, irregularly defined
area (the nucleus). As a rule, very little pigment is present.
The cell does not, in most cases, show any abnormality in
shape; it is large, and generally many processes are given off
with the usual fan-like expansions of the perikaryon; but
these processes (apex and dendrites) are extremely fragile,
* Berger (Monaisschrift fiir Psych, und Neur., January, 1898) figures similar
cells from the ventral horn in cases of general paralysis.
Digitized by {jOOQle
1898.]
by John Turner, M.B.
515
very slight pressure causes them to break with a clean frac¬
ture, generally at a little distance from the cell-body; on this
account it is difficult to get such good preparations of them
as of other cells. The following is a brief account of the
five cases in which this variety of cell has been seen (Fig. 3).
Male aged 40, admitted only a few days before his
death from pneumonia. He was suffering from acute general
paralysis, and was stated to have had several seizures re¬
cently. The duration of his mental disorder was probably
only a few months. His brain was large, and with no shrink¬
ing of the convolutions. The meninges were thin and clear,
and not adherent to the cortex.
Female aged 35, weak-minded as a result of epilepsy,
which she had suffered from since eighteen—a quiet, indus¬
trious woman, except shortly after admission, four years ago,
when for a short time she was acutely maniacal. She died in the
status epilepticus with pneumonia. Brain and membranes
appeared healthy to the naked eye, with the exception of a
small ecchymosed area in the cortex of the right island of
Reil (capillary haemorrhage).
Female aged 25; confined on the 9th, and admitted on
the 17th of March, 1898. She was said to have become
delirious on the 10th. When admitted she was very ill, with
a temperature of 100*4°, which rose to 104*6° the next day,
when she died from peritonitis. There was considerable
atrophy of the convolutions in her case, especially about the
motor region ; the meninges were healthy.
Female aged 58, many years an inmate suffering from
epilepsy, with attacks of mania and fury, gradually became
more and more demented and dirty in habits. Had a succes¬
sion of fits for the last two or three days of her life, and her
temperature rose to 106*6°. At the post-mortem examination
(twenty-eight hours after death) she was found to have
atrophy of left cerebellar lobe, corresponding but relatively
slighter atrophy of right cerebral lobe. There was a difference
of twenty-one grammes between the two cerebellar lobes, and
forty-two between the cerebral. Beyond this, to the naked eye
the brain and meninges presented no abnormality. Lungs
hypostatically congested ; kidneys granular.
Female aged 49, a general paralytic, probably of alcoholic
habits. She died in a “ seizure ” with a temperature rising
to 103°.
The first three of these cases died of acute inflammatory
disorders, but that these are not sufficient of themselves to
Digitized by L^ooQle
516 Giant-cells of the Motor Cortez in the Insane, [July,
give rise to the changes in the nerve-cells is shown by the
fact that others dying from the same bodily disorders failed
to show them.
Although the changes in the nerve-cells now under con¬
sideration do not appear similar to those seen in the spinal
cells, &c., of animals after administration of certain poisons*
(alcohol, &c.), yet they occur in cases of a character as to
render it probable that they may be the result of the action
of toxins on the nerve-cells. It is noteworthy that in the
five cases where I have met with this change the giant-cells
were all affected in the same way, and apparently to the
same extent; there were not, as in nearly all the other cases,
some fairly healthy cells, and others in various stages of
granular degeneration. This is a point I should like to em¬
phasise in view of the almost unanimous result obtained by
the experimental action of poisons on nerve-cells,—unanimous
in this respect, that in all these experiments we find it stated
that healthy cells are seen lying close to diseased, and that
various degrees of diseased cells are seen in the neighbour¬
hood of one another.
The condition is a form of chromatolysis, but differs in
several respects from that observed by Marineseo following
section of a motor nerve [Rivista di patalogia nervosa e
mentale, August, 1896).
In seventy-one cases of insanity I have made a systematic
examination of a certain part of the cortex, and have endea¬
voured to classify roughly the results arrived at.
The ascending frontal convolution at its upper end was
chosen because it contains the largest cells met with in the
cerebrum, and because this region represents a part of the
central end of the pyramidal tract, the great development of
which is essentially a human characteristic, and which there
in weighty evidence to show is intimately concerned in acts
requiring skill or intelligence for their performance.
Considering the comparatively small number of cases exa¬
mined, 1 have endeavoured to avoid attempting any hard-
and-fast deductions, and have, for tlfe most part, merely noted
and roughly grouped the appearances noted.
Also in the absence of control specimens from the brains
of non-insane, it is impossible to definitely enumerate and
'give their proper value to changes which undoubtedly occur
* Vide Barker, Brit. Med. Journ ., Dec. 25th. 1897 ; H. Dehrio, Ceniralbl./ur
Nervenheilkunde und Psychiatric , 1895, N. F., vi, 113 ; C. C. Stewart, Med.
Pioneer, August, 1897.
Digitized by CjOoqL e
517
1898.] by John Turner, M.B.
in the cells with advancing age, &c. My impression is, that
the alterations described in paragraph (3) (the granular de¬
generation of the chromophilic material), are not peculiar to
insanity from a qualitative but merely from a quantitative
point of view. A fairly extensive study of senile cases of
insanity goes to show that, apart from the degeneration which
we must expect in old age, and which will affect a smaller
or greater number of the cells according to other physical
circumstances, this factor has no specific influence on the
chromophilic material; in other words, those cells which have
escaped the degeneration incidental to old age still present
abundance of this material, and with the usual arrangement
and form.
Neither does there seem to be any constant change corre¬
sponding to our present classifications of insanity. In those
who have been deranged for many years abundance of healthy
cells as regards the chromophilic material are often found;
in others, dying shortly after the onset of mental symptoms,
there may be manifest changes, or a complete absence of this
substance and vice versa,.
Of the seventy-one cases examined (twenty-six males, forty-
five females), in twenty-five (eight males, seventeen females)
the giant-cells showed what I have assumed to be a normal
arrangement of their chromophilic material.
Cells with more or less advanced granular degeneration of
the chromophilic material were of course seen as in all the
brains which I have yet examined, but by far the greater
number were of a healthy type.
I do not wish to infer that in all these cases, because this
particular element was normal, that therefore the cells were
healthy; in fact, in several cases there were indications which
strongly pointed to this not being the case.
The following table gives details as to age, form of in¬
sanity, &c., of the cases in which the cells as regards their
chromophilic material were normal, arranged in the order of
their age.
It will be seen that no less than seven were over sixty
years of age, and that many were the subject of long-standing
insanity.
Digitized by t^ooQle
518 Giant-cells of the Motor Cortex in the Insane, [July,
Table I.— Cases whose cells presented a more or less normal
arrangement of chromophilic material.
o
K
*1
initials.
&
<
Form of Insanity.
Duration.
Cause of Death.
Pigmentation.
1
M
A. A.
17
lmbecil., ep.
From birth
Pneumonia
Very little.
2
G. C.
21
>» o
)) M
Pulmon. abscess
3
M
T. W.
45
G. P.(2n<l stage)
Over a year
Epileptiform
! seizure
Considerable.
4
H. W.
50
Acute mania
Recent
Pucumonia
£ to i of cell.
5
T.
50
Advanced G. P.
Over a year
Gen. par.
i
6
E. T. G.
56
Melancholia
Some years
i C. haemorrhage
J to i of cell.
7
„
B. B.
59
Sec. dem.
1 A year
Cerebral soft
i to §.
8
ft
S. W.
61
Sec. dem., ep.
Some years
!
Large amount,
i to b
9
F.
L. W.
15
Imbecility
From birth
Phthisis
None.
10
»
M. W.
20
Acute mania
Over a year
Mil. tut^ercul.
Very little.
11
M
E. B.
29
Puerp. mania
Some months
Pleurisy and
pneumonia
About i.
12
„
A. A.
30
Acute mania
H II
Syncope
M
13
”i
A. K.
33
Stupor
Over a year
Abscess of lung,
mitral stenosis
About j
14
if
J. P.
41
Acute mania
Recent
Granul. kidneys
J to t.
15
»
J. B.
44
Gen. par. (adv.)
Some years
Peritonitis
16
„
E. E.
44
Mania, ep.
Many years
Cerebral tumour
II
17
M
E. M. M.
49
Chronic mania
ii ii
Phthisis
i to |.
18
»
E. J. B.
49
l)elus., insanity
Over a year
C. haemorrhage
Little.
19
H
R. B.
56
Chronic inelan.
Six months
Strang, hernia
20
”l
C. S. V.
60
Dementia i
Three years
Subdural
haemorrhage
i to }.
21
1 **
E. S.
62
! Chronic mania
’ Many years
Necrosis of bone
Large amount.
22
M. H.
68
Senile mania
ii >»
Bronchitis
* to|.
23
»»
M. B.
71
Sec. demen., ep.
n ii
i
99
21
it
E. B.
73
Chronic mania
a a
Pneumonia
b
25
JJ
E. C.
80
Senile mania
Subdural
hsemorrhage
i to b
The above list contains cases where brains so far as
examined did not show any cells with the partial or complete
disappearance of chromophilic material, and other characters
described in paragraphs (4) and (5). The other departures
from the normal standard very possibly represented a more
or less usual degeneration of the nerve-cell peculiar to age,
&c., and not to forms of mental disease. In the next series
of cases, although normal cells (as regards their chromo¬
philic material) were sometimes noted, yet by far the greater
number presented the characteristics described in paragraph
Digitized by
1898.]
by John Turner, M.B.
519
(3), indicating a more or less marked condition of granular
degeneration of the chromophilic material.
Many of these (five) were old ; only one was, as far as could
be ascertained, a recent case of insanity, and no fewer than
five of the fourteen had granular kidneys.
From this table also have been excluded cases in which any
of the giant-cells exhibited the partial or complete disappear¬
ance of chromophilic material already referred to.
Table II. — Cases in which the majority of the cells presented
a breaking up of the chromophilic material into granules
(l granular degeneration ).
o
i
w
1 nitiali.
&
<i
Form of Insanity.
Duration.
I Cause of Death.
Pigmentation.
1
1 M R. H. H.
29
Imbecility, ep.
Prom birth
Phthisis
Very little.
2
»
G. W.
38
Gen. paralysis
Recent
Gen. paralysis
99
3
T.
38
Gen. paralysis,
demented.
Two years
tt it
h
4
M
J. J.
40
Sec. dem.
Many years
Pneumonia
Very
considerable.
5
T. S.
53
Gen. paralysis
Doubtful
Pneumonia,
granular kidneys
a
6 F.
A. B.
24
Mania
Recent
Phthisis
Very little.
a a
7
L. M. B.
30
Gen. par., acute
One year
Gen. paralysis
8
It
E. S.
31
Idiot, ep.
From birth
Acute nephritis
Pneumonia
None.
9
it
E. H.
45
Chronic melan.
Many years
» M
1 10 i-
10
it
H. C.
59
tt M
»•
Granul. kidneys
99
11
S. P.
61
Senile dementia
tt J>
Large amount.
12
T. W.
69,
Senile mania
M It
13
»>
M. A. M.
77
Chronic mania
it it
Senile decay
’ \ to
14
M.A.S.F.
79l
Senile mauia
Granul. kidneys
4 tof.
!.
15
tt
M. K.
83
*> »
it tt
Granul. kidneys,
subdural haem.
The third table contains all the cases which presented cells
with partial or complete absence of chromophilic material,
and with the other characteristics described in paragraphs
(4) and (5).
I have divided off into a separate group the five cases
already referred to, as there can be no doubt that they are of
quite a distinct nature, and represent in all likelihood an
acute pathological condition.
Most probably further investigation will I reveal other
changes of a pathological nature beyond those mentioned. I
am inclined to think that most of the cells grouped below
were no longer functionally active, and that those in which
the nucleolus is found pushed up to one side, or otherwise
displaced, where the staining is dense and irregular, and
Digitized by L^ooQle
520 Giant-cells of the Motor Cortex in the Insane , [July,
the cell manifestly smaller than usual and ill formed, are
the representatives of a chronic pathological condition. This
contention is to a certain extent supported by the fact that in
no fewer than seven out of eleven cases of secondary dementia
the cells were of this type.
Table III .—Cases in which the cells presented a partial or
complete disappearance of chromophilic material , and with
the other characters described in paragraphs (4) and (5),
Group A.
6
X
VI
a.
Initials.
u
bt
•e
j Form of Insanity.
Duration.
Cause of Death.
| Pigmentation.
1
M
F. T. K.
20
j Imbecility, ep.
Congenital
Phtlibis
Very little.
2
f>
J. E. B.
33
| Gen. paralysis
Recent
Gen. paralysis
99 99
3
99
W. T.
38
Gen. par. (dem.)
Years
*t tt
tt tt
4
R. P.
40| ,, »•
Pneumonia
Considerable.
5
C. W.
40
Sec. dem.
Cellulitis
* tof.
6
»»
H. I).
48
Gen. paralysis
6 months
Gen. parahsis
h
7
J. S. H.
53, Chronic melan.
Some years
Suicide
4 to J.
8
tt
F. M.
56
Chronic mania
Doubtful
i
Hydrothorax,
cerebral lnemor.
(old)
9
W. A.
56
Sec. dem.
Years
Phthisis
Little.
10
J. W.
58'Gen. par. (dem.)
tt
Pneumonia
£ to i.
n
J. M.
60
Acute mania
Recent
Bronchitis
i.
12
tt
R. B.
60
Gen. paralysis
?
Gen. paralysis
h
13
F.
E. W.
14
Congenital
Congenital
Pneumonia
h
14
tt
E. R.
26
Acute delirium
Recent
Tub. meningitis!
Large amount.
16,
t>
A. A. G.
26
Chronic mania
Over a year
Exhtn., mania
Very little.
16
tt
L. G.
32
Sec. dem.
Years
Decubitus
i'toi.
17
tt
E. H.
33
Acute mania
A few days
Gran, kidneys 1
Large amount.
18
a
M. T.
33
Gen. par. (adv.)
2 years
Gen. paralysis
19
tt
E. W.
33
Imbecile
Congenital
Pleurisy and j
pneumonia |
Very little.
20
\tt
M. E. B.
37
Mania, chronic
Years
Bronchitis j
21
tt
A. M. 1).
42
Sec. dem. j
»»
Conges, of lungs 1
£ to
22
H. J. C.
42
Sec. dem., ep. i
tt
Gran, kidneys j
Little.
23
it
C. L.
46
Chronic melan. |
»»
Pneumonia
i.
24
J. G.
47
Sec. dem.
i
Pleurisy and !
pneumonia
J to i.
25
tt
F. C.
48
Chronic mania
a
Erysipelas
J to*.
26
tt
M. K.
55
Sec. dem.
Subdural j
haemorrhage |
*•
Group B.
27
M
S. G. G.
40
Gen. paralysis
Recent
Pneumonia
Large amount.
28
F.
O. S. H.
25
Puerperal mania
a
Peritonitis
Very little.
29 ;
”
E. S. j
35
Mania, ep.
Years
Pneumonia
status epileptic.
i.
80
„
M. A. DJ
49
Gen. par. (adv.)
Over a year
Gen. P. (seizure)
».
31
i
S. B.
58
Mania, ep.
Years
|
status epileptic.
i.
Digitized by {jOOQle
1898.]
by John Turner, M.B.
521
This classification of these cases into three or four divi¬
sions is, of course, exceedingly rough, and refers only to the
appearance or absence of the chromophilic material. Un¬
doubtedly in many cases, although as regards this latter
there was no marked departure from the normal, yet in other
respects the cell did not present at all a healthy aspect. Thus
it is no uncommon occurrence to meet with cases where the
cells are of a manifestly smaller size than usual (75x45 p),
with fewer processes and of great toughness. These, peri¬
karyon and process alike, stain more intensely than they would
in a healthy condition, and often present a very definite
arrangement of the chromatic material, especially in the apex*
Such cells in alcohol-hardened specimens stain a dense blue
with no appearance of striation or granulation. I believe
there are instances of a sclerotic shrinking of the elements.
They are found in many varieties of insanity of long standing,
imbecility associated with epilepsy, and general paralysis. Tho
fact that such cells are seen in fresh-stained films puts the
genuineness of their case beyond question, although Lugaro
has asserted that they are artificial productions due to
hardening, &c.
General paralysis, it will be noted, figures in all three
tables. Perhaps this diversity of appearance in different
cases is a further corroboration of the views of some that
general paralysis, as at present understood, is a congeries of
symptoms embracing several diseases.
The most constant change met with so far has been in
cases of secondary dementia; in seven out of eleven of these
the cells have been found to be nearly or quite devoid of
chromatic material, and with the nucleolus displaced, either
quite against the side of the cell or up in the apex.
It is, I think, a point of considerable interest that one is
enabled to demonstrate a marked departure from the normal
in so many cases of insanity (64*7 per cent.), notwithstanding
that in several of these the brain and coverings showed
nothing abnormal to the naked eye, and no fewer than seven
were of recent origin.
Phagocytic Action of the Leucocytes on the Nerve-cells .—A few
words regarding the phagocytic action of leucocytes on the
nerve-cells. This appearance, which was first described by
Sir John Batty Tuke, and subsequently by myself in the
Journal of Mental Science (January, 1897), is often very
strikingly shown in the freshly squeezed-out films. The
invading bodies stick to the nerve-cells, so that in the mount-
Digitized by LjOoq Le
522 Qiant-cells of the Motor Cortex in the Insane , [July,
ing and preparing they are not parted from it, but are seen
in situ .
In many cases nerve-cells are met with large portions of
their substance, as it were, scooped out, and one or more
leucocytes lying in the cavity. Very often the whole cell is
encrusted with leucocytes, and not unfrequently but little of
it remains beyond the nucleus.
Not only is the perikaryon attacked, but the apex also is
sometimes partly eaten through. Instances also occur where
the apex consists of short, blunted, nipple-like eminences,
suggesting that it has been completely destroyed by this
agency.
Probably the dendrites are similarly attacked and de¬
stroyed ; and I believe that the degenerated spherical cells
seen are sometimes reduced to this form by the destructive
action of leucocytes on their apex and processes.
Although, with the exception of Sir J. B. Tuke and myself,
this phenomenon does not seem to have attracted any atten¬
tion, I am persuaded that it is of enormous importance from
a pathological point of view. If I am correct regarding the
destruction of the processes by this action, it is easy to imagine
the serious consequences of this lesion, which must interfere
greatly with nervous and mental actions.
I may say that I have hardly ever examined a section of
the human or animal (guinea-pig, rat, pig, and cow) brain
without meeting with what I take to be instances of this
action; and I have photographs from the guinea-pig's brain
showing a very decided action of the leucocytes on some of
the nerve-cells. The very universality of the process is to my
mind a mark of its pathological importance. If leucocytes are
endowed with this destructive action on nerve-cells under
certain conditions, it does not seem surprising that amongst
the multitude of cells in the cortex some should be in a fit
state to call forth this function on the part of the leucocytes;
or if, as I have suggested, the leucocytes take on this function
when blocked within the pericellular space, the exhibition of
this phenomenon here and there is only what might be ex¬
pected in most cases.
But there is a great difference in the importance to be
attached to these few isolated instances of cell destruction,
and those cases (common enough in general paralysis and
other varieties of insanity) where almost every nerve-cell in
certain layers is encrusted with leucocytes, and more or less
destroyed.
Digitized by t^ooQle
1898.]
by John Turner, M.B.
523
Although, perhaps, it is more common to find leucocytes
attacking diseased cells, yet they apparently do not confine
themselves to such. Cells are met with which have the
characters of normal cells, aud which are seen to be un¬
doubtedly undergoing partial destruction by leucocytes
(Fig. 5).
In conclusion, there are a few remarks on the nature of the
chromophilic material and its relation to cell functioning I
should like to make.
Sir William Gowers, in an address on the neuron and its
relation to disease {Brit. Med. Joum., November 6th, 1897),
referring to some of the latest researches on the intimate
structure of the nerve-cell, regards it as proved that the nerve-
fibrils pass uninterruptedly through the nerve-cell from
dendrite to axon. If such be the case, then, as he states,
our old conceptions that the nerve impulses originate in the
cell entirely disappear, and we must give up the idea that
the nerve-cells are sources of nerve impulse.
This would mean nothing less than an entire revision and
remodelling, and, indeed, in many cases an entire abandon¬
ment of existing hypotheses regarding nerve actions and the
psychological changes which accompany them. The distinc¬
tion drawn between sensations and thoughts supposed to
correspond to molecular changes in cells and fibres connecting
cells respectively (on which so much of our modern psy¬
chology is based) is swept away. For if a nerve-cell is
merely a meeting-point of a number of totally distinct and
insulated fibrils which have no relation one to the other
beyond propinquity, then to refer to feelings and thoughts
as on the physical side accompanying molecular changes in
cells and fibrils is a meaningless phrase. At the very least
we must shift our ideas of the physical seat of these changes
to the terminals of the dendrites and the intervening matrix.
However, in spite of the weight attaching to the opinion of
such an authority as Sir William Gowers, it may surely be
permitted one in the present state of our knowledge to pause
before acquiescing entirely in this derogation of nerve-cells.
The picture seen in normal fresh nerve-cells of certain
(? motor) types when treated by methylene blue has been
previously described in this paper, and is besides well known
in hardened cells by the observations of Nissl and others, and
therefore need not be recapitulated, but there are one or two
points which must be referred to here.
In views of whole cells it is clearly seen that the coloured
xliv. 35
Digitized by L^OOQle
524 Giant-cells of the Motor Cortex in the Insane , [July,
spindles, or rods, or threads (their shape varies in different
parts of the cell) are perfectly distinct one from another; in
other words, these coloured bodies appear as if embedded in
a more or less colourless ground substance. This structure
of the cell has been described (Berger, Monatsschrift Psych,
und Neur January, 1898) as a fine meshed scaffolding in
which the. Nissl flakes lie. And on making sections trans¬
verse to the long axis of the giant-cell, the coloured bodies
show as separate blue granules lying in a colourless ground
substance.
These appearances quite preclude us from regarding the
Nissl bodies, whatever their function may be, as insulators of
nerve-fibrils.
Whether the chromophilic material acts in some way as a
guide to nervous impulses, or whether it has some relation to
the cell energy, or whether it has quite other functions, must
be left at present for further investigation.
The achromophilic substance is probably that which is
concerned in the conduction of nerve impulses, and it has
been asserted not only that this is of a fibrillar nature, but
that fibrils have been traced uninterruptedly from axon to
dendrite.
Even were this statement conclusively proved,—and for the
present I think we are entitled to regard it as an open ques¬
tion, considering the very minute structures we are dealing
with, which necessitate very high magnification and very
special methods of staining for their elucidation,—we are
not thereby justified from our imperfect knowledge of the
conditions which govern nerve impulses, in arguing that
because fibrils can be traced uninterruptedly through a nerve¬
cell, that the nervous impulses passing along these fibrils are
insulated from all others in the cell, and that they must
necessarily pass unaltered and uninfluenced by neighbouring
impulses.
If we compare the cells of the sigmoid gyrus of one of the
lower animals (guinea-pig, pig, cow) with those of the motor
region in man, we notice that in the former the chromo¬
philic material is indistinctly marked off from the ground
substance, is irregularly disposed, and vaguely outlined; there
is, except perhaps at the apex, but little attempt at striation or
the formation of definite threads. And further, if we compare
either the motor cells of the cerebrum of one of the lower
animals with the anterior cornual cells of the cord, or the
frontal cells of man with the pyramidal tract cells and ante-
Digitized by
1898.]
by John Turner, M.B.
525
rior cornual cells, we notice a similar difference: on the one
hand, in the anterior cornual^ cells of the animal the chromo-
philic material, especially in the dendrites and superficial
parts of the cell, is more distinctly differentiated, and forms
a more definite pattern than in the cells of the cortex; and
on the other hand, in man the anterior cornual cells and the
giant-cells exhibit a much more distinct separation of the
chromophilic material from the ground substance, and a
more regular disposition of the same than is seen in the
frontal cells.
The very precise striation of the chromophilic material in
the large anterior cornual cells has led ^issl to take these as
the type or general standard of motor cells.
It seems quite feasible that this difference in structure
represents modifications in the functions of the cells, those
concerned with reflex acts having the most definite arrange¬
ment of their chromophilic material, and those concerned with
voluntary acts having the least. At any rate, in the lowest aud
most highly organised cells—the spinal-cord cells, which are
concerned with limited reflex acts—we meet with a very definite
arrangement; and in the higher and least organised cells,
which we have weighty reasons for regarding as concerned
with voluntary and varying acts, we no longer find such a
precise disposition of the chromophilic material, probably
because the ever-changing currents (supposed to pass along
the uncoloured ground substance) in these latter will not have
the same tendency to map out definite paths as the constant
currents concerned in routine acts have in the former.
On this supposition the reason why the pyramidal tract cells
in animals present a less definite pattern than those in man is
due to the fact that their reflex and automatic acts are so
much more largely carried out through the agency of spinal-
cord cells.
Without venturing any opinion as to the precise role which
the chromatin substance plays in the function of the cell,
there seem to be some grounds for asserting that the regu¬
larity with which it is disposed is an index to the degree of
organisation to which the cell has arrived in the execution of
definite actions of a routine nature—the lowest and most
highly organised having the most distinct and regular, and
the highest and least organised the least regular pattern.
Reference to Figures.
1.—Normal nerve-cell (69 x 57 /i, nucleolus 5x6 p) t showing the arrange-
Digitized by AjOOQle
526 Giant-cells of the Motor Cortex in the Insane . [July,
ment of chromophilic material in the perikaryon and apex, and the numerous
dendrites with fine threads. From a woman aged 59. Chronic melancholia.
2. —Granular degeneration of the chromophilic material, from the same case
as above. In the apex the threads are seen to be broken up into linearly arranged
segments. The perikaryon measures 99 x 49 /x. The nucleus (17 x 12 /x) is
deeply stained, and with clusters of granules around its margin. The nucleolus
measures 6 /x.
3. —Large (? swollen) cell (210 x 83 /x) stained of a pale, dull, uniform blue,
and showing no trace of chromophilic material, either in perikaryon or processes;
the nucleus is dimly visible, and centrally situated; the nucleolus measures
10 ft. The apex breaks up into a pale, fau-shaped expansion. From a case of
puerperal mania aged 25.
4. —Dark, irregularly-stained cell (90 x 63 /x), showing the pale, ill-defined,
ragged apex, and peripherally situated nucleolus (8 x 5 /x) surrouuded by a paler
zone. The processes are few, show no chromatin, and curl upon themselves when
detached from their matrix. From a case of secondary dementia in a man aged 56.
5. —Cell with normal arrangement of chromatin, showing a leucocyte destroy¬
ing the apex.
Colitis. By Alfred W. Campbell, M.D., Pathologist, Barnhill
Asylum, Lancashire.*
By colitis one understands a disease characterised anatomi¬
cally by an ulcerative or membranous affection of the large
intestine, and signalised clinically by acute sanguinolent or
muco-purulent diarrhoea, 1 ) 1 x 18 pyrexia and prostration.
Certain lengths of the intestine are specially prone to
disease, viz. the caecum and first part of the ascending colon,
the dip of the transverse colon, the lower part of the de¬
scending colon, the sigmoid flexure, and the rectum.
On anatomical grounds it is justifiable to divide the cases
into two groups:—(a) Membranous colitis. ( b ) Ulcerative
colitis.
The first variety is characterised by the formation on the
surface of the mucosa of a thick membrane, dark in colour,
rough and harsh to the touch, and composed of disintegrating
epithelial elements, fibrin and red blood-corpuscles, inspissated
mucus and leucocytes, solids deposited from the faeces, and
swarms of bacteria. This membrane may form in patches,
or it may spread itself over the entire surface of the bowel.
It does not tend to separate.
Similarly, in the ulcerative variety the whole surface of the
large intestine from caecum to anus may show disease, or it
may be limited to the localities above specified. The ulcers
* Abstract of a paper read at a meeting of the Medico-Psychological Association
in London on May 12th, 1898.
Digitized by LjOoq Le
IN ILLUSTRATION OF DR. TURNER’S PAPER.
JOURNAL OF MENTAL SCIENCE, JULY, 1898.
Fig. 3.
Fig. 4.
Hale, Sons <£ Lkinielmion, JML, Lith.
Digitized by
Google
Digitized by {jOOQle
1898.]
Alfred W. Campbell, M.D.
527
vary in size and shape, their edges are angry-looking, under¬
mining is a pronounced feature, and the floor is usually formed
by the muscular coat. In some instances they perforate.
Not only in membranous, but also in ulcerative colitis it is
not uncommon to find a membranous affection of the lower
few feet of the small intestine.
In both conditions the glands, into which the lymphatics
from the large intestine empty, undergo inflammatory en¬
largement and occasionally suppuration.
In females suffering from either variety, a complication in
the form of a sloughing cystitis and vaginitis is common.
This arises from the passage of feces containing the noxious
virus into the vulva.
According to the reports of the Commissioners in Lunacy,
the diseases colitis, diarrhoea, dysentery, and enteritis ac¬
counted for 1’56 per cent, of the total deaths occurring in
English asylums, &c., in the year 1895, and 2*35 per cent,
in the year 1896.
Out of a total of 9628 deaths occurring in the four Lanca¬
shire County Asylums during the years 1883 to 1896 inclusive,
247, or 2*56 per cent., were attributed to the four above-men¬
tioned diseases.
It definitely appears that colitis affects persons of advanced
or moderately advanced years much more frequently than
younger members of the population.
With the single exception of chronic interstitial nephritis
there is no disease of abdominal or thoracic organs which
can be coupled with colitis, or in any sense regarded as an
aetiological factor in its production. Out of twenty eight
cases of ulcerative colitis collected by the writer, chronic
interstitial nephritis was found in eleven, and out of eighteen
cases of membranous colitis the same disease existed in
eight. The association between these two diseases has been
already indicated by Hale White in an analysis of a series of
cases of colitis occurring at Guy’s Hospital.
There is likewise no special mental or nervous disorder with
which colitis can be associated.
General debility, be it the result of physical illness or
chronic mental complaint, brings susceptibility to colitis. This
point was determined in 78 per cent, of the writer’s cases.
Colitis may appear at any season of the year, but is more
prevalent during the late autumn and early part of the
winter than at other periods.
Though the disease does occasionally break out in epi-
Digitized by
Google
528
Colitis,
[July,
demic form, single isolated cases are often met with. That
the infective virus gains its entry per os is likely, but not
definitely proved. Concerning its infectiousness, this term
can only be applied in a limited sense, for it is rarely com¬
municated to sane individuals exposed to most of the same
conditions as those that suffer. I refer to nurses and at¬
tendants on the insane, but that the disease is, at any rate, to
some extent infectious is indicated by the fact that during
the past two or three years the deaths from colitis in Rainhill
Asylum have been far less numerous than they formerly
were, and this diminution has been synchronous with the
adoption of measures for the isolation of such cases, for the
disinfection or destruction of their excreta, and for the
therapeutic treatment of the condition by free lavage of the
large bowel with copious injections of bactericidal enemata.
Abnormal constipation or coprostasis, as well as other
mechanical causes, are factors of no practical import in the
production of colitis.
In the same way grounds for all toxic causes, e. g. decayed
fruit, spoilt food, or impure water, are all hypothetical.
A microscopic examination of the freshly voided fasces for
the Amoeba coli has always been attended with a negative
result, and it is certain that that organism is not related to
colitis.
In a long series of cases plate cultivations of the faeces
have invariably yielded abundant colonies, sometimes pure
cultures, of a micro-organism bearing all the characters,
morphological, biological, and chemical, of the Bacillus coli -
commune , but differing from normal samples of that organism
in the possession of a higher degree of virulence, and I am
forced to conclude that the bacillus stands in close pathogenic
relation to colitis.
In regard to its virulence, a series of experiments conducted
in Professor Rubert Boyce’s Laboratory (Liverpool) show
that doses of from 1 to 3 c.c. of a broth culture, forty-eight
hours old, suffice to cause diarrhoea and early death in rabbits
and guinea-pigs when injected subcutaneously or intra-peri-
toneally. In some instances a like result attended the
administration of cultures of the organism per os.
Points in favour of the suggested specific pathogenicity of
this bacillus' are—
(1) In other forms of dysentery, tropical, epidemic, and
sporadic, a similar organism of extreme virulence has been
isolated (Celli and Fiocca, Maggiora, Arnaud, and others).
Digitized by
529
1898.] 1 by Alfred W. Campbell, M.D.
Celli named the organism which he isolated the B . coli
dis8enterico .
(2) There is abundant proof that, under certain conditions,
the B . coli may assume a condition of great virulence.
(3) Colitis is a disease which we should expect, above all
others, to result from an increased virulence of the B. coli ,
because the large intestine is its normal habitat.
A microscopic examination of various tissues, e. g . small
and large intestine, lymphatic glands, kidneys, &c., reveals
the presence of two principal forms of bacteria, a short rod¬
shaped bacillus similar to that above mentioned, which pre¬
dominates, and micrococci. It has been determined that
these micrococci are of the pyogenic variety, and that they
play a role in the production of ulceration is more than
probable.
In a few cases only was the blood examined bacteriologi-
cally. In three instances cultures of streptococci were ob¬
tained, but the B. coli was never found. The results in this
direction cannot be considered conclusive.
Discussion.
The President. —I am sure we are all indebted to Dr. Campbell for bis most
interesting paper. The disease be has discussed is one which we see more or
lessin asylums, and one that sometimes gives us extreme trouble. I was very
much interested in his remarks as to the causation and symptoms of the disease.
I should especially have liked to hear more about those apparently inexplicable
and solitary cases of fatal colitis that one meets with now and again in institu¬
tions otherwise absolutely free.
Dr. Goodall. —I did not quite catch, in Dr. Campbell's very interesting
paper, reference to the insanitary state of asylums, of which no doubt he is well
aware, and with which this disease is so commonly associated, namely, the
condition of ventilation, sewers, faulty and defective drainage, trapping, &c.
The disease is one which 1 believe is especially found in the older asylums. In
one with which I was associated it was very common, and with the improvement
in the sanitary condition, particularly the drains, the death-rate gradually
diminished. Enteric disease and colitis seemed to occur in the autumn of the
year, and they would disappear with attention to the sanitary state. 1 do not
thereby wish to throw any doubt on the organism, and I am very glad it has
been worked out, and I hope it may prove to be correct. The difficulty is to see
how the organism can be conveyed with sewage emanations, sewer gas, Ac.,
because I believe the pathogenic organisms have not been demonstrated. It
may be possible to find out whether this organism is present in sewer or other
gas, and it would be interesting if it could be grown by means of experiment,
and a culture might hereafter be injected. We should then have an antitoxin
which would be very useful.
Dr. Jones. — I am in charge of what is absolutely a new asylum, and I am
therefore not quite a believer in the “ insanitary ” origin of colitis. I have here
a few notes taken hurriedly of about eighty-five post-mortems in cases of colitis—
that is to say, out of a death-rate of 1450 no less than 85, nearly 6 per cent.,
have been due to colitis. I classified these according to ages, as follows:
Digitized by {jOOQle
530
Colitis.
[July
Between 20 and 30
„ 30 „ 40
„ 40 50
„ 50 „ 60
„ 60 „ 70
99 70 „ 80
„ 80 „ 90
3 males.
10 females, 10 males.
11
4 „
13 „
7 „
2 „
It will thus be seen that my statistics correspond pretty closely with those of
Dr. Campbell. Then as to the time of year. Dr. Campbell has mentioned the
autumn. I think in the autumn and the spring there is a very distinct increase
in the death-rate. For instance, in my cases there were in—
January
February
March .
April
May
June
1 of each sex.
8 females, 2 males.
7
5
2
1
2 „
4 „
0 „
1 male.
July . .
August
September
October .
November.
December .
2 females, 1 male.
6 „ 7 males.
Dr. Campbell referred to the amoeba, and also to the Bacterium coli-commune as
being present in the normal colon, but the difficulty is how one or other of
these gets into the blood. My observations post mortem do not quite coincide
with Dr. Campbell’s as to the infrequent appearance of the stercoral ulcer.
1 have often seen it, and if once you get an abraded surface there is every
opportunity for these organisms to infect. I am glad to hear so much distinc¬
tion between the membranous and ulcerative varieties of colitis. I had hitherto
looked upon the membranous as the extreme and acute sloughing form of the
same disease, modified perhaps less by a difference in the toxin than by the
resisting power of the host. Acting upon the idea that this disease was distinctly
contagious or infectious, we are, I am happy to state, almost entirely free from
it now at Claybury. Everything in the shape of clothing or soiled linen that
comes away from the patient is disinfected, first in 1 in 20 of carbolic acid,
afterwards it is taken for further disinfection into a “ Washington-Lvons.”
I was very much struck by the fact that the nurses who gave the rectal injec¬
tions occasionally took colitis from the patients. *
Dr. Rayner. —The subject which Dr. Campbell has dealt with is such a wide
one that one cannot enter into it at all fully. In my own experience I recollect
that colitis was very much diminished in wards in which cases had frequently
occurred by the substitution of block-wood and polished floors for the old washed
stone floors. I cannot help thinking that a predisposition is given by imperfect
mastication, the food continually passing through the bowels imperfectly digested,
and acting as an irritant.
Dr. Campbell. —I am very much obliged for the interest which my paper
has aroused. In regard to Dr. Goodall’s remark concerning the association
between colitis and any insanitary condition in an asylum, I regret that I did
not bring the matter forward in my paper. I intended to, but it has been very
much cut down. I do not think, as far as my owu investigations go, that there
is any association between insanitary conditions and colitis, although I believe
that such might play a part in their production. At one time I suspected a
certain ward. It was closed, and a careful examination made, but nothing was
discovered to support my suspicion. We then concluded that it must be the
condition of the patients. The ward was one in which chronic epileptics and
depraved patients were kept; and this really was one of the things that set
me thinking about the physical conditions which assist in bringing about colitis.
Dr. Jones’ remarks are very interesting, and I am much obliged to him for
bringing his figures here. His age statistics agree very well with my own. I
am not absolutely certain about the season of the year, namely, that it is more
common in the autumn. There is no doubt it does occur in all seasons, and
Digitized by
1898.]
by Alfred W. Campbell, M.D.
531
quite recently I have had two cases, the only two for a year. 1 cannot find
proof of the disease having been directly passed from one patient to another, and
on questioning my colleagues I could only find instances of two cases in which
the disease hnd been communicated to attendants in the asylum.
The Industrial Training of Imbeciles .* By G. E. Shuttle-
worth, B.A., M.D., Medical Examiner of Defective
Children, London School Board; formerly Medical Su¬
perintendent, Royal Albert Asylum, Lancaster.
It occurred to me that, ou the occasion of our division
meeting at an asylum which has made special provision for
the care and treatment of imbeciles, apart from the other
patients, a brief dissertation as to forms of industrial training
appropriate to such might not be out of place.
In the training of imbeciles, I think that all experience
teaches that educational processes should be moulded with a
view to ultimate industrial usefulness. In school, indeed, the
senses must be sharpened, the muscles disciplined, and the
intellectual powers exercised ; but after all no great degree
of scholastic proficiency can be expected. I do not mean
that where sufficient capacity exists, the inculcation of the
“ three R’s ” should not be attempted, for doubtless the
imbecile’s enjoyment of life will be increased by an ability to
read books, to correspond with friends, and to add up figures.
When the patient belongs to a higher social grade, a larger
share of time may be devoted to such studies, though even
with such it must be remembered that more is learnt by the
hand than by the head, and manual training is often the best
means of mental amelioration, producing as it does tangible
results which are a source of satisfaction both to teacher and
taught. But with patients belonging to the pauper class, it
seems hardly justifiable to consume a large proportion of the
plastic period of youth in what we ordinarily term “ school
work.” Rather should it be utilised for the acquirement of
technical skill in some industry which will enable the imbecile
to produce something towards the cost of his maintenance.
It is true that in many cases appropriate physical exercises
will be needed as a preliminary measure to correct motor
irregularities which would militate against precision in
handicraft. Athetosis may be adduced as an instance of
this, and it is wonderful how much may be done in helping
# Read at the Spring Meeting of the South-Eastern Division at the Middlesex
County Asylum.
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532 The Industrial Training of Imbeciles , [July,
patients so affected to control purposeless movements by
means of such exercises as those of the “peg-board,” tying
knots in string for macrame work, and the picture-perforat¬
ing of the Kindergarten system. Drill with dumb bells,
wands, rings, &c., is also useful in strengthening powers of
grasping, often deficient with imbeciles. Many of the occu¬
pations of the Kindergarten form attractive as well as instruc¬
tive introductions to the employments of real life, and with
younger children are valuable in forming habits of industry,
as well as cultivating deftness and dexterity.
Passing now to consider the kinds of work best suited for
imbeciles, I should be inclined to assign the first place to out¬
door work, wherever practicable. Not only is the general
health (apt to be feeble) benefited thereby, but in every
garden and on every farm there are many small but essential
jobs which may be done by an imbecile, after a little train¬
ing, almost as well as by a paid labourer. A measure of
supervision is necessarily required ; but with this, weeding
amongst crops, harvesting, the feeding of cattle and even the
grooming of horses may be satisfactorily accomplished by
such. I was interested to hear from Mrs. Burgwin (superin¬
tendent of the London School Board special classes for feeble¬
minded children) that several of her ex-pupils (not far re¬
moved from imbecility) are employed as stable helpers and
are well reported on. In a dairy farm the preparation of the
stall food for the cows, which is more or less a matter of
routine, but takes a good deal of time, may be efficiently
carried out by imbeciles ; and at the Royal Albert Asylum
our boys helped in the milking, a cowman afterwards
going round to ascertain that each cow had been properly
“ stripped.” In Denmark, however, we found (with Dr.
Ireland) that “ milking is considered too nice an occupation
for imbecilesand at the large imbecile institution at
Ebberoddgard, three hired dairymaids performed this duty.
In England, and especially in the metropolitan district, the
prospects of profitable farming by imbecile labour are neces¬
sarily dubious ; but in America we find superintendents (like
Dr. Doren, of Columbus, Ohio) claiming to run a stock farm
in this way to a profit. Fruit growing and tinning seems to
be carried on remuneratively in some of the American insti¬
tutions for the feeble minded; and that for the state of Cali¬
fornia boasts of the possession of 1670 acres of fertile land,
with “ everything on it that the garden of Eden had, except
perhaps the forbidden fruit! ”
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1898.]
by G-. E. Shuttleworth, M.D.
533
In passing, I may put in a plea for the occasional out¬
door employment of imbecile girls as well as boys. Much
depends on the custom of the country, and in a Norwegian
institution I have seen girls gardening with a will, and even
constructing paths; and in Denmark the girls in Dr. Keller’s
industrial institution are similarly employed. Now that we
have lady gardeners at Kew, and womeu employed in our
market gardens, there seems no reason why our female imbe¬
ciles should not have the advantage of work in the fresh air
in such light occupations as hay-making, picking fruit and
vegetables, &c. Laundry work (the staple employment of
feeble-minded women) would be no worse done were some of
the workers occasionally permitted to vary their steamy and
enervating industry in the way above described.
Of course, industrial training must be considered in rela¬
tion to the probabilities of the imbecile’s employment in after¬
life. The training institution has to endeavour to fit its
pupils for life in the outer world under the care of friends ;
and for the town-bred imbecile suitable indoor occupation
must be found. As a rule, some simple handicraft, which
can be practised at home, or in a small shop, rather than in a
factory or other large establishment, is to be preferred, and
shoe-making, tailoring, mat-making, brush-making, &c., may
be the means, if not of livelihood, at any rate of contented
occupation under a modicum of supervision. But speaking
generally, in spite of an experience at the Royal Albert Asylum
of 15 per cent, of patients discharged after full training earn¬
ing wages, the struggle for existence in the outer world
seems too keen for the average imbecile, and for the majority
some permanent tutelage is necessary.
This seems to be a duty of the State rather than a matter
for charitable provision; and it is satisfactory to see that the
county of Middlesex has accepted this duty in no grudging
spirit. Those of you who have visited the idiot annexe will
have seen how admirably equipped the new building is for
the industrial training of imbeciles; and one advantage of
its connection with a large county asylurn is that the latter
supplies a convenient market for the industrial products.
Farm, garden, and dairy produce are, of course, always in
demand; and carpentering, tailoring, shoe-making, mat¬
making, brush and basket-making, sash-line making, book¬
binding, and even printing (which appears to be carried on
at a profit at the imbecile establishments which run a press),
will minister to the daily needs of the establishment, as
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534 The Industrial Training of Imbeciles , [July,
will also the sewing, laundry, and kitchen work of the
girls.
The selection of the particular occupation best suited for
each imbecile involves on the part of those in charge careful
observation and some experience; and valuable hints maybe
gathered in the course of the Kindergarten instruction. It
is important that those who preside in the workshops should
be regarded as teachers rather than as productive workers
themselves, as so much depends upon the painstaking indivi¬
dual tuition accorded to each pupil. A tactful industrial
trainer is, indeed, an instructor not only of the hand and eye,
but of the mind also.
Experience leads me to say that some slight recompense
for work well done, either in money or in kind, will form a
powerful incentive for imbeciles to “ put their back into
their work.” A penny a week thus paid on the satisfactory
report of the industrial trainer will produce more than a
shillingsworth of extra work ; and I see powers are given in
the new Lunacy Bill to recompense, to the extent of one
tenth of its value, work done by patients. I do not know
how this scale will be regarded by trades unionists amongst
the lunatics ; and even with aspiring imbeciles one must be
prepared for such a criticism as that mentioned in a recent
report of the Eastern Counties Asylum. A youth, who had
distinguished himself in button-holing, beiug told that next
week he should try his hand at a suit, retorted, “I suppose
I shall only get a penny a week if I make a suit, and I
think these are sweating wages ! ”
If time permitted it would be interesting to refer to the
miscellaneous and sometimes curious employments carried
on by imbeciles in various countries (e. g. cigarette-making
in the school at the Hague), but I have already exceeded
my limits, and must now close these discursive observations.
Discussion.
Dr. Bbach said the paper was a very practical one, and must appeal to every
one in the room, whether they have bad to do with imbeciles or not. He spoke
of children he had had at Darenth who were employed in the wards and
workshops, but where there were opportunities, lie said, a farm was very desirable.
As an instance of the benefit of training imbeciles he mentioned the case of
some boys who afterwards became soldiers, and to whom the bed-making learnt
in the asylum was of use. With regard to training in voluntary asylums,
where all children have to be discharged at a certain time, he said that if not
taught a trade they would have to go into the workhouse, so that in these cases
trades were useful. He also alluded to a proposal that had been made for the
castration of imbeciles.
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1898.]
by G. E. Shuttleworth, M.D.
535
The Chairman said ha agreed with Dr. Shuttleworth that it was not right to
spend county money in trying to educate such children to add up long additi m
sums or enumerate the kings of England. These could be of no possible use to
the children, as they would have to spend most of their time under institutional
discipline, and quite probably on the first series of fits would lose their ac¬
quisitions ; but he thought that it was perfectly right to teach them some
simple handicraft, or how to engage in agricultural pursuits. The chief points
that were aimed at in the education of these children at the annexe were
attained by a number of small class rooms, so that the children’s attention was
not easily distracted; short lessons, so that they need not become tedious or
irksome, daily repeated, so that they might remember them; and the importance
of not allowing the teacher or workman to work himself, but only to instruct
the children.
Dr. Bower congratulated Dr. Shuttleworth on his paper. He thought it a
great advantage to have such children trained, and though in years to come
they may crowd his wards with useful imbeciles, a few may also turn out as
useful members of society.
Remarks upon the term “ Weakmindedness” with Observations
upon the need of Definite Nomenclature for Cases of Con¬
genital Mental Defect which are not certifiable as Imbecile
or Insane. By A. R. Douglas, Deputy Medical Officer,
H.M. Prison,, Portland.
The term “ weakmindedness ” is a most misleading and
ambiguous one, and it is imperative that it should receive
early attention. It is confusing from the very comprehensive
scope of its significance, nnd altogether so capable of such
extremely varied and general interpretation that it is rendered
worthless, and perhaps worse than worthless, for the purposes
of actual practice. By some, the slightest departure from the
normal mental standard is regarded as “ weakmindedness,”
although the case in question might be one of mere eccentricity;
by others, again, the term is accepted in its full comprehen¬
siveness,—the lunatic and imbecile, the idiot and person of
defective intellect (who cannot be classified with either of the
above three divisions), are all included together, and in the
absence of a qualifying statement, confusion is the result. It
is most improbable that any two alienists would be likely to
interpret the meaning of the term in the same way, and the
Commissioners in Lunacy, who are most strict in the matter
of validity of certificate, would certainly not accept it per se on
account of its ambiguity.
Every insane person is weakminded, so are the idiot and the
imbecile, but there are a vast number of individuals who,
although they are neither insane nor imbecile, are congenitally
below the normal standard of intellect, and I submit that it
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53d
“ Weakmindedness,”
[July,
is these who should be described as weakminded if this term
is to be retained at all. Such cases are very numerous
amongst the criminal population, and it is to be regretted
that there is at,present practically no legislation affecting
them, and in courts of law, no exact and distinctive defini¬
tion which would ensure recognition of their defective mental
condition, with consequent modification of the legal attitude
towards them,—nearly all such delinquents being held to be
compos mentis and responsible for their actions. This is, I
consider, a terrible injustice, and one which demands early
redress; it is neither right nor just that the clever rogue and
his weakmindedbrother criminal should have the same measure
of punishment meted out to them. Surely, then, the creation
or adoption of a definite and distinctive form of nomenclature
for these cases of congenital weakness of mind is urgently
needed, and when obtained will do much towards securing
due and proper consideration in courts of law for the mental
condition of these unfortunates.
At present the diversity of opinion as to what the term
u weakmindedness” ought to be held as implying is very great,
and is perhaps only equalled by the trouble, and often confu¬
sion, so frequently resulting from its use. For the purpose of
describing these cases of congenital feebleness of mind which
are neither lunatics nor imbeciles, it is impossible to select one
and depict it as an example, and to say that its individual
mental characteristics are all constant and common to the
others; such a description must necessarily be a general
one, for no two instances are alike, and the variation in
degree is extensive. The salient features of the higher grade
cases are, for the most part, extreme vanity and conceit,
hyper-sensitiveness, eccentricity in special directions, and
stubbornness, with irritability and great liability to ebullitions
of temper on trivial occasions. They display more or less
incapacity for learning much, but possess remarkable tenacity
of memory for scraps of information picked up in a desul¬
tory and flighty way. Their manner and conversation does
not always afford much information as to their mental state ;
but if they are carefully observed for a sufficient period, and
their general conduct noted, their peculiarities gradually
become apparent. In nearly every instance will be found that
condition of tf mental restlessness,” with its attendant features
of inability to conform for any length of time to any system
of regularity or order, laziness, and incapability for any steady
and sustained effort of work, and an almost insatiable desire
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1898.]
by A. R. Douglas.
537
for constant change and novelty, which, in criminals of this
class, is often evinced in curious ways. The lower grade
cases are, of course, a nearer approach to the condition of the
mild imbecile, and do, to some extent, in physiognomy, manner,
and conversation, exhibit their mental defect. After four
years’ experience as assistant medical officer at a large and
deservedly celebrated asylum for idiots and imbeciles, I invari¬
ably found that the criminal instinct was most frequently
noticed in cases of very mild imbecility which, in appearance,
manner, and conversation, presented little or no variation from
the normal. I recollect one instance in particular, a thoroughly
irreclaimable and dexterous thief, and a most shameless
and plausible liar. This youth in his depredations frequently
displayed a refinement of design and an amount of cunning
and astuteness which were really wonderful. Now had this
individual (and there are very many like him) not been fortu¬
nate enough to be under care in an institution, what would
have been his fate ? Most assuredly we should have sooner or
later found him in one of our convict establishments after
having done half a dozen or more previous shorter sentences
in local prisons. This case in particular is one of the number
illustrating the need of the careful and intelligent observation
which ought to be bestowed before such persons are held to
be accountable for their actions. Although, to a casual
observer, this youth appeared upon the surface to be in a
way reasonably normal, yet after a time it would have been
discovered that he was undeniably defective in intellect, that
he could neither read nor write correctly, was extremely
ignorant generally, had a fiendish temper, and his distorted
mental action as a whole would, in course of observation, have
become apparent.
I certainly concede the fact that it would be difficult to
prove from an ordinary cursory examination of these cases,
that many of them were irresponsible for their acts, but
careful observation extended over a sufficient period would
undoubtedly go to show that the majority ought not to be
regarded as responsible persons, whilst at the same time it
would be impossible to certify such as being either insane or
imbecile.
It is a regrettable fact that a certain proportion of these
cases are to be found in the convict prisons, where their mental
deficiency is sooner or later recognised ; but why should this
recognition of their infirmity not take place before sentence
was passed upon them, and thus ensure their being differently
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538
“ Weakmindedness”
[July,
dealt with ? There can be no doubt that they have hitherto
not received the amount of consideration which their afflicted
condition demands. Provision is made for lunatics and imbe¬
ciles, but for these cases, which stand between sanity and a
mild degree of imbecility, and which, to my mind, are every
whit as deserving of consideration as the lunatic and imbecile,
little or no notice is taken; their mental defect is not suffi¬
ciently marked to secure for them a haven in the asylum, and
they drift about from the vagrant ward of the vrorkhouse to
the gaol, and ultimately become convicts; their lot is more
pitiable really than that of the insane, they drag out a miser¬
able existence, a considerable part of which is spent in prison,
with occasional interludes of squalid liberty, during which they
are a nuisance and very frequently a danger to society. At the
present time these unfortunates really appear to fare best in the
convict prison, for there, as I have already said, their mental
condition is recognised and allowances are made for it, and
they are ultimately sent to the penal establishment set apart
for invalids and convicts of weak mind. There can be no
doubt that such cases ought never to come to prison: whilst
there, they are a source of endless trouble and anxiety ;
besides, the punitive and preventive sides of the question
have little or no meaning for them, and these objects 1 do not
believe are attained in one single instance. For them some
special means of permanent disposal ought to be provided;
when at liberty they are simply the victims of their own low
grade individuality, and what is worse, they propagate de¬
scendants broadcast, the majority of whom go to swell the
ranks of insanity, drunkenness, aud crime.
Heredity in Relation to Mental Disease. By W. F. Far-
quharson, M.B.Edin., Assistant Medical Superintendent,
Counties Asylum, Carlisle.
In the following paper, dealing with the hereditary trans¬
mission of mental disease, my conclusions are based on a
statistical review of 1200 cases of hereditary insanity ad¬
mitted into the Cumberland and Westmorland Asylum during
a period of thirty years (1865—1895). So far as I can
ascertain, no analysis of such a large number of cases of
hereditary insanity has hitherto been made by any one ob¬
server ; there is, therefore, ground for the hope that results
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W. F. Farquharson, M.B.
539
of value may accrue from such an investigation. One of the
most important contributions to this subject is contained in
a paper* by the late Dr. Hugh Grainger Stewart, which
appeared in the Journal of Mental Science in 1864. That
paper was based on the statistics of 447 hereditary cases
admitted into the Crichton Royal Institution, Dumfries; the
patients belonged mainly to the middle and upper classes of
society, with a smaller number of pauper cases. The cases
I propose to analyse were almost entirely paupers admitted
from the general population of Cumberland and Westmorland.
Private patients often come to an asylum from a considerable
distance, and from beyond the limits of the district in which
the asylum is situated ; inferences drawn from the tabulation
of such cases are scarcely likely to give so reliable a picture
of the features of insanity in any district as when the cases
analysed stand for almost the entire insane population of all
the districts from which the patients come.
I propose, to a certain extent, to follow the methods used
by Stewart, but shall endeavour also to throw some light on
additional points not touched on by him.
I shall deal with the subject under the following headings,
and shall consider at the same time various side issues that
arise:
1. The Proportion of Cases of Insanity in which there is
Hereditary Predisposition to the Disease .—The 1200 cases
under review represent all the cases admitted into Garlands
(Cumberland and Westmorland) Asylum during a period of
thirty years in which there was ascertained an hereditary
history of actual insanity in the family. It must, however,
not be inferred that these 1200 cases include all the patients
admitted who inherited the predisposition to insanity. In
reality the number of cases with neuropathic heredity should
be much greater. In the first place, it is often very difficult
to ascertain reliable particulars about the family history of
pauper patients; and if, secondly, in many cases of an un¬
doubtedly hereditary nature, though there may hitherto have
been no actual insanity in the family, yet the unsoundness of
the stock may have previously evidenced itself by other allied
nervous disorders, such as epilepsy, chorea, neuralgias,
spasmodic asthma, &c., I have not included such cases in
tabulating the present series. For these reasons it is impos¬
sible to state accurately the proportion that the hereditary
* ‘‘On Hereditary Insanity/* by H. G. Stewart, M«D., Joum. Ment. Sci. t
vol. x, p. 50.
XL1T. 36
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540
Heredity in Relation to Mental Disease, [July,
cases bear to the total admissions during the same period;
only a very rough estimate can be given. The total admissions
during the thirty years numbered 3907, giving the proportion
of hereditary cases as 30*7 per cent, of the total.
Authorities vary very greatly in the proportions at which
they estimate the frequency of hereditary predisposition in
cases of insanity; some have put it as low as 5 per cent.,
while, on the other hand, some * maintain that at least 90
per cent, of the insane have an heredity of insanity.
Grainger Stewart found that 49*6 per cent, of the cases
admitted into the Crichton Institution had a history of here¬
ditary insanity or eccentricity; but, as already stated, a
majority of his patients belonged to the middle and upper
classes of society, about whom more reliable facts as to
ancestry can usually be ascertained than in the case of
paupers.
It is evident that in a computation of this kind a great
deal depends on the personal equation of each investigator
(i. e . on what he considers sufficient evidence of neurotic
heritage), and also on the thoroughness or otherwise of the
knowledge about the family history of the patients.
2. Degree of Relationship, to the hereditarily Predisposed, of
those Members of a Family previously affected .—A history of
insanity in relatives, whether in the direct line or collateral,
has been considered sufficient evidence of hereditary pre¬
disposition to warrant the case being included in my list.
Naturally, a history of insanity in the direct line is the
strongest testimony; but, failing this, the occurrence of
insanity in collateral relatives is also of great importance.
It is well recognised that it is not actual insanity that is
transmitted from parent to child, but an inherent flaw in the
nervous organisation, which renders the individual liable at
some critical period of his life to an attack of mental disease.
This flaw need not necessarily make its appearance during
the life of an individual who has inherited it; it may lie
dormant for one or more generations till in some subsequent
descendant it is called into active being—it may be as the
result of an unsuitable marriage of the tainted parent, or it
may be from mere stress of environment. Though it may not
be possible to ascertain a history of insanity in ancestors in
the direct line, the neuropathic heredity may be evidenced
by insanity in collateral relatives, e. g . in uncles or aunts of
* Cf. " Heredity ip Mental Disease,” by J. F. Briscoe, Journ. Ment . Sci.,
▼ol. xlii, p. 759.
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1898.]
by W. F. Farquharson, M.B.
541
the patient, or, again, in the children of those relatives, i. e .
in cousins of the patient. Insanity in cousins only is less
reliable evidence of hereditary predisposition, as the flaw in
them may have been imported into the family from outside
by a faulty marriage. Some authorities (e.g. Bucknill and
Tuke*) would exclude such evidence entirely; still, insanity
in cousins does afford a degree of probability of neurotic
inheritance, especially if associated with insanity in others of
the stock. Again, in the absence of a history of direct
transmission, insanity in brothers or sisters of the patient
affords strong presumptive evidence of an inherited flaw,
more particularly if at the same time there is insanity in
other collateral relatives.
The following table shows how the insanity was distributed
amongst the relatives of the 1200 hereditary cases. Each
case is noted once only ; where more than one relative was
affected, that one has been selected whose insanity throws
most light on the transmission of the disease to the patient
under consideration (as a rule the nearest of kin affected).
Table I.
Grandparents . Insane
Parents. „
Brothers or sisters ... ,
Uncles or aunts. ,
Cousins. ,
Nieces or nephews ... ,
Relatives, degree undefined ,
Males.
Females.
Total.
... 25
... 19
.. 44
... 193
... 219
.. 412
... 130
... 188
.. 318
... 114
... 122
.. 236
... 28
... 43
.. 71
9
8
.. 17
... 56
... 46
.. 102
... 555
... 645
... 1200
8. The Influence of Sex in transmitting Insanity .—Table
II shows from which side of the family the predisposition to
insanity was inherited.
Table II.
Cases hereditary on the paternal side .
„ „ „ maternal side .
„ „ on both paternal and maternal sides
Not defined from which side.
Total hereditary cases .
Total admissions in same period.
Males.
Females.
Total.
170 .
.. 147 .
.. 317
136 .
.. 185 .
.. 321
23 .
.. 26 .
49
226 .
.. 287 .
.. 513
555 .
.. 645 .
.. 1200
2019 .
.. 1888 .
.. 3907
The hereditary predisposition is strongest when it is
inherited from both parents ; this double heritage was ascer¬
tained in 49 cases, i. e. in 4'09 per cent, of the total number.
Table III gives details of these cases.
* Psychological Medicine , second edition, p. 266.
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542
Heredity in Relation to Mental Disease , [July,
Table III.
Males. Females. Total.
Both paternal and maternal grandparents insane. 2 ... 0 ... 2
Father and mother both insane ... 7 ... 14 ... 21
Father insane, also reversional or collateral maternal H. P. 5 ... 4 ... 9
Mother „ „ „ paternal H. P. 0 ... 2 ... 2
Paternal and maternal „ ' „ H.P. combined 9 ... 6 ... 15
Turning now to a comparison of the paternal and maternal
influence in transmitting insanity, we find from Table II that
the actual numbers of cases hereditary on the paternal and
maternal sides respectively are nearly equal, with a very
slight preponderance on the maternal side.
Table IV.
Total admissions . 3907.
Paternal influence— I Maternal influence —
317. I 321.
Percentage on total admissions—
81. | 8-2.
The majority of writers appear to consider that the maternal
influence is more potent than the paternal in transmitting
the tendency to insanity. Bucknill and Tuke* quote from
Baillarger that “the insanity of the mother, as regards
transmission, is more serious than that of the father; not
only because the mother's disorder is more frequently here¬
ditary, but also because she transmits it to a greater number
of children.”
I quote the statistics of other writers on this subject:—
Thurnam,f paternal influence 8*3 per cent., maternal 8*5
per cent.; Grainger Stewart, paternal 9*1 per cent., maternal
7*5 per cent; Brigham (quoted by Grainger Stewart), pa¬
ternal 6*7 per cent., maternal 7 7 per cent. Thurnam's
statistics tally closely with mine; Brigham’s results show
more markedly the greater potency of the maternal influence;
Grainger Stewart is the only authority who has found the
paternal influence the stronger. From a study of all these
statistics we must for the present conclude that insanity
inherited through either parent seems almost equally dan¬
gerous for the children, but that on the whole the insanity
from the mother is slightly more liable to be transmitted.
Another question to be considered here is whether the
insanity of one parent is more dangerous to children of one
sex than of another. From Table II we can extract the
following:
* Op. cit.y p. 269.
t Statutics of the Retreaty Table 14.
Digitized by {jOOQle
1898.]
by W. F. Fabquhaeson, M.B.
543
Table V.
Paternal influence. Maternal influence.
Male. 170 | Female ... 147 Male. 136 | Female ... 186
Percentage on total admiuione. : Percentage on total admieaione.
8-4 | 7-7 6-7 | 9-8
It is thus shown that insanity inherited through the father is
slightly (*7 per cent.) more dangerous to the sons than to
the daughters, while insanity inherited through the mother
is markedly (over 3 per cent.) more dangerous to the
daughters than to the sons.
4. The Influence of sex in receiving Insanity .—The female
sex is markedly more liable to suffer from hereditary insanity
than the male, as is shown by—
Table VI.
Males. Females. Total.
Total number of admissions ... ... 2019 ... 1888 ... 3907
Cases with hereditary predisposition 555 ... 645 ... 1200
Percentage of hereditary cases 27 4 ... 34-16 ... 30*7
The statistics of Thurnam, Grainger Stewart, and other
authorities show similar results ; but, as a rule, the diversity
between the proportions in the two sexes has been stated to
be less marked than that given in the above table.
5. The Frequency of the Different Forms of Insanity in those
hereditarily Predisposed .—
Table VII.
Percentage of
Total admissions. Hereditary cases, hereditary cases.
... 126 ... 44 ... 34*9
... 154 ... 35 ... 22*7
... 231 ... 43 ... 18*6
... 2234 ... 717 ... 32-5
... 892 ... 310 ... 34-7
... 270 ... 51 ... 18-8
Total. 3907 ... 1200 ... 30*7
Table VII gives the total number of admissions of each class
of cases during thirty years, with the number of instances in
each class in which hereditary predisposition to insanity was
ascertained. The highest ratio of hereditary cases is found
in congenital imbecility (with and without epilepsy); taking
epileptic imbecility separately, it was found to yield the
highest proportion of all, but the series of cases is so small
as to render exact inferences unreliable.
Melancholia gives the next highest ratio of hereditary cases.
In an analysis of 730 cases of melancholia published by me
Congenital imbecility
Epileptic insanity ...
General paralysis ...
Mania
Melancholia
Dementia ...
Digitized by L^ooQle
544 Heredity in Relation to Mental Disease , [July,
some years ago,* hereditary predisposition was ascertained in
38*2 per cent.; in the present series the selection of here¬
ditary cases was more rigid, and a few cases in which there
was slight doubt as to its presence were excluded. This, and
also the fact that the present series of cases of melancholia is
considerably larger, have given a slightly lower proportion of
hereditary cases; the proportion, however, still remains high.
The proportion of hereditary cases in mania is over 2 per
cent, lower than in melancholia. There is a considerable
drop in the proportion of hereditary cases in epileptic insanity
(mania and dementia). Next comes dementia, while general
paralysis has the lowest proportion of all.
Leaving out of account cases due to accidents at birth, or
to serious illnesses or injuries during infancy, congenital
t imbecility is frequently a sign of origin from an excessively
faulty stock; the flaw in the nervous organisation is so great
that it makes its appearance at an early period of the life of
the organism; it is not to be wondered at that a history of
hereditary predisposition to mental disease is very common in
such cases. Imbecility with epilepsy represents a still
greater departure from the normal, and therefore, as one
would expect, shows the highest proportion of hereditary
cases. Most authorities agree that hereditary predisposition
to insanity is present more frequently in cases of melancholia
than in mania. In Grainger Stewart’s statistics dipsomania
shows the highest ratio of hereditary cases. Owing to in¬
sufficient data I have not tabulated cases of dipsomania
separately.
As already indicated, it is not actual insanity, or any
special form of it, that is transmitted from one generation to
another, but a flaw in the germ-plasm, which, if it become
manifest at all in a member of a new generation, need not
necessarily appear in the same guise as it did in preceding
generations. Nor do members of the same generation of a
family always exhibit the same form of mental aberration ;
some may throughout life show average or even exceptional
mental development (every now and then a genius crops up
in families with a history of mental instability) ; one or
more may be imbecile, another may be melancholic and
suicidal, a daughter may have puerperal insanity at succes¬
sive confinements; other members of the family may never
exhibit signs of insanity, but may be subject to neuralgias
or other nervous ailments ; or, again, one or more individuals,
* Journal of Mental Science, vol. xl, p. 11.
Digitized by AjOOQle
1898.]
by W. F. Farquharson, M.B.
545
though they may never be actually insane, may throughout
life be eccentric or cranky, irritable or highly immoral, or
may in other ways give evidence of their ill-balanced nervous
system. The law of variations goes hand in hand with the
law of heredity ; the offspring never exactly resemble each
other or their parents.
6. The Forms of Insanity in the Ancestors of those heredi¬
tarily Predisposed .—It is often impossible to ascertain the
forms of insanity in the ancestors of those hereditarily pre¬
disposed to the disease, and one cannot give complete statis¬
tics on this point. However, in 532 cases out of the 1200 I
am able to specify forms of insanity that had previously
occurred in relatives, direct or collateral. In a considerable
number of cases more than one form of insanity had pre¬
viously occurred in the family, but, to simplify matters, I
only quote the form that occurred in the relative nearest in
the direct line to the patient:
Table VIII.
Mental disease in relatives of patients.
Mental disease in patients.
Mania.
1
P
*5
a
j Suicido.
Dementia.
Epilepsy.
I
Imbecility ;
or 1
weak-
mindedness
Gen. paralysis,
Total.
Congenital imbecility .
,0
2
1
_
1
13
1
28
Epileptic imbecility .
4
2
1
■
2
2
—
11
Epileptic insanity... ... ...
1
—
4
1
8
4
—
18
General paralysis ...
2
_
3
—
—
4
—
9
Mania
111
27
104
4
10
33
3
292
Melancholia
31
25
85
—
7
10
1
159
Dementia ...
3
4
5
—
3
—
15
Total
jl62
60
203
5
28
69
5
532
A glance at Table VIII shows that one form of insanity in
a patient may have been preceded in another member of the
same stock not only by the same form of insanity, but also
by almost any other variety of mental disease. The most
noteworthy fact to be derived from this table is the fre¬
quency with which suicide precedes, or is contemporaneous
with, insanity in a family. Out of those 532 cases no fewer
than 203 had had relatives who had committed, or had
attempted to commit, suicide. The proportion of suicides in
Digitized by LjOoq Le
546' Heredity in Relation to Mental Disease, [July,
Cumberland is very high. According to Morselli,* Cumber¬
land has the fourth highest suicide rate amongst the counties
of England, the annual average of suicides in this county
being 96*2 per million inhabitants. As shown by Table VIII,
suicide occurred in the same family tree as each of the
different forms of insanity there classified. Suicide and
dipsomania may, however, be classed together as the two
forms of neurotic heritage that have the strongest tendency
to be transmitted unchanged from one generation to another.
Of the 85 melancholiacs who had an hereditary history of
suicide, 61 (or 71*7 per cent.) had themselves the suicidal
tendency. The suicidal impulse is very frequently present
in cases of hereditary insanity considered generally; it
existed in 381 of the 1200 cases (i. e. in 31*75 per cent.).
The different forms of insanity may all occur in the mem¬
bers of the same family tree at one period or another, and it
is interesting to trace in a stock the progress of the neuropathic
diathesis. A flaw in the nervous organisation of a family
may become intensified in successive generations as a result of
unsuitable marriages and antagonistic environment; or, on
the other hand, owing to favourable combinations of circum¬
stances, the flaw may gradually fade away, till at last only
healthy members of the family are produced, still retaining,
however, the latent tendency to disease, which unfavourable
conditions may once more call into active existence. When
there is progressive deterioration of the mind in successive
generations, the march is onwards to complete destruction of
the mind, i. e . to amentia or dementia.
In many cases the origin of hereditary neuroses in a stock
can be traced to alcoholic excess in one or more ancestors,
where one can find no history of previous insanity; in other
cases inherited drunkenness often goes hand in hand with a
neurotic heredity.
Along with hereditary predisposition to mental disease
there may exist in a family the predisposition to other bodily
diseases. Thus in many cases of the present series there was
a family history of phthisis as well as of insanity, and a
considerable proportion of the deaths in the hereditary
cases resulted from tubercular disease. Some members
of a family may develop tubercular disease, others may be
subject to attacks of insanity, or the two diseases may co¬
exist in one person.
7. The Exciting Causes of Insanity in those hereditarily
* Suicide, by H. Morselli, 2nd edit., p. 189.
Digitized by
1898.]
547
by W. F. Farquharson, M.B.
Predisposed .—On the whole, the alleged exciting causes,
moral or physical, of attacks of insanity do not seem to vary
greatly in proportion in the hereditary as compared with
the non-hereditary cases. I find, for instance, that the pro¬
portion of cases in which alcoholic excess preceded the
attack has been much the same in the hereditary cases as in
all cases together.
Table IX.
Total admissions. Hereditary cases.
3907 ... 1200
Alcohol the exciting cause ... ... ... 488 ... 147
Proportion per cent. . 12*4 ... 12*25
Hereditary insanity is prone to show itself at critical
periods of life, such as the puerperium; thus I find that
amongst the females the proportion of cases of puerperal
insanity has been appreciably higher in the hereditary series
than in the total admissions.
Table X.
Total female admissions. Hereditary female admissions.
1888 . 645
Cases of puerperal insanity .... 145 . 60
Proportion per cent. ... ... 7*6 . 9*3
In looking through these cases I have found it noted in
repeated instances that the mother or other relative of a
woman suffering from puerperal insanity has been afflicted
with the same malady; in a considerable number of other
cases it has been stated that the mother of a patient admitted
with hereditary insanity suffered from puerperal insanity at
the time of the patient’s birth.
8. Ths Number of Attacks in Cases of Hereditary Insanity .—
Relapses are more frequent in cases of hereditary insanity
than in non-hereditary cases.
Table XI.
Hereditary cases ... . 1200
First attack. 761, or 63*4 per cent.
Not first attack ... ... ... 439, or 36*5 per cent.
I am unable to give similar statistics with regard to the
total admissions to Garlands Asylum during the thirty years,
but for comparison quote the following table from Thurnam,*
giving particulars as to cases generally.
* Statistics of the Retreat, table xxii.
Digitized by L^ooQle
548
Heredity in Relation to Mental Disease , [July,
Table XII.
First attack.,. . ... 358, or 76*3 percent.
Not first attack . Ill, or 23 7 per cent.
In my analysis of 730 cases of melancholia I also found
relapses to be appreciably more frequent in the hereditary
than in the non-hereditary cases.
9. The Age on First Attach in Cases of Hereditary Insanity .
—On the whole, hereditary cases of insanity are apt to come
on earlier in life than non-hereditary cases. Referring again
to the 730 cases of melancholia, 20*1 per cent, of the here¬
ditary cases were under thirty years of age when attacked,
as compared with 16 per cent, of the non-hereditary ; 13*6
per cent, of the hereditary cases were above sixty years of
age when attacked, as compared with 18’4 per cent, of the
non-hereditary.
Table XIII.
Hereditary cases.
Thurnam—cases generally.
Ages.
No. of cases.
Percentage? Percentage.
Under 10 years ...
... . 49
6*4
09
10 to 20 years ...
54
7*1
... 12*7
20 to 30 „
... 206
27*1
... 32*5
30 to 40 „
166
21*8
... 20-0
40 to 50 ,,
136
179
... 159
50 to 60 „
75
9-8
10*6
60 to 70 „
44
5*9
603
70 to 80 „
27
3*5
0*9
80 to 90 „
4
*5
•2
The above table shows in decennial periods the ages at
which the insanity first appeared in the 761 cases of hereditary
insanity that were admitted suffering from their first attack;
for comparison, Thurnam’s statistics of cases generally* are
quoted alougside : this is not altogether a satisfactory mode
of comparison, but I am unable to give in a similar fashion
the ages at the origin of the attack of all the cases admitted
to Garlands Asylum during the same period of thirty years.
Table XIII shows that in the hereditarily predisposed the
first attack of insanity may set in at any period of life ; in
the largest proportion of cases the attack comes on in the
third decade, and the proportion gradually diminishes in each
subsequent decade. The high proportion of cases in which
the attack came on before the age of ten years is owing to
the cases of congenital imbecility being included; the in¬
herited flaw in such cases must be very great, and shows
itself at an early stage of the individual’s life-history. On
* Statistics of the Retreat , p. 71.
Digitized by L^ooQle
1898.]
by W. F. Farquharson, M.B.
549
the other hand, persons hereditarily predisposed to insanity
may remain sane during the greater part of their lives, and
have an attack of insanity late in life. I have made an
analysis of 200 consecutive cases of senile insanity admitted
into Garlands Asylum during ten years (1886—1896), taking
solely those cases in which the first attack of insanity came
on after sixty years of age. Hereditary predisposition to
insanity was ascertained in fifty-five of these cases, i. e. in
27‘5 per cent. This is a much higher proportion of heredi¬
tary cases in senile insanity than that given by Clouston *
(13 per cent.), and considerably higher than that given by
Bevan Lewis f (22 per cent.). The percentage of hereditary
cases ascertained here in all forms of insanity has already
been stated to be 30*7 per cent. The difficulties in ascertain¬
ing particulars about the ancestry of the aged poor are very
great, and were it possible to obtain more accurate informa¬
tion it would probably be found that the proportion of
hereditary to the total cases of insanity occurring in the
aged did not fall far short of the corresponding proportion
at all ages combined. An inherited flaw in the organism
frequently tends to make its appearance in the descendants
at the same period of life as it originally developed itself in
the ancestors. When, from unfavourable combinations of
causes, the inherited flaw is gaining in intensity as it passes
onwards from generation to generation, the mental breakdown
is apt to appear at an earlier age and in a more aggravated
form in each succeeding generation, till finally there is reached
the stage of congenital imbecility with subsequent extinction
of the race. On the other hand, when, owing to the intro¬
duction of healthy blood into the stock, and also owing to
the environment being favourable, the inherited flaw is be¬
coming neutralised, then we frequently find that the attacks
of insanity are milder and come on later in life in each new
generation, and that at last there comes a generation the
members of which remain sane throughout life.
Melancholia, hereditary or otherwise, is more essentially a
disease of middle and advanced life than is mania; hereditary
insanity coming on early in life is more prone to take the
form of mania; in the later stages of life hereditary insanity
is proportionately more liable to be of the melancholic type.
10. The Domestic Condition of those having Hereditary
Insanity .—Table XIV gives the condition as to marriage of
* Mental Diseases , 4th edit., p. 625.
f Text-book of Mental Diseases , p. 409.
Digitized by AjOoqL e
550
Heredity in Relation to Mental Disease , [July,
the 1200 eases of hereditary insanity, and also of the other
cases admitted during the same period.
Table XIV.
Hereditary cases. Non-hereditarv cases.
✓-*- N :-s
No. of cases. Percentage. No. of cases. Percentage.
Single ... 616 ... 51*3 ... 1250 ... 46*1
Married ... 482 ... 401 ... 1101 ... 407
Widowed ... 102 ... 8*5 ... 356 ... 13*1
It will be observed that the proportion of unmarried
persons is considerably higher in the hereditary, while the
proportion of widowed is markedly higher in the non-
hereditary, the proportion of married being almost equal in
the two series. Probably the reason of the difference between
the hereditary and the non-hereditary cases in this respect is
chiefly to be found in the tendency of insanity to come on at
an earlier age in those hereditarily predisposed.
11. The Proportion of Recoveries and Deaths in Hereditary
Insanity .—
Table XV.
, Male*.
, No. of
cases.
Percentage.:
Total hereditary cases
555
i _ j
i
I
Discharged recovered
294
I 52-9
Died.
113
J 20-3
Females. I Total.
No. of
cases.
Percentage
No. of
cases. |
Percentage.
645
1200
-
345
534 I
639
53*25
154
23-8
267
1 22-25
The proportion of recoveries in cases of hereditary insanity
is considerably higher than in non-hereditary cases. The
general recovery rate in Garlands Asylum during these
thirty years was 44*6 per cent., so that the recovery rate in
the hereditary cases has been 8*6 per cent, higher than the
general recovery rate. In my analysis of 730 cases of
melancholia I found a recovery rate of 60*2 per cent, in the
hereditary as compared with 56’5 per cent, in the non-
hereditary. The higher recovery rate in hereditary insanity
is partly, but by no means entirely, due to the higher number
of readmissions of cases with hereditary predisposition.
The death-rate is lower in hereditary than in non-hereditary
cases; the proportion of deaths calculated on the total
Digitized by
1898.]
551
by W. F. Farquharson, M.B.
admissions during the thirty years was 28*5 per cent., as
compared with 22*2 per cent, in the hereditary cases. In the
730 cases of melancholia the hereditary cases showed 17*9
per cent, of deaths, the non-hereditary 21*3 per cent.
12. The Age at Death in Cases of Hereditary Insanity.—
The following were, in decennial periods, the ages at death in
the 267 cases of hereditary insanity that died in the asylum,
contrasted with the ages at death of all the cases that died
in the asylum during a period of ten years (1885—1894).
Table XVI.
Age period*.
10 to
20 to
GO
O
o
40 to
60 to
60 to
70 to
80 to
Total.
20.
30.
40.
50.
60.
70.
80.
90.
-- -
—
—
—
, -
-
- -
—
—
Number of deaths in hereditary 1
cases
1
26
[ 54
1
58
38
47
36
7
267
Percentage...
*37
9*7
20-2 21-7
1 1
14*2 17*6
13*4
2*6
1 "
100
Total deaths (10 years) .
4
35
i 82
i
94
1 90
84
86
21
496
Percentage... .
•8
| 7 0516-5 18-9 18-1 16-9 17 3
4*2
100
It will be seen from an examination of the above table that,
on the whole, the duration of life in those suffering from
hereditary insanity is shorter than it is among the insane
generally. In the former class 51*9 per cent, of the deaths
occurred before the age of fifty, as compared with 43*3 per
cent, of the deaths of all classes of cases; only 16 per cent,
of the hereditary cases reached the age of seventy before
death, as compared with 21*5 per cent, of cases generally.
13. The Causes of Death in Hereditary Insanity .—
Table XVII.
Cerebral and spinal diseases
Males.
... 47
Females.
39
Total.
86
Thoracic diseases ...
... 41
72
. 113
Abdominal diseases
... 6
9
15
General diseases.
... 19
34
53
— ■ ■
—
_
Total
... 113
... 154
. 267
Of the deaths due to cerebral and spinal diseases 39 resulted
from general paralysis, 8 from cerebral haemorrhage, 11 from
softening of the brain, and 6 from epilepsy. Phthisis pul-
monalis caused 56 deaths, while other tubercular diseases
accounted for 4 more deaths. Tubercular diseases thus
caused 22*4 per cent, of the total number of deaths. Out of
Digitized by
552 Heredity in Relation to Mental Disease, [July*
a total of 1162 deaths in Garlands Asylum during the thirty
years from 1865 to 1894 tubercular diseases were the cause
of death in 178 instances, i. e. in 15*3 per cent. Of the
1200 cases of hereditary insanity exactly 5 per cent, died in
the asylum from tubercular disease; of the total number of
admissions of all classes of cases during the same period 4*6
per cent, died from those diseases. Persons suffering from
hereditary insanity, therefore, appear to be distinctly more
liable to suffer from tubercular disease than are persons
suffering from non-hereditary insanity. The other causes of
death do not seem to call for any special comment, except the
fact that ten deaths were due to cancer; these have all been
included amongst the deaths due to “ general diseases,”
although in the majority of instances one or more abdominal
organs were affected. Cancer thus accounted for 3*7 per
cent, of all the deaths. In the same period forty-five patients
in the asylum died from cancer, i. e. 3*8 per cent, of the deaths
of all classes of cases; so that the proportions of deaths
from cancer amongst cases generally and in hereditary cases
are practically identical. Cancer, therefore, does not seem
to have any special relation to hereditary insanity, though the
number of cases has been rather small to permit of reliable
inferences being drawn.
14. The Duration of the Attach in Gases that recover. —A
comparison of cases generally and hereditary cases has brought
out no very striking differences in this respect. In the here¬
ditary series I found a smaller proportion of very short
attacks getting well within three months of coming to the
asylum; on the other hand, during the next nine mouths a
considerably larger proportion recovers of the hereditary cases
than of cases generally. Of the hereditary cases that re¬
cover 80*5 per cent, do so within a year after admission, as
compared with 78*4 per cent, of cases generally.
Summary. —The principal points brought out in this paper
may thus be briefly summarised :
(1) Authorities vary greatly in the estimates they give of
the frequency of hereditary predisposition in cases of insanity.
In the Cumberland and Westmorland Asylum 30*7 per cent,
of all the cases admitted showed a history of previous insanity
in their family.
(2) A history of insanity in relatives, whether in the direct
line or collateral, may be deemed sufficient evidence of here¬
ditary predisposition. It is not actual insanity that is trans¬
mitted, but an iuherited flaw in the nervous organisation.
Digitized by AjOoqL e
1898.]
by W. F. Farquharson, M.B.
553
This may remain latent for one or more generations, and
subsequently reappear.
(3) Hereditary predisposition to insanity is strongest when
it is inherited through both parents.
(4) The maternal influence is very slightly more potent
than the paternal in transmitting the tendency to insanity.
(5) Insanity inherited through the father is slightly more
dangerous to the sons than to the daughters; insanity in¬
herited through the mother is markedly more dangerous to
the daughters than to the sons.
(6) The female sex is markedly more liable to suffer from
hereditary insanity than is the male.
(7) The order of sequence of the different forms of mental
disease amongst the cases admitted into Garlands Asylum, as
regards the frequency of hereditary predisposition which they
exhibit, has been as follows :—1. Congenital imbecility. 2.
Melancholia. 3. Mania. 4. Epileptic insanity. 5. Dementia.
6. General paralysis.
(8) The suicidal impulse is very frequently present in cases
of hereditary insanity.
(9) Suicide and dipsomania have a marked tendency to be
transmitted unchanged from one generation to another.
(10) In most cases, however, the form of insanity in the
descendants shows great variations from that which occurred
in the ancestors, and different members of the same family or
generation may exhibit widely different varieties of mental
disease or other nervous disorder. Insanity, the tendency to
which is inherited, may have been preceded in the family not
by actual insanity, but by other forms of nervous disease.
(11) In successive generations the propensity to mental
disease may become gradually intensified; finally a state of
amentia or dementia is produced, with a tendency to bring
about extinction of the family. On the other hand, the
tendency to mental disease may become gradually eliminated
in the course of generations.
(12) The origin of hereditary neuroses in a family can
sometimes be traced to alcoholic excess in the ancestors.
(13) Hereditary predisposition to insanity in a family is
frequently associated with the tubercular diathesis.
(14) The exciting causes of attacks of insanity seem on the
whole to be of much the same nature in the hereditarily pre¬
disposed as in those without predisposition.
(15) Hereditary insanity is specially prone to show itself
at critical periods of life; thus puerperal insanity is propor-
Digitized by LjOoq Le
554 Heredity in Relation to Mental Disease. [July,
tionately more frequent iti the hereditarily predisposed than
in those without predisposition.
(16) Relapses are more frequent in cases of hereditary
insanity than in non-hereditary cases.
(17) Hereditary cases are apt to suffer somewhat earlier in
life than non-hereditary cases.
(18) Attacks of hereditary insanity may come on at any
period of life. Even in senile insanity the proportion of here¬
ditary cases does not fall very far short of the proportion
existing in cases at all ages combined.
(19) Hereditary insanity frequently makes its appearance
at about the same period of life in successive generations.
When the taint is becoming intensified it tends to make its
appearance at an earlier age in each succeeding generation ;
and, conversely, when the taint is becoming eliminated it
tends to appear later in life in each succeeding generation.
(20) The proportion of unmarried persons is considerably
higher amongst those suffering from hereditary insanity than
amongst those without predisposition.
(21) The recovery rate in hereditary cases of insanity is
considerably higher than in non-hereditary cases.
(22) The death-rate is lower in hereditary than in non-
hereditary cases.
(23) The duration of life is somewhat shorter in those
suffering from hereditary insanity than it is in the insane
generally.
(24) A larger proportion of deaths from tubercular dis¬
eases occurs in cases of hereditary insanity than in non-here¬
ditary cases.
(25) The duration of the attack in hereditary cases that
recover does not seem to differ very much from that in non-
hereditary cases.
Digitized by Google
1898.]
Occasional Notes of the Quarter.
555
OCCASIONAL NOTES OF THE QUARTER.
The Lunacy Bill.
The Lunacy Bill of the present session has advanced so far
in its parliamentary gestation, that it will almost certainly
escape the fate of its predecessor of last year.
The Bill has been so fully discussed in detail at various
meetings of the Association, and has received such careful
consideration from the Parliamentary Committee, that we need
allude only to its more salient features, and deal with brevity
even with these, since when this appears before our readers
there will be little time for action, if indeed the Bill has
not already become an Act.
The limitation of the urgency order is foremost, as well as
one of the most important changes in the Bill, and there can
be little jloubt that its r emaining in force for “ four ” instead
of “ seven days” will hft"“p rod nati ve of much inconvenience
to the friends of pati ents.
The liberty of the subject which this change is supposed to
safeguard will probably not be appreciably affected, but the
emphasising of the penalties connected with this procedure
will assuredly still further deter medical men from giving
certificates. This will result m giving msanE
urgencyc
sons full
sons lull opportunity of demonstrating to their friends and
neighbours the dangers arising from the liberty of the
lunatic.
A striking deficiencyj&_J]m Bill is the ne glec t to provide
for a sutncieni numberof ju stices ofj he p eace empowered
tcTileal willi lllllacy petitions, and to provide mea ns whereby
t heir na m es and addresses c an be ascertaine d. The mere
forwarding ot the names of such justices PoTJbe Commis¬
sioners in Lunacy (as provided in Clause 2, Section 3) is of
little use to this end. The framers of the Bill can have little
idea of the amount of time, trouble, expense, and annoyance
to the friends, or of delay and risk to the patients, often
entailed by the existing difficulty in finding a magistrate.
The Pensions and Allowances clause (20) is probably the
most satisfactory that has hitherto been drawn. An irre¬
ducible minimum on the Poor Law Officers Superannuation
scale, with the possibility of the more liberal scale of Section
280 of the old Act, will almost certainly meet with acceptance
37
Digitized by
Google
556
Occasional Notes of the Quarter .
[July,
from a large majority of those interested. The power to
grant allowances or gratuities to officers and servants in cases
of injury (Clause 21) is satisfactory even in its permissive
form, but it is widely held that this should be compulsory.
The remuneration for the labour of pauper lunatics, pro¬
posed in Clause 23, has been opposed, we are aware, by a
majority of those who have expressed an opinion on the
subject. We cannot, however, refrain from expressing the
view that the power to encourage occupation by reward thus
offered should not lightly be rejected. The mode of using it
rightly might entail, in the first instance, much difficulty, but
with care and experience such a permissive power ought
to find a valuable use.
That branch establishments are to be considered as part of
the asylum or hospital (Clause 16) is shown by Dr. Mould, in
the example of Cheadle, to entail great limitations on their
usefulness, and to distinctly savour of that “ legal restraint ”
in the treatment of insanity which is already productive of
so much injury to the treated.
The section of this clause which provides “ that no patient
shall be , received in the first instance ... in a branch
establishment” is simply vexatious and absurd. Patients
are being daily received into private houses all over the
country ; why then should they not be received in a branch
of an asylum ?
The regulations introduced with regard to boarders are
certainly not conducive to the extension of this most valuable
means of treatiug incipient insanity, and the limitation of the
freedom of action in the management of hospitals is distinctly
bad, since it would prevent new departures in treatment, and
tend to stereotype or fossilise existing methods.
This Bill, while showing some indications of increased
enlightenment in regard to Lunacy matters by our legisla¬
tive authority, yet gives very clear indications that the pre¬
dominant idea is still that of safeguar ding the liberty of t.hp
subject, and that the tre atment of^rtl^insane islc onsidoirad to
matter of v ery s eco nda ry impo rtance. ^ This fixed idea
irTtlie legislative mind produces legal procedures which delay
patients being brought under treatment at the most curable
stage of their malady, resulting, as has been demonstrated
ad nauseam , in homicides, suicides, and protracted in¬
sanity. This it is that hampers treatment (when the diffi¬
culties of certification have been overcome), by occupying the
time and attention of asylum physicians in filling up endless
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forms, or reports and returns. Effective means of treatment,
from the same cause, are practically almost tabooed by the
laborious records that have to be made of their use, and new
departures in providing care for the insane would be largely
restricted by the provisions of the present Bill.
Restraint, by mechanical and chemical means, are evils in
treatment from which the insane in this country have, after
long effort, fortunately escaped. The legislative tendencies
of the past few years, however, make it patent that there is
danger of their falling victims to a still more insidious and
pernicious evil, deliverance from which would be still more
difficult and tedious. This legal meshwork which is being
woven around the treatment of the insane may be fittingly
described as “ red-tape restraint.”
Defective Children and Imbeciles .
The report of the Departmental Committee on “ Defective
and Epileptic Children,” and the contemplated developments
of the Barony Parish in Glasgow, point to new and very
striking sociological departures.
The importance of dealing efficiently with these defective
children cannot be too strongly emphasised, for there can be
little doubt that they furnish a very large proportion of our
social failures, criminals, lunatics, unfortunates, and incapa-
bles. What proportion of these classes respectively thus
originate there are as yet no data to determine, but from the
more thorough investigation and observation which is now
proposed we shall learn not only this, but probably also many
of the reasons of their occurrence, and of the best means of
diminishing their number.
“ Feeble-minded ” the Departmental Committee interprets
as excluding idiots and imbeciles, and as denoting “only
those children who cannot be properly'taught in ordinary
elementary schools by ordinary methods.” The committee
objects to the term “ feeble-minded,” and recommends that
they shall be spoken of as “special class” children. It
wisely refrains from attempting any definition of the mental
state, but contents itself by formulating the procedures by
which such children shall in practice be brought under
“ special class ” training.
The term “special class” will probably overcome the ob¬
jection which parents would manifest to their children being
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558 Occasional Notes of the Quarter . [July*
classed as “ feeble-minded,” and in its vagueness and want of
definition embraces every possible variety of ordinary un¬
teachableness, whether from physical, sensory, or mental
defect.
The separation of imbeciles who require only nursing and
care, from those capable of being taught and trained, which
the Barony Parish is about to carry out, is another progres¬
sive step of great importance in dealing with this class, and
may be expected to give better results than those hitherto
attained.
The education and training which is given to the defective
minded will, however, be of little real value if the efforts at
making them useful members of society cease at the age of
puberty.
Training in industrial habit for a considerable time after
the age of sixteen is necessary to prevent their becoming
social failures. Many of the special class children, for
example, if left to their own devices or the influence of
their relatives, will only have been rendered more efficient
criminals.
Voluntary philanthropic organisations will probably be the
most efficient means of'watching over these classes after the
school age, and in aiding them to start satisfactorily in life;
fortunately many such bodies are already coming into
existence, but much more comprehensive and systematic
organisations will be required if the recommendations of the
committee come into practice.
The need of legislation of this kind is most urgent, and it
is not too utopian to anticipate that it would in course of
time result in a considerable diminution of the numbers
whom we are now obliged to class as social failures.
The Early Treatment Clause.
The joint committees of the British Medical and Medico-
Psychological Associations have formulated a recommenda¬
tion in regard to this clause, which is practically identical
with that in the present Scottish Lunacy Law.
The indications given in the Lunacy Bill preclude any
sanguine expectation that an extension of the means of
treatment in the early stage of mental disorder has much
likelihood of being accepted.
The increasing accumulation of lunatics in our asylums, and
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559
the heavy expenditure entailed by their maintenance will,
however, ere long awaken the interest of ratepayers, and we
may then hope that this will reinforce philanthropic effort and
lead to more enlightened and liberal views predominating in
our lunacy procedure.
Irish Local Government Bill .
The Local Government (Ireland) Bill has passed through
the stage of Committee, and, as it is little likely to be modi¬
fied in the House of Lords, may be considered to have reached
its final shape.
In the April number of the Journal we drew attention to
the clauses which deal with asylums.
Section 9 provides, as we then pointed out, for the general
management of asylums, giving to asylum committees ap¬
pointed by the county councils, and consisting in a propor¬
tion of not less than three fourths of county councillors,
powers generally similar to those possessed by asylum com¬
mittees in England. In Ireland the Lord Lieutenant will
take the place held in England by the Home Secretary, as
approving of the purchase of new lands and buildings,
sanctioning plans for new works, and approving regulations
for the government of the asylum.
Sub-section 6 of Section 9 has been amended in the manner
indicated below, certain words being added which we dis¬
tinguish by italics :
“ (6.) The county council, through the said committee,
may, and if required by the Lord Lieutenant shall, make re¬
gulations respecting the government and management of
every lunatic asylum for their county, and the admission,
detention, and discharge of lunatics, and the conditions as to
payment and accommodation under which private patients may
be admitted into and detained in the asylum , and the regula¬
tions when approved by the Lord Lieutenant with or without
modifications shall have full effect, and shall have the same
effect for the purposes of the fourth section of the Lunatic
Asylums {Ireland) Act , 1875, as if made by the Lord Lieu¬
tenant and Privy Council”
The power is conceded under the first of these amendments
by which county asylums will be able to receive paying
patients on reasonable business terms. The old Privy Council
Rules laid down that no patient was to be charged a larger
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560
Occasional Notes of the Quarter.
[July,
sum for maintenance than the average capitation cost, and
that no distinction was to be made between the treatment of
a patient whose friends paid for him and a non-paying
patient. As we often pointed out, this put a premium upon
friends declining to pay. Another result was an immense
exodus of poor middle-class lunatics to the English and
Scotch Royal and Chartered hospitals, and a corresponding
lack of interest in Irish asylums among the most intelligent
part of the population, which again told injuriously on the
welfare of those institutions in others, besides the mere
money aspect of matters. We never could understand why
the Privy Council should not have exercised long ago the
powers it possessed to enable Irish asylums to receive paying
patients on more favourable terms. Doubtless the county
councils, on whom in future the expense will fall, will be
more enterprising. We shall see presently how this special
point came to be provided.
The second amendment to Section 9 places the new regula¬
tions of the asylum committees on the same footing legally
as the Privy Council Rules. Boards of governors of Irish
asylums used to have a favourite excuse for being backward
in many matters, namely, that they were very closely tied up
by rules not made by themselves. The new bodies will not
in future be able to cloak indifference under so plausible a
pretext.
The Treasury grant, as we noted previously, is discontinued,
and its place taken by a rate in aid derived from the local
taxation (Ireland) account under the following terms:
“ (c) To each county council who satisfy the Lord Lieu¬
tenant that they have fulfilled their duty with respect to
accommodation and buildings for lunatic poor, and that their
lunatic asylum is well managed and in good order and con¬
dition, and the lunatics therein properly maintained and cared
for, sums at the rate for each lunatic in the asylum for whom
the net charge upon the council (after deducting any amount
received by them for his maintenance from any source other
than poor rate) is equal to or exceeds four shillings a week
throughout the period of maintenance for which the sum is
calculated, of one-half of such net charge, or four shillings a
week, whichever is least ” (Section 50, 1 c.).
In this manner a large measure of eventual control is very
properly left with the central government. The Lord Lieu¬
tenant is, of course, merely a name, under which it may be
conjectured the Lunacy Commissioners, or inspectors, as the
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Occasional Notes of the Quarter .
561
Irish law calls them, will act; and they are probably here
provided with ample powers, especially as they will also have
the function of advising as to the sanction of building works
and as to the approval of rules. They will thus be enabled
to impress their own ideas upon the local bodies quite as
fully as is judicious. Government retains the power of “ the
mailed fist,” though very wisely enduing it with a silken
glove.
The following provision is worthy of notice :
“ (1) The council for a county may, either by the exercise
of their powers under this Act, or by taking over for the
purpose any workhouse or other suitable building in posses¬
sion of the guardians, provide an auxiliary lunatic asylum for
the reception of chronic lunatics who, not being dangerous
to themselves or others, are certified by the resident medical
superintendent of an asylum of such council not to require
special care and treatment in a fully equipped lunatic asylum;
and any such auxiliary lunatic asylum shall either be a
separate asylum within the meaning of the Lunatic Asylum
Acts, or, if the Lord Lieutenant so directs, a department of
such an asylum :
“ Provided that the sum payable out of the local taxation
(Ireland) account in respect of the net charge for any lunatic
therein may be paid when the net charge equals or exceeds
three shillings and sixpence a week, but that sum shall not
exceed two shillings a week ” (Section 58, c. 1).
It is a favourite notion in Ireland that disused or super¬
fluous workhouses, which seem to exist in abundance, could
be cheaply converted into asylums. We doubt whether it
would not be more expensive from an architectural point of
view to modify the wretched structures which are considered
good enough for paupers than to build new asylums. The
fancy that chronic and harmless lunatics can be maintained
for three shillings and sixpence a week with clothing and pro¬
visions at the prices they command in Ireland is a fond
illusion. The resident medical superintendent, with whom,
in spite of the jealousy of those unfortunate officers which
exists everywhere, the supreme power in this matter by this
quaint provision rests, is never likely to draft away to
the auxiliary asylum all his working patients, and thereby
increase his own difficulties in management, and bring upon
himself the discredit of an increased cost at the parent asylum.
Accordingly the helpless imbecile is the person who will be
sent to the auxiliary. If he is badly clothed, insufficiently
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Occasional Notes of the Quarter.
[July,
fed, and not attended to, the helpless imbecile will promptly
show his gratitude by disappearing, and a great economy will
thus be brought about: solitudinem faciunt , pacem appellant.
The notorious result of cheap treatment in Irish workhouses
has not been encouraging up to the present.
The following enactments with regard to officers are im¬
portant to those who are serving in our specialty in Ireland :
“ Where any part of the salary of an officer of a county
council is paid out of money provided by Parliament, or from
the Local Taxation (Ireland) Account, he shall not be ap¬
pointed or removed, nor shall his salary be fixed or altered,
without the concurrence of the Local Government Board, and
he shall have such qualifications (if any) as may be pre¬
scribed ” (Section 63, 4).
“ Where . . . any resident medical superintendent or as¬
sistant medical officer of a lunatic asylum is appointed by a
county council after the passing of this Act, and at the time
of such appointment held an office in another luuatic asylum,
he shall, upon ceasing to hold office, be entitled, for the pur¬
pose of the enactments relating to superannuation, to reckon
any previous service as officer of a lunatic asylum which he
might have reckoned if his appointment had been under the
appointing committee ” (Section 63, 12).
“ (1) Subject to the provisions hereinafter contained, the
county council acting through their committee—
“ (a) shall appoint for each lunatic asylum a resident
medical superintendent, and at least one assistant medical
officer, and
“ ( b ) may appoint such other officers as they consider
necessary; and every officer so appointed shall perform such
duties and be paid such remuneration as the council may
assign to him.
u (2) Every resident medical superintendent shall be a
registered qualified medical practitioner of not less than seven
years’ standing, and shall have served for not less than five years
as a medical officer or assistant medical officer in an asylum for
the treatment of the insane , and every assistant medical officer
shall be a registered medical practitioner.
“ (3) The Pauper Lunatic Asylums (Ireland) (Superannua¬
tion) Act, 1890, shall apply to every officer appointed under
this section.
“ (4) The provisions of this Act respecting officers of the
county council shall, subject as aforesaid, and with the sub¬
stitution of the Lord Lieutenant for the Local Government Board ,
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Occasional Notes of the Quarter.
563
apply to the officers appointed under this section, as well in a
county borough as in any other county, and the grant paid out
of the Local Taxation (Ireland) Account for lunatics shall be
deemed to be paid in respect of a part of the salary of any
resident medical superintendent and assistant medical officer.
“ (5) This section shall be without prejudice to the pro¬
visions of this Act respecting existing officers ” (Section 64
entire, the amending words and sentences being italicised).
* * * * *
Section 83 provides for the transfer of the business of certain
authorities to the new county councils, and for the transfer
of the officers serving such authorities to the service of the
new authorities, and enacts (sub-section 16) that—
“ Subject to the provisions of this Act, every existing officer
transferred under this section shall hold his office by the same
tenure and upon the same terms and conditions as heretofore,
and while performing the same or analogous duties shall
receive not less remuneration than heretofore.”
It would thus appear that the rights of those officers who
are at present in the service of public asylums are safe¬
guarded as completely as possible, and that some control is
still maintained by Government over the appointment, dis¬
missal, and payment of all medical officers. Therefore we
may presume that in Ireland such a shameful scandal will be
impossible as that which recently occurred in Eugland, where
an officer was entrusted with the duties of a first-rate post and
paid on second-rate terms, solely in order to evade the Act
under which the dismissal of a chief officer, at the mere whim
of a timid committee in search of a scapegoat, was supposed
to be guarded against.
The provision by which service can be carried from one
asylum to another and reckoned for pension is a fair one,
and will certainly assist committees in obtaining the best
men for the best offices.
Sir Walter Foster is to be thanked for the amendment
whereby a medical superintendent is required to have had
five years’ experience in an asylum, which he succeeded in
carrying easily, in spite of some opposition from the Nation¬
alist members. It is a pity that the amendment did not go
further, and provide for an examination for the post of
assistant medical officer. It appears probable that if our Irish
brethren had been as keenly alive to the advancement of
their order as the Irish engineers were, and had, like the
latter gentlemen, secured qualifying clauses in the original
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564
Occasional Notes of the Quarter.
[July,
draft of the Bill, such clauses would have passed with little
or no opposition. It seems unreasonable enough that the
county surveyors (surveyor of roads, &c., civil engineers) and
their assistants should need to be specially educated and
examined, while the assistant medical officers of asylums,
of whom the public ought to expect much more, and whose
responsibility is far greater, may be selected any way. Per¬
haps the explanation of the anomaly lies in the sentiment of a
former Chief Secretary, who in introducing a once famous
Bill described it as a measure “ for the protection of life, and
above all of property.” A few roods of well-mended high¬
way have a market value far above the life of a few lunatics.
Nevertheless Sir W. Foster’s clause is a great improvement,
and will go far to protect the asylums from the risk, to which
it must be admitted they were sometimes exposed in old
times, of getting for their chief officer a man whose qualifica¬
tions were more political than medical.
If our Irish colleagues were, as we think, a little late in press¬
ing their views, they eventually put them forward with consider¬
able vigour, and obtained a respectable measure of support.
The Irish College of Physicians and the Irish College of
Surgeons warmly supported Sir W. Foster’s amendment, and
also an amendment moved by Mr. Carew, and eventually nega¬
tived without a division, providing for the examination of
assistant medical officers. An endeavour was made to press
upon Government to adopt a clause whereby the Lord Lieu¬
tenant would retain the gift of the superintendencies in his
own hands for a limited number of years, on the supposition
that in this way those who had entered the service in the
hope of Government promotion would be provided for. In
spite of the kindly advocacy of Mr. Lecky this failed, as did
also an attempt to induce Government to make compulsory
the clauses of the Pauper Lunatic Asylums Superannuation
Act (Ireland), 1890, which are now permissive.
They also generally deprecated strongly the notion of giving
any control over asylums to the Local Government Board.
We hardly think that this was contemplated in the original
Bill in spite of certain safeguarding clauses, but it was in the
view of several Nationalist members, who urged that the Local
Government Board should take the place occupied by the
Lord Lieutenant in the lunacy provisions of the Bill. Happily
Government stood firm on this point. It would have been a
lamentably retrograde step to associate the treatment of the
insane with the relief of paupers, which would have been the
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Occasional Notes of the Quarter .
inevitable consequence of establishing the rule of the Local
Government Board.
The Boards of Governors of Irish Asylums did not collec¬
tively do much to improve the Bill. Many of these bodies
wasted their powder by petitioning Government to drop local
government qua asylums, and take these institutions entirely
under central control.
Nevertheless a conference of asylum governors was held in
Dublin on the 28th of April, at which several points in the
Bill were discussed, and some rather important resolutions
come to. One, strongly pressed by the Board of Enniscorthy
Asylum, on the initiative of our able colleague Dr. Drapes,
secured the ear of Government, and was accepted as the first
amendment of sub-section 6 of Section 9, to which we have
already called attention, by which paying patients can be
received into district asylums.
The Boards of the Richmond Asylum, Dublin, of the Ennis¬
corthy Asylum, and of several others, drew attention very
strongly to the financially bad position of asylums under the
new Bill. The Treasury grant disappears, and the local taxa¬
tion fund, with a small margin at present, has no means of
expanding, and will be wholly unable to meet the many in¬
creasing demands which will be made upon it. The conference
drew the attention of Government to the fact “ that the
Government rate in aid to Irish lunatics, hitherto paid out
of the Consolidated Fund, has risen from £101,800 in 1887 to
£143,635 (estimated) in 1897, an increase of £41,835. If the
number of insane under care continues to increase—and there
is no reason to expect otherwise—the surplus will be wholly
inadequate, after a few years, to take the place of the increased
contribution from Government which would have been avail¬
able had the Bill not been introduced.”
Government refused to reconsider the financial aspects of
the Bill, but no doubt this very serious question must come
up again before very long.
This conference also adopted the two following resolutions :
“That we would further most strongly urge that the passing
of this Act should be availed of to enable such of the provi¬
sions of the English and Scotch Lunacy Acts to be adapted
to Irish purposes as may be considered advisable. A com¬
plete code of lunacy laws exists in England and Scotland,
but practically nothing has been done for many years past in
connection with the Irish Lunacy Law. Reference to the
Acts scheduled in Part 2 of the Bill will show this. A most
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566
Occasional Notes of the Quarter . [July,
important question is that of boarding out of lunatics. In
Ireland there is no such power. In England and Scotland
the power exists, and is very much used, especially in Scotland.
We are of opinion that facilities for boarding out patients
ought to be extended to Ireland.”
“ That we are of opinion that lunacy administration in
Ireland should be assimilated to that of England and Scotland
as regards the establishment of a lunacy commission in this
country.”
The former is probably what is the fashion to call rather
too large an order; the latter slightly too vague; both of
them rather pertaining to a lunacy regulation Bill than to a
local government Bill. Neither met any response from
Government, but they are, we hope, to be regarded as signs
that some healthy interest is felt in lunacy affairs in Ireland.
Such interest is badly wanted. Nothing is more singular
than the little interest or intelligence shown by the majority
of the Irish members in the debates on the lunacy clauses in
this Bill. Some of them used these sections as a mere excuse
for personally reviling the Inspectors of Lunatics and the
officials of the Board of Control. Others fell foul of asylums
generally, and seemed to have been briefed by the Society
of Imputed Lunatics. The most ridiculous blunders as to
matters of fact were made on all sides. Even the Chief
Secretary is reported by all the Irish newspapers as having
spoken of the Treasury rate in aid of 4$. 2d. per week per
head, which is really only 4s.
We hope before the Irish Lunacy Act comes which we
have been so long hearing about, but which appears as far
off as ever, the Irish public will be somewhat educated as to
the requirements of the case, and further that the state of
Irish politics will be such that Irish parliamentarians will be
able to afford a little time and consideration to a subject which
is not perhaps showy, but is of vast importance to a large and
very pitiable class of their countrymen.
Habitual Inebriates Bill .
The progress which this Bill has made does not justify any
expectation that it will become law in the present session of
Parliament, and so for still another year these unfortunates
may be permitted to drink themselves into criminality,
lunacy, or the grave, as accident shall determine.
The Bill provides that an habitual drunkard, convicted of
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Occasional Notes of the Quarter .
567
crime, may be sentenced to not more than three years in any
State inebriate reformatory, &c., this being in addition to, or
in substitution of any other sentence. Should this become
law, there can be little doubt that it will act as a powerful
deterrent to incipient drunken habit, and, it may be hoped,
prove a curative measure in a certain number of instances.
The Bill further provides for the establishment of State
inebriate reformatories and of certified inebriate reformatories
in which such treatment may be carried out.
Any habitual drunkard who has been four ti mes c onvicted
of drunkenness within twelve months s hall algo be liable to
detention for a term not exceeding three years in an inebriate
reformatory. This provision, if it ever becomes law, will
most certainly arrest the development of those chronic
“ drunks,” whose appearances before the magistrates are to
be reckoned in hundreds.
!Jhe Bill, however, has little chance of becoming law, even
in so qtneta session as the present, and we can only express
the regret that while legislation affecting special interests, of
railways, banks, &c., is comparatively easy, it is still so diffi¬
cult to pass a Bill which afFects only the general interest of
the community.
Criminal Evidence Bill.
This Bill, marking a very wide departure in our law of
evidence, is so far advanced that there is every probability
of its becoming law in the present session, but probably its
clauses will yet undergo such considerable modification as to
render criticism of its existing form unnecessary.
The admission of the evidence of criminally accused persons
and of the husband and wife will, without doubt, afiFect con¬
siderably the plea of insanity in such cases. Many specula¬
tions might be indulged in with regard to the manner in which
it will act in this respect; but probably in the question of
insanity, as well as in that of criminality, the extension of the
scope of evidence will help to a greater approximation to the
truth, and thereby to justice, than that attained when the
evidence of the most important witnesses was inadmissible.
The exact conditions and limitations of such evidence
must, however, be defined before any satisfactory opinion
can be expressed on the manner in which it will affect the
plea of insanity, but it is easy to foresee that many interest¬
ing questions will arise in this connection.
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Occasional Notes of the Quarter.
[July,
The Examination of Defective Children under the London
School Board.
The appointments of Dr. Shuttleworth as an examiner under
this Board will be generally recognised as the best that could be
made. Mrs. Dickinson Berry, M.D., who is appointed, pre¬
sumably for the examination of the female children, has high
qualifications for the post.
These appointments are, without doubt, the outcome of the
recommendations in the report of tha Departmental Committee
on Defective Children, and an evidence of the acceptance of
its main principle by the Loudon School Board.
Reception Houses.
The retirement of Dr. Norton Manning, to which we draw
attention in Notes and News, naturally reminds all who are
interested in the care of the insane of the reception houses
established during his regime in New South Wales.
The success of these reception houses has been very great,
and the rumour reaches us that the establishment of similar
houses in London is under the consideration of the County
Council.
The advantages of having well-organised institutions for
receiving, treating, and distributing mental cases over the
existing system is so obvious, and has been so often insisted
on, that little need now be said in regard to it, beyond the
expression of astonishment that the change has not been earlier
contemplated.
That the insane, often not in any sense paupers or criminals,
should, in the large majority of cases, only find their way to
the asylum through the police cell or the workhouse, would
certainly seem an erroneous procedure.
The unfitness of the police cell as a place for the treatment
of an early phase of insanity is clear even to the most legal-
minded, but many of the workhouse “lunatic wards” have
been and still are very unsatisfactory, to say the very least
of them.
Reception houses properly equipped, staffed by medical
officers and nurses of special experience, will assuredly be of
the very greatest advantage in caring for these early phases
of disorder, and it may confidently be predicted that a very
considerable number of cases would thus be arrested in their
development and escape the need of asylum treatment.
Digitized by L^ooQle
1898.] Occasional Notes of the Quarter . 569
Early treatment, too, would probably be facilitated, from the
fact that there would certainly be less reluctance on the part
of patients and their friends to go to an institution not an K
asylum and not a workhouse, than is now the case. This re- f
luctance at the present time constantly leads to delay, with
the result that illnesses which might have been abbreviated
become protracted and incurable, or the sufferer is permitted
to commit some overt act of insanity.
Great economy in the long run should result directly from
the diminution of the number of cases going to asylums, and
indirectly by a more systematic distribution of the cases to
the institutions most appropriate to their mental state. Under
existing conditions great expense is often entailed by cases
having to be transferred from one institution to another, as
well as from want of systematic inquiry as to settlement at
the outset of the case.
We may earnestly hope, therefore, that the rumour is well
founded, and that we may soon be able to record that the
London County Council has made another advance in the
care of the insane, of even more importance than those which
we have from time to time with satisfaction recorded.
x Hypnotism in Court .
In the newspaper reports of a recent action for slander it
was stated that the British Medical Association had officially
recognised hypnotism as a therapeutic agent. The medical
man whose evidence led to this incorrect statement has shown
that his remarks had been misapprehended by the journalist.
It is of some importance to recall the circumstances, to show
how the matter really stands. The committee appointed to
report upon the subject included well-known names, and
after a considerable interval presented their conclusions.
They expressed themselves as satisfied of the genuine nature
of the hypnotic state, and were of opinion that, as a thera¬
peutic agent, hypnotism was frequently effective in removing
pain, procuring sleep, and alleviating many functional ailments.
As to its permanent efficacy in the treatment of habitual
drunkenness, the evidence before the committee was en¬
couraging, but not conclusive. They specially indicated that
care in the employment of hypnotism was necessary, and
suggested important limitations.
The report was referred to the committee on its first pre¬
sentation, and when it was again brought up in 1893 it was
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disposed of by a motion that the report be received and the
committee thanked for its services, on the understanding
that it be not adopted by the Association.
The general sense of the profession was against the recog¬
nition of hypnotism as a means of treatment. Dr. Kingsbury
complains that a handful of men, who had not engaged in
close observation of the phenomena in question, should thus
have disposed of the report. In fact, he holds their verdict
to be incompetent. But hypnotism must win its place in the
armoury of medicine by general acceptance. Unless it com¬
mands the confidence of the profession it will continue, as
heretofore, sporadic, limited, uncertain of favour. While it
must be acknowledged that it is potent for good in certain
directions, the most enthusiastic must admit that it entails
very grave disadvantages. Just as some men of tender con¬
science and decided opinions decline to prescribe alcohol,
others will avoid the employment of hypnotism. No doubt
it may be urged that medicine must not be restricted to the
use of innocuous drugs, but in our special department, at
least, the evils consequent on hypnotic influences are so grave,
and the scope of the remedy is so limited, that we doubt if it
will ever be other than an infrequent means of treatment.
We recall a visit to the Zurich Asylum, where Professor Forel
has long studied the phenomena of hypnotism, and where
many of his “ subjects ” could be seen among the members
of the staff. Only one patient, an habitual drunkard, was
then sensitive to the hypnotic influence exerted by Professor
Forel. And, in our own experience, the few cases in which it
seemed prudent and desirable to induce hypnotic sleep were,
in the end, apparently deteriorated in mental condition. The
conservation of mental power, so urgently indicated, was in
fact endangered.
In our opinion the British Medical Association acted dis¬
creetly in refusing to endorse the finding of the Committee
with its approval and recommendation.
The Darenth Scandal.
The special committee appointed to consider whether any
measures should be taken on behalf of this Association, in
support of the sufferer in this matter, by his desire has taken
no action.
That the victim of such apparent ill-treatment and un¬
pleasant publicity should desire to avoid the continuance of
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the annoyance and suffering entailed by a prolonged struggle
in getting “ the truth ” made manifest, is almost to be ex¬
pected, although a more combative attitude might be of
advantage to others.
The sympathy shown by this Association has been fully
appreciated by the person principally affected, and has prob¬
ably not been without influence on some of those who were
associated in the infliction of what appeared to be a gross
injustice.
The Handbook for Attendants .
The Handbook has now been thoroughly revised, and is in
process of printing. The publishers will probably be enabled
to have it ready for distribution soon after this number of
the Journal is in the hands of our readers. As their stock
has been exhausted for some time, and the demand continues
urgent, we make special acknowledgment of the energy and
labour bestowed upon the production of the fourth edition by
the Committee, and we trust that the improvements made will
still further secure that confidence of teachers and nurses
which has been so freely bestowed in the past.
PART 11.—REVIEWS.
The Eighth Annual Report of the State Commission in Lunacy
of the State of New York , U.S.A., October 1st, 1895, to
September 30th, 1896. Pp. 1335.
This report, like its predecessors, affords much interesting
reading to all who are eager to study the treatment of the
insane from all points of view. The statistical parts of the
bulky volume show that insane people group themselves in
incidence of particular forms of disease, in recovery, in
death, very much on the same lines in New York as they do
here. The chief point ,of interest, however, lies in noting
where general administration differs in the two countries.
It may be said at once that the whole volume testifies to
care and study of the patient, and to his interests being
carried out in the most praiseworthy method. This particular
report brings with it the record of a completed scheme, begun
XLrv. 38
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some ten years ago, for the transference of the care of the
whole body of rate-paid patients to the State Commission
from the various bodies who were charged with the duty
before that date. The city of New York was the last to
hand over its authority. The scheme now completed is
briefly this :—at the head of all is the State Commission, con¬
sisting of three Commissioners, whose province is very similar
to that of our own board. For each of the eleven hospitals,
which together supply the whole public accommodation in
the State, a board of seven managers is appointed by the
Governor with the advice of the Senate. This board is charged
with the general management and supervision of the parti¬
cular hospital. It has power to appoint or remove the
medical superintendent and treasurer only. The medical
superintendent, under the supervision of the board, has a
very free hand indeed. He has full power to appoint and
remove all other officers and employes whatsoever. He
orders all supplies, and is the chief executive head.
Though the hospitals have a certain independence of man¬
agement, they each form a unit in one system. Patients can
be transferred from one to the other. All goods are supplied
on contracts extending over the whole system; salaries,
wages, uniforms, are on one settled scale applied to all the
institutions. The Commission, having devised and procured
the adoption of this uniformity, is naturally gratified by its
consummation. It claims the following advantages among
several others:—it is found that already the maintenance cost
per patient has been reduced from #216 to #186 per annum,
making a yearly saving of #600,000 on the 20,000 public
patients who are now cared for by the State. It has been
found possible to get #80,000 reimbursed in the past year
by the friends of patients who before were allowed to
escape liability, the “ incentive being political or other
influences.” The legal distinction between hospital and
asylum has been removed, all institutions now being organised
on a curative basis. This has had a most beneficial effect.
A civil service regulation has established competitive exa¬
minations for appointment of all resident officers. This has
effectually checked all partisan influences. A material in¬
crease in the average rates of salaries and wages has been
secured. A State-directed pathological laboratory has been
established, together with a uniform system of training and
“ graduation” of all the subordinate staff.
A somewhat peculiar arrangement for a monthly conference
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has been organised. The conferenoe takes place at the office of
the Commission itself, and is attended by the Commissioners,
the medical superintendents, and, at the discretion of each
board, a member thereof. The discussions embrace all
“ matters relating to the care and maintenance of the State
hospitals, and particularly with reference to the purchase of
supplies for their use.” The care and treatment of patients
is held to come within this reference. The points in discussion
are settled by a majority of votes of the conference, but the
Commission is careful to state that its statutory prerogatives
are not hereby qualified.
We cannot say that in our opinion such an arrangement
is free from doubt. It may work well while all are harmonious,
but we should fear that a cross-grained Commissioner or a
cantankerous superintendent or two would create very
unpleasant positions. We cannot think that it is altogether
wise for a Commissioner to leave his independent position,
which he must do in voting with others on questions which
may under unfortunate circumstances bring into sharp relief
the difference of the relative positions of Commissioner and
superintendent. More important still, there is the chance
that, while a high state of minimum efficiency over the whole
may be secured, the formation and carrying out of happy
ideas by brighter brained individuals may be unduly repressed.
We know well enough that such ideas have led to the real
progress which has been made in asylum life. Doubtless
this particular experiment will be watched with interest.
We note that an allowance of $240 per 1,000 patients
is made for amusements, music, outdoor sports, &c. The
Commission makes a strong point of the establishment of a
good band in each hospital. We are glad to see that reli¬
gious exercises and Bible classes are not put so prominently
forward, to the exclusion of lighter forms of recreation, as
used frequently to be the case. Among other matters of
importance the commission remarks on the following points:—
it deprecates strongly a recent change in the law of com¬
mitment. Heretofore a certificate by two qualified examiners,
approved by a judge of court of record, was requisite, the
judge having power to call for further evidence, or to call
for a jury. Now, an order of the judge granted on a verified
petition with the same certificate is required. The powers
of the judge are very similar to those of our justices, and so
far the only difference between the English system and that
of New York is the difference between a justice and a judge
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of a court record, together with the fact that the arrangements
apply to public as well as private patients. But the sequelae
are positively dreadful. If the patient or a friend is dis¬
satisfied with the order he may within ten days appeal to a
justice of the supreme court, who shall call a jury to decide
the matter. The appellant has to make a deposit or give
security for costs of the appeal, while on the other hand the
petitioner may, if the case is given against him, be saddled
with all the costs.
The question of alien and non-resident patients is, indeed,
a serious one in New York. In the seven years ending
October 1st, 1895, 33,754 cases were admitted, of which
number no less than 50 per cent, was foreign-born. The
commission reckons that the capital cost of each bed is $550,
the yearly maintenance is $186, and the average residence of
an unrecovered case is twelve years. The burden of imported
insanity is therefore tremendous. The law now provides that
if an alien becomes insane within one year of his arrival, and
provided that it can be shown that his inability to support
himself was the result of causes which existed at the time or
prior to the date of his landing, he may be deported at the
expense of the steamship company importing him. The
commission recommends that the period of one year should
be extended to two years, and that it should not be necessary
to show existence of any cause at the time of immigration.
Further, that at each principal port of departure in Europe,
and at each principal port of arrival in the United States, a
trained alienist should be employed to €t examine ” and pass
upon the mental condition of persons seeking residence or
citizenship in the United States. Verily the disease is des¬
perate, but the remedies are heroic.
It should be mentioned that of the 2814 aliens admitted
into the New York hospitals, 1067 came from Irelaud, 700
from Germany, 173 from England, 133 from Prussia, 109
from Canada, 107 from Austria, 81 from Italy, &c.
The Commission is of the opinion that there is no evidence
of the correctness of the common opinion that insanity as a
disease is becoming more*prevalent. It reproduces and sup¬
ports the report of the English commission in 1897 on the
same subject.
The statistics show that the percentages of recoveries
during the year under report to admissions (no deduction
being made for transfers as with us) was 17*5, and the pro¬
portion of deaths to average daily population was 9*5. A
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great deal of other valuable statistical information is given
both as to the total of the State and of the individual hos¬
pitals. But, as is the case sometimes nearer home, a good
deal of this value is dissipated by diffuse and unsatisfactory
heads of enumeration. We would suggest that the Commis¬
sion should take in hand, as it has every opportunity to do,
the preparation of really scientific tables of, inter alia , causa¬
tion of insanity and death. The assignment of such causes
as “ Christian Science,” “ intestinal toxaemia,” “ intemper¬
ance (peppermint),” “ use of hair-wash,” would suggest that
the causation was taken from the admission papers rather
than from inquiries carefully made by the medical staff,
which alone can give a table that will be worth the paper it
is written on. The table of death causes, however, must
emanate from the staff itself. “ Cerebral diseases” are
assigned as such in about 2*6 per cent., which is altogether
too small a proportion to be accurate. We cannot see the
advantage of returning deaths under the head of “ status
epilepticus” as well as “ epilepsy,” &c.
Hereditary predisposition is given as a cause in about
6 per cent, in the cause table ; but in another table,illustrating
the operation of heredity, it was shown in 1200 out of 5600
admissions. In another 1800 cases it was “ unascertained,”
while in no less than 2500 cases it is roundly stated that
there was “ no hereditary tendency.” This latter fact, again,
suggests too much reliance on admission papers. We feel
sure that the statistical portion of the volume will be brought
up to the level of the other parts.
Alcoholism accounts for about 10 per cent, of the admis¬
sions, the female cases in which.this was assigned being
about as one to five of the male cases, the proportion in
England being about one to two and a half.
The admissions of cases of general paralysis during the
year were about 7 per cent. The sexes are not divided in
the table of forms of insanity on admission, but in the
tables of causes of death the female cases appear to be
about one eighth of the total deaths from this cause. Of
2469 cases admitted in eight years only one recovery is re¬
corded.
We have space for but a brief note of the remarks of some
individual superintendents.
Dr. Alder Blumer, of Utica, presses on the authorities the
adoption of the boarding-out system. He also strongly
advocates Nurses’ Homes.
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Dr. Mabon, of the Willard Hospital, speaks favourably of
his experience of the thyroid treatment, and of the use of red
bone marrow in cases of anaemia.
Dr. Pilgrim, of the Hudson River Hospital (several photo¬
graphic views are given), is very gratified with the results
during the last three years of putting experienced women
nurses in male wards. There is at least one woman in each
ward, with the exception of those for violent and disturbed
cases.
Dr. Talcott, of the Middletown Homoeopathic Hospital,
gives a detailed description of the therapeutic uses of about
twenty drugs. We confess that we never saw so much
generosity in imparting medical instruction in any report
intended to be read by laymen, and we do not think it wise
generosity. Cantharis may be useful, as stated, “ among the
insane when the female patient suffers with an intense
nymphomania, or the male is afflicted with satyriasis.”
Stramonium, which causes frightful objects “to terrify the
victim of a stramonium proving ” may be very successful in a
patient who sees snakes by reason of his insanity, and so
forth, but such little matters are best kept for professional
eyes, and we would suggest that the Commission should use
its great influence towards the cultivation on Dr. Talcott’s
part of that medical reticence which adorns the reports of his
colleagues. Certainly, when he begins a special report to
the Commission itself on the care and cure of the acute insane
by stating that “ the treatment of the insane requires, first of
all, buildings which are especially adapted to the necessities of
this class of invalids,” and tells the Commission that the soil
should be dry and porous, and all about the benefits of
fire brigades, extinguishers, engines, escapes, &c., Dr.
Carlos Macdonald will have thought of an appropriate
proverb connected with eggs. It is odd reading, too, to find
wedged in between such items of real instruction as have
been recorded above a detailed list of the repairs to the
kitchen table top, doors, floors, &c., and a record of the
number of apples, carrots, and other produce consumed.
The General Superintendent of the Manhattan Hospital,
Dr. A. E. Macdonald, who attended the Annual Meeting at
Newcastle last year, has under him 3 medical superintendents,
32 assistant male physicians, 2 women physicians, and 8
medical internes. This hospital was involved in a curious
lawsuit, turning on a point whether the superintendent was
bound to receive a patient who was not properly and whole-
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somely clothed. The Supreme Court decided that he was
justified in refusing to receive.
This report is the last that will be issued under the
authority of Dr. Carlos Macdonald, who has now resigned his
presidency of the Commission. The completion of the great
scheme, towards which he has worked so industriously and
successfully, releases him from his labours. We feel sure
that he and others can look back on them with satisfaction
and approval.
The Structure of the First or Outermost Layer of the Cerebral
Cortex . By W. Bevan Lewis. ( Edinburgh Medical
Journal, June, 1897.)
The author gives the results of his researches into the
complicated peripheral zone of the cortex. Evidence is
adduced to show that a notable relationship exists between
this zone and the underlying series of nerve-cells. This
zone, “ being the territory of reception of the terminal den¬
drites of the large bulk of nerve-cells of the underlying
strata, will vary in depth proportionately with the poverty or
health of such cells.” The constituent elements of the area
in question are considered seriatim, as follows:—Neuroglia
and lymph connective elements, tangential or superficial
medullated belt; terminal dendrites, from the apices of
pyramidal and other cells; termini of the second layer of
cells. The question of the existence of nerve-cells in this
zone is discussed. The author is somewhat difficult to
follow in places, the argument is, perhaps, scarcely so clear
here and there as one would desire. His conception of
the peripheral zone of the cortex is, however, clearly ex¬
pressed—“ an enormous field of the cortex in which sensory
units are brought into close contiguity with the terminal
dendrites of the motor pyramidal cells, ... a field facile
princeps that whereon the transference of sensory currents to
motor energy is realised.” Incidentally reference is made to
the view of Golgi, that the protoplasmic processes of cells
administer to the nutrition of the cell—a view based upon an
assumed connection between these dendrites and the vas¬
cular channels and connective-tissue elements. The author
considers that it may be affirmed that no such connection
exists.
In these researches the author used a modified form of
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Golgi’s method, which consists in applying to the silver
chromate section as it lies on the slide a drop of liquor
potass®. This causes an almost immediate disappearance of
the red coloration which so frequently disfigures Golgi’s
specimens. The expansion of tissue caused by the potash
produces, however, fine fractures across the dendrites, and
alcohol cannot be used in dehydration. The author has,
therefore, experimented further, with the object of im¬
proving the method, and his results, published in the same
periodical for August, 1897, are highly satisfactory. The
improved method gives exceptionally clearly the details of
structure :—It is as follows :—Harden in Cox’s sublimate
fluid (two to three months). This fluid is composed of
5 per cent. sol. of bichromate of potash, 20 parts; 5
per cent. sol. of bichloride of mercury, 20 parts; 5 per
cent. sol. of chromate of potash, 16 parts; aq. dest, 30—40
parts. Place the sections on a slide, and treat them momen¬
tarily with liq. potass®, washing this away with water;
dehydrate in spirit, clear in clove oil, mount in balsam.
Pieces hardened in Cox’s fluid should be well washed in
alcohol for half an hour to remove superfluous sublimate.
Le Gervelet: Etude anatomique , clinique, etphysiologique. Par
le Dr. Andre Thomas, Ancien Interne des Hopitaux de
Paris. (Travail du Laboratoire du Dr. Dejerine Hospice
de la Salpetriere.), Paris : G. Steinheil, fiditeur, 1897,
pp. 356. Price 14 fr.
This is perhaps one of the most exhaustive and complete
works on the cerebellum that has been published. It contains
not only Andre Thomas’s own results, but a digest of all that
is known on the subject. The design of the work is to
study the cerebellum not from an anatomico-pliysiological
standpoint, nor yet from an anatomico-clinical standpoint,
but from a combination of the two, and it is on these
lines that Dr. Thomas has arranged his book. The first
chapter contains the history of our knowledge on the subject,
and the gradual evolution of our ideas is indicated step by
step. He divides it into two periods, the first comprising the
work of Willis, Rolando, Flourens, Bouilland, Majendie,
Lussana, and Louget; and the second of the work of
Luciani, Russell, Ferrier, Turner, and Schiff. As Dr. Thomas
remarks, it is only since the advent of antisepsis, chloroform.
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and the perfection of histological methods that any real pro¬
gress has been made. Before that the animal usually died
soon after operation, and the observations were necessarily
those of a short period before death. Daring this time it was
impossible to distinguish the proceeds of the operation per se
from the proceeds of the actual absence of the cerebellum.
The history of the cerebellum reveals many diverse views
as to its function, the diversity being probably due to a
difference in the methods of experimenting and the part de¬
stroyed. It has been considered as a centre for organic
function and common sensation (Willis), as a genital centre
(Gall), as a centre of muscular energy (Haller, Rolando,
Weir Mitchell), as a centre for the co-ordination of move¬
ments (Flourens, Bouilland, Wagner, Lussana, and many
others), some being based on mere speculation, some on ana¬
tomical relationships, and others on experiment. Dr. Thomas
shows later that its anatomy is in complete concord with its
physiology, the one supporting the other.
Chapter II gives a general description of the cerebellum
from an anatomical point of view, and a few morphological
facts. Three systems of fibres are usually described, projection,
association, and commissural fibres. Dr. Thomas maintains
the latter to be few in number, most of them being ex¬
pansions of the cerebellar peduncles. In the succeeding
chapters the anatomy of the cerebellum is minutely described,
—in fact, no part is left unexplored, advantage being taken
not only of coarse anatomy, but of experiment and the
teaching of clinical cases. The origin and terminations
of afferent fibres is first taken up, the various columns
of the cord, i. e . the direct cerebellar tract, the tracts of
Gower, Goll, and Burdach, being traced upwards through the
medulla, inferior cerebellar peduncle, &c., to the cerebellum.”
Some fibres of the antero-lateral descending tract are traced
as far as the pons only, but recently Mott has established
their connection with the cerebellum. In Dr. Thomas's
experiments Dr. Marchi's method was used. This is one
of the most important pieces of work in the book, and
ample space is allotted. A page or two is allotted to
the middle peduncle, and then begins the description of
the efferent fibres. This takes up some fifty pages, with
description of experiments and clinical observations, and
demonstrates that there is no part of the central nervous
system that is not directly or indirectly connected with the
cerebellum. One or two new efferent groups of fibres are
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described ; a retro-peduncular fasciculus, uncrossed; a “ fais-
ceau en crochet; ” and a fasciculus joining the corpus denta-
tum with the pons. Dr. Thomas is deserving of great praise
for his lucidity and clearness on a most difficult subject, his
chapters on anatomy being most readable. In Chapter V the
histology as demonstrated by the methods of Golgi and
Ramon a Cajal is briefly touched upon, but here we notice an
absence of any mention of much important work that has
been done in this country within recent times. The two
points laid stress on are that all cells seem to be arranged
in such a manner as to influence Purkinje’s cells, and that the
close interlacing of the arborisations of the latter seem devised
to admit of a wide distribution of any one impulse. The
symptoms of cerebellar disease in man, atrophy, sclerosis, &c.,
are detailed in the next section. This occupies much space, a
large number of clinical cases and post-mortem records being
given. Chapter VII deals with the results of experimental
destruction, first of various parts and then of the whole. The
animals were anaesthetised by intra-peritoneal injections of
chloral and morphine. This part is well illustrated, pictures
of the various attitudes taken by the dog being given. Ex¬
perimentally, Dr. Thomas shows that each half of the cere¬
bellum presides over the side of the body to which it belongs.
The cerebral hemispheres share with the cerebellum the
function of equilibration, more especially with regard to the
head and anterior extremities; and the vermis presides over
the posterior extremities and trunk.
As a result of all these anatomical, experimental, and clinical
observations, Dr. Thomas in his last chapter states the
“theorie anatomo-physiologique ” of the cerebellum. He
states that the theory of Flourens, Bouilland, and Luciani is
the correct one. The cerebellum registers impressions from
the cerebrum and the periphery. The wide connection of the
cerebellum with peripheral organs such as those of sight, hear¬
ing, touch, &c., supports this. When one group of muscles is
put into play, then the cerebellum puts others in force, and
produces the requisite muscular tonicity to make the movement
co-ordinate. The cerebellum is not the seat of any particular
sense, but of a particular reaction, put in force by diverse
stimuli. This reaction is used for the maintenance of equili¬
brium in the various forms of attitudes and movements,
whether automatic, reflex, or voluntary. This destruction
or severing of certain connections prevents the cerebellum
from putting in force certain muscles, and the result is
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inco-ordination of the part in connection with the damaged
part.
Dr. Thomas is to be congratulated on an excellent work,
the result of much patient research and compilation. Un¬
doubtedly the best part of the book is the anatomical section.
The book suffers somewhat from repetition and numerous
resumes. Like many foreign works, it lacks an index, but the
orderly way in which the subject-matter is arranged com¬
pensates somewhat. It is well illustrated, most of the drawings
being original.
De V interdependance functionelle des centres corticaux du
langage. By Dr. Fitz Sano. [Journal de Neurologic et
d’Hypnologie, 1897.)
Sano begins his paper by a detailed account of an inter¬
esting case of aphasia resulting from softening of the posterior
third of the superior temporal convolution, and the poste¬
rior two thirds of the supra-marginal convolution of the
left side. The patient suffered from word-deafness, alexia,
agraphia, jargonophasia, and paraphasia, and although he
could repeat words that were said to him he soon forgot
them. Sano accepts the usual opinion as to the position of
the visual, auditory, and motor speech centres, but does not
think that there is a special writing centre. His view of the
physiology of speech is that there are originally the sensory
motor centres, which are in early life connected directly with
each other by association fibres (the primitive paths). As
life progresses further paths develop, leading to certain
co-ordinating or association centres, where the various im¬
pressions received are co-ordinated into ideas. Speech is
the result of the combined action of all these centres, and
injury to any one of them impairs speech, since the motor,
visual, auditory, and co-ordinating impulses are all equally
necessary for the perfect conception of words. Sano does
not think there is any necessity for the hypothetical
ideation centre, since the “idea” of the word is simply
the result of the co-ordination of certain motor acts and
sensory impressions. Of these centres the auditory is the most
important, since hearing is primordial, and speech and writing
are subsequently acquired by the memory of the sound of
words.
Sano accepts the usual subdivision of aphasia into motor,
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sensory, and complete. Like Dejerine, he distinguishes a
pure aphasia, when the centre is left intact but the centri¬
fugal or centripetal fibres are destroyed. In such case there
may be word-blindness, or word-deafness, or incapacity for
speech, but intelligence and internal speech are unaffected,
since none of the centres have been attacked. He is of the
opinion that transcortical aphasias, resulting from lesions of
the associating fibres between the centres, are purely theore¬
tical. Anatomical grounds for his views are put clearly for¬
ward, and there are accounts of the modes of partial recovery
and partial preservation of speech in cases of aphasia.
In addition there is a criticism of the various schemes of
the mechanism of aphasia advanced by Kussmal, Bastian,
Crocq, and others.
The paper is one of great interest, and should be read in
the original, as it is not one that can be easily condensed
into a digest.
Les localisations motrices dans la moelle lumbo-sacree. By Fitz
Sano. Societe Beige de Neurologie, 1897.
In this paper Sano advances the opinion that there are
within the cord certain definite groups of cells, which act as
nuclei to certain muscles or groups of muscles, and that
these nuclei are as distinct and invariable as, for instance,
the subdivisions of the oculo-motor nucleus into groups of
cells supplying the various ocular muscles. His opinion is
supported by the examination of the spinal cord in four
cases of amputation in the human subject. He found that
there were definite changes in certain groups of nerve-cells
in the anterior horn. These changes were similar to those
described as reaction d distance by M. Marinesco and others,
except that having reached a certain stage of chromatolysis
they remained without further alteration for seven months
in one case, and beyond being eccentric in position, the nucleus
continued healthy. Sano was further supported in his
opinion by the results obtained by injecting the vessels of the
cord of a cat. He found that there was distinct evidence that
many of these groups of cells or nuclei had terminal vessels
and definite blood-supply. The nuclei which Sano was able
to localise were as follows :—The muscles of the foot and leg
are supplied by a nucleus in the dorso-lateral group of the
anterior horn cells between the fourth sacral and third lumbar
segments; the glutei by an antero-lateral group between the
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second sacral and the upper border of the fifth lumbar; the
quadriceps femoris by. cells in the antero-lateral group,external
to those for the quadriceps, between the fourth and second
lumbar segments; the abdominal muscles by cells iu the
external angle of the cord in the first lumbar segment and
higher; the lumbo-sacral muscles probably in the median
group of cells in the upper lumbar segments.
Sano found, further, that the cells of the intra-spinal neurons
showed reaction a distance after an injury to the cord in the
same manner as do those whose axis-cylinders pass into the
peripheral nerves when the nerve is injured.
The Localisation of Headaches and Sick Headaches . By H.
Bendelack Hewetson, F.L.S., &c. Simpkin, Marshall,
and Co., London.
This small work of 140 pages contains Dr. Hewetson's
account of the relation of errors of refraction to headaches
and sick headaches, and also to digestive disorders occurring
between the attacks of the latter. The first chapter is largely
made up of illustrative cases from the writer's practice. The
second chapter is devoted to the discussion of the relation of
various general neuroses to ophthalmic defects. The third
chapter contains an account of the headaches due to carious
teeth, pathological conditions of the naso-pharynx and ear
and other local lesions.
None of the views are particularly new, but they are pre¬
sented in an interesting and suggestive manner. The work
concludes with a series of diagrams, in which the position of
the headache produced by the various causes is indicated in
colour. It would be interesting to know if this precise
localisation accords with the experience of other observers.
Text-book of Nervous Diseases ; being a Compendium for the
Use of Students and Practitioners . By Charles L. Dana,
M.D. Fourth edition, revised and enlarged. 246 illus¬
trations. London : J. and A. Churchill. Price 20s.
Dr. Dana is to be congratulated on the rapid succession of
the four editions of his text-book. When this volume is
compared with the first edition of 1892 it is seen how much
care and trouble have been expended in bringing the work
up to date, and in rendering it one of the most readable as
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[July,
well as one of the best informed works on nervous diseases.
It is written in a style that is at once crisp and lucid. Ex¬
ception may be taken to occasional lapses into colloquial
Americanisms, and to an occasional looseness of statement
which is out of place in a work of this high class.
The various departments of the subject are so clearly
arranged as to be readily consulted by the busy practitioner,
and at the same time the work is one eminently well suited
for the senior student of neurology. If we were to pick out
any portion of the work as being specially valuable, we should
mention the chapter on functional diseases, and in particular
the account of neurasthenia and its treatment.
The author has written on this subject with a fulness of
knowledge and a breezy common sense which render his
account of exceptional value. On the other hand, the trophic
and vaso-motor disorders are too briefly described, myxoedema
getting little over one page, and cretinism a still smaller
space. The other sections on diseases of the cord and brain
are very full, and they are well illustrated, a large proportion
of the diagrams being borrowed (with acknowledgment)
from the works of others. The book concludes with two
very valuable chapters on the disorders of sleep and on neuro¬
logical therapeutics, the latter being characterised by a pre¬
ciseness and a detail which will render it particularly
acceptable to the busy practitioner.
Metopismus. By G. Buschau. Real-Encyclopadie der ge -
sammten Heilkunde. Berlin, 1897.
Dr. Buschau’s paper is devoted to a careful consideration
of the frequency and the cause of persistence of the frontal
suture (or metopism). In the first part of the paper it is
noted that the condition is present in from 5*9 per cent, to
12*5 per cent, of the natives of the various European nations,
but that in the coloured races the percentage is very much
lower, the average being about 2 per cent. The position,
which is not exactly in the middle line, and the associated
peculiarities of the other parts of the head are then described.
Buschau concludes by stating that the persistent frontal
suture is a sign of intellectual superiority, not a reversion to
an inferior type, and that it is probably due more to the
active growth of the cerebral hemispheres than to abnormal
weakness of the frontal bones.
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The New Psychology . By E. W. Scripture, Ph.D. (Leipzig),
Director of the Yale Psychological Laboratory (The
Contemporary Science Series). London: Walter Scott,
Ltd., 1897. 8 vo, pp. 500. Price 65 .
This ambitious book of Dr. Scripture's is more an attempt
to bind together in the form of a new science the results
of experimental psychology and its allied subjects than to
state any new method or fact. There is little within recent
times that has aroused so much controversy as the attempt to
elucidate and illuminate the region of the mind by active
experimental and other means. Psychologists for long have
maintained this region sacred from the heretical attempts of
the physiologists. But in spite of this there has been a
steady progress and advancement, much of it done, as the
book explains, quite unconsciously.
Centuries ago all our sciences consisted of speculation, with
its worthy associates, superstition and the supernatural,
together with the superadded black incrusting of the pre¬
judices, bigotry, and religion of the dark ages. Gradually,
in the light of experimental inquiry, the dark clouds have
lifted, speculation has been replaced by observation and
experiment, and to-day the various branches of science are
monuments marking the progress of man. That psychology
has lingered behind none will deny, and the reason why is
not difficult to find, the tenacity with which the majority
have held to their tenets and the great difficulty in investi¬
gating the subject experimentally being the chief stumbling-
blocks. Dr. Scripture's book errs, if anything, in being too
previous, and its title is more attractive than correct. We
are of the opinion that there is not enough material at present
on which to build a “ new psychology," and hardly sufficient to
forecast one. All Dr. Scripture’s book does is to summarise,
and put in an easily obtainable form, facts which go to show
that in the future there is a likelihood of a vast change
occurring in our notions of psychology.
The book is divided into five parts, with the addition of an
appendix. Part I deals with “ Methods " generally; Part
II with “ Time;" Part III with “ Energy; " Part IV with
“ Space;" while in Part V we find the position of “ Psy¬
chology, Past and Present," taken up, including a short
account of the work of Fechner, Helmholtz, and Wundt.
The first chapter is a fair sample of the way Dr. Scripture
treats the subject. In dealing with “ Observation " he dis-
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[July,
cusses the difference between the two rival schools of Intro-
spectionists and Psychu-physiologists. He carefully states
both sides, and then, attempting a reconciliation, yields to
both what they strive for. To the Introspectionist he yields
the point that the examination of brain processes is not neces¬
sarily the examination of mental processes. Both sets of
phenomena are inseparably connected and parallel. Yet
mind and body are not the same, and observation of the brain
is not observation of sight, sound, pain, volition, &c. No
physiological experiment can ever reveal a mental act. Both
schools have the same faults and inaccuracies. A mean must
be met. The Introspectionist would maintain a true science
of mind apart from physiology, and rightly so. The Psycho¬
physiologist would replace the inaccuracy of the Introspec¬
tionist with truly scientific work, and rightly so. The new
psychology, he claims, gives to both what they wish—a purely
mental science founded on careful experiment and exact
measurement.
The various other chapters are lucidly written in spite of
innumerable technicalities, and are of absorbing interest; but
we are afraid the book will not appeal to the general reader,
as some parts will prove quite unintelligible to all but those
'who have had the benefit of some previous knowledge on the
subject. The book is well illustrated with 124 diagrams, &c.,
many original, some borrowed; and an excellent general
index is added.
Le Subconscient chez les Artistes , les Savants , et les Ecrivains .
Par le Dr. Paul Chabaneix. Paris: Bailliere, 1897.
Pp. 121.
This book belongs to the department of psychology dealing
with genius, a region which has seldom been cultivated by
English investigators, but has long been attractive to French
psychologists and alienists. The author is a pupil of Professor
Regis, of Bordeaux, who writes a short preface in which he
thus states the conclusion of the book :—“ It proves that the
personality of men of talent and genius, so variously interpreted,
is composed rather of nervous erethism than of insanity, and
that great creators are often not insane, but waking sleepers,
lost in their subconscious abstraction,—in a word, beings
apart, living in a starry dream.” That is really Dr. Regises
own belief, and though clearly shared by the author, the
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587
latter is evidently not much concerned with arguments or
conclusions. His book is simply a classified collection of facts
bearing on his title. In part, these facts are merely the
old familiar stories concerning Coleridge, Goethe, Shelley,
Tartini, &c., usually repeated from second-hand sources, for
Dr. Chabaneix’s knowledge of literature appears to be mainly
confined to his own language. The really new and valuable
part of the book is made up of the numerous interesting
confessions which the author has extracted from various
French poets, novelists, painters, musicians, &c. A few of
these communications, which will no doubt be used by many
subsequent writers, may here be mentioned. Mdme. Rachilde,
a remarkable contemporary novelist, appears to owe much to
dreams which persist into the waking state. As a young girl
she regarded her dreaming state as at least as real as her
waking state, and she traces her literary activity, which began
at the age of twelve, directly to her dreams. Since marriage,
she adds, her dreams have become more confused, but they
have gained in method, and by looking at particular objects
before falling asleep she can nearly always succeed in con¬
trolling the course of her dreams. Nearly all her books were
first seen in dreams, “ and very often when I add chapters on
my own authority,” she remarks, “ they are not the best.”
M. Remy du Gourmont, another author of reputation, has
often found that he cannot distinguish reality from dreams.
M. Camille Mauclair, a critic of high standing, writes :
“ I may say that not only the ideas and the plan of my book,
but even the least metaphors, are dictated to me in a con¬
tinued dream. Never, either in prose or verse, do I make
any alteration in a manuscript,” and this not from careless¬
ness, as he has a passionate love of his work, but because he
finds that no other method succeeds; the only explanation
he can suggest is that he is really working when asleep.
Raffaelli, the painter, remarks that he sleeps badly at night,
but on the other hand is seldom completely awake during
the day. Interesting communications are also furnished by
M. Sully Prudhomme, the poet. The general tendency, as
the author remarks, is to show that the dream-state is the
point around which the subconscious actions of artists and
men of letters revolve, and that all conditions in which the
subconscious reveals itself are analogous-to dreams.
XLIV.
39
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Reviews.
[July,
Le Suicide: fitude de Sociologie. Par Emile Durkheim.
Paris: Alcan, 1897. 8vo, pp. 462. Price 7 f. 50 c.
The ablest and best known studies of suicide have
hitherto been written from a psychiatric, psychological, or,
at all events, medical standpoint. The interest of the present
very able and detailed study of the matter is that it is the
work of a writer who desires to be above all a sociologist,
and who, as such, has gained a distinguished reputation
throughout Europe, It is true that Professor Durkheim
invokes the assistance of history, ethnography, and statistics
— ei without which sociology can do nothing ”—but he re¬
gards suicide as, above all, a social manifestation, and he
considers that the sociologist deals with realities as definite
and solid as the psychologist or the biologist.
The author classifies suicides into three main classes, as
(1) egoistic, (2) altruistic—chiefly found in lower stages of
civilisation,—and (3) anomic, or those due to sudden social
disturbances, like an economic crisis. He considers that
this classification itself indicates the chief causes of suicide.
But before expounding it he discusses with great care
and acuteness the extra-social causes usually put forward
to account for suicide—psychopathic conditions, race and
heredity, climate and temperature, imitation,—and seeks to
determine the part, if any, possessed by these alleged factors
of suicide. It is only necessary here to state briefly the
outcome of the chapter on the psychopathic factor.
If suicide is always a form of insanity, the author remarks,
it must be an individual manifestation, not a social manifes¬
tation. He quotes Esquirol, Falret, Moreau de Tours, and
others who so regarded it, and then argues that if suicide
is a form of insanity it must be a monomania, and he
proceeds, in approved fashion, to demolish the whole concep¬
tion of monomanias. But it might be claimed that, though
not a special form of insanity, suicide only occurs during
insanity. It certainly may be an episodic “ syndrome ” of
insanity; is it always so ?
Such a conclusion, the author remarks, would be precipi¬
tate. Because an act may occur during insanity, and even put
on a special character then, it does not follow that the insane
man does not share such aptitude with the sane man. To
test this he proceeds to classify suicides taking place during
undoubted insanity, and finds that they mostly belong to
four classes : (1) maniacal suicide, (2) melancholic suicide.
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1898.]
(3) obsessional suicide, and (4) automatic or impulsive suicide.
In all these groups there is either no motive at all, or a purely
imaginary motive, and the author argues that it is an abuse
of words to attempt to thrust into these insane classes a suicide
which has its motive in real and reasonable grounds. Even
Esquirol, he points out, admitted certain exceptions, and the
door once opened it is difficult to close it. But granting
that suicide is not necessarily a form of insanity, it may be
asked, do not other slighter psychopathic conditions, such
as neurasthenia, play a part in producing it ? Professor
Durkheim admits that a general neuropathic or neurasthenic
state—which he describes very graphically—presents the
psychological type most frequently associated with suicide,
but with that admission the facts are still not accounted for;
if suicides are in ratio with the general neuropathic tendency,
then, since there are by accumulation a greater number of
insane women than of insane men, suicide should be com¬
moner among women. Again, the Jews, who are specially
liable to insanity and other nervous affections, rarely commit
suicide, and there is great difference in different countries
and among different religious communities. The countries
where there are fewest insane are, indeed, on the whole,
those where there are most suicides—Morselli’s contrary con¬
clusion, it is pointed out, being due to mixing up idiots and
the insane. The suicide rate has therefore no definite relation¬
ship to the tendency to insanity, nor, by induction, to a neuro¬
pathic diathesis, and so vague an influence cannot be accepted
as completely accounting for so definite a social fact as the
suicide rate. In a similar manner the author deals with the
alleged influence of alcohol, and by the help of four maps of
France comparing the incidence in the different departments
of suicide, of the consumption of alcohol, of crime due to
alcohol and of alcoholic insanity, he shows that there is
no tendency to coincidence. The conclusion of this inter¬
esting discussion is that while degenerescence, in its various
forms, constitutes a soil eminently suitable for the action of
the causes which determine a man to kill himself, it is not
itself one of those causes.
Leitfaden derphysiologischen Psychologie. Yon Professor Dr.
Th. Ziehen. 4th edition, with 23 figures. Jena:
Fischer, 1898. Pp. 263. Price 5 mk.
In reviewing the English translation of this introduction
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to physiological psychology some years ago, we pointed out
its value for the English reader as due in part to the fact
that Professor Ziehen works along familiar English associa-
tional lines, instead of following Wundt, and in part to the
fact that, as an alienist who was impelled by the study of
abnormal psychology to investigate normal psychology, the
author is specially familiar with the needs of the alienist.
Various works on psychology, both original and translated,
have appeared in English since then. If we are to judge by
the output there must, indeed, be a special demand for such
works at the present time; but it cannot be said that Pro¬
fessor Ziehen's work has lost its value. It must, indeed, be
said that he is a very cautious, almost an old-fashioned
guide ; but notwithstanding the activity with which psycho¬
logists are now following up many lines of detailed research, it
cannot be claimed that on the larger issues they have yet
reached any very complete unanimity, so that the most reli¬
able guide is not necessarily the guide who is most ready to
follow up the newest paths. Professor Ziehen has, however,
as his foot notes show, made some attempt to keep up with
recent literature, and he has, in revising the chapter on visual
sensations, obtained the assistance of Professor A. Konig
with reference to physiological optics. This fourth edition
of his work, in its much enlarged form, may be cordially re¬
commended as a reasonably clear and intelligible statement
of physiological psychology on an empiric and associational
basis.
Uric Acid as a Factor in the Causation of Disease. By
Alexander Haig, M.A., M.D., F.R.C.P. 4th edition,
with 65 illustrations. London: Churchill, 1897. 8vo,
pp. 698. Price 12s. 6d.
When Dr. Haig's book first appeared in 1892, we called
attention to the remarkable character and interest of this
“ contribution " (as the author now terms it on the title-page)
“ to the pathology of high blood-pressure, headache, epilepsy,
mental depression, paroxysmal hemoglobinuria and anemia,
Bright's disease, diabetes, gout, rheumatism, and other dis¬
orders." Since 1892 Dr. Haig has greatly developed and
elaborated his main thesis, extending or guarding his posi¬
tions at many points. The book has doubled in size, and the
interest and variety of its contents are greatly increased.
It cannot, however, yet be said that the field Dr. Haig
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1898.]
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591
is so enthusiastically cultivating has been definitely con¬
quered for medical science. He speaks with the fervent
conviction of one who has experimented chiefly on himself,
and who finds the evidence of his arguments in his own ex¬
perience. But his work still arouses divided opinions. On
the one hand the light which this uric acid theory throws on
a number of perplexing conditions has carried conviction to
many experienced and sagacious observers (like the late Sir
John Bucknill), while, on the other hand, some expert inves¬
tigators (like Dr. Luff) deny the validity of many of the facts
here set forth. It may be added that certain imperfections of
method in Dr. Haig's earlier work, together with generalisations
that were, perhaps, premature, and in this latest edition certain
intemperance of expression with regard to eaters of meat
—which he regards as the chief source of uric acid, and
therefore the toxic source of innumerable evils—have created
in many minds a prejudice not yet broken down by the large
amount of work here presented.
Even those, however, who reserve their judgment as to
Dr. Haig’s main position, must admit the value of his detailed
work, and the extreme suggestiveness of many of his ob¬
servations. He has much to say of the psychic aspects of
menstruation in relation to uric acid, which here plays, he
considers, a large part. Again, he supplies us with what
may be called a physiological theory of the summer rise in
the incidence of suicide and crime. We already have the
widely prevalent cosmic theory, which attributes this rise to
temperature, and Professor Durkheim’s recent sociological
theory, according to which it is due merely to increased
social activity during the long days. Dr. Haig now argues
that it may be entirely accounted for by the annual fluctua¬
tions in uric acid excretion and the mental state thereby
induced. Even the experiences here recorded of the results
of special dieting will be found useful, though we may not
all be prepared to believe that by feeding criminals on a diet
free from uric acid and related substances we should sensibly
diminish the prevalence of crime.
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Reviews.
Quelques Considerations snr la Propagations des Excitations
dans le Systems Nerveux . Par M. Benedikt (de Vienne).
Extrait du Bulletin de VAcadernie de Medecine, January
4th, 1898.
M. Benedikt in this short lecture aims rather to elucidate
the manner in which impulses travel, than to explain the
nature of the impulse itself, although with regard to the
latter he is by no means silent. The first half is taken up
with a discussion of the relation between physiological and
pathological impulses and their propagation, and as a pre¬
liminary he states what he terms some fundamental laws of
biomechanics. These laws are very involved, and difficult to
follow, but the main fact one gathers is that there is an
intimate co-relation between all processes of evolution, deve¬
lopment, and growth, and that pathological impulses broadly
follow similar rules, but not entirely. In support he gives
several examples.
He pleads very earnestly for the recognition of the fact
that there are many grounds for the belief that all nerves are
conductors in a double sense, and that they are capable of
carrying impulses both upwards and downwards, in the same
way that in telegraphy the same wire can carry messages
both to and fro. He states that having regard to our pre¬
sent knowledge of the anatomy of the nervous system, we
ought rather to be more astonished at the fact of isolation,
than at the fact of irradiation of nerve impulses.
The other half is limited to the transmission of morbid
impulses. These he divides into two classes; functional,
which are similar to physiological ones, and those which are
the result of actual anatomical change, such as secondary
growths in the brain.
These progress not only by continuity and contiguity, but
by incoherent diffusion. These latter he likens to impulses
in a state of intoxication. These incoherent impulses propa¬
gate themselves widely, not sticking to beaten tracts, but
taking unusual paths and thus spread themselves widely in a
mysterious sort of manner, the exact mechanism of which is
unknown. Further, he states that the passage of these
impulses may result in areas of softening and degeneration.
Many examples are given in support, and many of the sym¬
ptoms of cerebral tumour are put down to the same cause ;
usually explained, however, on the plea of increased intra¬
cranial pressure. This latter view he states to be in oppo-
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598
sition to all principles of mechanics. “ It is convenient,”
remarks he, u and it is therefore become common/’ We are
afraid the facts of morbid anatomy do not give him an
unqualified support. His views are clearly put, closely
reasoned, but are not convincing.
UHeredite Normale et Pathologique. Par Ch. Debierre.
Price 1 fr. 25 c.
This monograph appears as fourth in a series which is
designed to keep us up to date in the controversial and
novel questions of medicine, surgery, pathology, and biology.
The number before us admirably fulfils its purpose. Though
perhaps we might expect from such a series that the authors
would have difficulty in attaining the purely historical point
of view, we cannot complain that Professor Debierre errs
after the manner of partisans. He presents us with a fair,
lucid, not too critical account of heredity as the subject pre¬
sents itself in these times.
It would be absurd to criticise in detail a work which is
really a review of the question with which it deals. To do
so would be to open up argument over every page. It may
suffice to say that the author does not beg the questions
which he raises, and we may add that on the whole he ex¬
pounds them from what is now the orthodox point of view.
Heredity is simply defined—the transmission to offspring
of the characters and qualities of its ancestors. After a few
sentences upon“les modes de l’heredite,” Professor Debierre
goes on to discuss, in two sections, physiological and patho¬
logical heredity. In the former of these two sections, the
transmission of individual variations, male and female con¬
tributions to procreated character, the heredity of sex, effects
of consanguinity, atavism, the transmission of mental quali¬
ties, the origin of species, &c., are touched lightly but with
suggestion. As regards psychical transmission, the author,
as authors will, seems to fail to appreciate sufficiently the
effect of an evolving environment.
In the pathological section a similar range of subjects is
discussed—teratology, neuropathy, degeneracy, diathesis and
predisposition, neoplasms, infection and immunity, alcoholic
and other vicions excesses, &c.
The next section, which is more controversial, deals with
the theory of the mechanism of heredity. The processes, so
far as known, before and after fertilisation, are admirably
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[July,
summarised; the general fact of the continuity of the germ-
plasm is admitted; its complete physiological isolation is not.
The various theories of the essential mechanism—from Hip¬
pocrates to Weismann—are skilfully reviewed. Professor
Debierre, naturally, has his kick at Weismann’s edifice of a
geometrical progression of specialised determinants; but,
notwithstanding, gives Weismann full value in his “ con¬
clusions.”
Acquired Immunity . By Dr. Archdall Reid. ( Lancet ,
September 11th, 1897.)
No one who is a serious student can afford to ignore the
writings of Dr. Archdall Reid on all questions relating to the
li present evolution of man; ” and this address is certainly an
important contribution. In it he explicitly discards certain
previous theories as disproved, or at least discredited:
Pasteur’s idea that the micro-organism of disease perished
when it had exhausted its essential pabulum within the body ;
Chauveau’s, that the micro-organism developed as a by-pro¬
duct some substance which was fatal to its own life, as yeast
develops alcohol, which kills it; Behring’s, that the human
organism develops an antidote to the toxins of disease; and
Fraser’s modification of the last, that in the human body
the toxins become transformed, and that the antidotes are
part of the transformation. His own theory of immunity he
calls a modification of Metschnikoff’s general theory of pha¬
gocytosis. The addition, I gather, which is Reid’s own, is
that, quoad disease, the method of phagocytes and other
cells is to secrete enzymes which can resist micro-organisms
and their toxins by digestion either at a distance or at close
range.
In the early part of the paper, which is more or less
destructive of previous theories, we find the fallacies usual
to a work which pursues the hypothetical rather than the
physiological method. We find the usual weakness of asking
an idea to do duty for every case instead of for only some
cases. It is the habit both of exponents and of critics of any new
idea to kill it by asking it to carry a burden which there is
no need for it to bear. In this case, for example, though we
have no doubt that Dr. Reid’s account of immunity is fitted
for wider application than any other, we have also little
doubt that there are diseases immunity from which can be
explained on Pasteur’s theory, though we are told that that
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595
has been disproved—that Chauveau’s will explain other
cases, Behring’s others, Fraser’s others, Metschnikoff’s others.
We may even believe that, some years hence, there will be
facts brought to light which Dr. Reid’s comprehensive theory
will not explain. He culls facts from such various diseases
as syphilis (a disease, to my mind, quite apart from all
others), anthrax, rabies, smallpox, measles, scarlet fever, &c.
To seek for a common ground for immunity from all these
and from many more is to imply that they all kill by the
same mechanism, which is an evident untruth.
Again, we have the old anthropomorphic fallacy. Despite
his recognition, in his magnum opus, that the micro-organisms
of disease have a universe of their own outside of the human
body, we find Dr. Reid, in this lecture, writing as if they
came into existence with an inspired intention of infesting
man. He writes as if the organisms whose activities in the
human body denote disease had been evolved under natural
selection with special relation to inhabitation of man. On
the contrary, in the light of evidence which proves another
environment as normal to such organisms, we may believe that
the infection of man is an accidental or incidental experience
for them and not the end and aim of their existence. In short,
Dr. Reid implies a teleology with man as the centre of life
rather than with every life as its own centre. If we are to
be anthropomorphic let us say that when organisms of the
marshes find themselves confined and cabined in the human
blood-stream, probably no one is more surprised than the
intruders, and that we cannot judge from their activities
there what they are capable of on their native soil.
But when we come to Dr. Reid’s exposition of his view of
the mechanism of phagocytosis in opposing disease, we cannot
but be convinced of the value of his contribution. Starting
from Fraser’s experiments, he finds that various somatic cells
are capable of secreting something in the nature of a ferment
which antagonises micro-organisms and their toxins. The
full development of such digestive processes constitutes the
resistive power of the human organism to various diseases.
If this intra- and extra-cellular digestion of the toxin-albu-
moses, &c., is complete, the host is immune from the attacks
of the disease germs and their toxins. We have two sides to
the question really, although, perhaps, Dr. Reid does not
separate them with sufficient distinctness. We have what we
may term the offensive and the defensive function of cells in
resisting the micro-organisms of disease and their toxins.
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To the mechanism of offence Dr. Reid makes a distinct con¬
tribution, in accounting for immunity as a development of
the toxin-digesting function of cells. The defensive function
he admits. He regards the process of habituation or toler¬
ance as essential to the efficacy of the offensive function.
You cannot hope to secure a victory if your men are killed
before'they use their weapons. But Dr. Reid does not con¬
tribute to the physiology of habituation. He speaks of an
“ increased power of physiological resistance in the cells,”
but that is only a statement of tolerance, and he does not
give us any help in understanding it.
This distinction is vital, and the mechanism of tolerance
is probably of more practical import than the mechanism of
toxin-destruction. You may avoid a poison, as the teetotaler
does; you may develop a ferment which will disintegrate the
alcohol, let us say, and split it up into innocuous elements;
or your cells may develop a habit of tolerance and not suffer
from the contagion of alcohol. We should like to know
Dr. Reid's views on this last possibility in the process of
immunity.
Sulla Dignita Morphologica dei Segni detti Degenerative.
(On the Morphological Value of the So-called Signs of
Degeneration.) By Dr. V. Giufforda-Ruggeri. Rome :
E. Loescher and Co. Pp. 117.
This recent work is divided into three chapters, as follows.
The first is largely historical, and treats in a philosophical
spirit of the general relationship between somatic and psy¬
chical abnormalities; then more particularly of this rela¬
tionship as it obtains in the case of the insane, in that of
criminals, in that of prostitutes, and of men of genius. The
second chapter deals with the various anatomical stigmata;
these are described in fair detail. The third chapter is
concerned with three questions:—(a) What abnormal signs
predominate in the male sex, and what in the female, inde¬
pendent of the psychosis? ( b ) What abnormal signs pre¬
dominate in the male and female sex respectively in the
various psychoses ? (c) What abnormal signs predominate in
the graver forms of psychical degeneration, and what in the
less serious, independent of the sex ? To these questions
the author furnishes replies drawn from his observations
made on a large number of patients at the Provincial Asylum
of Rome. Some useful statistical tables, dealing with these
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points, add to the value of this chapter. The work is closed
by a lengthy list of references to writings quoted by the
author, which bears testimony to his wide experience of the
literature of his subject, and much enhances the value of this
timely contribution to the literature of degeneration.
Rapports de VAlcoolisme et de la Folie. By Dr. Henry
Darin. 8vo, pp. 120. Price 3 fr.
There are many useful things in Dr. Darin's brief work, of
which the most useful is his point of view. He succeeds, as
few of us do, in getting a view of drunkenness wider than
that of pathology. He regards it as it is, a social blot, a
national vice, first; a lesion or series of lesions later. We
are not sure, however, that the mixture of medicine and
economics is palatable, or that it is easy of digestion. We
should prefer more exclusive courses.
He deals at considerable length with the increased produc¬
tion and consumption of alcoholic liquors; the vital statistics
of drinkers, drunkards, and abstainers ; the various forms of
alcoholic poison; the various lesions ; the relation of alcohol
to infant mortality, and its effect on embryonic tissues;
alcohol and insanity; alcohol and suicide. There is an espe¬
cially interesting discussion of the importance of alcohol in
the aetiology of general paralysis.
The practical question, the prophylaxis and treatment of
drunkenness, receives the attention it deserves, and more
than it usually receives. Considerable space is devoted to
the relation of the State to the vice—high licences, State
monopolies, the Gothenberg and Bergen systems, prohibi¬
tion, penalisation of drunken offences, supervision of the
quality of drinks, &c. More important, however, is Dr. Darin's
contribution on the medical and moral treatment of the
vice—how retreats should be organised and conducted, what
powers they should have, what is essential in the way of
control, and how the moral rehabilitation is to be effected.
There is not enough attention paid to the analysis of the
various characters of drunkards—a discriminating study,
without which the treatment of the vice will fail, as the treat¬
ment of insanity fails, for want of intimate diagnosis.
All over, the work is valuable and suggestive, although, as
has been said, rather too diffuse. It is high time that some
one should edit an encyclopaedia of drunkenness. An editor
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of Magnau alone—so sound and oft-quoted an author—would
be a most useful person. Dr. Darin, like every one else,
makes full use of him and of other writers, and furnishes a
considerable bibliography.
Les Troubles audit ifs dans les Maladies nerveuses . Par le Dr.
F. J. Collet. Paris : Masson et Cie., Editeurs. Pp.
182. Price 2 fr. 50 c.
While the condition of the eyes is usually described in the
notes of cases pf nervous diseases, it is quite an exception to
find any reference to the state of the ears and hearing; and
one of the reasons which have led to the publication of this
small work is to collect a number of positive observations in
which the condition of the auditory organs has been a help
in diagnosis, and to show that a systematic examination of
these organs may be of great importance in certain obscure
cases. Moreover, by an analysis of clinical cases, the author
is able to deduce certain points of great interest in connec¬
tion with the bulbar and cortical acoustic tracts.
One of the reasons probably why hearing is not more
generally tested in nervous cases is the time required for the
investigation ; no one method of diagnosis is sufficient, and it
is only by a combination of various tests {e. g. Weber, Rinne,
&c.) that we can conclude that an affection of hearing is
dependent on disease of the middle ear or the internal ear,
for instance; while the diagnosis between a lesion of the
internal ear or of the auditory nerve itself is often not prac¬
ticable.
The main bulk of the book is devoted to a consideration of
the auditory signs and symptoms which are usually, or may
be, associated with the various nervous diseases (hydroce¬
phalus, cerebral tumour, meningitis, softening of the brain,
tabes, &c.). The general effects of cerebral tumours on the
auditory nerves are dealt with in an interesting manner in
Chapter 3 ) and in Chapter 4 is discussed the important
question of the function of the corpora quadrigemina. The
conclusions deduced from an analysis of cases recorded in
this connection are “ that the posterior corpora quadrigemina
act as a relay along the acoustic tract, and that at this level
the decussation of the eighth pair of cranial nerves is already
completely accomplished.”
In Chapter 6 we find an interesting confirmation of Helm-
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holtz's theory of audition based on the clinical observation of
cases of meningitis affecting the labyrinth.
Chapter 8, “ Auditory troubles in tabes,” is another im¬
portant chapter. It is well to remember here that chronic
dry catarrh is frequently present in locomotor ataxy, and has
no doubt often been mistaken for true nerve deafness. The
possibility of the presence of an anatomical substratum to
explain the occurrence of hallucinations of hearing in these
cases is wisely emphasised. From the association of sensory
and trophic lesions of the face with chronic dry aural catarrh
in tabes one is led to conclude that the aural lesions are due
to some affection of the fifth nerve ; Gelle and Laborde's
researches are of great interest in this relation.
In Chapter 10 there is a discussion of the question of a
neuro-paralytic otitis media, analogous to neuro-paralytic
keratitis, and arising like it from some lesion of the fifth
nerve.
In the chapter on neurosis we find an account of the
auditory troubles in hysteria, epilepsy, megrim, &c.
Altogether Dr. Collet's little book is a useful addition to
that valuable series of monographs, the * Encyclopedic
scientifique des aide-memoire.'
La Responsabilite medicate; Secret medical. Declarations de
Naissance ; Inhumations ; Expertises midico-legales.
Par P. Brouardel. Paris : Librairie J. B. Bailliere et
fils, 1898. Pp. 456. Pr. 9 fr.
Professor Brouardel has done well to publish this collec- ,
tion of lectures on medical jurisprudence to the Paris stu¬
dents in book form. The delicate question of medical
responsibility, considered from the point of view of French
law and opinion, is handled in a fascinating manner by an
eminent authority, and cannot fail to be interesting to medical
men, whatever may be their nationality, and whatever may
be their varying legal responsibilities on this subject.
With the evolution of society the medical man's duties
become more onerous, and the difficulties of practice increase;
and it is difficult to realise, in reading Professor Brouardel's
introductory remarks concerning the antagonism between
public opinion and medical opinion, the abuse of hospitals
and medical aid societies, the overcrowding of the medical
profession, with its attendant evils of advertising, touting,
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“ dichotomy,” &c., that his observations do not extend
beyond the limits of his own country. In 1876, whereas only
one or two cases a year, involving the responsibility of the
medical man, were dealt with by the French courts, at the
present time there are eight or ten per month.
The most important question discussed in these pages is
the professional secret in its relations to criminal and civil
actions, to life insurance, marriage, &c. The theory which
tradition and law have imposed in France, but which is far
from being universally accepted, is practically that the medi¬
cal secret is inviolable. The legislator there has considered
that the interest of the health of a man, the social interest
in the professional secret being kept, is so great as to place it
even above the interest of justice.
The secret imposed upon the medical man is not a privi¬
lege ; it is a duty imposed upon him in the public interest,
and for the violation of which a severe penalty is dealt;
whether there be intention to do harm or not,—nay, whether
the result be even for the patient’s welfare. For example, a
woman who has contracted syphilis from her husband, sues
him for separation. Dr. Fournier., who had treated her, is
called as a witness, and by her released of his secret. Dr.
Fournier refuses to give evidence on the point, and his reso¬
lution is firmly upheld by the court.
Before the courts the received formula is —“ I consider as
confidential the relations which led to my knowledge of the
facts upon which I am examined, and I therefore cannot
answer.”
That difficulties frequently occur, a perusal of Dr. Brou-
ardel’s work amply shows, as in the case of medical aid
societies, clubs, &c.; moreover, as regards hospital patients,
there is practically no such thing as the professional secret.
As regards the bulletins which are published when distin¬
guished or notorious personages are ill, there are words of
wisdom to be found in the pages of this book which might
well be pondered over by the profession in this country.
“ In England there is no medical secret,” says Dr. Brou-
ardel, which is, of course, an exaggeration, and the reasons
he gives to explain this on p. 131 are simply ridiculous, such
as —“ In England there is not between doctor and patient the
same intimacy as is found in France,” &c.; “ their relations
are purely commercial,” &c.
Compared with the condition of affairs with us, the relations
of medical men to life insurance companies are interesting.
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In France no certificate is given by the candidate’s medical
attendant (whatever may be the state of the candidate’s
health), and no death certificate, to the company.
The remarks on “ declaration of birth” are very interest¬
ing. This function often falls to the lot of the doctor to
perform, as, for instance, with illegitimate children. In
Paris, where nearly a third of the total number of births are
illegitimate ( e . g . 379 in 1157 between February 6th and 12th),
this adds to the practitioner’s duties, and to his responsibility;
for the declaration must take place without revealing the pro¬
fessional secret; this usually means concealing the name of
the mother, her address, &c. If the child is killed by its
mother matters are still further complicated ; for the infanti¬
cide must not be revealed by the medical attendant, but the
birth must be declared.
Burial is another of those questions which are dealt with
very differently in France compared with England ; and while
the system of having medical men to “verify” deaths, as in
Paris, may be in some respects a good one, the condition of
affairs in country places is very unsatisfactory; for there, not
unfrequently, “ people are buried who have never been seen
by the doctor, neither during their last illness nor after their
death.”
Writing a death certificate would be, on the part of the
medical attendant, revealing the professional secret; con¬
sequently the “ verifier ” is supposed not only to report the
fact of death having taken place, but by looking at the body
and hearing the particulars of the last illness from friends,
&c., he is supposed to decide that death has taken place from
natural causes—a risky performance, it appears to us.
Dr. Brouardel’s lectures on medico-legal experts are, as one
would expect, excellent. The duties, training, appointment
of these experts in France constitute a subject of paramount
interest. In civil matters there are usually three experts ; in
criminal questions only one expert is appointed by the court,
a position of great responsibility for any medical man to hold,
and requiring important qualifications. Many of us are con¬
scious of the objections which may be raised to the procedure
common in this country—the presence of an expert on each
side— i. e . for the prosecution and the defence. “ In England,”
says Brouardel, “ I can affirm that this method [i. e. an expert
on each side] has given the worst results. The experts be¬
come in truth counsels, each pleading for his client, one for
the prosecution, the other for the defence.”
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Finally, Professor Brouardel deals with the question of
medical certificates,—certificates of complaisance, imprudent
certificates, fraudulent certificates, &c.
The appendix contains a number of interesting letters
written to the author by medical men in difficulties as regards
medical responsibility, and test cases, &c. It would have been
interesting to learn the solutions given by him to the various
problems raised in these communications.
We have only referred to the matter with which Professor
Brouardel deals in these lectures; it requires a perusal of
his book to appreciate the lucid and fascinating style in
which the author communicates his views, relieved here and
there with such shrewd though perhaps cynical observations
as the following:—“ Contrasted with man, woman lies with
perfection ; ” “ Those who deal with the dead take to drink
“ The medico-legal expert must close his ears and open his
eyes,” &c.; and finally, the legal taunt to the medical profes¬
sion, “ Get a medical certificate to this or that effect; you
will always find a doctor who will give it you.”
L’Innervation du Corps thyroids. Par le Dr. Eugene Brian.
Libraire J. Bailliere et fils, Paris, 1898.
The undoubtedly important place which the thyroid gland
occupies in the animal economy renders any careful study of
it worthy of consideration, and in the publication of his
paper on the innervation of the thyroid the author is to be
congratulated on the completion of a long and painstaking
investigation, which is none the less valuable because it
mainly corroborates the work of other observers. The most
important sections are concerned partly with the origin and
disposition of the thyroidal nerves, and partly with their
function.
I. Anatomical Results .—(1) The main nerve-supply of the
thyroid is derived from the cervical sympathetic branches
being given off at various levels, in man chiefly from the
second cardiac nerve and from the middle cervical ganglion.
The branches form, especially round the inferior thyroid artery,
periarterial plexuses, which it is easy to demonstrate in the
foStus by ordinary dissection. A subsidiary supply is con¬
stantly derived from the recurrent and inferior laryngeal
nerves, each of which sends two or three filaments to the
gland. No thyroidal branches from the glosso-pharyngeal
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or hypoglossal were found. (2) Histologically his results
are in complete accordance with those previously obtained
by Anderson. In the interior of the gland “ vascular ” and
“ glandular ” nerves were found, the former ramifying in
the peri-vascular connective tissue, and terminating in the
vascular walls in an undetermined manner, the latter forming
anastomoses around the gland follicles and terminating close to
the outer surface of the epithelium without actually penetrat¬
ing between the cells. No ganglionic nerve-cells were found in
the substance of the gland, though artificial deposits might
simulate their appearance.
II. Physiological Results. —(1) A long and inconclusive
section is devoted to a discussion of the results of stimulating
the various cervical nerves with the view of investigating
their influence on the thyroid secretion. The author reviews
various histological evidences of the secretory activity of the
thyroid, and finally declines to accept any of them as reliable.
It does not seem to have occurred to him that there are
criteria of increased thyroid activity other than merely histo¬
logical changes, and he makes no reference to such physio¬
logical conditions as variations in the body temperature, or
in the general nutrition, which might have afforded a guide.
(2) By means of a specially designed and delicate plethysrno-
graphic apparatus he investigated the vaso-motor influence of
the various cervical nerves, and found that the sympathetic
alone produced any result on the thyroids vaso-constriction
when stimulated above, vaso-dilatation when stimulated below
the inferior cervical ganglion. He concludes by stating that
in these experiments may be found the reason for the improve¬
ment which has been said to follow division or excision of the
cervical sympathetic in cases of exophthalmic goitre. He does
not, however, explain by what process of thought he can corre¬
late two such dissimilar conditions as that of the thyroid in
simple vascular dilatation, and that in exophthalmic goitre.
In fact, as he states, it his inference is quite illogical.*
Hypnotism and its Application to Practical Medicine. By
Otto G. Wetterstrand, M.D. Authorised translation
from the German edition by Henrik G. Petersen, M.D.
G. P. Putnam’s Sons.
Dr. Petersen has done useful service in translating into
English Wetterstrand’s well-known work on “ Hypnotism,”
* For inferior read superior laryngeal, p. 602 , third' line from bottom of page.
XLIV. 40
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as applied to practical medicine. The original is in Swedish,
the English translation being from the German. The trans¬
lator has acquitted himself fairly, albeit his English is not
always elegant. Such diction as “ but this does not prevent,
however,” and “ he has never had nose-bleed,” does not
commend itself.
We are gratified to find the author making frequent
references to English writers, amongst others Braid, Anstie,
Broadbent, Douglas-Powell, Balfour, Bristowe, and Lionel
Beale.
The work is essentially a practical one, and is commend-
ably free from speculation. The author holds “ that most
people can be hypnotically influenced by a properly adapted
method. Nevertheless both patience and perseverance aro
sometimes required. “For instance, I finally succeeded in
hypnotising a lady of forty, after having endeavoured in
vain seventy times to do so.” His method is as follows :—“ We
tell the patient that sleep will most probably cure his disease,
and that he will enjoy a quiet, refreshing slumber. . . Wo
ask him to sit down and to concentrate all his thoughts upon
sleep. Then, while fixing our eyes upon him, we suggest a
'heaviness in the lids and the limbs, and an increasing impos¬
sibility to move. Continuing to speak about sleep and its
symptoms, which soon are to make their appearance, we
finally say that they are already there. . . . He is then told
that sleep, or even the slightest slumber, is beneficial, and if
that state be not obtainable, we make him witness the result
upon one or two who previously have proved good subjects.”
The author gives a list of the disorders he lias successfully
treated by hypnosis, and appends numerous illustrative cases.
With stutterers he has had excellent results. The most
inveterate stutterer, we are informed, speaks without the
slightest stutter while in the hypnotic sleep. Hypnosis haa
also yielded good results in diseases, in which one would not
a 'priori expect to get much £ood from it,—to wit, paralysis
of organic origin, chlorosis, haemorrhages, and heart disease
(both organic and functional). Our own experience is in
complete accord with the author’s in regard to the beneficial
effect of hypnosis in these diseases. Of chlorosis and allied
anaemias he observes, “ I can say with certainty that the
condition improves after a few treatments, the appetite be¬
comes better, the cold hands and feet grow warmer, the
headaches disappear, and, most remarkable of all, the leu-
corrhcea ceases, and a desire to live and better spirits are
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1898.]
manifested. . . . Most cases of this class are very susceptible
to hypnotic treatment. ... It seems remarkable that a
trouble as obstinate as leucorrhoea, and which defies all re¬
medies, should disappear so quickly by hypnotic treatment.”
The following case of uterine haemorrhage successfully
treated by hypnosis is as instructive as it is surprising.
“ A woman of fifty-seven had suffered from uterine haemor¬
rhage for some time. I tried various remedies without
success. . . . On examination it was found that the vaginal
walls in places were as hard as wood and infiltrated. The
lower uterine segment was a cartilaginous hard mass. ... I
had recourse to hypnotism, as I had no other means at my
disposal, and obtained a sleep of third degree. The haemor¬
rhage stopped after the second treatment. . . . The dis¬
charge diminished perceptibly, and the pains in the back
were less severe, so that she was able to sleep better.”
After referring to the value of hypnosis in phthisis, the
writer adds that he knows “ no other remedy that soothes a
dying person more than hypnotism, which so often produces
a real euthanasia.” One other case of successful treatment
by hypnosis may be quoted, that of a girl of seventeen who
had never menstruated. u I hypnotised her, as she had
derived no benefit from iron previously taken. She received
the suggestion that her menses should appear at 6 a.m. on
September 20th, and continue for three days, without giving
her the least pain. She remembered perfectly well what I
had said upon awaking. She came on September 22nd, and
told me the menses had appeared exactly as I had suggested;
the same condition resulted on October 10th and November
19th, and the girl was very well after six treatments.”
Sleep, its Physiology , Pathology , Hygiene , and Psychology .
By Marie de Manaceine (St. Petersburg). Walter
Scott, London : Contemporary Science Series, 1897.
Pp. 341. Price 3s. 6d.
We reviewed this work a year ago when it appeared as a
French translation, and expressed our satisfaction that it was
soon to appear in English. We now find that it has been
presented in a readable form. The style is clear, and well
calculated to attract the attention of the lay audience to
whom it is specially addressed.
We are disappointed that no mention is made of Leonard
Hill's striking experiments on the circulation of the brain,
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and that the treatment of insomnia has been dealt with in a
manner which is scarcely trustworthy. The chapter on the
physiology of sleep is admirably put together, although the
authoress’s definition of sleep as “the resting time of con¬
sciousness” can scarcely be regarded as any advance on the
explanation of that state.
The whole work bears evidence of great research and
ability in the selection, condensation, and presentation of the
points of interest and importance relating to the subject
considered. It contains so much information and such an
extensive bibliography that it is well worthy of a place on
the alienist’s bookshelf.
Methods of securing Health for Insane Convicts, By H. E.
Allison, Medical Superintendent Matteawan State Hos¬
pital, Foshkell-on-Hudson, New York.
The author of this pamphlet treats his subject in a tem¬
perate, clear, and convincing style. He briefly sketches the
conditions of prison life, reviews the various forms of insanity
to which prisoners are usually liable, and classifies the factors
which contribute, both outside and inside ihe prison walls, to
foster the onset of mental disease. He describes the indi¬
viduals who by some insane act break the law, and are after¬
wards improperly convicted. Such cases not unfrequently
occur in this couutry, more especially in connection with
minor offences. At the trial the insanity is either undetected
or ignored. The author next portrays those criminals who
become insane through conditions within the prison, and
through regret and dwelling upon crime; and he states that
this class constitutes a large proportion of the criminal insane.
No doubt the prolonged anxiety and suspense endured while
awaiting trial, the excitement of the legal proceedings, and
the subsequent reaction are fruitful sources o danger, espe¬
cially in the case of those who are predisposed to mental
unsoundness. Dr. Allison’s third category comprises the
class of habitual criminals whose excesses and debaucheries
while at large, combined with the effect of repeated imprison¬
ments, sometimes undermine the mental health. These indi¬
viduals, he considers, are unfit to associate with the inmates
of an ordinary asylum, on account of their frequent dan¬
gerous and homicidal tendencies, and their propensities to¬
wards house-breaking and lock-picking, which necessitate
constant vigilance on the part of those under whose care and
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607
treatment they are. In conclusion he advocates the detention
of the insane convict in an institution specially designed for
the purpose, where he should have, as far as possible, all the
benefits of treatment for his development and cure that are
given to the free citizen in any well-regulated hospital for the
insane, and wherein he should be kept until he is pronounced
a fit subject for absolute release. "
The Planning of Lunatic Asylums . By G. H. Bibby, F.R.I.B. A.,
Bottesford. London, fol., pp. 132.
The Housing of Pauper Lunatics. By the same Author and
Publisher. 8vo, pp. 113.
These two small works are a compilation of facts relating
to lunatic asylums and their inmates. The facts are chiefly
those which can be gleaned from asylum reports, &c., and a
moderate acquaintance with a large institution, but it is
difficult to imagine the class of readers whom they would
interest or instruct.
There is nothing of novelty in the contents of these works,
which consequently require no criticism—beyond the expres¬
sion of wonder that they should have been printed.
PART III.—PSYCHOLOGICAL RETROSPECT.
RETROSPECT OF CRIMINAL ANTHROPOLOGY.
By Havelock Ellis.
The Stigmata of Degeneracy among American Criminals. —Dr.
Eugene S. Talbot, of Chicago, whose work on the aetiology of
osseous deformities of the head and face is now becoming widely
known, has lately published a valuable study of such deformi¬
ties among American criminals (E. S. Talbot, “A Study of the
Stigmata of Degeneracy among the American Criminal Youth,”
Joum. Amer. Med. £88 April 9th, 1898). The observations were
made during 1895-6 at the Illinois Reformatory at Pontiac, and
the New York Reformatory at Elmira. The head and face were
chiefly investigated. The object of the inquiry was to determine
to what extent youthful criminals come from the ranks of the
degenerate. The youngest inmates were excluded on account of
immature face and jaw development. The total number examined
was 414 at Pontiac and 1018 at Elmira, and the average ages
(varying between 15 and 30) were at the former place a little
over 19, and at the latter 21. Nationalities were numerous, and
all those with an American parent were regarded as natives,
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Retrospect of Criminal Anthropology . [July,
birthplace being ignored. Pontiac is more of a reform school
than Elmira, which receives an older and graver class of criminals.
The inmates of Elmira are consequently markedly inferior in general
physique to those of Pontiac, who, indeed, compare very well with
the average urban population. The author points out, moreover,
that there are special causes producing an accumulation of the
most defective classes in New York ; not only has the charitable
policy of that State induced an undue proportion of the defective
and semi-criminal classes to remain there, but there is a general
tendency for the more energetic immigrants to move westwards,
while the incapables remain on the eastern seaboard where they
were landed.
As regards cephalic index, there is a marked dolichocephalic ten¬
dency in both institutions ; “ as it contrasts with the marked meso-
cepbaly of the population whence these criminals are drawn, it is
clearly a stigma of degeneracy.” Even the negroes were much
more dolichocephalic than the ordinary negro population. As
regards height of palatine vault, width of jaws, and distance
between eyes—to which some investigators attach importance—
Dr. Talbot got no very striking results.
His results as regards total number of stigmata of degeneracy
in criminals are more interesting. In order to obtain a normal
standard of comparison, he took at random a series of forty-two
respectable urban residents, and noted their stigmata of degeneracy,
especially in head and face. Not one of these normal persons was
found to possess more than twelve stigmata (quite a sufficiently
high figure, no doubt), and the average for each individual was only
eight. But the number of stigmata of the average reformatory
inmate was nearly double that of the average normal individual.
The native Americans in Elmira presented an average of sixteen
stigmata each, those in Pontiac of fourteen.
While stigmata other than those of the head and face were not
systematically investigated, the author notes that bodily asymme¬
tries, flat feet, &c., were more common than in the ordinary popu¬
lation. In this connection he refers to the investigation of an
American army surgeon, Dr. Woodruff, who examined 138 young
criminals in an Illinois reformatory (excluding boys and negroes)
precisely in the same way as be would recruits, but omitting subjec¬
tive tests where untruthful answers might come in. He found that
they could be divided into five classes: (1) fourteen who might
have been passed, though a careful surgeon would have rejected at
least ten; (2) thirty who would only be passed if known to possess
some special qualification; (3) thirty-seven who could only be
passed in emeg*ncy by special authority; (4) thirty-three who
could only be passed in time of war, and then only as messengers,
&c.; (5) twenty-four totally unfit for any service. It must be
remembered that these men belonged to the best grades of crimi¬
nality. An examination of an ordinary prison (Joliet) led Wood-
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1898.] Retrospect of Criminal Anthropology. 609
ruff to believe that very few of the men were capable of military
service.
Dr. Talbot made no attempt to obtain systematic craniometric
data; the most notable peculiarity was the large proportion of
eases of high bregma, approaching true oxycephaly. There was
also tendency to excess of occipital development. Both these
tendencies were more marked at Elmira.
The face tended more towards arrested than excessive develop¬
ment. There was no predominance of unusually large orbits,
diminished orbital capacity being the rule, and (especially at
Elmira) deep sunken eyes. Normal jaws were decidedly in the
minority, abnormalities being excessive at both reformatories (63
per cent, at Pontiac and 60 at Elmira). Begularity of dentition,
on the other hand, was rather above the average.
The percentage of deformities of ear was rather under that
observed in the non-criminal population. Size of ears was not
extraordinary ; but the ear grows throughout life, and bearing this
in mind, Talbot considers that the proportion of very long ears
was large. The chief peculiarity was the number of ears set at an
obtuse angle to the head.
The general conclusion is that these young criminals, in the vast
majority, belong to the degenerate class. At the same time there
is no such predominance of one or more features as would justify
the creation of a criminal type.
The Jaws among the Degenerate Classes. —Dr. Talbot took advan¬
tage of a visit to the Moscow Congress to cover nearly all the
countries of Europe. In all the chief cities he made special ob¬
servations of the degenerates in the various institutions for the
defective classes—prisons, asylums, schools for idiots, reforma¬
tories, <feo. He has lately published a summary of his results as
regards the jaws and teeth. The institutions included in the
inquiry were at Athens, Constantinople, Vienna, Moscow, Stock¬
holm, Hamburg, Amsterdam, and Paris, together with six of the
chief English idiot asylums. Figures are given with more or less
fulness for each of these institutions. (“A Study of the Defor¬
mities of the Jaws among the Degenerate Classes of Europe/’
Journ. Amer. Med. Assoc ., February, 1898.)
The general result is to show a gradual increase in degeneracy
from the examinations made in Greece to those in England, defor¬
mities being, further, more numerous in the private institutions
for the better classes than in the public institutions. Previous
examinations made by Dr. Talbot in Spain, Italy, and Switzerland
had shown a very small percentage of deformities of the jaws and
teeth. “ These observations have proved to me,” he concludes,
4t what I long ago suspected from my studies of the degenerate
classes which have come to America, and which fill our public
charitable institutions as well as our prisons, that the higher the
intellectuality the greater the degeneracy of the jaws and teeth.”
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Retrospect of Criminal Anthropology.
[July*
Criminality in Russia .—It appears to be very difficult to examine
criminals in Russia, on account of official regulations, imperfect
data, and, not least, tbe extreme unwillingness of prisoners to give
assistance, any attempt at investigation being regarded as made
with hostile object. Professor J. Orchansky, of Kharkoff, has,
however, lately published an interesting medico-psychological
study of certain general aspects of Russian criminality (Or-
chanskv, “ Les Criminels Russes,” Archives di Psichiatria y vol. xix,
fasc. 1, 1898).
A striking and interesting point brought forward is the very
small incidence of insanity among Russian criminals. The pro¬
portion of insane and idiots found among Russian recruits is four
per thousand ; including women, we may say, according to Russian
alienists, that the proportion for tbe country generally is three per
thousand. But among 90,000 criminals at trial, there are only 304
examinations into the mental condition, and many of these are not
insane; so that we reach, says Orchansky, tbe bizarre conclusion
that the proportion of insane persons among criminals is not
greater than among the general population, i. e. 3 per 1000. The
evidence scarcely seems conclusive, but Orchansky adds that it
is confirmed by the evidence of prison surgeons. He points out
also that, as compared to Western Europe, Russian criminals
come chiefly from the country, which furnishes a smaller propor¬
tion of mental diseases than the cities.
Orchansky finds that the size of the head is the same both
among the worst criminals, and among soldiers punished for petty
offences against discipline. The circumference of the head, both
for criminals and the ordinary population, varies between 50 and
55 centimetres. In appearance also, he remarks, Russian crimi¬
nals resemble the ordinary population. (Twenty-five photographs
of Russian women criminals accompany the paper.) We seldom
meet the deformed face so common among criminals in the rest
of Europe. (This impression, it may be added, thus confirms
Talbot, who found stigmata of degeneracy very rare among Russian
criminals.) Orchansky does not deny the reality of the portraits
drawn in so masterly a manner by Dostoievsky, but regards them
as a small minority.
The maximum of Russian criminality is to be found in the
neighbourhood of Odessa and along the rivers Ural and Volga,
and then around Moscow. It is in these districts that the popula¬
tion is most shifting.
Drunkenness, especially in what the author calls its epidemic
and communal forms, is the chief exciting cause of Russian
criminality. Such drunkenness indicates a race scarcely emerged
from barbarism ; “ the primitiveness of the civilisation is the basis
of our criminality.”
The psychology of Russian criminals has been little studied. A
leading trait is the unwillingness to confess, even at any stage; only
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1898.] Retrospect of Criminal Anthropology. , 611
37 per cent, confess their crimes. Another trait is the marked con¬
tentment of the prisoners. Only the criminals from the Caucasus
suffer from home-sickness, the others laugh and sing, and show
every sign of happiness. “ As things are, our prisons present to
the majority of their inmates an amelioration of their ordinary
existence. ,, We must also remember the cheerful fatalism of
Eussians. As a rule Kussian murderers have an unstained past
up to the date of their crime, which may have been produced by a
most futile cause; it cannot even be said that they drank more or
oftener than others of their class. There is no criminal “class”
in Eussia ; it can only be said that we have to do with “ a primi¬
tive psychic organisation, lacking the elements of maturity and
solidity acquired by historical development and transmitted by
heredity.” The superficiality of the criminal taint is further
shown by the fact that in Siberian towns, inhabited mainly by old
criminals, it is possible to live in even greater security than in
many Eussian towns.
The Physical Development of Criminals. —A French army sur¬
geon, Dr. J. Marty, has lately published the results of his investi¬
gations of criminality among 4500 French soldiers, usually only
guilty of somewhat petty offences. He compares the results
throughout with the measurements obtained among 10,000 non¬
criminal French soldiers (“ Kecherches statistiques sur le Deve-
loppement physique des Delinquants,” Archives <TAnthropologie
criminelle , March 15th, 1898).
As regards height, he finds that there is an excess among the
criminals both of short statures and low statures, the medium
statures being deficient. The general average is a few millimetres
below the normal. As regards weight, he confirms those observers
(Lombroso, Franchini, Bischoff, Ac.) who found that criminals
are somewhat heavier. As regards chest circumference the same
result is reached as regards height; large and small circumferences
are unusually frequent, medium circumferences unusually defec¬
tive. Somewhat the same result is reached as regards general
health and constitution; “very good constitutions” are only 11
per cent, of the normal corps, as against 19 per cent, of tho
criminal battalion ; the “ good ” also are 49 per cent, of the first,
as against 62 of the second; while the fairly good, on the
other hand, are 30 per cent, of the normal corps, and only 14
per ceut. of the criminal battalion, while the feeblest class are
1*5 of the normal, and 2*5 of the criminal men. The author
endeavours to account for this result by the theory that in the
bad social conditions which produce criminals only the strongest
can survive.
He has also noted the temperament, and finds that all the
simple temperaments (except the sanguine, which is equal) are
defective among the criminals, while mixed temperaments pre¬
dominate. The explanation offered is that “ a good condition of
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612 Retrospect of Criminal Anthropology . [July,
life to avoid disorders is tlie possession of an organism which
tends always to impress on tlie individual an identical line of
aetion. ,,
Insanity among Criminals. —Dr. Allison, the experienced superin¬
tendent of the Matteawan State Hospital of New York, has lately
been discussiug the forms of insanity among the criminals which
his position brings him in contact with (H. E. Allison, “ What con¬
stitutes an Insane Criminal?” Albany Medical Annals, December,
1897; “Method of securing Health of Insane Convicts,” Journal
of Social Science , December, 1897). The number of insane in
custody in the State of New York is about 20,000. Of these
nearly 700 may be classed as insane criminals. Insanity is very
prevalent among the convicts. The three chief New York prisons
nave a total population of about 4700, and the average yearly com¬
mitments to Matteawan are 54, showing that 1 in 87 becomes insane
aunually. (A small percentage of these were insane before the
crime.)
All varieties of insanity are found, though very strongly modified
by criminal habits, so that, as is found elsewhere, insane criminals
are an intractable and dangerous class. With regard to causation,
insane criminals are here divided into three groups: (1) causes
arising outside prison life; (2) causes mainly due to conditions within
prison—confinement, reflection, &c.; (3) mixed causes. The first
class are benefited by removal to asylums ; they are dangerous, but
not really criminal. The second class have often been confined in
small, dark, insanitary cells, and are also greatly improved by
removal to the asylum. Dr. Allison speaks strongly against the
custom of using dark cells for purposes of punishment, and also
refers to the prevalence of insanity among long-term prisoners.
“ Twenty-three per cent, of the life-men in the prisons of the State
are inmates of this hospital to-day. Most of them are hopelessly
insane.” The author agrees with those observers who assert the
intellectual and moral superiority of murderers over other criminals.
The third class is made up of degenerates, mostly recidivists and
often imbeciles. The individual of this class is never quite sane;
“ his insanity may be regarded simply as an exacerbation of his
natural condition.”
It is interesting to compare the average length of confinement in
Matteawan with that in an ordinary prison. Allowing the usual
deduction for good conduct, and excluding life and execution
sentences, the average sentence served in Sing Sing is three years
nine months and twenty-four days; at Matteawan, including deaths
and transfers, it is five years and one month. “ The popular idea that
the asylum is a shield, under cover of which many guilty persons
escape the penalty of crime, is not, I think, borne out by facts.”
Dr. Allison recommends reformatory methods for the young and
the indeterminate sentence. The chief point to be decided, he
concludes, before degenerate and insane individuals are released, is
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1898.] Retrospect of Criminal Anthropology . 613
•whether it is safe for the community to permit such persons to be
At large.
The Elmira Reformatory .—The Twenty-first Year-book of the
New York State Reformatory (for 1896)—“editing, typography,
illustration, and binding, the product solely of prisoners’ labour ”
—is as usual an attractive and instructive volume, and is furnished
with some forty process illustrations. There are no strikingly new
features to record, either in the volume itself or in the work of
the Reformatory, and in the case of an institution which has been
so widely misunderstood and attacked nothing is more to be desired
than uneventfiilness. Two points may, however, be mentioned. In
accordance with a new law passed by the State (not actually in
•operation during the period covered by this report), the prisoners
must be constantly employed without, producing any commodities
of value. At present thirty-four trades are being taught in the
Reformatory; how far it will be necessary to discontinue these
trades, which have an enormous influence, direct and indirect, in
preventing crime (less than 2 per cent, of the prisoners know any
trade on admission) is not clear from the report, but the managers
are working iu the direction of the new law, and have specially
•developed the Slovd system and similar methods of manual train¬
ing, which appear to work very satisfactorily. Another point is the
unusually high insanity rate during the year. In a population of
1400, not less than twenty-three were transferred to the Matteawan
State Asylum. In partial explanation of the high ratio, we are
told that “ there has been a more liberal interpretation of mental
alienation in the past year, and 4 insanity of conduct ’ has, in certain
cases, been referred to lesions of the mind. Of those committed to
Matteawan as insane, and prior to being so adjudged, nine were
instances of crankism, 4 borderland dwellers,’ and might properly
be termed mattoids; eight were psychopaths, deficient in inhibitory
power, and subject to recurring nervous explosions ; and seven
gave a faulty family history of alcoholism in the father and
•epilepsy or insanity of brother or sister.” It should be added
that, according to a recent law of New York State, no direct
transfer to the asylum can be made by the Reformatory officials ;
application must be made to a judge, who appoints a commission
of two physicians who are qualified examiners in lunacy; these
report to the judge, who, in the event of the case being declared on
oath to be one of insanity, issues the order of transfer to Matte¬
awan. Coincidently with this increase iu insanity there has been
an accompanying increase in the attempts to feign insanity, sixteen
cases (equal to the aggregate of over three preceding years) being
reported.
The work of the gymnasium has been extended on account of
its beneficial results, the plan of subjecting all new arrivals to it
for a seasou having been found specially satisfactory. As the
gymnastic system has now been operating side by side with the
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614
Retrospect of Criminal Anthropology. [July,
military system in the institution for seven years, it has been
possible to reach valuable conclusions concerning the relative value
of the two systems. The comparison is here worked out in some
detail, and it is stated that while military discipline and exercises,
show certain advantages, the more scientific and thorough methods
of gymnastics are, on the whole, to be preferred.
Special training, partly in connection with the new manual
training department, is devoted to three groups, differently
organised according to their special requirements: (1) mathema¬
tical dullards ; (2) those lacking in self-control; (3) stupids or
mattoids. (It may be here pointed out that to identify the
“ mattoid,” as is here apparently done, with the ‘‘all-round defec¬
tive,* * is a loose and unjustifiable misuse of terms, aud should not
be sanctioned.) The first group were almost or quite incapable of
solving the most elementary problem in mental arithmetic, and
were sluggish, sleepy, and dreamy, whether at work or repose. They
suggested arrest of mental growth. They received five hours’
special exercise per week, half an hour at a time, with daily rain-
bath and rubbing down ; the exercises include light calisthenics
with loud counting aud simultaneous movements, the laying out
of geometrical fields for athletic events, jumping, and target¬
throwing, each feat being measured and recorded by the performer.
The second group are superior both physically and mentally to tho
other groups, though they sometimes show the deteriorating effects
of sexual abnormality, and their exercises are specially devoted to
the cultivation of self-control and self-reliance; it has been found
possible to greatly increase their will power. The third group
of all-round defectives are not far above the standard of feeble¬
mindedness, and it is a great object to arouse them from the
lethargic state into which they periodically relapse. Tho bath
has here been found very useful. Physical defects of many kinds
are common in this class, and such conditions are met by special
exercises. “After a general resume of the work accomplished, it
can be safely asserted that outdoor athletics and gymnastics have
proven to be, in a measure, a prophylactic for a number of ills to
which these three groups of defectives are subject.”
The volume concludes—in pursuance of a method initiated in
the previous Year-book—with nineteen tables giving the age
height, age weight, age lung capacity, height lung capacity, weight
lung capacity, weight height, age strength of chest, &c. Of the
538 prisoners committed during 1896 the averages are almost the
same as for the previous year, the age being twenty years ten
months, weight 135§ribs., height 5 feet 5 T °, r inches, lung capacity
210 cubic inches, strength of chest 60 lbs., &c.
The Idea of Responsibility .—Professor Hamon, of Brussels, who
has devoted considerable study to the development of the modern
conception of criminality, has lately discussed at some length the
question of responsibility. The question may seem an academical
Digitized by
615
1898.] Retrospect of Criminal Anthropology .
one to many, but a review of it, especially when effected with Pro¬
fessor Hauion’s vigour aud lucidity, will be found nob uninstructive.
(A. Hamon, “La Responsabilite,” Archives d 9 Anthropologic crimi -
nelle , November, 1897.)
He starts with the statement that the biological root of the
ideas of law and justice is to be found in the reflex instincts of
defence. That is the immediate basis of the most primitive of
laws, the lex talionis . To the reflex action of pure defence suc¬
ceeds the reaction at a long interval. This delayed reaction or
veugeanee may co-exist with immediate reaction, but it appears at
a much later date. The responsibility is no longer regarded as
individual; it becomes familial, communal, tribal. The law of
retaliation is developed and codified, but, slowly though unceas¬
ingly, at the same time the idea of responsibility becomes re¬
stricted. At first inanimate things, then animals, finally corpses,
were regarded as irresponsible. This evolution has only been
completed lately; in the seventeenth century animals and corpses
were still solemnly tried and executed. Thus while responsibility
was being socially extended, it was being individually restricted.
It began to be held that to be really the author of an act the
individual must be compos mentis. But no one had yet asserted
that the insane were not compos mentis . Before 1789 insanity
appears to have been practically unknown to French law ; (a seven¬
teenth century rule prescribed that no one in a state of insensate
fury should be punished, but this rule was of no effect) ; one
eighteenth century magistrate, indeed, Serpillon, raised his voice
against the custom and law, but jurists firmly resisted any med¬
dling with solidly established traditions. Even the French Revo¬
lution failed to bring any recognition of insanity into legal codes ;
it was only through the influence exerted by Pinel that, in a
grudging and restricted manner, the irresponsibility of the insane
began to be recognised. How much progress was left to make
Professor Hamon shows by bringing forward incidents which have
taken place down to the present, and by the quotation of the
uncertain and conflicting opinions of authorities.
By the constant efforts of men of science the field of irrespon¬
sibility has thus constantly grown larger, and the author proceeds
to discuss various contemporary attempts to state the matter
scientifically. Thus, dealing with M. Tarde, who admits all
degrees between complete responsibility and absolute irrespon¬
sibility, he remarks that “ responsibility is not a state of con¬
sciousness,” and that while there can indeed be all degrees of
consciousness, there cannot be all degrees of responsibility, re¬
sponsibility being merely a human conception, “ a purely social
relationship without real existence.” This confusion between
responsibility and state of consciousness Hamon regards as very
common, and as therefore very necessary to bear in mind.
It must further be remembered, Hamon points out, that the idea
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616
Retrospect of Criminal Anthropology.
[July;
of responsibility was formulated by lawyers who accepted the
doctrine of free will. Now at tbe present day the doctrine of free
will has almost everywhere among thinking persons given place
to the more scientific doctrine of determinism. Thus with the
disappearance of the doctrine of free will the idea of respon¬
sibility is left with nothing to rest on. Responsibility, as Scho¬
penhauer long since said, supposes that an individual could have
acted differently from the way he actually did act.
Having thus cleared the ground, and shown that the various
new attempts to find a metaphysical basis for responsibility have
not succeeded, Hamon briefly and simply states the modern
scientific doctrine. The individual aud society feel the need to
react against a nuisance by suppressing the criminal or preventing
his acts. The ouly real responsibility is social responsibility. So
long as we retain that we may, if we like, retain the old doctrine
of a free will. “ Society has the right to defend itself and to
preserve itself. Man is responsible because he lives in society,
and only because of that social existence.” We are thus brought,
Hamon points out, to the acceptance of the old English legal
maxim, that every one, whatever his state of consciousness, always
acts at his own risk and peril. The insane and abnormal are,
socially , necessarily responsible.
Since the continued use of the words “ responsibility ” and
“penality” thus leads to an apparent contradiction, it would be
much better, the author concludes, if we finally abandoned them.
Every individual who commits dissonant acts in the society he
belongs to necessarily provokes a reaction. We should replace
the term “social responsibility” by “social reaction.” Such
social reaction manifests itself in preventive treatment, and in
social hygiene and prophylaxis, applied not only to the agent, but
to the causes which produced his acts.
AMERICAN RETROSPECT.
By C. Hvbeii Bond , M.D. y B.Sc.
The After-care of the Insane. —The Committee of the American
Neurological Association upon the After-care of the Insane have
published their report (Joum. of Nerv. and Ment. Disease , Novem¬
ber, 1897). Their method of inquiry was to issue a circular letter to
about fifty-six leading alienists and neurologists. Fifty replies were
received, the large majority of which were decidedly favourable to
the principle. Only six were doubtful or positively opposed to it:
and the chief objections of these were the paucity of the cases
likely to be benefited by such aid; the inexpediency of the project,
though admitting its possible desirability; and that, while excellent
Digitized by
1898.]
617
American Retrospect .
in theory, it would be impossible in practice. Eighty-eight per
cent, of those who were consulted and who replied are of opinion,
and some of them very strongly so, that great good would be likely
to accrue from a properly organised system of after-care for con¬
valescent or improved cases of mental disease. The majority seem
to think that such a system should at first be the outcome of
private organisation, and that a successful issue of such would be
all the more likely to make out a good case for State aid and recogni¬
tion at a later date. The number of patients, for whom such provi¬
sion would be likely to be fruitful of good results, the various super¬
intendents are as yet unable to fix with any certainty, as hitherto it
has, of course, not been the custom to inquire into the circumstancea
and future surroundings of each patient on his discharge from the
asylum. The following is a summary of the Committee’s conclu¬
sions :—“ (i) It is the general and well-nigh unanimous sentiment
of those who are the most conversant with the needs of the insane
in this country that measures should speedily be inaugurated
for the temporary relief of discharged, recovered, convalescent,,
and improved insane patients of the dependent class by organised
outside assistance, (ii) As a preliminary step, inquiry should be
made of all such patients before they leave the hospital regarding
the mode of life, surroundings, and occupation to which they are
returning, and appropriate advice given by a medical officer of the
hospital. This precautionary measure is, we believe, too often
neglected in large institutions for the insane, (iii) The legal pro¬
vision whereby an allowance of money and clothing is made in
some States to each patient on his discharge should be adopted by
all. And (iv) that outside assistance can best be provided, we
believe, through the medium of an after-care association, which,
until its utility be proven, should be entirely a private undertaking,,
and should be organised like most existing charitable associations
depending upon voluntary contributions. Obviously a large city
offers the best field for starting and developing such a system.”
The Psychical Mechanism of Delusions is the title of a paper
read by Dr. W. Hirsch before the New York Academy of Medicine
( Journ . of Nerv. and Ment. Disease , March, 1898). It contains a
thoughtful, able, and suggestive exposition of the writer’s views upon
this much vexed psychological problem; and even should the reader
be unable to agree with the theory hazarded therein he will probably
feel that a perusal of the article has not been in vain, for it sets
forth in addition, clearly and shortly, the various explanations that
have from time to time been offered of the subject in question.
These have been chiefly six, the first of which was that the mind was
only partly affected, and that the abnormality was limited to the
individual delusions ; in this originated the doctrine of monomanias.
It is a view that has been generally discarded, owing to the fact
being realised that the prominent delusive state is only a part of a
general mental disease. A second theory sought to show a relation
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618 American Retrospect, [July,
between delusions and imperative ideas, on the supposition that
the former are often the outcome of the latter; but such is not
supported by clinical facts. A more modern explanation, and one
that has found not a few supporters, suggests a primary disturbance
in the process of association resulting in the formation of a new
and morbid ego , which gradually predominates over and actuates the
normal ego . Such compulsory associations are more probably, how¬
ever, the explanation of certain imperative ideas than of delusions.
A fourth theory—and one which, if carried to its logical outcome,
would lead us to practically adopt the first-mentioned one—endea¬
vours to trace delusions to a disproportion between the intensity of
the emotional tonus of the various ideas one to another. A very
favourite doctrine teaches that delusions always depend upon in¬
tellectual weakness, the defect in the patient's reasoning power
leading him to misinterpret his environment; thus not a single
paranoiac could be said to have a normal amount of reasoning
power. Hirsch combats this view at some length, and cites the
existence of the power of dissimulation, so often observed among
paranoiacs, as directly opposed to such a view being tenable. And
in close relation to this theory, he says, are all attempts to explain
delusions by comparing the mental process of paranoiacs with that
of children or savages. He believes much obscurity has accrued
by the delusions themselves being considered a pathological entity,
and their psychical mechanism necessarily the same, no matter of
what nature they are or under what circumstances they occur. He
admits, however, that there are certain delusions which may be ex¬
plained by one or other of the above theories.
The view that Hirsch would prefer to adopt he bases upon a
consideration of the nervous system as a whole. Modern investiga¬
tion, he says, shows that the psychical organ—the brain—is made
up of precisely the same material as the peripheral part of the
nervous system, and we are therefore entitled to look on psychical
disturbances as being caused by the same disorders which are seen
in the peripheral nervous system. Thus, for instance, he argues
that as the two principal symptoms, spasm and paralysis, produce
in the motor nerves convulsions and loss of motion, and in the
sensory system hyperaesthesia and anaesthesia, so in the psychical
realm paresis of the inhibitory apparatus will cause a condition of
exhilaration, while its spasm might cause a retardation of associa¬
tion, as in certain cases of melancholia. Again, pain may be
produced in the peripheral end-organ, or in the course of the nerve,
or even in the brain itself. The last case is well illustrated by the
production of hypochondriacal complaints, and points to a cen¬
trifugal instead of the normal centripetal action of the sensory
tract—in other words, a retro-action. And it is from this point of
view that the writer endeavours to consider primary delusions.
A psychical process may be analysed into its component stages
in the following sequence:—Sensations of sense,—perceptions,—
Digitized by Le
1898 .] American Retrospect . 619
conceptions,—thoughts and ideas (conclusions), emotions andmoods.
Apply the principle of retro-action to this, aud the ready-formed
idea, either produced by some emotional state or some other internal
cause, such as fancy, dreams, &c., is now the first stage in the
psychical mechanism, and, by a process of centripetal analysis, it is
transformed into various conceptions, which may go on to produce
real perceptions—that is, hallucinations. Delusions and hallucina¬
tions are closely related; they both almost invariably have reference
to the ego —in fact a delusion might be not inaptly termed an hal¬
lucinatory idea. The above reversed mechanism would apply to
the delusion as to certain hallucinations. The morbid condition is
not the formation of the idea or perhaps a primary emotional
.state as such—for such may occur under perfectly normal con¬
ditions—but it is this retro-active mechanism by which the baseless
conclusions take the character of reality, just as endogenic percep¬
tions are transformed into real images—that is, into hallucinations.
Headache with Visual Hallucination .—A curious case illustrative
of this point is described by Dr. J. K. Mitchell (Joum. of New .
and Mental Disease, October, 1897). It occurred in a man (age
not stated) who came of a healthy stock, and who had no direct
neurotic heredity. It is stated that he had indulged in excessive
smoking. His complaint, which extended over three years and
was increasing, was that of recurrent headache, accompanied by
a very curious apparition, followed then by blindness, and finally
by loss of consciousness with violent convulsions. Commencing
loss of vision always heralded in each attack. The sequence of
events was then the appearance of a minute dwarf at a great
distance; he would gradually approach, and at the same time
would increase in size, till finally he assumed the form of a gigantic
gladiator, with bare limbs and armed with a club. During his
approach the pain in the head would constantly grow worse.
Finally the monster seemed to strike the patient repeatedly on the
head with his club, causing excruciating pain, culminating in loss
of consciousness, and usually followed by violent convulsions;
during the latter there was generally marked opisthotonos. The
duration of the attack was formerly about twenty-four hours, but
it has gradually diminished to eight hours—that is, between the
appearance of the dwarf and his striking the patient’s head. The
intense pain and convulsions usually last fifteen to forty minutes,
and afterwards the patient feels a general sense of soreness, while,
in addition, his teeth feel on edge. The eyes were examined, and
considerable error of refraction and accommodation in the right
eye was discovered. This was fully corrected, but with negative
results as regards the headache. It is noteworthy that the attacks
only occur between the months of May and December, and that
their frequency has increased to one every five days or so, while
at first there would be an interval of five months between them.
The patient stated that on only one occasion was he able to con-
xliv. 41
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verse with the giant; and that the reason the latter then gave on
being asked why he so tortured the patient was that “ he had
been ordered to do so, and would continue while patient remained
in the country.”
Other human apparitions in connection with headaches have been
recorded before, the earliest in 1887, but the writer believes that
this case is unique in the causal relation between the spectral
hallucination and the pain. He is of opinion that this cycle of
symptoms is an expression of that multifarious disease migraine,
founding this view upon the order of the events in the cycle, upon the
periodicity of the attack (malaria having been excluded), upon the
progressively increasing severity of the disorder, and from the fact
that epileptoid convulsions do sometimes accompany migraine.
Neurasthenia .—An admirably defined picture of this disease is
given (Alienist and Neurologist , October, 1897) by Professor
Dercum. He points out the confused and hazy conception there
is concerning this affection even among neurologists, and especially,
he says, among alienists; and in support of this he cites
Binswanger’s new treatise on neurasthenia, where it is taught that
all neuropathic appearances, based on a general functional disease
of the nervous system, are to be classed under neurasthenia if they
do not fall under the fully developed psychoses and neuroses.
A careful distinction is to be made between the application of
the word neurasthenic to nervous symptoms associated vyit-h
general organic visceral diseases and true neurasthenia. For the
former spurious variety Dercum propounds the term “ ueurasthenia
symptomatica,” in contradistinction to “ neurasthenia simplex ” or
“ essentialis.”
The fundamental conception of true neurasthenia should be that
it is a, fatigue neurosis, and that its symptoms may be divided into
primary and secondary. The former, essential ones, are those
directly expressive of fatigue, are prominent, and bear well-defined
relations to each other; while the secondary ones are mere out¬
growths of these, though it is to be remembered that they too are
sometimes pronounced and striking, and are then a possible source
of fallacy to the clinician. Charcot’s cardinal symptoms were—
(1) neurasthenic headache; (2) sleep disturbances ; (3) rachialgia
and spinal hyperrosthesia; (4) muscular weakness ; (5) digestive,
and (6) sexual disturbances; and lastly, (7) mental symptoms;
the remaining secondary group included all those symptoms not
essential to the diagnosis of neurasthenia. Weakness and irri¬
tability expressive of fatigue are the essential characteristics of
the affection. Thus among sensory disturbances, there may be
a general sense of weariness, usually, however, accentuated in one
particular spot or another—this spot often being determined
according to the nature of the patient’s occupation ; and it is
characteristic of this fatigue and these various aches that rest
always relieves, and exertion always increases them. These
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symptoms are to be considered as primary. As an instance of
secondary ones, the headache of neurasthenia may be accompanied
by a sense of pressure or constrictiou, obviously adventitious, and
probably depending on disturbances of the circulation. Again,
the spinal tenderness, often distributed in patches down the
spinal gutter, is an outgrowth of and secondary to the simple
feeling of fatigue referred to the lumbar region. Among visual
defects, a common primary symptom is an inability to read for
more than a few consecutive minutes owing to a certain amount
of pain, and to the letters becoming blurred; irritability is also
shown by the presence of distinct photophobia. Should objects look
either exceedingly dull or unusually bright, or as though they
were either far distant or very large, would be clearly secondary
symptoms. To the primary slight impairment of hearing, coupled
with great irritability to noises, secondary parsesthesi® are often
added, such as varieties of tinnitus. On the motor side, muscular
weakness is so prominent a symptom that Charcot, in grouping it
among his neurasthenic stigmata, reserved for it the term amyo -
sthenia. Secondary to it tremors may manifest themselves, either
as a fine intention-tremor, best seen in the extended hands, or as a
fibrillary one, most frequently observed in the muscles of ex¬
pression. Disturbances of digestion, of circulation, of secretion,
and of sexual functions may be similarly considered and divided.
The psychical side of the patient may furnish numerous mani¬
festations of neurasthenia. Of these, a foremost position must be
given to a diminution in the capacity for study or for intellectual
work, any attempt in this direction being soon followed by signs
of exhaustion. Next comes loss of the power of concentrating
the attention, which the patient then often mistakes for loss of
memory. A lack of spontaneity of thought and of volition, and a
general indecision, with mental and emotional irritability, are addi¬
tional primary psychical symptoms. Secondary ones, however,
usually also appear, such as an apparently causeless general sense
of fear; this may be a vague general feeling of anxiety, or oftener
it is more defined. The latter specialised fears may take most
aberrant forms, among which agarophobia and claustrophobia find
a place.
Finally, Dercum alludes to a condition which he has termed
“Neurasthenia terminali8. ,, Under this he includes terminal
cases of neurasthenia, in which simple and uncomplicated func¬
tional derangement has continued for so long a time as to result
in actual tissue change ; such cases are largely intractable to
treatment.
Melancholia—an Analysis of 3000 Cases , is the basis of a paper
by Dr. S. Weir Mitchell ( Joum . of Nerv . and Meat. Disease , De¬
cember, 1897). Frank admission is made that certain of the
tables compiled from these statistics are largely open to fallacy,
and in fact the writer disclaims any attempt at dogmatic infer-
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American Retrospect.
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ences from any of his eight tables. The following are probably
the most interesting points in the inquiry; they are clearly
brought out, and are gathered from tables into which error does
not so easily enter. It would appear that there is an entire
absence of anything like a “ seasonal melancholia.” For, while it
is true that it was during April and December that the largest
number of cases of melancholia originated , yet the differences were
small, &7 and 9*4 being the minimum and maximum percentages
that any individual month yielded. The tables of ages were more
productive of results. They are classified according to decades,
but somewhat unfortunately, in that the influence of the meno¬
pause might have been made clearer. The correspondence in the
ages of the two sexes is very striking in each of the six decades
after the age of twenty ; and the figures denoting the average age
of the total cases for males and females respectively approxi¬
mate as closely as 37*2 and 36 25. Of the entire series of cases,
the oldest male was seventy-six, the oldest female seventy-eight,
while ten and twelve were the ages of the youngest male and
female respectively. The age table, as a whole, would seem to
show that the time of greatest liability is between twenty and
sixty for both sexes, but that under twenty it falls upon girls
nearly twice as heavily as on boys. In order to arrive at the
influence of the menopause, the decades between forty to fifty and
fifty to sixty are specially considered ; in the former decade the
percentage for men is 20 2 and 21*4 for women, while in the latter
the corresponding figures are 15 and 14*2. These two sets of
figures, in Weir Mitchell’s opinion, seem to dispose of the idea
that women are more liable to melancholia at or about this critical
period. However, in order to be more accurate, he subsequently
calculated the percentages for the years forty-five to fifty-five from
a series of 289 males and 354 females, and arrived at a like result,
the percentages working out at 20*25 and 19*8 respectively. No
mention is, however, made of the fact that climacteric changes
may and probably do exert their influence among men as well as
women. He further is of opinion, and is supported in it by com¬
ments from Dr. Chapin, that there is no special tendency for
women to recover from insanity at the climacteric period.
Xerostomia , or “dry mouth” is a very rare condition, and until
recently there were on record but little more than a dozen cases.
Dr. Thomas Harris describes (American Journal of Medical Sciences,
March, 1898) a well-marked example occurring in a woman aged 30.
She complained of intense dryness of the mouth with the resulting
great discomfort; and, associated with the arrest of the buccal and
salivary secretions, was an enlargement of both parotid glands.
Each gland felt firm and dense, and on firm pressure a little glairy
tenacious secretion could be squeezed from their ducts, both of
which were patent. The senses of taste and smell were greatly
interfered with, and any acid food or drink, or glycerine prepara-
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623
tions caused much paiu, while plain cold water was found, after
numerous methods of treatment, to afford the greatest—in fact, the
only—relief. The condition had existed for three years, and was
preceded by a febrile attack, believed to be influenza. Both jaws
were quite edentulous, and, as far as the patient could recall, the
crumbling away of the teeth had occurred within these three years.
In addition she was extremely anaemic and suffered from palpita¬
tion. The family history was obtained fairly completely, but
yielded no facts bearing on the case. She herself was of an ex¬
tremely nervous disposition. With the view that the parotid
enlargement might be reflexly dependent upon some pelvic affec¬
tion, the necessary examination was made, but with negative results.
Dr. Harris supplements his paper with a brief outline of twelve
other cases described by other observers. Parotid enlargement by
no means accompanies them all, and in some it has been relapsing
in character, and, since the secretion of not one only but of all the
salivary glands is arrested, the parotid enlargement and the “ dry
mouth ” are most probably due to a common cause. It is highly
probable that xerostomia is the result of a functional derangement
of the nervous system. Most of the cases have occurred in people
advanced in years, and with two exceptions all in the female sex ;
the condition had usually existed many years, and was very un¬
amenable to treatment.
A Brief for the Cigarette is held by Mr. W. H. Garrison in an
article appearing in last December’s number of the Medico-Legal
Journal. An editorial in the same number states that the paper in
question may be regarded as an opening of the discussion against
the present popular prejudice regarding the cigarette, and repro¬
duces a letter of inquiry, which has been sent to the various boards
of health, superintendents of insane hospitals, &c., with a view of
eliciting the opinion of those to whom the subject must have con¬
siderable importance.
Mr. Garrison brings out clearly the great prejudice in which
the cigarette is held by the public, and mentions two State legisla¬
tures and two cities that have even forbidden the sale of the
article within their borders. He gives an entertaining history of
the cigarette, dated from 1842. At the present day, according to
the chief chemist of the IJ.S. Department of Agriculture, the com¬
modity in question has an annual consumption of four thousand
millions, and, selecting the brand which comprises more than half
this number, a sample may be said to contain 1*0926 grms. of tobacco,
enveloped in a paper wrapper weighing 0*038 grm. The purity of
these two ingredients remained unchallenged until the year 1888,
when it was asserted in a London daily paper that the tobacco
contained a large amount of opium and an unclassified alkaloid,
while in the paper either arsenic, copper, or chlorine was to be
found. No scientific evidence or authoritative analysis accom¬
panied these assertions; nevertheless the whisper, handed on from
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American Retrospect.
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writer to writer, has grown in magnitude and become an accepted
fact. The anti-cigarette crusade culminated in 1892 in a petition
to Congress for a heavy tax on the article, the petitioners alleging
that for the deaths of “ 100 ” boys under sixteen in the previous year,
and for the presence of “100” men in the lunatic asylums, the
cigarette was responsible. The writer comments upon the attrac¬
tiveness which such round numbers have to those only superficially
informed, and goes to considerable pains to demonstrate the entire
lack of any scientific investigation in support of these vehement
endeavours to place the cigarette into a prominent place in the
domain of toxicology. Science, he says, as a matter of fact finds
a unanimous verdict in favour of the luxury. In corroboration
of this he quotes the findings of men of repute both in America
and this country, which show that the fillings of samples purchased
in the open market contain no morphine, strychnine, or other drug
foreign to tobacco; that the latter is of “ bright Virginia,” which
contains only from 1 to 1£ per cent, of nicotine, while 8£ per cent,
may be found in the best brands of domestic cigars ; and that the
wrappers yield no trace of arsenic, white-lead, or other poison.
The writer disclaims any wish to assert that tobacco is innocuous;
he only claims that science has proved that cigarettes are made of
good tobacco.
ENGLISH RETROSPECT.
By Dr. Fleming.
The Therapeutic Value of Spleen Extract. By A. Campbell
Clark, M.D. ( Edin . Med. Journ ., February, 1898). —Dr. Clark
gives the results of an investigation at Lanark County Asylum
extending over a period of two years. The object aimed at was
the cure or alleviation of mental disease, and was suggested by
the frequency of splenic deficiency noted in asylum post-mortem
records. Three classes of cases were submitted to treatment:
1. Those of an intractable character, e. g. chronic inertia. 2. Recent
cases of insanity due to physical weakness, e. g. puerperal cases.
8. Selected cases suggested by treatment of the first two classes.
He quotes the result of six out of thirty cases, and arrived at the
following conclusions:—That splenic treatment (1) increases nutri¬
tive activity by aiding digestion and stimulating the glandular
activity of the skin; (2) gives rise to striking mental changes,
sometimes of an abnormal character—exhibition of temper in
stuporose cases; elevation in shy and stupid cases, &c. Con¬
trasted with thyroid treatment, spleen treatment was more pheno¬
menal in its effects, more lasting and sure in its results, and
exceedingly safe. He strongly recommended a preparatory course
of spleen in any case where thyroid treatment was proposed.
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Hypnotism and Crime. By A. Stoddart Walker, M.B., F.R.C.P.E.
( Edin. Med. Journ ., January, 1898).—Criticising a paper by Dr.
Milne Bramwell “ On the Evolution of the Hypnotic Theory,”
Dr. Walker discusses at some length the important question of the
suggestion of crime. The results in his opinion depend on whether
the suggestion involves the safety of the individual or not. He
found that the hypnotised subject refused to commit an experi¬
mental crime without reason; but that, as a means of self-defence,
the suggestion proved perfectly successful. He cites the example
of a patient who doubted the suggestion when only warned that a
certain person disliked him, but when told next day that the same
person only waited for an opportunity to poison him, immediately
acted on the suggestion.
Remarks on a Case of Porencephaly. By G. A. Gibson, M.D.,
F.R.C.S.Ed., and W. Aldren Turner, M.D., F.R.C.P.Lond. (Edin.
Med. Journ., February, 1898).—The following case is reported
from an setiological as well as pathological point of view. The
patient, aged 22, was admitted into hospital in a status epilepticus,
and died next morniug. The history showed that the illness dated
from birth. The labour had been tedious and difficult, and had
required instruments, leading to injury of the patient’s head.
Three days after birth she had left-sided convulsions which passed
off, but shortly it was found that she was paralysed in the left
hand, and that there was asymmetry of the head. She was back¬
ward at school, and never learnt to write. While at school she
developed convulsions, the fits increased in number and frequency,
and after them she was almost insane. At the post-mortem the
extremities were of equal length, but the circumference of the left
was less than that of the right. The left half of the skull was
much larger than the right. The frontal sinuses were large, and
the skull itself thin. The middle and posterior fossae on the left
side were larger than those on the right. The right hemisphere of
the brain weighed ounces, and was partly cystic. The cyst con¬
sisted of the occipital lobe, the convolutions round the posterior
end of the fissure of Sylvius, and the ventral part of the temporo-
sphenoidal lobe. The gyri over the cystic portion, with the excep¬
tion of the gyrus fornicatus, the tip of the temporo-sphenoidal
lobe, and the paracentral lobule, were atrophied and replaced by
fibrous tissue. The basal ganglia were also atrophied. As the
cystic portion corresponded to the distribution of the posterior
cerebral artery, the authors concluded that the primary lesion was
probably thrombosis of that artery. The left half of the cerebellum
was atrophied, showing a crossed cerebello-cerebral connection by
way of the superior and middle peduncles. Sections of the pons
and medulla showed partial atrophy of the mesial fillet on the
right side, the internal fibres being least affected, supporting the
view that the mesial fillet ends partly in the optic thalamus, and
is partly continued direct to the cortex cerebri. There was partial
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Italian Retrospect.
626
[July,
atrophy of the i*ight pyramidal tract. The paper was further
illustrated by three excellent plates.
ITALY.
By W. Ford Robertson, M.D.
Bacteriological Researches in Acute Delirium .—The question of
the relation of certain forms of acute mania to bacterial infection
is one that has lately been brought prominently forward in this
country. A recent paper by Ceni ( Rivista Sperimentale di Frenia -
tria , 1897, Fasc. iv, p. 796), in which the observations that have
been made upon the subject on the Continent are somewhat fully
reviewed, may therefore merit notice hei*e at some length.
For some time, he says, there has been an inclination to regard
acute delirium as determined by either auto-intoxication or infec¬
tion. Briand in 1881 was the first to observe organisms in the
blood in such cases, and to contend that the condition was infec¬
tive in origin. In 1884 Rezzouico described a case in which the
vessels of the brain contained emboli of micrococci. In 1892
Buchholz observed bacilli and micrococci in preparations from one
case, although cultures made from the blood remained sterile.
About a year later Biancbi and Piccinino asserted that they had
demonstrated experimentally the infective nature of acute delirium.
They isolated from the blood and cerebro-spinal fluid of patients
who died from the disease what they believed to be a specific form
of bacillus. In some forms of acute mania they were unable
to find this organism, and they concluded that among the forms of
mental disease attended by acute delirium there is one to which
we are entitled to give the name of “ acute bacillary delirium.”
This form was distinguished from all others, according to the
authors, not only bacteriologically, but also “ by the greater
intensity of the symptoms, by the adynamic phase which quickly
follows that of excitement, by its very - rapid course, and its fatal
termination.” Rasori shortly afterwards described another form
of pathogenic bacillus which he found in the blood and cerebro¬
spinal fluid in a similar case. In 1895 Martinotti stated that he
had been able to isolate from the blood and cerebro-spinal fluid of
cases of acute delirium only some common organisms, staphylo¬
cocci and micrococci, which, on the other hand, Bianchi and
Piccinino had only been able to obtain from allied forms of mania.
In 1896 Cabitto made a bacteriological examination of five cases
which were clearly of the nature of acute primary delirium. He
was unable to find any organism in the blood. In one case,
however, he found in the liver and spleen an organism identical
with that of Bianchi, and also the Staphylococcus pyogenes albus .
It is thus evident that the observers who have investigated the
Digitized by L^ooQle
1898 .] Italian Retrospect . 627
subject of the relation of acute delirium to bacterial infection are
by no means in accord with regard to it.
Ceni has made an examination of the blood and cerebral tissues
from two cases of typical acute delirium. He was unable to find
the bacillus of Bianchi. On the other hand, he obtained from the
blood in both cases pure cultures of the Staphylococcus pyogenes
dibus. He observed the same organisms in microscopic prepara¬
tions of the brain. These observations Ceni regards as having
demonstrated that in acute primary delirium the presence of the
specific bacillus described by Bianchi and Piccinino is not constant,
while, on the other hand, it is possible to find other organisms in
the blood in such cases. The presence of these organisms must,
he thinks, be looked upon as the result of a secondary invasion
from the natural cavities of the body. It cannot be regarded as
having any direct aetiological importance in acute delirium. While,
owing to insufficiency of contrary proof, he is unable to deny the
existence of a specific bacillary agent in acute delirium, he suggests
the possibility of a mixed infection, such as has receutly been
demonstrated by Sanarelli to occur iu certain cases of yellow fever,
resulting in the complete disappearance of the specific bacillus in
consequence of a rapid invasion of common organisms from the
intestiue. There are not, however, as yet sufficient data to allow
of this hypothesis being accepted. For the present he thinks it is
preferable to admit a simple auto-infection by germs which, owing
to some special bodily conditions attending acute delirium and
the other psychopathic forms in which these organisms have been
found, invade the tissues from the intestine, complicating and
aggravating the primary disease. This view is supported by
various observations in experimental pathology which show that
auto-infection of intestinal origin can occur in consequence of
powerful disturbance of the animal organism from various causes.
Auto-infection in the Insane .—Some further light on the ques¬
tions discussed in the paper noticed in the preceding section is
afforded by a preliminary note more recently published by Ceni
and G. C. Ferrari (Rivista Sperimentale di Freniatria , 1898, fasc. i,
p. 182). These observers have made a bacteriological examination
of the blood of eighteen lunatics suffering either from acute
maniacal excitement clinically analogous to that of acute deli¬
rium, or from the mental confusion associated with repeated
epileptic seizures. In each case cultures were made from the blood
from day to day so long as the severe mental symptoms lasted.
Growths of bacteria were obtained from seven of the cases (one
being an epileptic), while in the remaining eleven the results of
the examination were quite negative. In the former group there
had been in each case noteworthy elevation of temperature; in
the latter there had been none. In the positive cases pure growths
of germs were obtained in each instance, and the form remained
constant for each individual throughout the period of examination.
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Italian Retrospect .
[July,
These forms were in one case the Staphylococcus pyogenes aureus , in
another the Staphylococcus pyogenes albus , and in the remaining five
streptococci. In two of the cases which terminated fatally, the
organisms which were isolated were in the one case the Staphylo¬
coccus pyogenes aureus aud in the other streptococci. Although the
organisms present were the same in some of the cases, their viru¬
lence, as tested upon rabbits, varied greatly. Thus in the two
cases which terminated fatally the organisms showed a high degree
of virulence, while those from the other cases produced no reaction
either local or general.
The authors conclude that, as a rule, in the class of cases under
investigation, germs are present in the blood only when there is
fever; and that the presence of the fever, and the course and
result of the illness, do not depend so much upon the kind of germ
as upon the degree of its virulence. The germs have no setiological
relationship to the mental disease. They represent merely a com¬
plication, the determining causes of which are at present un¬
known, but which is probably essentially related to severe disturb¬
ance and exhaustion of the bodily forces.
The Parathyroid Glands. —Since the great importance of the
parathyroid glands was established two years ago by Yassale and
Generali (see Journal of Menial Science , July, 1897, p. 611), much
labour has been expended upon their further experimental and
histological study by several workers on the Continent and in this
country. The conclusions formulated in 1896 by the observers
just named have been confirmed by the experimental work of
several others, among whom may be specially mentioned Gley in
France and Welsh in this country. Yassale has recently ( Rivista
Sperimentale di Freniatria , 1897, fasc. iv, p. 915) given a very
full account of some remarkable observations made in the course
of his own more recent experimental work. The subject of the
experiment was a bitch, upon which partial parathyroidectomy was
performed, the left internal gland being alone allowed to remain.
A few days later the animal presented in a mild form symptoms
which are now recognised as those of parathyroid insufficiency, and
which may or may not follow partial parathyroidectomy. From
these she soon recovered, although for some weeks afterwards there
were occasional slight returns. Eighteen months after the opera¬
tion she gave birth to eight pups, seven of which she suckled. All
went well until the fifth day, when the mother was suddenly
seized with violent tetany (tetania), —the name which the author
applies to the group of symptoms produced by ablation of the
parathyroids. The illness was so severe that it was feared that the
animal was about to die. As indicated by the results of previous
experimental observations, very large doses of thyroid gland were
at once administered, both subcutaneously and by the mouth. In
about three hours the animal had completely recovered, and was
suckling her pups. The experiment was subsequently varied in
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Italian Retrospect.
629
numerous particulars, into which it is impossible to enter here.
Suffice it to say that it was found that further attacks of severe
tetany could always be rapidly overcome by large doses of thyroid
gland; that, on the other hand, an attack could be induced by
stopping a small daily dose of thyroid, and that attacks could be
entirely prevented and the animal kept in good health by the daily
administration of very large doses of the gland. After lactation
had ceased all thyroid treatment was suspended, and the animal
still remained well.
In this paper Yassale does not make clear to the reader his own
views as to why the tetany of parathyroid insufficiency should be
curable by very large doses of thyroid gland. Unfortunately the
later papers upon the parathyroid glands by himself and G-enerali
have been published, not in the neurological journal in which
their earlier work was recorded, but in the Riforma Medica , to the
particular issues of which containing the articles in question we
have been unable to get access. Yassale, in the paper under
review, seems almost to imply that he attributes the potency of the
thyroid gland in the tetany of parathyroid insufficiency to the fact
that it contains, or has attached to it, the internal parathyroids.
But the experiments of Welsh in this country have shown that the
ingestion of parathyroids has no influence in overcoming the effects
of parathyroidectomy.
A point of much interest in the above experiment is that this
animal suffering from parathyroid insufficiency could take enor¬
mous doses of thyroid substance without apparently suffering any
of the usual toxic effects of such doses. From GO to 100 grammes
of the dried gland of the pig were given daily for a considerable
period.
Yassale points out that this experiment proves that the function
of the parathyroids is not only one indispensable to the economy,
but one that cannot be replaced by other glands. The early
symptoms of parathyroid insufficiency disappeared owing to com¬
pensatory action of the remaining internal parathyroid; but rather
than a complete functional compensation on the part of the one
existing parathyroid, there was probably an adaptation of the
organism. This was suddenly disturbed when there arose a cause
which acted more or less profoundly on metabolism, the cause in
this instance being excessive lactation. Eighteen months after
the operation, therefore, the condition of parathyroid functional
insufficiency remained in a latent state. The author draws a
parallel (without suggesting any identity) between this latent
condition in his experiment, and a neuropathic constitution in
cases of lactational insanity.
A New Journal. —Still another neurological journal has been
started in Italy under the name of the Rivieta Quindicinale di
Psicologia, Psichiatria , Neuropatologia ad uso dei Medici e dei
Oiurieti. The first number appeared in May, 1897. Each fasci-
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Italian Retrospect.
[July,
cuius, of which twenty-four are published yearly, is composed of
sixteen pages, and contains, in addition to original articles, digests
of current neurological literature and reviews of books. The
journal is the organ of the Psychiatric Clinic of the Royal
University of Rome, and is edited by Dr. E. Sciamana, Director of
the Clinic, and by Professor G. Sergi, who fills the chair of
anthropology and experimental psychology. From its commence¬
ment it has been conducted with great ability. Many original
papers of much interest have appeared in its columns, and the
digests of contemporary literature have been numerous, and
evidently most carefully written. The journal, the annual sub¬
scription to which is only six lire, may be safely recommended to
those in this country who may desire to keep abreast of the more
important neurological work which is being done in Italy.
Changes produced in the Central Nervous System by Want of Sleep .
—Two Italian neurologists, independently of each other, have
recently made some experimental observations upon this subject
which furnish a new anatomical basis for clinical phenomena of
the first importance in mental diseases.
L. Daddi ( Rivista di patologia *nervosa e mentale, 1898, fasc. i,
p. 1) describes the microscopic changes in the nervous system of
three dogs, which he compelled to keep continuously awake until
they died. One of them was at the same time deprived of food.
This animal lived for seventeen days, the other two for eight and
thirteen days. Large numbers of the cortical and other nerve-
cells showed more or less advanced chromatolysis, swelling of the
cell body, and vacuolation of the protoplasm. The method of
Golgi revealed also varicose atrophy of the protoplasmic prolonga¬
tions and disintegration of the cell body. The nucleus presented
marked structural changes, and was in many instances displaced
to the periphery of the protoplasm. These alterations the author
regards as the expression of a process of atrophy of the nerve-cell.
He thinks they are not due to an inflammatory process, as the
vessels and neuroglia were always normal. In all three cases they
were most marked in the frontal lobes, next in the sphenoidal and
occipital lobes, parietal lobes, cerebellum, and spinal ganglia. The
medulla and cord seemed unaffected. He thinks that these morbid
changes in the nerve-cells may be in part due to the modification
in the general nutrition which Tarozzi has proved to result from
insomnia, but that there are reasons for believing that they are
also caused by a special action of insomnia and over-exertion.
They are not characteristic of insomnia, but correspond essentially
with those found by other observers to result from prolonged
electrical stimulation and fatigue, as well as with the changes that
have been described in mental diseases, in various forms of
poisoning, Ac. But although the nature of the lesions is not
characteristic, their distribution, and notably their special implica¬
tion of the frontal lobes, are, the author claims, almost so. He
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Italian Retrospect.
631
regards the results of his researches as confirmatory of the theory
of Pfliiger, according to which during consciousness there is a
consumption of the component substances of the nerve-cells, and
a restitution of them during sleep. The need of sleep depends
upon modifications produced during the conscious state in the
elements of the nervous system, and more especially in those
regions which he has found affected in his experiments, although
the finer modifications corresponding to the purely physiological
degrees of this need cannot be demonstrated by any of the.
histological methods yet devised.
Agostini (Rivista Sperimentale di Freniatria , 1898, fasc. i,
p. 113) has carried out two very similar experiments upon dogs,
and has found changes in the nerve-cells corresponding to those
described by Daddi. He gives a minute description of the morbid
phenomena presented by the animals during life, and concludes
that continuous insomnia induces a state of progressive blunting
of the mental faculties, of the sensory perceptions, and of the
cutaneous and other reflexes. The clinical picture is one with
many resemblances to general paralysis of the insane.
He also relates two cases—one that of a man of fortv-five and
the other that of a young woman—in which several days of
enforced deprivation of sleep resulted in attacks of insanity of
sudden onset and characterised by excitement, mental confusion,
delusions and hallucinations. Both patients recovered after a
prolonged sleep. He also refers to the case of the cyclists who
manifested symptoms of serious mental derangement in the course
of a six days contest at New York, and relates an experience of his
own in an Alpine excursion, when he as well as other members of
his party, after walking for (three days without any proper rest,
suffered in the night-time from various remarkable hallucinations
of sight.
Agostini maintains that these cases of mental disorder produced
by want of sleep should be included in the group of acute transi
tory psychoses from exhaustion or from intoxication. The most
probable cause of the morbid phenomena is, he thinks, an auto¬
intoxication of the cortical nerve-cells from excessive production of
waste materials or defective elimination of them. Similar changes
are produced in nerve-cells by various known toxic agents. These
may cause permanent and irreparable alterations in the cells, but
more often they cause merely transitory disturbances with sub¬
sequent complete restitutio ad integrum . He urges that the results
of these experimental observations should emphasise the great
importance of combating insomnia in the various forms of mental
disease especially in their early stages, in order to save the nervous
elements from so grave a cause of exhaustion and degeneration.
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[July :
PART IV.—NOTES AND NEWS.
MEDICO-PSYCHOLOGICAL ASSOCIATION OF GREAT BRITAIN AND
IRELAND.
GENERAL MEETING.
A General Meeting was held at n^Chan^sStree^jCavendish Square, on the
^2th May f 1898. under the Presidency or 1 Dr. T. W. McDowall.
'JL'IWS Council Meeting was attended by Drs. T. W. McDowall. R ichard Legge,
C. Mercier. E . B. Whitcombe, J. B. Spence, Ernest W. White, E. GoodsII,
P. YV. MacDonald, Harry A. Benham, W. Julius Mickle. H. Hayes yAwinyftnq r
Walter S. Kay, S. Rutherford MacPhail, David Bower, H . Ravner, W. R. Watson,
J. M. Moody, and Robert Jones.
Members present at General Meeting:—Drs. W. Julius Mickle, S. Rutherford
MacPhail, T. W. McDowall (President), Richard Legge, P. W. MacDonald, David
Bower, Walter S. Kay, E. Goodall, J. B. Spence (Registrar), E. B. Whitcombe,
Charles Mercier, Ernest W. White, Harry A. Benham, Evan Powell, W. R.
Watson, James M. Moody, H. Gardiner Hill, C. P ercy S mith. Strangman Grubb*
Robert Jones (General Secretary), H. Hayes Newington (Treasurer}, H. jmyHUy,
Frank A. Elkins, C. Hubert Bond, A. H. Boys, J ). S. Pasmore, John Shaw, A. K.
M qiihL Ja mes R. Whitwell, G. Stanley Elliot, H. C. MacBryan, G. H. Savage.
A. E. Patterson, Athelstane Nobbs, Theo. B. Hyslop, C. T. Ewart, T. Outterson
Wood, H erbert Smalley, A. W. Campbell, Elizabeth J . Moffett, G. E. Shuttle-
worth, John Baker, Francis H. Edwards, H. J. Macevoy, H. A. Kidd, A. W.
Boycott, Cecil F. Beadles, James Chambers.
Letters of regret for non-attendance were received from Drs. Urquhart, Oscar
Woods, A. Turner, and Savage, the last tendering his resignation from the
Council, which was accepted with regret.
The following were elected Ordinary Members:—Thomas Aldous Clinch, M.D.
Fdin., Pathologist, Durham County Asylum. Francis Graham Crookshank,
M.D.Lond., M.R.C.S., L.R.C.P., Assistant Medical Officer, County Asylum, Berry-
wood, Northampton. Robert Vincent Donnellan, L.R.C.P., L.R.C.S.Edin.,
Assistant Medical Officer, Barnwood House, Gloucester. Henry Byam Eller ton,
M.R.C.S., L.R.C.P., Assistant Medical Officer, County Asylum, Nottingham.
R. Taafe Finn, L.R.C.P. & S.Edin., P.F.P.S.Glas., Assistant Medical Officer,
Isle of Wight County Asylum. Norab Kemp, M.B., C.M.Glas., Assistant Medical
Officer, The Retreat, York. Julius Labey, M.R.C.S., L.R.C.P., L.S.A., Medical
Superintendent of the Jersey Public Lunatic Asylum, The Homestead, Gronville,
Jersey. Norman Lavers, M.R.C.S.. L.R.C.P., Assistant Medical Officer, Camber¬
well House, London, S.E. John R. Lord, M.B., C.M.Edin., Assistant Medical
Officer, Hanwell Asylum, London, W. George William Falconer MkcNaughton,
M.D., F.R.C.S.Edin., 2, Broadway Buildings, Walham Green, London, S.W.
David John Sherrard, A.B., M.B., M.Ch.Dubl., The Laurels, Hailsham, Sussex.
William St. John Skeen, M.B., C.M.Aberd., Deputy Medical Superintendent,
County Asylum, Winterton Ferry hi 11, Durham. Itobert Hunter Steen, M.D.
Lond., Senior Assistant Medical Officer, West Sussex County Asylum, Chichester.
John Sutcliffe, M.R.C.S., L.R.C.P.Ed., Assistant Medical Officer, Royal Asylum,
near Manchester. William R. K. Watson, M.A., M.B., C.M.Glas,, H.M.Prison,
Holloway. Thomas Yeates, M.B., C.M., Assistant Medical Officer, Borough
Asylum, Sunderland, Durham.
Dr. Robert Jones exhibited a model of a bedstead adapted for fixing to the
floors of single rooms, and manufactured by Wilson Brothers, Ledsam Street,
Birmingham.
Papers were read by A. W. Campbell, M.D., Pathologist, County Asylum,
Rainhill, Lancs, on “ Colitis ” (with microscopic and lantern demonstrations); by
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1898.]
Notes and News.
638
Dr. J. Turner, M.B., C.M., County Asylum, Brentwood, Essex, “ Remarks on
Giant-cells in Brains of the Insane, examined in a fresh state, with microscopic
demonstrations; ” and by E. S. Pasmore, M.D.Lond., M.R.C.P.Lond., London
County Asylum, Banstead, on “ Observations on the Classification of Insanity.”
The members dined together after the meeting at the Cafe Royal, Regent
Street, at 6.30 p.m.
SOUTH-WESTERN DIVISION.
The Spring Meeting of the South-Western Division was held on 19th April,
1898, at Littlemore Asylum, Oxford. Present, Drs. Urquhart (President Elect),.
Brain Hartnell (Worcester), lies (Fairford), Sankey (Littlemore), Good (Little-
more), Bower (Bedford), Noott (Broadmoor), Mumby (Portsmouth), Aveline
(Taunton), Benham (Bristol), P. W. MacDonald (Hon. Secretary, Dorchester)*
R. Sankey, jun. (visitor, Littlemore), Blachford (Bristol), Scott (Warneford),
and Stewart (Bristol). On the motiou of Mr. Sankey, seconded by Dr. Benham,
Dr. Urquhart was voted to the chair.
The minutes of the last meeting having been read and confirmed, the Hon.
Secretary said the President of the Association (Dr. McDowall) had written to-
express his regret at being unable to attend, owing to the examinations at
Durham University being in progress this week. Dr. Wade and Dr. Richards
had also sent letters of regret at being unable to attend.
Election of New Members.
The following new members were elected:—Davison, James, M.D., M.R.C.P*
Lond., &c., Streate Place, Bath Road, Bournemouth. Proposed by P. W.
MacDonald, A. Davidson, A. Law Wade. Embleton, Dennis Cawood, M.R.C.S.*
L.R.C.P., St. Wilfrid’s, St. Michael’s Road, Bournemouth. Proposed by
P. W. MacDonald, A. Davidson, A. Law Wade. English, Evelyn A. V., M.B.,
C.M.Edin., Resident Medical Officer Eastern Dispensary, Bath. Proposed by
L. Weatherley, P. W. MacDonald, A. Davidson. Jobson, Thomas Battersby,
M. D., B.Ch., B.A.O.Dub., Assistant Medical Officer Somerset and Bath Asylum*
Wells. Proposed by A. Law Wade, E. B. Whitcombe, George A. Watson.
Middlemist, Edwyn George, M.B., Assistant Medical Officer County Asylum,
Dorchester. Proposed by P. W. Macdonald, A. Law Wade, A. Davidson.
Sproat, James Hugh, M.B., L.R.C.P., M.R.C.S., Ac., Assistant Medical Officer
Somerset and Bath Asylum, Wells. Proposed by A. Law Wade, E. B. Whitcombe*
Geo. A. Watson. Astbury, Thomas, M.R.C.S.Eng., L.R.C.P.Lond., Assistant
Medical Officer Wonford House, Exeter. Proposed by P. Maury Deas, P. W.
MacDonald, A. Davidson.
Election of Honorary Secretary.
The Chairman said the next business was the election of the Hon. Secretary *
He did not think that would occupy the meeting, except by some one making a
complimentary speech, which he thought was very well deserved. (Hear, hear.)
Dr. Benham said those who attended the meetings of the South-Western
Division knew the time and attention that Dr. MacDonald gave to the work,,
and he had great pleasure in proposing his re-election. He was sure they
could not do better than reappoint him.
Mr. Ileb seconded the proposition, which was carried und voce .
The Hon. Secretary thanked the meeting for asking him to continue the-
work; and while he agreed to do so for another year, he would take this oppor¬
tunity of saying that perhaps before long it might be as well for the Division to think
of somebody else. Not that the work had been other than a pleasure to him, but
he did not see why he should go on holding the office, so to speak, for an indefinite
time. There were other men—young men—in the division who, he was quite
sure, would be willing to do the work, and do it as well, perhaps better (“No”)*
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Notes and News.
[July,
than he had done it. He wished to thank in a special degree those members
who had assisted him by contributing papers. One of the anxieties of an honorary
secretary was to get useful contributions, and he thought the South-Western
Division would be recognised as having done good work in this direction.
(Applause.)
Vacancies on the Council at Annual Meeting.
The Hon. Secretary proposed and Dr. Hartnell seconded that Dr. Wade’s
name be nominated for one of the vacancies.
Committee of Management.
The following were appointed a Committee of Management for 1898-9:—
Drs. Deas, Benliam, Soutnr, Morton, Aldridge, and Goodall.
The Nursing Certificate.
The Chairman said they had now to consider “proposed amended Regula¬
tions for the Examination for the Nursing Certificate.” This was a question of
some difficulty. He knew that in Scotland it occupied two or three meetings, and
it was a question on which the division must be guided in great measure by Dr.
MacDonald’s formulating propositions which they could accept, or amend, or
refuse. Unless there was anybody present who had given a great deal of
personal attention to this matter of the nursing certificate, he thought it would
be better for Dr. MacDonald to make a statement to them.
The Hon. Secretary explained that the first proposition they had to consider
was whether they approved of the amendment, that the term of training be
extended from two to three years. The second proposition w r as whether they
approved of two examiners being appointed for the whole of England, Scotland,
and Ireland. The third proposition was whether they approved of the entrance
fee being raised from 2s. 6d. to 5*. These were the three propositions which
he thought need only take up any time in discussing. The Chairman had in¬
formed them that the Scottish members took up two or three meetings; certainly
they took up the greater part of two. The result of their deliberations would
assist gentlemen present, though they did not bind them. They voted against
three years’ training; they suggested that ten examiners should be appointed
instead of two, and they approved of the 5s. subscription. He wished to point
out that by a resolution passed at the last annual meeting they had that day to
take definite steps to instruct their Secretary what to report to the next annnal
meeting. Whatever resolution they came to that day he was bound to report
as the deliberate opinion of this division on these points. He believed Dr. Ben ham
held some strong views on the subject, and he would pass the matter on to him.
Dr. Benham said he did not know the Hon. Secretary was correct in saying
that he held strong views on these points, but he certainly did hold a strong
view that the term of training should not be increased from two to three years.
His opinion, based upon the experience he had gained by seeing the training of
nurses in the past, was to the effect that if they could not adequately train their
nurses in two years’ time to pass an examination which was quite within the
limits of their capacity, or what he thought they should be taught, the time
they 6pent in asylums was of little use. With regard to appointing two
members from each division, it would be nice if one could be in two places at the
6ame time; but if it was expected that he should go round and examine the
various candidates, he would say frankly that he should not have the time.
If there were members who expressed an opinion in favour of it, or were
prepared to accept such an appointment, he had nothing to say. As regarded the
raising of the fee from 2s. 6d. to 5s., he did not know why it was proposed to
increase the fee. (A voice: “ To pay the Examiners.”) To pay the Examiners.
That was a proposition which so far had not been made to them, and he was not
prepared without consideration to express a definite opinion upon the subject.
Dr. Bower —Do I understand that it is proposed to appoint two Examiners
for each division P
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635
1898.]
The Hon. Secretary —That is the proposition of the Scottish Division, so as
to lessen the labours of the examiners. The amended regulation you are asked
to approve or disapprove of is that there be only two examiners. The Scottish
Division tliiuk this impracticable unless you pay men an actual salary, more than
the mere out-of-pocket expenses. I am of opinion, and I think most men will
agree with the view of the Scottish Division, that it cannot be done.
Dr. Benham —If two men are to visit the whole of England you must appoint
paid examiners.
The Hon. Secretary —You are not supposed to visit the asylums. The vivd
voce will go on as before; this refers to written papers.
Mr. Sankey said he did not see the good of appointing examiners in the
written examination, because there was nothing whatever to do. The Council
set. the questions that were placed before the candidates. What object could
there be in the appointment of public examiners, so to sav ? The work was
done by a committee already appointed. With regard to the question of two or
three years’ training, he agreed with Dr. Benham that two years was enough.
If it was not he did not think the nurses were worth much. Ho was sure he
could not get female attendants to stay three years to undertake it; they would
go away, as there would be no inducement for them to stay. As regarded the
proposal to raise the subscription from 2s. 6d. to 5 s. t he thought if these public
examiners were not appointed, that would not be necessary; 5s. was rather a
heavy sum to ask persons going in for the examination to pay for such a trifling
bit of paper as they received to show for it.
Dr. Noott said he had had experience of training classes for five or six years
past, and although agreeing with the general principle of the examination,
there were several things which he thought might be improved. The Medico-
Psychological Association having once started a course of this kind, it was a
great pity that, instead of encouraging, they should seem, as it appeared to
him these new regulations would do, to discourage attendants and nurses from
going up for it. It was very difficult in many places for nurses and attendants
to appear for examination; but where they did so he thought it was of great
benefit to themselves and the institution. Two years was, to his mind, the abso¬
lute limit, and he agreed with what Mr. Sankey had said, that if they asked
them to come up year after year they would lose all interest in the work. So
far as the examination was concerned, it was very important in itself,
but it was of very much less importance than the teaching the attendants and
nurses had to undergo. He thought the book was far too elaborate in one
part, and not sufficiently elaborate in another. That was to say, the anatomy and
physiology went beyond what the nurses should do; but when it came to the
practical knowledge of their work in the wards, their attention to patients, the
method of dealing with classes of patients, suicidal and homicidal, dirty
patients, and the nursing part of asylum routine, there was little in the book
that might not be improved aud enlarged upon, and they might with advantage
cut half the first part out and double the second part. (Hear, hear.) As re¬
garded the examiners he had not a word to say, but with respect to fees he
thought it was preposterous to ask people in this position in life to pay 6$., and
if they happened to fail, 2s. 6d. for each subsequent examination. He did not
see how they .were going to compel them to do that unless the asylum com¬
mittee were willing to pay the examination fees, and he supposed there were few
asylum committees who would see their way to do that.
Mr. Sankey —The auditor would surcharge.
Dr. Noott said the only way he could see was that asylum committees might
be inclined to subscribe to the Medico-Psychological Association in this matter,
and relieve the nurses and attendants of all fees. Whenever he had asked
members of a class to send in their half-crowns he had done it very shame¬
facedly ; he had not liked it, because he thought it was hard lines on them to be
asked to pay at all. At Broadmoor they were fourteen hours in the wards, and
xliv. 42
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Notes and News.
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then they came to him for an hour and a half for instruction. He repeated,
therefore, that he considered it hard lines to ask them to pay any fees at all.
Dr. Good said he did not think they would get the nurses to go in for a three
years’ training, he found it hard enough to get them up for two years. They
attended the first six months, and the next year they were told to attend again,
and they said they did not see their way to give up so much of their spare time.
They could not do it in asylum time; they had to give up a couple of hours a
week,and it was conceivable the lecture came on what they called their half-day.
They did not like coming back at half past seven, or at whatever time the lecture
was fixed; they went to see their friends, and they did not present themselves at
the lecture. If the time of training was lengthened he was certain they would
not get nurses to go in for the examination. As regarded the fees, he agreed
with Dr. Noott that it was very hard lines to make the attendants and nurses
pay, and if they increased the amount he thought it would be very few who
would do so. As to the examiners, he bad nothing to say on that part of the
question.
Dr. Benham remarked with regard to fees, some of his committee had solved
the difficulty by paying the money themselves.
Dr. Bower said, as to the reason for the appointment of special examiners for
various parts, the Association had complaints that the passes in the different
asylums were unequal. In some asylums there were no " pluckings ” at all, and
in other asylums comparatively few passes. It was plainly hinted that this was
because each superintendent was able to choose his own examiners, which on the
face of it seemed rather an unusual proceeding. The suggestion to appoint
special examiners to examine at least the papers of all asylums arose from this
fact, and there was no doubt a certain amount of ground for it. Then the
difficulty of getting examiners to do so much work without pay or without their
expenses being paid raised the next question, and though only two examiners
for the whole country, probably it would be an impossible task for them to do
the work unless they were meu of great leisure. He thought there was a
general consensus of opinion that two years’ training was quite long enough.
As to the payment of the fees, there was a great deal to be said. It could
hardly be expected that the members of the Medico-Psychological Association
should burden themselves with the expense of this, which was really for the
benefit of the nurses, and the county asylum committees could not pay the fees.
Asylums like those where Dr. Benham was superintendent were able to do a
great deal in the way of gratuities because they had no auditor.
Dr. Benham —I beg your pardon. We have an auditor, like every one else.
Dr. Bower —A city auditor. You do not have a Local Government Board
auditor, which is very different indeed. Your auditor is appointed by yourselves,
like the examiners at present are.
Dr. Benham —He is appointed by Act of Parliament. One is appointed under
the Municipal Corporations Act, and the other under the County Councils Act.
Dr. B. Hartnell said he was also of opinion that a period of three years’
training was too long; two years was ample. As to fees, he considered 2$. 6rf.
quite sufficient. He agreed with Dr. Noott that it was trying to stop a good
thing by asking another 2*. 6d. whenever the candidates failed. To ask the
nurses to attend a certain number of lectures, and unless they did so they would
not be “ signed ” for, was a retrograde step. As regarded the number of exa¬
miners, that was a matter he was not qualified to speak about. They taught and
certificated their own, as at Dorchester.
The Chairman gate a brief rtsumS of the evolution of this question, in re¬
ference to the production of the Handbook and the granting of the Nursing
Certificate by the Association. He referred to the fact that the Handbook had
been a great success, although it represented very diverse opinions and attempted
to reconcile opposing views. He held that no question should be asked in tbe
examinations which could not be answered from the Handbook, for that would
moderate in some measure the erratic course sometimes steered by examiners.
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637
«nd ensure fairness for all. They ought to have an authoritative and compre¬
hensive work. For his part, he thought it as good as could be reasonably
expected. No doubt it might be held that it was too full here and too restricted
there, as it might be looked at individually. He himself was strongly of opinion
that nurses ought not to be aborted doctors, but that they should be trained to
care for the sick and insane in an intelligent manner. That necessarily meant
some anatomy and some physiology, yet not to the detriment of their knowledge
how to place a draw-sheet or apply a fomentation. Every nurse should pass
some time in attending the sick. That should be compulsory before entering
for the certificate. As to the period of training, three years had been proposed
in order to bring them into line with general hospitals, but there was consider¬
able difference of opinion as to this point. Scotland had declared for the status
quo iu a very evenly divided meeting. Referring to the proposal to appoint
only two examiners, and stating the reasons, the Chairman doubted if two men
could deal with the large number of papers sent in without undue sacrifice of
time. He concluded by asking the Hon. Secretary to put his resolution.
The Hon. Secretary — I shall ask the meeting for its opinion as to whether the
period of training shall be two or three years.
The Chairman then put the question, and declared that the meeting was
practically unanimous in favour of two years.
Dr. Noott proposed— (a) That the meeting disapproves of the proposal to
appoint two examiners, (b) That the present system be continued, but that
the assessor, who shall in future be known as the local examiner, be not
suggested by the superintendent of the asylum, but be directly appointed by
the Association.
Mr. B. Hartnell seconded the resolutions, which were agreed to nem. con.
Dr. Benham moved, and Mr. Sankey seconded, that the fee be not increased
from 2s. 6d . to 5s.
The proposition was adopted.
Compulsory Pensions.
The Hon. Secretary said, as secretary of the sub-committee appointed at
their last meeting to report on the question of Compulsory Pensions, he had a
short statement to make. With the agenda of this meeting was circulated a
report of the sub-committee. Ten days after the report was sent out, viz. on
the 25th of March, the Lord Chancellor introduced into the House of Lords a
Bill entitled “ An Act to amend the Lunacy Acts.” Clauses 20 and 21 of the
Bill dealt most effectively, and he was glad to say most satisfactorily, with the
question of pensions and also gratuities to injured people. He now begged to
move that the report of the sub-committee, so to speak, lapse, and that instead
they consider Clauses 20 and 21 of the Lunacy Bill, on which he believed Dr.
Benham would move a definite resolution.
Dr. Bower said he thought they might receive the report of the committee,
who had taken considerable trouble in the matter, and thank them for it.
(Hear, hear.)
The Chairman— Certainly. Will you take that as read ? (" Yes.”)
Dr. Benham moved—“That the South-Western Division of the Medico-
Psychological Association approves of and supports the Pension clauses (Clauses
20 and 21) of the Lunacy Bill Amendment Act, now before Parliament.” He
said he was a member of the Parliamentary Bills Committee, and about a
fortnight ago they met in London, and spent about three and a half hours in
considering the new Lunacy Bill. They were unanimously of opinion that they
would not get anything more favourable from the Government than these clauses
as they now stood. Shortly stated, they were to the effect that every committee
should make provision for every servant in the employ of an asylum, which
should not be less than that granted on the present scale of the Local Govern¬
ment Board. That was to say, they could go up to two thirds, but on no account
was it to be less than was paid to Poor Law servauts. They thought that was
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638
[July,
the most they were likely to get, and he would propose the resolution which hfr
had read.
Dr. MacDonald seconded the resolution. He hoped the Government would,
stick to their guns, and carry the Bill through.
Dr. Bower —Is it clear that the allowance will be granted without any con¬
tribution ?
Dr. Benham —Certainly. That was one reason why we were so unanimous itt
supporting the Bill.
The resolution was carried unanimously.
The Next Meeting.
The Hon. Secretary said the date of the next meeting, according to the^
present arrangement, would be Tuesday, October 18th. As to the place of
meeting, he would suggest that it be referred to the Committee of Muuagement.
The suggestion was adopted.
Papers Read.
Dr. Noott read a paper on M Points of Similarity between Epileptic and Alco¬
holic Insanity ” (see p. 492), and Dr. Blachfobd communicated an “ Analysis of
the Causes of Insanity in One thousand Patients ” (see p. 500).
Vote op Thanks.
The Chairman proposed a hearty vote of thanks to Mr. Sankey for his kindness
to the members of the division that day. (Applause.) To him it was especially
gratifying to meet Mr. Sankey after so many years, and to find him in such
excellent health aud spirits. He was sure it was as much a pleasure to Mr.
Sankey to meet his colleagues of the specialty that day ns it was in the days of
long ago. This was an anniversary season with Mr. Sankey, for on the following
day it would be forty-four years since he was appointed to this important institu¬
tion. They were also very much indebted to Mr. Sankey for his presentation to
the Association library of the Journal of Mental Science from the beginning,
and now accessible to all the members. (Applause.)
The proposition was carried by acclamation.
Mr. Sankey, in acknowledging the compliment, said it was exactly forty-three
years ago since the last meeting of the Association at Littlemore, and the only
gentleman living that he could call to recollection who was present beside himself
was their late consulting surgeon, Mr. Hussey, who was now in his eighty-third
year.. In conclusion he proposed a vote of thanks to Dr. Urquliart for presiding.
(Applause.)
The proposition was carried und voce, aud duly acknowledged.
In the evening the members and several visitors dined together at the Mitre
Hotel, and a most pleasant evening was spent.
SOUTH-EASTERN DIVISION.
The Spring Meeting of the South-Eastern Division of the Medico-Psychological
Association wras held at the Middlesex County Asylum, Wandsworth, S.W., on
April 20th. From 11.30 a.m. to 1.30 p.m. members were show n round the main
asylum, annexe and grounds by Drs. Hill, Rolleston, Ew’bank, and Worth. From
1.30 to 2.30 p.m. members partook of light refreshments, at 2.30 p.m. the Divi¬
sional Committee of Management met, aud at 3 p.m. the General Meeting took
place. Present: Drs. Fletcher Beach, J. M. Moody, C. H. Bond. E. W. White,
H. Gardiner Hill, C. Rolleston, G. E. Mould, A. Maclean, A. F. Stocker, H.
Rayner, W. J. H. Hasted, F. H. Edwards, G. E. ShuttleWorth, J. S. Tukc, A. G.
Ewbauk, A. S. Newungton, D. Bower, D. J. Thomson, H. A. Kidd, A. N. Boycott,
and Stilwell. Dr. Hill was voted to the chair. The minutes of the last meeting
were read and confirmed.
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The Chairman said the next duty was the nomination of Honorary Divisional
Secretary for the year 1898-9. It was proposed that Dr. White be re-elected,
and reference was made to the fact that this branch of the Association had been
most prosperous during his tenure of office, and also to the admirable way in
which he had performed his work. The proposal was carried unanimously.
Dr. White thanked the members for re-electing him, and promised that
he would do his duty in the future as he had endeavoured to do it in the past.
The question of retiring members of the Divisional Committee was next con¬
sidered.
Dr. Rayner expressed his wish to be permitted to retire.
An election took place by ballot, and Drs. Moody and Beach were appointed
scrutineers.
The result of the election was that the following members of committee
continued in office: Drs. Bower, Boycott, Newington, Moody, Swain, and Thomson;
while the retiring members were Mr. Bay ley, and Drs. Rayner and Turner.
Election op Three Members op Divisional Committee.
The election of three members of Divisional Committee to fill the vacancies
created by ballot then took place.
The Hon. Sec. said it was necessary to replace those members who left, by
electing members with similar interests. With regard to registered hospitals.
Dr. Percy Smith would be very pleased to succeed 5lr. Bayley. As regards the
other vacancies he had no suggestions to make, as he had not heard the wishes of
members.
Dr. Bower proposed, in the place of Dr. Rayner, Dr. Outterson Wood, who had
taken great interest in the Association.
Dr. Beach seconded.
The Hon. Sec. explained that the third must be an assistant medical officer.
Dr. Moody proposed, and Dr. Tuke seconded. Dr. Bond of Banstead Asylum.
As no other names were suggested for election, the cliairmau put these to the
meeting, and they were carried unanimously.
Nominations por Council.
The Hon. Secretary said the two names submitted to the Council last year for
nomination to fill vacancies upon that body at the Annual Meeting were Dr. Moody
and Mr. Bayley, with the result that Dr. Moody had been elected on the Council.
Dr. Thomson proposed that the names of Mr. Bayley and Dr. Chambers be
submitted at the next Annual Meeting to fill vacancies on the Council.
Dr. Tuke seconded, and it was carried.
Regulations for Nursing Certificate.
The Hon. Secretary said with regard to the proposed amended regulations
for the Nursing Certificate, the principal alterations were the extension of the
time of service from two to three years, and the increase of fee from 2s. 6d. to
5 s.; and it was for the meeting to decide whether to discuss them in detail or
to appoint a sub-committee.
Dr. Bower stated that the South-Western Division, and also the Scottish Divi¬
sion, had come to a definite conclusion, and thought it desirable that the South-
Eastern Division should do so.
The Hon. Secretary then read to the meeting the Schedule of proposed new
regulations.
After some discussion the Chairman said, in order to clear the way, it would
be best to decide whether to discuss the matter now, or to refer it to a sub-com¬
mittee. *
It was proposed by Dr. Mould, and seconded by Dr. Shuttleworth, that the
matter be discussed at the present time.
An amendment was moved by Dr. Hazlett, and seconded by Dr. S. S til well,
that the matter be referred to a sub-committee, with power to act.
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The amendment was lost, and the discussion took place.
The Hon. Secretary said that with regard to the two or three years, he waa
in favour of three years, and he could speak with experience, as his asylum was
one of the first to take up training, to hold examinations, and to issue certificates
of its own before the Association started its certificate. He thought two years
an insufficient time. Nurses and attendants who obtained the certificates and
medals received extra pay, in many asylums as much as £2 a year extra. They
could get employment in public work, and in private cases, and as these certifi-
cates were so valuable, it was desirable that the examination should be of a high
standard, and he would speak in the strongest terms possible in favour of three
years.
It was proposed by Dr. Beach, and seconded by Dr. Thomson, that the time
he extended to three years.
An amendment that it be two years was moved by Dr. Rayner, and seconded
by Dr. Bower, and lost.
The members voted as follows:
In favour of time being increased from two to three years, 10; against, 6;
the resolution being carried.
The Chairman said the next point was whether examiners should be ap¬
pointed by the Council for the special purpose.
Some discussion arose as to whether two examiners would be sufficient for the
whole of England.
Dr. Shuttleworth explained that the desire of appointing two examiners
was to obtain a standard of uniformity.
After further discussion the Hon. Secretary spoke of the varying standards
of excellence which existed under the present system, where those who prepared
the candidates provided their own examiner. If two General Examiners were
appointed by the Association their fees would have to be paid.
After further discussion it was proposed by Dr. Shuttleworth, and seconded
by Dr. White, that the suggested amended regulation on this point be approved
and submitted to the Council.
Dr. Bower moved and Dr. Halbted seconded an amendment that the Division
approves of the present regulations, with the exception that the assessors be in
future appointed by the Council, instead of by the Medical Superintendent pre¬
senting candidates.
The amendment was lost, and the resolution was then put to the meeting and
carried.
The next point considered was the proposed increase of the fee for examination
to 5s.
Dr. Shuttleworth proposed and Dr. Bower seconded that the fee be
increased from 2s. 6d. to 5s.
Dr. Mould moved an amendment that it stand as at present, but there being
no seconder the amendment was not put.
The Hon. Secretary said the fee should be commensurate with the labour
involved, and he thought it should be increased to 5s,
The motion was put and earned.
The Hon. Secretary asked the Chairman to put the whole of the resolutions
with regard to the Nursing Certificate to the meeting en bloc.
It was then proposed by Dr. Gardiner Hill that these drafted amended
regulations be approved en bloc , and submitted to Council.
Dr. Tuke seconded, and the motion was carried.
Dr. Turk said he understood thnt this would all be again discussed in July,
when the opinions of the other divisions had been given.
The Lunacy Bill, 1898.
The Chairman said the next business was the consideration of the Lunacy
Bill, 1898, and the Pensions question.
The Hon. Secretary said the Bill had nor? appeared as the Lunacy Bill, 1898,
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641
and was introduced by the Lord Chancellor. It was for them to consider whether
it was necessary to send any report on the matter, but anything they wished to
do must be done to-day.
Dr. Bower asked for the conclusions of the Parliamentary Committee.
Dr. Beach said the Committee had come to the conclusion that they would
approve the Pension clause, aud that with reference to injury. They did not agree
that the urgency order should be reduced from seven days to four, because in
the country there was great difficulty in getting magistrates to sign petitions.
Two wav8 that might obviate the difficulty, if the Bill were introduced, were for
all Justices to sign orders, or for a list of the authorised Justices to be kept at
the Commissioners* office, but they strongly objected to the time being reduced.
As to the paying of patients, he had sent out to all asylums questions as to the
opinion of superintendents on the matter, and of the replies already received far
more were against paying than in favour of it. He said the Act also stipulated
that no superintendent of an asylum should be permitted to move patients from
one part of the asylum to another without the permission of the Commissioners
in Lunacy. This he characterised as absurd, as, in the event of an epidemic
breaking out, the patients could not be removed to the infirmary.
The Hon. Secretary, in reply to question, said payment for work done was
optional in the Bill, but it would create great difficulty with patients who at
present work well if the money were granted to those who do but little. Working
patients are now remunerated by luncheons, tobacco, picnics, and other privilegei
Dr. Rayner spoke of the difficulty of scheduling the work done.
The Hon. Secretary said he had spoken very strongly against the clause, as
the ouly member from this Division of the County and Borough Asylums < n the
Parliamentary Committee. Dr. Benham and he stood very firmly against it, and
believed in doing so they were representing the opinion of medical superin¬
tendents throughout the country.
Dr. Rayner said the proposal of payment should be approached from a wide
point of view, and thought members should be very careful before giving it a
direct negative.
The Hon. Secretary thought it very desirable that the meeting Bhould
express an opinion on the matter. He himself was in favour of remuneration
by going out to picnics, luncheons, tobacco, &c., as more suitable than money
payments, which would cause dissatisfaction aud jealousy amongst patients
generally, and even aid escapes.
Dr. Moody was opposed to remuneration, as, on account of the size of his
asylum, the matter would have to be trusted to subordinates, which he did not
consider desirable.
The Chairman stated that he agreed with Dr. Moody, but thought it would
be very desirable that the Parliamentary Committee should recommend an
amendment to the clause to enable the Visiting Committee to be empowered to
remunerate patients on discharge out of the County Maintenance Fund on the
recommendation of the Medical Superintendent. This be said would not be
ignoring the liberal tendency that the Bill indicated, but would be making some
use of it. He mentioned that the Middlesex County Asylum had the advantage
of a large benevolent fund called the Queen Adelaide Fund, which had been of
great benefit to patients on discharge.
The Hon. Secretary seconded this proposal, and spoke of the benefit rendered
to patients by a benevolent fund at bis asylum.
The resolution that the Visiting Committee be empowered to remunerate
patients for their labour on discharge, on the recommendation of the Medical
Superintendent, was put to the meeting and carried unanimously.
The Hon. Secretary said it is taken that the present clause be not agreeable
to the division. This was carried.
A discussion took place with regard to the clause of the Bill shortening the
period of an urgency order from seven to four days, and several members drew
attention to the great inconvenience it would cause.
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Notes and News.
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The Hon. Secbetaby stated that he was led to believe the Lord Chancellor
was very decided on this matter, as he thought the urgency order had been used in
some cases where it should not have been, and his idea seemed to be to reduce the
number of urgency orders.
Dr. Bower thought the action of the Lord Chancellor need not prejudice the
meeting expressing its opinion. He drew attention to the difference between
English and Scottish law, and thought that what might work well in Scotland
might work very badly in England.
Dr. Newington described the difficulty that often existed in a country district in
finding a magistrate, it frequently being necessary to come into a London district
to secure one. Dr. Bower proposed and Dr. Rayner seconded, that the Parlia¬
mentary Committee be informed that the opinion of this division is against the
reduction of the urgency order from seven to four days. The motion was
carried.
The Chairman asked if any gentleman had anything to say about any other
clause save that dealing with the pensions. No other point was brought
forward.
The Hon. Sec. then spoke of the Pension scheme in the Bill. He drew
attention to the similarity of the clause to a proposal of his made ten years
ago. He stated that it fixes the minimum, leaves a sliding scale for merit in the
hands of committees, does not interfere with vested interests in county and
borough asylums like his own, and stated he was very strongly in favour of
it. He added that it remained for the meeting to discuss the matter, and
for him to report upon it to the Parliamentary Committee. He farther stated
that no deduction would be made from salaries, and that pensions would not be
calculated from aggregate service, as is the case under the Poor Law Officers'
Superannuation Act, 1896.
Dr. Beach, in reply to a question, said he understood from the general body
of the Parliamentary Committee, that no deductions would be made.
The Chairman asked if it was the feeling of the meeting that they approved
of Clause 20 referring to pensions. The feeling of the meeting was that it was
approved of. Clause 21 referring to injuries was also considered, and approved
with the following amendment.
Dr. Moody drew attention to the word “ may ** in the injury clause of the
Pension scheme, and asked whether it should not be “ shall.”
The Chairman thought that as it was a small remuneration they might ask
for “ shall,’* Dr. Moody then proposed and Dr. Bower seconded that the word
“ shall ** be substituted for the word %< may,** the clause to read “ The Visiting
Committee shall grant out of the County and Borough Fund.** The motion
was carried.
Next Meeting.
The Hon. Secretary said it was considered desirable by the Divisiona l Com -
roittee of. Management^ hat visits should be made north and south of TUT?
Thames alU , P!llll6iy. Jtwonld be necessary to go north this time, and it was
thought advisable if there was an offer, to visit a private asylum. Dr. Bower,
acting on this suggestion, had invited the division to Bedford on the 10th
October, the second Monday in the mouth. The day was changed from
Wednesday to Monday, as some members had found the former inconvenient.
Dr. Moody proposed and Dr. Shuttleworth seconded, that the division
accept Dr. Bowers’kind invitation to Bedford. Carried.
Dr. Shuttleworth read a paper on “ Industrial Training of Imbeciles **
(see page 531).
Dr. Allan-Maclean’s paper was postponed until the next meeting of the
Division, from want of time.
Dr. Thomson proposed a vote of thanks to Dr. Hill, and spoke of the excel¬
lent condition of the Middlesex County Asylum.
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Dr. Beach seconded, and remarked that the present state of the building
showed the effect of a good administrator who was always at work.
Dr. Hill thanked the members for their kind expression of feeling, and said
that he considered it an honour to be visited by the South-Eastern Division of
the Association. I n the evening the memb e rs dined together at the Cafe
.Monico, Piccadilly Circus, W. ' ~
NORTHERN AND MIDLAND DIVISION.
The Spring Meeting of this division was held at the Lunatic Hospital,
Cheadle, near Manchester, May 25th, 1898.
Members present: G. W. Mould, Henry ,T. Mackenzie, C. K. Hitchcock, C.
H. Gwynn, W. H. B. Stoddart, David Nicolson, J. Sutcliffe, W. S. Kay, G. E.
Mould, H. C. Halstead, P. G. Mould, Crochley Clapham, and two visitors—
Frank A. Gill and D. C. M. Lunt.
Dr. G. W. Mould was voted to the chair.
The minutes of the last meeting having been confirmed, it was explained by
the Secretary that owing to the late fixture of the present divisional meeting the
Council of the Association had been obliged to proceed with the selection of
members to represent the division on the Council, and of a member to act as
Hon. Sec. to the Northern and Midland Division for the coming year, viz. T. S.
Sheldon, M. Macclesfield, and A. W. Campbell, M.D., Rainhil), for the Council,
and Crochley Clapham, M.D., Rotherham, as Hon. Sec. These selections were
approved by the meeting.
Proposed by the Hon. Sec., seconded by Dr. W. Smith Kay, and carried
unanimously, “ that future Spring Meetings of the Division be held in April
instead of May.”
Lunch was kindly provided by Dr. Mould before the meeting, and afterwards
members were shown round the hospital and associated residences by the staff.
>In the evening the members dined together, at Dr. Mould’s invitation, in the
ball-room of the hospital.
Regulations fob Nubsing Cebtificatb.
Dr. Clapham having opened the discussion by a rteumS of the alterations
proposed—
Dr. Gilbert Mould said that, so far as the appointment of two examiners for
the papers for the whole of the country was concerned, it was an excellent
alteration, for it insured uniformity of judgment. At present the papers were
set by one set of examiners, and examined by persous of different systems,
probably taking different views of what the questions meant, and to what
standard they should conform. It w f as still proposed to leave the vivd voce
examination in the same state,—that was to say, that the superintendent of the
asylum, together with an assessor, should conduct it as heretofore. It was quite
obvious that was also perfectly reasonable. They could not appoint two
examiners to examine vivd voce all the candidates in the kingdom, but two could
quite easily examine all the papers. He thought the number of candidates was
greater than 600—that was only, he believed, for a single examination. He
thought the number of candidates who passed during the year amounted to
several thousands, but, however that might be, that was comparatively a small
number. He thought that 2.?. 6 d. was quite sufficient for the fees. Five
shillings was more than those people might care to pay. Of course the argu¬
ment for the increase in the fees was that they would be necessary in order to
remunerate the examiners for their time and labour. That might or might not
he so. On the whole, he would say that 2$. Gd. was quite enough for the fee.
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Notes and News .
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and that two years was quite sufficient time for the attendants to hare been in
an asylum. The amended regulations, so far as the examinations were con¬
cerned, were well worthy of being adopted. (Hear, hear.)
Dr. Kay quite agreed that a period of two years was sufficient, and he also
agreed with what the previous speaker said about the 2s. 6d. fee. Amongst his
attendants he had a few who had goue in for the examination, but he found
some difficulty in persuading them to do so as it was, without raising the fee to
5s. The principle of having two examiners for all the papers was certainly an
excellent one, if it could be carried out; but, as Dr. Clapham said, he should not
like to be an examiner. The principle certainly was good, for the difficulty was
always to know what was the exact answer to the question which the examiner
put. For instance, set a question, and then ask a colleague what is the exact
answer. He probably would differ from you; and if he did, how much more
would persons of that class who were examined differ in their ideas of what was
the answer! The whole difficulty would be got over by having two examiners
only for all the papers. He perfectly agreed with the principle, but it w r as in
practice that he felt there would be difficulty.
Dr. Nicolson said that he had a general notion, from what had been said on
the question, as to the desirability of having two examiners ; he did not see why
there should be any considerable difficulty in having them if individuals could
be found who would take up the work. As to the fees, before he (Dr. Nicolson)
would throw in his vote against the five shillings he would be glad to know the
reasons outside the question of the difficulty of finding the mouey on the part of
the nurses—the reasons on their part why they should not be willing to pay an
increased sum for the object of ultimately improving their own position in life,
for there was no doubt that those nurses and attendants who weut in for the
examination did so with the object of getting some benefit from the certificate.
He personally would be glad if it could be done for the 2s. 6d. as hereto¬
fore, but if there were sound reasons why the higher sum should be fixed, he
should, in the face of that, be glad to support the suggestion made to them.
On the other question, that of the three years instead of two, he felt that the
two years would suffice, and he had no feeling that it would be at all necessary
to extend the period, for by adding another year it would make it a very
long time for them to maintain their book education; it was very largely a
book education upon which the written papers had to be settled. He considered
that at present two years was a sufficient period, in the absence of some cogent
reasons in the proposal for extending it to three years. Regarding the number
of lectures, that, he thought, would be included in the question of the three
years period. “That they should attend nine out of twelve; ” this, too, was a
matter of detail which would stand or fall in the decision of the two or three
years as it happened. “The two final examiners**—that would be a most
desirable thing if they could get them.
Dr. Mould then asked if there was any question as to the vivd voce examiners
—the superintendent and an outside assessor.
Dr. Kay said that in certain cases the senior assistant ought to be allowed to
take the position of the superintendent, for it sometimes happened that the
latter was not able to take the examination. Such a case happened quite
recently, and the assistant was allowed to take the part of his superintendent.
The examination had been fixed to take place, when unfortunately the superin¬
tendent fell ill, and if the assistant had not been allowed to take the examina¬
tion it would have been postponed—a considerable hardship to those about to be
examined. The registrar took the case into his ow*n hands, and gave the
authority for this. A good senior assistant would be quite qualified to conduct
the examination, and the speaker agreed with the proposal that, under certain
conditions, he should be allowed to replace the superintendent.
The Chairman —Would you propose the conditions of this?
Dr. Nicolson opposed the idea. He said that he did not agree with his
friend Dr. Kay, because if they already had the power to relieve the superin-
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tendent, and allow the senior medical officer to do wliat was required, that waa
all that was necessary if they could do it authoritatively. He thought if they
put in the senior assistant as a possible substitute for the superintendent, the
tendency would be rather for the latter to allow the senior assistant to do the
work, and in that case the tone of the examination and the general status of the
certificate would be liable to suffer. He thought that if there was power to
sanction it under exceptional circumstances, that would meet all the requirementa
of the case, and all the difficulties arising from the superintendent being unfit
to undertake the duty. It w r ould be a mistake to go any further when the
registrar had done it, and it was found to hold good. He considered that
it would be dangerous to interfere with the present wording of the section
which dealt with that particular point when they had power to do what was
wanted.
Dr. Halstead thought the appointment of two examiners, as proposed, would
be very desirable, but it scarcely appeared to be practicable. He should suy
that if the framers of set papers could only signify what answers they wanted, it
would relieve much of the difficulty. The candidates were examined upon the
text-book of the Association, he thought, and in marking they w r ent by the book,
but if to a certain extent they would answer the questions, that would relieve
them from sending all the papers up to headquarters to be examined.
Question —Supply the answers, or sketch them ?—Yes.
'Ihe Chairman was quite sure that each superintendent knew his own nurses
and their capabilities as no one else could, as each teacher knew' his own
students on such points as the way of expressing themselves.
Dr. Kay. — That is viva voce.
The Chairman continued that it might be in writing too. They would
know men who attended lectures, excellent men all round, but with a bad way of
expressing themselves in waiting. On the other hand, he knew that a man
might in examination w r rite a good paper, and get a number of marks for facility
of expression rather than actual knowledge of what he was expressing.
The superintendent of an asylum would be able to give a helping hand to a
deserving nurse that an outside man w’ould not consider, simply on account of
expression. He spoke from what he knew of the University of London, Victoria
University, and Oxford University examinations, and certainly what did for
higher examinations w r ould do in a lower. He (the Chairman) then referred to
the first question:—“ Is it your opinion that it should be necessary for nurses
to be in attendance at lectures for three years before examination ?**
On being put to the meeting it was carried that two years was a sufficient
length of time, opinion being against an extension to three years.
The Chairman —Of course that carries with it the number of lectures.
The Chairman then put the question :—Whether the nurses pay 5s. in the
future or 2s. 6d. as at present ? The voting of those present was in lavour of
2s. 6d. being the fee.
Dr. Stoddart suggested that the other question be put first:—Whether
there should be two examiners for the whole kingdom, or the present system be
adhered to ?
The Chairman —The question now before you is wdiether there should be two
examiners for each, as superintendent of asylum and outside assessor, or two
gentlemen for the whole. 1 shall put the amendment first, “ That there shall be
two gentlemen for the whole of the kingdom ”
Dr. Gilbert Mould— This only applies to the papers. The vird voce exami¬
nation is to remain as at present.
The Chairman then put the amendment (ns above).
Five were in favour of two for the whole . Three w'ere agaimt.
Amendment carried.
The Chairman— Now r , gentlemen, the fees. I shall put first of all that the
fee shall be 5s. for each nurse, and if rejected she pays 2s. 6d. for re-exami-
nation.
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646 Notes and News . [July,
Dr. Kay presumed that if there were two examiners appointed for all the
papers, there would be some fees attach* d to it.
Five were in favour of 5#. fee. Five were against.
The Chairman gave his casting vote for 2 s . 6 d .
Carried that 2s. 6d. be more suitable.
The Lunacy Bill.
Dr. Mould (Cheadle) said that he rose with some diffidence in the matter,
because it really was not one upon which a person could read a paper—only
upon which one could express oue’s own views. In expressing their views upon
it they could quietly discuss the far-reaching effect of propositions in the Bill,
as they bore grave consequences to those who had the administration of asylum
work and to the patients under their care. The first question came : What was
it ? It was the new Lunacy Bill as introduced, which had passed the first and
second reading in the House of Lords, and had gone into committee. It had
thus practically passed the House of Lords, and would come before the House of
Commons some time next month. He understood from very high authority that
if there was any very strong opposition afforded to any of those points—clauses
absolutely necessary in the Bill—the Bill would be dropped. Therefore, before
they offered any very strong opposition to the Bill, they should carefully con¬
sider the risk they ran. It was a great matter to offer opposition to what was
proposed in excellent faith by able men in the government of asylums. The
first clause of the Bill dealt with 41 Urgency Orders, 0 and was a proposition
to reduce the time for which they should hold good to a period of some two davs
less than in the pievious Bill. So far as asylum assistants and officers were
concerned it really did not matter very much, but in the interest of the patients
it was a serious matter, because what were called urgency orders could be
abused. It was necessary that they should be carried out with the least irrita¬
tion to the patient and the least degradation. They knew' that the certificate
carried with it a degradation, and there was a very large amount of opposition
for the examination at the patient's own house. The Urgency Order, as at
present used, allowed a patient to come in at once, and within seven days they
got another certificate, and they had fourteen days in which the patient was
absolutely under the control of the asylum authorities. It was now proposed to
shorten that time very considerably. So far as the working of the asylum was
concerned lie did not think it mattered very much, but for the patient it did
matter, because an Urgency Order was given in cases of great emergency, and
if they had an examination taking place within three or four days, they would
be pretty certain to have the same condition of things prevailing as when the
patient was admitted. If they had more than that the patient had time to
recuperate, and remedy somewhat his state, as in cases }ie (the speaker) had
known. Ho said emphatically that so far from helping the liberty of the
subject, or, in other words, the patient, it was going exactly in the opposite
direction. Clause 4 dealt with the “ Suspension of Summary Reception Orders.’*
Clause 6 related to the “ Disqualification for Signing Medical Certificates.**
“ (6) Whereas it is expedient to extend the disqualification for signing medical
certificates in support of a petition for a reception order, there shall be added at
the end of 6ub-section 1 of Section 32 of the principal Act the words (c) * The
person who makes the reception order,* and at the end of sub-section 3 of the
same section the words * or any officer or servant in the employment of that
committee, or in a licensed house under an order made on the application of or
under the certificate signed by a licensee of that licensed house, or any person in
the employment of such licensee.’*
They put higher penalties, and, so far as he could see, it did not require the
sanction of the Public Prosecutor or judge in chambers to order prosecution. He
could only say that he had always signed certificates for patients* admission to
any asylum. They said , fi No, you cun’t do that, because you are paid for it, and
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1898 .]
you have no right to have private practice.” He saw a great number of patients
in his private and consultation practice, but was not to be able to sign any certi¬
ficate of admission to any asylum. That, he thought, was a small matter. Clause 7
related to “ particulars to be specified in case of absence for ill-health.”
“ (7) The manager of a hospital or of a house licensed by justices shall,,
within two clear days after sending or taking any patient to any place for
the benefit of health under sub-section 3 of Section 55 of the principal Act, send
notice to the Commissioners stating the name of the patient, and the address to
which,” &c.
That, the speaker considered, was very inquisitive. All particulars had to bo
stated; he often wauted to send a patient to an outside branch, and here it
stated that they must further specify what were the reasons and other matters*
almost entirely unnecessary, and a detail they should not be called upon to do.
On the next clause, he remarked that he should be very much more pleased at
all times to see one Commissioner instead of two together.
“Special Inquiries with Regard to Lunatics, Clause 11.
“(11) If any person .... fails to comply with the order, he shall be liable
on summary conviction to a fine not exceeding £10, and on conviction or indict¬
ment pay a fine not exceeding £50, or an imprisonment for a term not exceeding
two years.”
That, he must confess, he did not quite understand, because here there were
some grave penalties indeed attached to it. He did not think that any Com¬
missioners or anybody appointed by the Lord Chancellor should have such
terrible summary power as to inflict such grave penalties.
Clause 12 related to the “ Reception of Boarders ”—
“ (12) The power under Section 222 of the principal Act of receiving a person
and lodging him as a boarder may be exercised also by the manager of an
asylum or hospital with the consent of two members of the visiting committee
or managing committee, as the case may be, and sub-sections 1, 4, 5, and 6 of
that section shall be construed accordingly.
. (2) The consent required .... to be given by two of the Commissioners may
be given by one.
(3) The application under that section by the intending boarder must be
made personally, or in his own handwriting.
(4) For sub-section 3 of that section shall be substituted (3) “The total
number of patients and boarders in a licensed house, and all the patients absent
therefrom on trial or for health, shall at no time exceed the number of patients
for which the house is licensed,”—
and applied. Dr. Mould said, much more to hospitals and to the private asylums
than to county asylums. He had had a very long experience, and he might say a
very uncomfortable experience, in the admission of boarders. He maintained,
and the Commissioners accepted it, that if you explained to a patient that he
was here in an asylum voluntarily, and that he could leave at twenty-four hours’
notice by giving that notice, he would be a voluntary boarder, unless certified by
Visiting Commissioners. The doctor might say, “ Do you understand that you
are here as a voluntary patient ? Do you further understand that you can give
notice, and can leave after twenty-four hours ? ” It used to be customary to go
further into the matter, and further say, “ What is the reason you are here ? ”
unless they saw on the face of it that the person was manifestly, so to speak, in
need of it. If they must treat insanity in the incipient stage, Dr. Mould said,
they must do it through boarders, through the voluntary system or none. They
could not treat it through a certificate—that would be monstrous. There wero
patients who came to the hospitals, and were treated, who were undoubtedly
insane, and yet one would hesitate to put in an asylum. If a person went to Dr.
Clapham, and was advised to go to Cheadle or York, as the case might be, what
could be a better method of treatment than that ? There was no keeping this,
under a bushel at all. They sent at once a statement as to admission of patients,
the condition in which he or she was in, and there was the book in which they
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648
Notes and News.
[July,
recorded the condition. So he said that a boarder was guarded just as much as
a certified patient, so far as concerned being under the jurisdiction of the
Commissioners of Lunacy. He spoke strongly upon the restrictions upon
boarders, as that “they shall sign in their own handwriting; ** to ask some poor,
miserable, nervous creature to write what he was suffering from, and that he
wished to put himself under care; many a poor voluntary boarder could not do
it. He, however, did not see any objection whatever if they had to sign a printed
paper to that effect, but that they should have to write it all in their own hand¬
writing was too much. That would be like the Drunkards’ Retreats, which were
the most miserable failures in the world. These were his objections to the
alteration. They would do away with the incipient treatment of insanity in its
highest, best, and most skilled form.
Then there was “ the number of patients received into the hospital, the man¬
agement of the hospital, &c.; *’ he would briefly show his objections to what was
proposed under those sections. As to the number of patients received, he did
not see much objection to that. He did not think the Commissioners would
differ much from the authorities in the hospital; it was a grandmotherly way
of doing things—that the committee of the hospital and the medical officer
should not be able to say and to carry out what number of patients they should
put in a room, just as much as the Commissioners, who must be guided by the
report of the cubical space they received in the hospital.
“ Rules and regulations : ”—
“*(14) The Commissioners may by notice require the Committee of Manage¬
ment of any hospital to make such alterations in, and additions to, the rules and
regulations of the hospital as the Commissioners may consider expedient, and if
the Committee do not .... the Commissioners may make a report to the
Secretary of State, who may .... determine the question as to alterations.**
This, he held, was an arbitrary power which should be most strenuously
opposed.
“ Power to require amendment of regulations of hospitals, management of
hospitals, and branch establishments,'* Clauses 14# 15, and 16. On the question
of branch establishments he would speak very feelingly. For instance, they
had here (Cheadle Royal), in round numbers, accommodation for more than
200 patients—that was in the main building. Also they had 150 or more patients
outside, in the houses, and in cottages, which were rented by the Asylum autho¬
rities. If those were, as it was stated, to be made “ branches of the hospital,**
they must be the property of the hospital; or the owners of them must allow
such alterations to be imide in accordance with the ideas of the Commissioners
which would be absolutely wrong and uncomfortable iu an ordinary dwelling-
place. They (Cheadle Royal) had had ordinary houses, large ones and small
ones, for the last thirty years, and they had not made any alterations, except
those required in ordinary social life. He felt very strongly upon the question.
If it was not somewhat egotistical, he should like to read the report of the State
Commission of Illinois, U.S.A., sent over to specially examine the State asylums
of England, German}’, France, Sweden, &c. They had found that asylums had
been started in every part of the world on the same plan, and they had received,
over and over again, almost fulsome praise for what they had dared to do in
Cheadle.
“ At Cheadle, in England, is an institution not attracting the attention at this
aide of the world it deserves, an interesting experiment is in progress. Of
200 patients, 140 are iu the main building, 60 in cottages.**
Returning to the report, he read :—“ 1 visited every one of these cottages. I
saw no restraint upon the freedom of any patient occupying them. The doctor
and his assistants visit them daily on foot, on horseback, or in carriages, just as
ordinary patients are visited. . . . The result of this experiment is entirely
satisfactory.*’
I)r. Mould pointed out that the registration of these branch establishments,
and the compulsory purchase of the branch establishments would stop them
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649
1898 .]
from doing what they had doue so successfully for so many years. Take, for
instance, a house which they rented for the small sum of £100 a year; to
purchase it, what would they have to pay ? Again, if they should also have to
do, us it was said in the clause,—“ that any patient who left should have his bed
left open,”—they would have 150 beds out of 200 always vacant; 150 on leave,
and 50 occupied, on the possibility of their return. The speaker went on to
remark, that what he had said above would be his very strong objection to the
registration of these brauch establishments: in the first place, the initial cost
would be enormous; and in the second place, the question of vacant beds. He
also remarked on the disinclination of those from whom the houses were
rented to have them termed an asylum, instancing a case in point of a lady.
Next came the—
" Allowance (superannuation) to officers and servants of nsylums** (Clause 20),
and also for “injuries” (Clause 21).
“ (20) It shall be the duty of the visiting committee of every asylum to grant
superannuation allowances to their officers and servants, under Section 280 of
the principal Act, and the allowance to be granted . . . shall not be less than
would be granted if he were an officer or servant to whom the Poor Law Officers*
Superannuation Act, 1896, applies.”
“ (21) Where any officer of an asylum is injured in the actual discharge of
his duty, without his own default, and by some injury specifically attributable
to the nature of his duty; the visiting committee may grant him out of the
county or borough fund, as the case may be, such annual allowance, or if he
dies from the injury, to his widow, or mother, and to children such allowance
as the visiting committee,” &c.
That really affected the county asylums more, he remarked. There was no
doubt all hospitals took a liberal view of the matter, but he should leave the
question of pensions to be spokon of by those who could speak with more
authority than he. He would only point out that in the clause in which the
peusions were mentioned, it was proposed that no one should be allowed this,
unless he had fifteen years* service; then in sub-section further on, it was put
that “ where any officer of asylum is injured,** that was, if he had only been in
a day, he should be allowed something. He (speaker) should say that was not
necessary to be put in at all. Under the ordinary Workmen’s Compensation
Act, there was no doubt that any attendant receiving an injury in the discharge
of his duty would have compensation. In conclusion he said that he objected to
the urgency orders, to the disqualification of signing medical orders; with
regard to the reception of boarders he thought it most disastrous, and on the
point of branch establishments, management, Ac., he and those connected with
him would most strenuously oppose what they believed to be truly unnecessary
and unwarrantable interference with what had been ably and well done in all the
hospitals of the kingdom with one single exception, and that a transitory one,
which ought not to carry any weight.
Dr. Hitchcock —I think the shortening of the period of urgency orders
would not be any detriment to the patient or to the superintendent whatever.
As you say in your speech, the urgency cases are modified considerably before the
seven days elapse. So far as one’s own practice goes, I invariably get the
urgency order made permanent in three or four days. I don’t think it would
make the slightest difference.
“ Disqualification of signing Medical certificates.”
Dr. Clapham — I think that disqualification, as applyiug to superintendents of
private asylums, is a rather invidious matter.
The Chaibman —Yes.
Dr. Clapham —“The certificate must not be sigued by the licensee of a
licensed house, or any other person in the employment of the licensee.” That
would disqualify me as superintendent from signing any medical certificate
whatever. It is a distinct interference with private practice.
Dr. G. Mould —I was told at the meeting of the South-Eastern Division that
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that clause had been dropped out of the Bill this year; that it was in last year
hut not this.
The Chairman—I t is in this year’s Bill. I have got the copy here.
Dr. G. Mould —In that case it is an unjustifiable interference with the rights
of those interested, aud an insult to the whole medical profession, that because
a man is in the service of a licensed house, that therefore he must be disqualified
from signing a medical certificate.
The Chairman (quoting)—“The manager of a hospital or of a house licensed
by justices, shall within two clear days after sending or taking any patient to any
place for the benefit of health.send notice to the Commissioners/*
(Clause 7.) Why they should be sent to the Commissioners, except as a matter
of form, 1 can’t see at all.
Dr. Nicolson —It is only a matter of form, I suppose.
The Chairman —But supposing, as might often happen, a patient from one of
the outside houses is not very well in the morning, is sent in, and towards night
gets better, and is sent back again. Look at the trouble of notice being sent in
on each occasion.
Dr. Nicolson —If, for the purpose of the Act, those are part of the asylum,
it would not be necessary.
The Chairman —There it comes in—all these places we rent now would have
to be registered, and bought by this institution.
Dr. Nicolson spoke of the carrying out of sub-section 16, which would
alter the case.
The Chairman —That would simply ruin us. These country people will now let
us their houses, but would not allow them to be called an asylum. One lady I
know who takes a great interest in the patients, and lets the house, but would
strongly object to its being called an asylum. The house alone would cost about
£60,000. We have thirty of these houses, you know.
The Chairman then referred to “ Visits to Licensed Houses/* No one, he
said, would object to one Commissioner instead of two. “ Special Inquiries as
to Lunatics. Clause 11/* As a matter of discussion it seemed that the pains
and penalties which they could inflict without a judge were very grave, but
perhaps he might have misread that. For any infraction of that sort, they might
have a “ term of imprisonment not exceeding two years.” That was not in¬
flicted by a judge, but by a Commissioner. He considered the gravity of the
situation would come in when it was seen that the accuser would also be the
judge. The accuser would be the Commissioner, and the Commissioner would
be the judge.
Dr. Nicolson supposed that they would be only acting for the State. He
knew nothing about it himself.
The Chairman —It may be that after finding a primd facie case against him,
he should be brought before a judge.
Dr. Nicolson — They might have to indict them.
The Chairman —It they have to indict them it is a simple matter.
The Chairman then continued—“ The reception of boarders,** and “The
treatment ot incipient insanity.** I have already spoken on these matters. On
the first I say again that you would not get one in ten to write in their own
handwriting what is required here.
Dr. Clapham —I think this clause is merely putting the lunatic hospitals
under the same conditions as private asylums are now. We can't take a boarder
in the same way as a lunatic hospital can. They are obliged to “present them¬
selves before two visiting magistrates, or obtain their consent in writing, to come
in as voluntary boarders for a certain time.**
The Chairman —What can be more disastrous ?
Dr. Clapham —I think with Dr. Mould that this is very absurd.
The Chairman —I quite agree with this—that we receive boarders who are
not of sound mind and should have to be certified, sometimes in a short period,
but 1 maintain that we have them certified at once, if we think it is necessary.
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1898.]
Notes and News.
651
After a pause the Chairman said—May I take it for granted that what I
have said, and what Dr. Clapham has said on this, would be the sense of the
meeting—that to place these grave restrictions on the treatment of incipient
insanity would be hurtful ? 1 should propose that the power which at present
exists should be given to private asylums, and should not be abrogated in the
case of hospitals. (Hear, hear.)
The Chairman further referred to the examination of a boarder by the Com¬
missioners, who when he was in the asylum had to be taken outside formerly;
now the Commissioners allowed the examination in the asylum itself, and
it had acted successfully. There was no doubt that there were cases in which
they took a boarder in when he ought to be certified. The objection held, of
course, was that they had got him under their thumb.
Dr. Mould remarked—You might as well say that the men who^come to certify
are so venal that they simply do what you say.
The Chairman, continuing—Could it be put to the meeting that by the pro¬
posals of Section 12 it would at once interfere very materially in the early
treatment of incipient insauity in its less developed form, but when that form is
developed then the boarder ought to be certified; that in the first instance we
ought to be able to receive a man for a certain definite period as above.
Dr. Nicolson —Why not put it that we regret that any further restrictions
should be placed, such ns that in sub-section 3? Send it up as the positive
expression of the views of the meeting. Don’t compare with inebriate homes or
anything else.
The Chairman —Yes. I only mentioned inebriates’ refuges as an instance.
The Chairman— Then we have the “ Management of Hospitals and Branch
Establishments,” the outcome of which we shall have to find for ourselves.
They do not propose to do this with regard to county asylums, managed by men
at auy rate no more intelligent th»m those in charge of hospitals. They insult
the management of the hospitals, because one hospital has been directed with some
stupidity.
Dr. Hitchcock asked to what this referred.
The Chairman said that he was speaking of the clauses relating to the rules and
management of hospitals. Why should they take in the management of hospitals
what they did not take in the county asylums, when they were not conducted
for private gain, and conducted by the same class of men, or superior ?
Dr. Hitchcock remarked that he had not seen a copy of the Bill before be
came to the meeting, and was hardly able to express an opinion.
The Chairman —You know the serious restrictions there are now upon the
management of hospitals. What I want to know is whether hospital men would
wish these restrictions, which I think are very unnecessary, to be infinitely
increased. I think you would not say they should be ?
Dr. Hitchcock—N o.
The Chairman —Now the Commissioners propose to take the power themselves,
and impose certain pains and penalties.
Dr. Hitchcock —I should not express any opinion upon it. The Commis¬
sioners would take a just and proper view of their powers if this was given
them, I think.
Dr. Halstbad—I should be sorry to see any further restrictions imposed.
The Chairman then read Clauses 20 and 21, “ Relating to Pensions,” given
above.
Dr. Nicolson remarked that it was only a question of a compulsory pension
instead of being as at present.
Dr. Kay —The conditions of getting the peusion are the same as have been
existing, except that it gives you a minimum, and says it is compulsory. I
think they are recognised if having been under the service of the same com¬
mittee.
Dr. Nicolson said—Dr. Newington wrote to me about a fortnight ago in a
confidential sense, saying that the Parliamentary Bills Committee seemed to he
XLIV. 43
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652
Notes and News.
[July,
in a difficulty with regard to Section 18, which has reference to the accommoda¬
tion originally given on a plan for any asylum, and approved by the Secretary of
State, that with reference to such accommodation it shall not be appropriated or
used for other purposes than those shown in the plan without the approval of
the Secretary of State. There was a feeling amongst the couuty asylum officers
and the representatives on the Committee that this rather put them out of
court in making those necessary alterations in the location of the inmates of
asylums that happen to be necessary from time to time, arising from painting
and cleaning, over-crowding, or from any other temporary difficulty which came
up for them to deal with. Their feeling was that it was not a desirable section
for them to put in. That was the first one. 1 went up to Mr. Mackenzie about
this, and he said that they had perfectly open minds upon the matter, and the
Lord Chancellor would only be too glad to receive any recommendations from
the Parliamentary Bills Committee, and that they themselves w'ere not satisfied
as to the desirability of this particular section. The other section upon which
they were not agreed was Section 23, that having reference to the payment of
pauper inmates for work done by them. That opens out a very big question,
and I told Mr. Mackenzie what appeared to me to be the difficulties, although,
so far as I saw from experience as Superintendent of Broadmoor in the old days,
it was a most excellent thing, for we had in Broadmoor a great many inmates
who could not by reason of their recovery be kept in county asylums. We
had to encourage them to work by giving them some small payment, the
work being for their own good, as well as an advantage to the State, and doing
away with the necessity of paying so many artisans and labourers about the
asylum. This point did not hold fully with regard to the inmates of pauper
asylums, because when they recovered they got rid of them. He (Mr. Mackenzie)
said he himself was not clear as to the desirability of this. Speaking to me
personally, he said he was not assured that they were desirable things to have
settled on statutory authority as at present. I afterwards went to the Home
Office to speak to them about the special question, and I found the whole matter
rather misrepresented there, and they had come to the conclusion that the medical
superintendents were not anxious to have this section. I assured them 1 was
perfectly satisfied that the medical officers were anxious to have the compulsory
retirement scheme, although in a few individual instances they would prefer to
take the chance of their own committee for the time being, some knowing that
they would he well treated, and having served for a long time, but the feeling of the
Association was clearly in favour of compulsory superannuation allowance and
pensions.
The Chairman. —As proposed in this new Bill ?
Dr. Nicolson. —Yes, as proposed. Then I saw Mr. Digby (?), and I said I
should like to write to Dr. Newington, and this morning I got from him this
sketched-out scheme, rather too long to read perhaps. He wants this division
to be made acquainted with the present position of the work done by the Parlia¬
mentary Bills Committee, and assuring the Home Office that the feeling was
entirely in favour of compulsory pensions. He wants tbe meeting here to clearly
understand the points of the work they have been doing with regard to it.
Dr. Nicolson here read the statement mentioned.
He then continued—1 told them the officers would be only too glad to have
their pension assured. If it was not assured it was not to be expected that the
right stamp of man would go in for the work, if he did not see his future was to
be considered. That seemed to be an idea which caught on with the Under
Secretary. I assured them that if the compulsory pension was granted it would
be the means of assuring that a good class of men would join the asylum service.
If this meeting endorses that statement it would be a help to the Parliamentary
Bills Committee in urging it forward and sending in their memorandum,
strengthening their hands.
Dr. Kay —Is that a statement to the Home Secretary ?
Dr. Nicolson —That is a statement which will go before the Home Secretary,
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1898.]
Notes and News .
653
and if it will be approved by this meeting it can be sent to him with that
approval.
The Chairman —You have heard the statement sent to Dr. Nicolson by Dr.
Newington, the secretary of the Parliamentary Bills Committee ? Are you of
opinion that it should he sent with approval 1
Agreed to unanimously.
The Chairman —Could you not add a rider to it that hospitals should be
included ?
Dr. Nicolson —These points the Bills Committee think cannot be taken up
now. If you write to them after, it might do good. They are only too glad to
know the opinion of persons interested.
The Chairman —Then they could not take this on now ?
Dr. Nicolson —I don’t know how far the Committee have got bv this.
Dr. Hitchcock —Can we add anything to the effect that if possible some con¬
ditions should be added, so as to make the present permissive clauses with refer¬
ence to hospitals compulsory P
After some discussion the Chairman suggested that this meeting send a
request to the Parliamentary Bills Committee to add to their request on Section
20, that the hospitals should be treated in the same manner as the public
asylums, so far as pensions and allowances for servants are concerned.
Dr. Nicolson —That would be all right so far as it goes, but I don’t think
they would be on the same footing as regards payment, &c.
The Chairman—I think you will know that there are hospitals which are
generous, as there are County Councils which are generous, and hospitals which
are very ungenerous.
Dr. Nicolson —The question is, whether the request of this particular thing
might not do more risk of harm than if you waited till after this was accepted.
The Chairman —Then you would have to wait for another Lunacy Act.
Dr. Nicolson —Oh no, not exactly.
The Chairman —This will come before the House of Commons as a propo¬
sition in any case. The question is whether it would not come with better force
if it had been before the Parliamentary Committee.
Dr. Nicolson —But you might damn it altogether. It may be desirable, but
I think it would be a pity to tack it on. The compulsory idea is the first idea;
if we could get that through, a good many things might follow.
The Chairman —Will you propose that it is desirable that hospital officers
and servants should be treated in the same way with regard to pensions as is
proposed under Section 20 of the new Act? We can send it to the Parlia¬
mentary Committee to do what they like with it, and we can send it up by
ourselves.
Dr. Nicolson—I don’t see the meeting would do any harm in asking the
Parliamentary Committee to deal with it, but not to ask that it be tacked on.
The Chairman again read his suggested proposition. Every hospital, he
said, had pensioned its superintendent on retirement, and they only asked that it
should be a necessity, not simply a rule.
Dr. Kay—I t is a recognised thing in the West Riding of Yorkshire that all
officials engaged now sign a paper on the distinct understanding that they receive
no pensions.
Dr. Nicolson —At Middlesbrough, so far as I understand, atone asylum they
undertake that there should be no pensions.
Dr. Kat—I n the West Riding all officers accept office on the distinct under¬
standing that there is no pension.
The Chairman (in conclusion)—Perhaps this is too debatable a subject to
continue. (Hear, hear.)
Regarding the clause respecting the “ Master in Lunacy,” the Chairman said
he thought that every one would approve most strongly of all that was there
proposed to be done.
This concluded the meeting.
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654
Notes and News.
[July,
MEETING OP THE IRISH DIVISION.
Members present at the meeting on April 12, 1898: William Graham, Georg.?
R. Lawless, M. T. Nolan, E. L. Fleury, John Mills, Samuel Graham, G. J. West,
J. A. Oaksliott, Daniel F. Rnmbaut, J. M. Remington, R. Lockhart Donaldson,
Bagenal C. Harvey, W. S. Gordon, H. M. Cullinan, J. A. C. Donelan, Conolly
Norman, Dr. Charles Hetherington in the Chair; Arthur Finigan, Oscar Woods,
G. J. Rivington.
After considerable discussion the following resolutions were passed:
Local Government (Ireland) Bill, 1898.
Resolved —That we, the members of this Association, protest in the strongest
manner against the transfer of lunatics and lunacy administration to the juris¬
diction of the Local Government Board, or any legislation that would associate
insanity with voluntary pauperism ; and are further of opinion that such impor¬
tant matters as the care and treatment of the insane should be completely
independent of any other Board dealing with public charities. We consider that
in any legislative changes the Lunacy Laws of this country should be assimi¬
lated to those in England, where a separate body exists for the supervision and
protection of the insane; or adopt the findings and recommendations of the
committee appointed by the Lord Lieutenant on Lunacy administration, known
as the Mitchell Report of 1891.
We consider the existing and beneficial jurisdiction of the Lord Chancellor in
lunacy should be preserved.
We recommend that every resident medical superintendent appointed to an
asylum should have served for not less than five years (is a medical officer or
assistant medic il officer in an asylum for the treatment of the insane, and that
the power of appointment to the office of resident medical superintendent shall
be retained, as at present, by the Lord Lieutenant of Ireland for the period of
five years after the passing of this Act.
We deem it right that the existing resident medical superintendents of district
asylums, having been appointed by the Lord Lieutenant, ahull not be removable
from the office without the couseut of the Lord Lieutenant.
We recommend that the Lord Lieutenant have power to direct that assistant
medical officers shall be examined and their qualifications certified by such
persons as his Excellency may direct.
We request that the following clauses in the Lunacy Bill now before the
House of Lords may be added to the Local Government (Ireland) Bill. It shall
be the duty of the visiting committee of every asylum to grant superannuation
allowances to their servants and officers under Pauper Lunatic Asylum (Ireland)
(Superannuation) Act, 1890, and the allowance to be granted to an officer or
servant under that section shall not be less than would be granted if he were
an officer or servant to whom Poor Law Officers Superannuation Act, 1896,
applies.
Extract from the Report of the Parliamentary Bills Committee of the Medico-
Psychological Association.
The Committee support the recommendation of the Irish Asylum Medical
Officers* Association, that a resident medical superintendent should have at least
five years* experience as an assistant medical officer in an asylum.
The Committee also endorse the protest of the Irish Asylum Medical Officers’
Association, against the proposition to transfer lunacy administration from the
Lord Lieutenant to the Local Government Board, being firmly of the opinion
that such administration should be independent; and the committee fully
endorse the findings of the committee appointed by the Lord Lieutenant of
Ireland on lunacy administration in the year 1891. "The Committee are of the
opinion that if any change is made in the provisions for giving pensions and
allowances in case of injury to asylum officers in Ireland, the provisions of the
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law now relating to the granting of pensions and similar allowances to asylum
officers in England, as proposed to be amended by!the Bill now before Parliament,
should be applied.
SIR EDMUND DU CANE ON CRIMINAL TREATMENT.
In the May number of the Nineteenth Century Sir Edmund du Cane’s article
on the Prisons Bill and Progress in Criminal Treatment will be read with much
interest. He shows that, under the proposals of the Bill, a complete change of
fundamental principles will be possible at the will of the Secretary of State.
The Act of 1865 was designed to remedy pre-existing evils, and specially to
provide for separate treatment. This is in all countries acknowledged to be the
best system, and it was attained in England after much discussion and great
expense. As crime has so markedly decreased, it may be inferred that some
credit is due to the Prisons Acts.
Sir Edmund du Cane insists on the necessity for uniformity of regulations,
and doubts if there will be found a more efficacious means of reform than punish¬
ment for misdeeds. He is strongly of opinion that reform requires time, and
states that the average period of detention of boys in reformatories is necessarily
some three years, while some of them turn out to be the most incorrigible convicts.
If, as many now think, the reformatory principle should have fair trial, it will
be requisite to change the criminal law, so that longer sentences may be inflicted.
Sir Edmund du Cane thinks that the worst cases would not really he detained
longer than they are under the present system of short sentences. We are glad
to note that he states that reformatory and industrial schools are probably chief
among the causes of the decrease of crime, and that he advocates a special prison
for young criminals, ns the most mischievous years are from sixteen to twenty-two.
THE REPORT OF THE DEPARTMENTAL COMMITTEE ON DEFECTIVE
AND EPILEPTIC CHILDREN.
The appointment of the Commission in December, 1896, the Report tells us,
arose from the application, of the London School Board to the Education Depart¬
ment, for increased grants in aid of the special classes tor defective children which
had been formed on the recommendation of the Royal Commission on the Blind,
the Deaf and Dumb, &c.
The Committee reports that it has visited all the special classes with the
exception of Nottingham, also the Darenth Schools for Imbecile Children and
the Epileptic Colony at Chalfont. Witnesses connected with these institutions
have been examined, as well as medical men of special experience, in addition to
Mr. Knollys, of the Local Government Board; Miss Cooper, Secretary to the
Association for Promoting the Welfare of the Feeble-minded; Mr. Loch, Sir
Douglas Galton, and others. Much written information from cognate sources
lias been also received and considered. The Committee, indeed, seems to have
neglected no source of information, and the voluminous appendix to the Report,
compiled from the evidence given and information received, is a mine of instruc¬
tion for all interested in arriving at the best methods of treating these classes.
“ Feeble-minded ” the Committee interprets as “ excluding idiots and imbe¬
ciles,” and as denoting “ only those children who cannot be properly taught in
ordinary elementary schools by ordinary methods.” The term is used through¬
out the Report, having been employed in the referendum to the Committee,
who, however, recommend that in dealing with these children the term
“feeble-minded” shall not be used, but that they shall be designated as
“ special classes.”
The recognition of these children the Committee insists must be based on the
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history, habits, conduct, and power of learning, as well as on the co-existence of
malformations and peculiarities of function; but it recognises the fact that they
are physically defective (suffering, e.g ., from low nutrition, neurosis, struma,
epilepsy, syphilis, &c.)> and that their “ proper treatment in school depends to a
great extent upon medical considerations.”
The proportion of children requiring special class treatment the Report
estimates at 1 per cent.
The physically defective children, unable to attend school from that reason,
the Committee estimates at from 1 to 2 per thousand, but has no evidence of
the proportion of these who would be capable of attending school if the means
of conveyance were provided.
The feeble-minded, the Report points out, are at present under the same law
as the normal in regard to school attendance, and there is no direct power to
enforce attendance at a special class. Whether this can be accomplished
indirectly, by first refusing admission to the ordinary school and then prosecuting
for non-attendance, has yet to be tested.
The powers of guardians in regard to the feeble-minded are probably the same,
the Committee considers, as those exercised in relation to the blind and deaf
under 25 and 26 Viet., c. 43, and are therefore of very wide application.
The initial age at which the “ feeble-minded ” are to be dealt with the Com¬
mittee fixes at seven years, and considers that under that age the ordinary infant
school, with its kindergarten exercises, is sufficient.
The discrimination of the special classes the Committee recommends should
be provided for by the appointment of a medical officer, who should examine and
give a certificate (in all cases of non-attendance on the ground of physical or
mental defect) as to whether the child is capable of being educated in special
classes or is not (and consequently imbecile), and suggests that in the latter
case this certificate might be used as a basis of admission to the Imbecile
Schools.
Admission to the special classes, it is suggested, should be the result of an
examination, at which there should be present the child's past teacher (who
presents a written report in scheduled form), the special class teacher, a parent
if possible, her Majesty's Inspector, and the Medical Officer of the school authority.
The medical officer, after receiving a prescribed form (filled up by the teacher
• who presents the child), and conferring with the two teachers and the inspector,
should make a recommendation to the school authority. The recommendation
should state that the child is not imbecile, but from physical defect (which
should be stated) or mental defect, is incapable of deriving benefit from the
instruction in ordinary schools, but might be benefited by instruction in the
special classes. If rejected, the medical officer should state the reason of his
rejection. Appeal against the decision should be to the Education Department,
who should have at their service a medical adviser. The Committee has with
great care drawn up recommendations for the records to be made ; of the exami¬
nation of the special case, of the family history, and of the progress in the
special class; it advises a yearly medical examination of such classes, or, if
necessary, individual examinations, which should be recorded, and that the
teacher should be guided by the medical advice in dealing with the child.
Retention in the class until the age of fourteen is recommended, with power
to retain until sixteen on the advice of the medical officer, and it is suggested
that the school authority should have a discretionary power of compelling
attendance up to that age. The mixture of the sexes in the special class is not
objected to if suitable provision is made for those over fourteen years.
The size of the special class the Report advises should be limited to twenty
(on the roll) for each teacher, except where there are three or more teachers,
when the third, fourth, &c., may have thirty.
The special training of teachers is rightly insisted on, and a sketch given of a
suitable course. No system of training being yet available, the Committee
recommends that certificated teachers should only be recognised as head teachers
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657
of a special class after two months’ experience in a class approved by the
Department.
The Committee makes careful recommendations in regard to school hours,
time-tables, subjects of instruction, elementary manual instruction, physical
exercises and games.
Corporal punishment the Committee dismisses with the brief comment that it
requires great care in this class of children.
Special classes, the Report considers, would almost certainly be required in
towns of over 20,000, and would not be necessary in those under 10,000, and
prefers the concentration of two or three classes, where practicable, to isolated
classes.
The constitution of school authorities, the structure, &c., of schools, their
inspection and returns to the Educational Department, are all provided for, as
well as the assistance to be derived from voluntary agencies.
The “ conveyance or guidance ” to the special classes in cases where it is
needed, and the “ hoarding out ” near special classes of children whose homes are
not within reach of them, involve questions of expenditure in which additional
powers are recommended.
''Physically defective” children, who cannot benefit by the ordinary schools,
are recommended by the Report for admission to the special class, while those
who are unable to attend any class are regarded as allording a lair field for
voluntary assistance. The “ blind and deaf ” feeble-minded should have special
arrangements made, the Committee think, in institutions for these classes.
Epileptic children of normal intellect are recommended to be left in ordinary
schools, whose teachers should have some general instructions in regard to them ;
the ** feeble-minded ” epileptic should attend the special class, whilst severe
epilepsy should be treated in homes provided for that purpose, in regard to
which full details are given.
The Report concludes with a sketch of the legislation required to carry out
the various recommendations, and insists on the importance of their becoming
law at the earliest possible date.
THE BOARDING OUT OF HARMLESS LUNATICS.
A Conference was held at Larbert, the 17th February last, in connection with
the question of hoarding out of harmless lunatics, the subject having been
brought to the front by the District Lunacy Board with the object, if possible,
of rendering further additions to the asylum unnecessary at the present time.
Major Dobbie, Chairman of the Stirling Lunacy Board, presided. Representa¬
tives were present from each of the counties and burghs in the Stirling Lunacy
District, and also representatives from nearly all the parishes in the district—
about fifty in number. ,
The Chairman, in opening the proceedings, referred to the fact that since the
asylum had come under the control of the County Councils a very large sum of
money had been expended in extending the buildings, the sum borrowed up to
the present being close upon £74,000. The extraordinary rise in the number of
annual admissions was again making it necessary to consider the question of
additional accommodation.
Dr. Macpherson stated that although the increase in the numbers of the
insane in the district had within recent years attracted a good deal of attention,
yet the increase had been steadily going on all along, and had only now reached
such proportions as to make it necessary to deal with it in as practical a manner
as possible. While this increase was in one sense regrettable, in quite another
sense it might be regarded as representing an increased amount of prosperity
within the four couuties which formed the district, as the actual increase of
.nsanity depended entirely upon an increasing population, and consequently upon
1 ncreose in financial and industrial prosperity,
i
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658
Notes and News.
[July,
The proper functions of an asylum, he considered, were to treat new and recent
cases of insanity with a view to their recovery, or to the alleviation of their malady,
to nurse and care for the weak and helpless insane, and, while rendering their
existence as endurable as possible, to contine those persons who, through uo fault
of their own, were obnoxious to their fellow-men, and unfit to live in their
society; and that the chronic, harmless, and inoffensive lunatic was therefore out
of place in the costly and complicated organisation of a modern asylum, because
he did not require asylum treatment, because it was iu his case an unnecessary
extravagance, and because he would be happier under other and more natural
conditions of life.
Scotland, he said, stood in the very first rauk of civilised nations so far as the
care and the treatment of the insane were concerned ; its asylums were among the
best in the world; the public attitude towards the insane was one of solicitude
and almost unbounded generosity, and the administration of the lunacy system
was characterised by a minute attention to detail and great discrimination in the
classifying of the patients. There were in Scotland on the 1st of January, 1897,
12,221 pauper lunatics, of which number 2667, or 22 per cent., were placed in
private dwellings throughout the country.
Referring to the Scottish Lunacy Blue-book for 1897, Dr. Macpherson
observed that the assessments for lunacy purposes on the landward parts of the
counties and burghs of each district for the year ending 15th May, 1896,
amounted to £58,995, and that the number of patients in district asylums at 1st
January, 1897, was 4673, thus giving an expenditure per patient for land,
building, and up-keep of building of £12 12$. 6d. This may be taken as repre¬
senting the sum which the ratepayers have to pay annually for lodging each
patient in this or any other district asylum, and this will be found to be about
the average expenditure over a number of years.
Taking the average maintenance accouut, as it was last year in the district
asylums of Scotland, at £23 3$. 8<?. per patient, and adding to that the average
providing account of £12 12$. 6d. per patient, each lunatic in a Scottish district
asylum at present cost the country £35 14$. 2d. per annum. The grent financial
argument in favour of boarding out was that it cost nothing to the ratepayers for
buildings, these being already provided, whereby, at the present rate for the
provision of building, as had already been mentioned, each patient boarded out
was an absolute saving to the ratepayers of from £12 to £13 per annnm. Not
only so, but the maintenance of the patients cost less in private dwellings than
in asylums. The average cost in the district asylums of Scotland for the year ending
15th May, 1896, was £23 3$. 8 d. per patient, of which the Imperial Government
paid the proportion of £11 1$. per patient, so that the actual cost to the
ratepayers was £12 2$. 8 d. per patient. The average cost of boarding out for
the same year was £16 12$. lit?.; but this sum was somewhat misleading, as it
included imbeciles living with relatives, who only received a nominal sum for
their keep, as low as 6d. per week in some cases. The real average cost of
boarding out pauper lunatics with strangers over all Scotland was £22 per
annum. Of this sum the Imperial Government last year paid the proportion of
£11 1$., leaving a balance iu favour of boarding out, as against asylum treat¬
ment, of £1 3$. Sd. per patient. In short, to sum up the whole financial
argument upon the basis of the Scottish average already given, each patient kept
in an asylum cost the country £13 16$. 2d. more than a patient boarded out.
With regard to the moral and social objections to the system. Dr. Macpherson
thought them more sentimental and imaginary than real, his own experience
leading him to consider the general condemnation of the system to be unjust,
although at the same time he did not deny that it was not without blemishes,
like any other human institution. He also quoted from the experience of the
Inspectors of Poor for the Barony and Edinburgh parishes, who represented the
care of over 500 boarded-out patients, and who averred that in their long and
extensive experience no authentic case of ill-usage had ever come uuder their
notice.
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Notes and News.
659
In conclusion, what was wanted was to get the parish councils in the district to
admit the principle of placing chronic harmless lunatics in private dwellings.
Once the principle was admitted, the ways and means of working and perfecting
the system could be afterwards considered. The continued detention, moreover,
in asylums of patients for whom asylum treatment was unnecessary was
contrary to the spirit of the Lunacy Act (Sectiou 17, 25 & 26 Viet., cap. 54).
A large number of the representatives present afterwards expressed their
opinions on the question, the great majority of the speakers favouring the
principle of boarding out.
THE CLAUSE FOR PROVIDING TEMPORARY CARE FOR INCIPIENT
MENTAL DISEASE.
The joint committee of the British Medical and Medico-Psychological Associa¬
tions have drafted the following clause and certificate:
Draft Clause for providing Temporary Care.
(1) Where a medical practitioner certifies that a person is suffering from
mental disease, but that the disease is not confirmed, and that it is expedient,
with a view to his recovery, that the patient should be placed under the care of
the person whose name and address are stated in the certificate, for the period
also therein stated not exceeding six months, then during that period the provi¬
sions of Section 315 of the Lunacy Act, 1890, shall not apply.
(2) A medical practitioner who signs such certificate shall within three days
after signing the same send a copy thereof to the Commissioners, and it shall be
lawful for any Commissioner to visit the patient. The person under whose care
the patient is placed shall not be the person who signs the certificate.
(3) The person who receives a patient under such certificate shall within ten
days after the expiration of the period mentioned in the certificate, or if he
ceases to have the care of the patient under the certificate at an earlier date,
then within ten days after such earlier date send a report to the Commissioners,
stating whether the patient recovered, and if not in what manner he was dealt
with when the person making the report ceased to have the care of him under
the certificate.
Certificate.
I [insert full name and address ], a duly registered medical practitioner, certify
that [insert name , address , and description of the patient ] is afflicted [state the
nature of the disease'], but that the disease is not confirmed, and that I cousider
that it is expedient with a view to his [or her] recovery that he [or she] should
be placed under the care of [ insert full name and description] at [imert full
address of the place where the patient is to be received] for a temporary residence
for a period of [specify a period not exceeding six months] from the day
of 18 .
Dated . Signed
RELIEVING OFFICERS AND ALLEGED LUNATICS.
The Hackney Case in the Court of Appeal.
The case of Harward v. the Guardians of the Hackney Union on March 22nd
came before the Court of Appeal, composed of Lords Justices A. L. Smith, Chitty,
and Collins, on the application of the defendant, J. B. Frost, for judgment or
new trial, on the appeal from the verdict and judgment, dated January 22nd last,
at a trial before Mr. Justice Hawkins aud a special jury in the Queen’s Bench
Division. The action was brought by Mr. Theodore Bulmer Harward, who
formerly practised as a dentist, to recover damages from the Guardians of the
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Notes and News.
[July,
Poor of the Hackney Union, and their geueral relieving officer, Julius Bernard
Frost, for alleged false imprisonment in having forcibly removed him from his
house to the workhouse infirmary, and having detained him there as a dangerous
lunatic. The defendants pleaded that the steps taken with regard to the removal
of the plaintiff were taken in good faith, and in discharge of their duties under
the Lunacy Act, 1890. It was alleged that on October 14th, 1896, the plaintiff,
who was then living with his wife in Hackney, quarrelled with her, and took
down a picture from the wall and tore it up. The wife, who was very angry,
said, “ You are mad,” and went out of the house and complained to the police,
who referred her to Mr. Fenton, relieving officer of the district. It was said
that she told Mr. Fenton that her husband was out of his mind, that he talked
of committing suicide, and had threatened to kill her and the children. Fenton
then sent for the defendant Frost, the relieving officer, and appointed under the
Lunacy Act of 1891 to deal with lunacy cases. Section 20 of the Lunacy Act
of 1890 gives authority to the relieving officer to remove dangerous lunatics to
the workhouse, but provides that no such person shall be detained for more than
three days, and “before the expiration of that time the cbnstable, relieving
officer, or overseer shall take such proceedings with regard to the alleged lunatic
as are required by this Act.” The plaintiff’s ca^e was that on October 14th,
while he was sitting at supper, two men came to his house aud forcibly removed
him to the workhouse infirmary, where he was confined in the padded room, and
made to put on workhouse clothing. He was detained at the workhouse till
October 19th, when he was taken before a magistrate, who, on hearing the
medical evidence, at once discharged him. The plaintiff’s wife, when she was
called as a witness, denied that she told Fenton that her husband was a lunatic,
but that he was ill. She admitted, however, in cross-examination, that she told
Fenton that her husband had threatened to commit suicide and to “ do ” for her
and the children. Mr. Justice Hawkins held that there was no case against the
guardians, and judgment was entered in their favour. The jury, however, found
a verdict for the plaintiff for £25, as against Frost, on the ground that he did
not exercise reasonable care to satisfy himself that the plaintiff was a dangerous
lunatic, but they could not agree as to whether the defendant was “ honestly
satisfied ” as to the truth of the information which he acted upon. Mr. Justice
Hawkins, upon this finding of the jury, eutered judgment for the plaintiff, but
stayed execution until the parties had gone to the Court of Appeal.
After hearing arguments Lord Justice Smith, in giving judgment, said that in
his opinion there was ample evidence communicated to Frost to lead him to the
conclusion that the plaintiff was deemed to be a lunatic, or alleged to be a
lunatic, at the time in question. He thought that the verdict of the jury must
be set aside, and judgment entered for the defendant. The other Lords Justices
concurred, and the appeal was accordingly allowed with costs.
THE CAIRO ASYLUM.
We are glad to observe, from Lord Cromer’s report for last year, that Dr.
Warnock’s services will he retained in the interests of the insane at Cairo. The
temporary appointment has been made permanent. A number of patients are
now brought by their friends for treatment, whereas they were formerly brought
by the police. Lord Cromer refers in detail to the difficulty of providing
accommodation for the large number of patients requiring asylum care, and the
financial burden imposed upon the State. He says that, although local taxation
has been willingly borne, the purposes for which the money was raised were such
as could be readily appreciated— e.g. the construction of roads. He doubts if
this appreciation would extend to taxation for such objects ns sanitation and the
care of the insane.
Lord Cromer’s report is a document reflecting the highest honour on the men
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1898.]
661
who have worked such a marvellous change in Egypt. Every department is
emerging from the chaos which so long reigned supreme.
ASYLUM WORKERS’ ASSOCIATION.
The Annual Meeting of this Association was held on the 28tli March
under the presidency of Sir James Crichton-Browne, M.D., LL.D., F.R.S.,
Lord Chancellor’s Visitor. The audience, including (amongst others) Mrs.
Creighton, wife of the Bishop of London, Mrs. Langdon-Dowu, Miss Honnor
Morten, L.S.B., Dr. David Nicolson, C.B. (Lord Chancellor’s Visitor), Mr.
Bagot, Commissioner in Lunacy, Mr. F. D. Mocatta, the Rev. H. Hawkins,
Drs. Alexander, Bower, Cassidy, Chambers, Elkins, Haslett, Gardiner Hill, P.
Langdon-Down, Neil, Stilwell, Savage, and Outterson Wood. Miss Crouchley,
Miss Warren, and other asylum matrons were present.
The President gave an eloquent and interesting address on the objects of the
Association, especially dwelling on the misrepresentations recently made in re¬
gard to the training of asylum nurses.
The report of the Committee showed that the membership of the Association
tmrl ripon ° pi3 to 2534 d uring- the past year (1897), and stated that an
employment bureau (for male Attenda nts nq l y) , m^dey t] u» anspiyo s yiLThu Asso¬
ci ation, llUfl bWMl Uk HI Wished at It). Thayer , ^jllirlnCfNiff Trqiinrv, Wi
The accounts showed a satisfactory balance at the end of the year.
MALE NURSES’ (TEMPERANCE) CO-OPERATION.
The annual report of this co-operative society shows that it has continued to
thrive during the present year.
The stall', it is reported, has considerably increased during the year, yet the
average earnin gs per man, after paving all expenses. H myp °
~-*rha Sick FlUld established last year has been drawn on only to the extent of
8Jrf. per member.
The report affirms that the tendency to employ’ male nurses for male cases is
increasing, and that applications are being received from provincial hospitals for
young men with asylum experience lor employment iu the male wards and about
the hospital.
The co-operative principle is steadily growing in many directions, and it is
satisfactory to note the success of it in this particular form.
THE UNFORTUNATE MIDDLE CLASSES*
“ Passing reference was made at the last meeting of the City Council to a
deficiency in our lunatic asylum system which is deserving of much more atten¬
tion than it has hitherto received. This is the provision of accommodation for
lunatics of the middle or lower middle class, to form a connecting link between
the existing pauper institutions and the private retreats where the fees are such
as can only be paid by people in comparatively affluent circumstances. We are
wont to indulge, not without reason, in a good deal of self-satisfaction at the
reforms which the present century has wrought in the treatment of the insane.
A hundred years ago the attitude of the community towards those of its members
who were mentally infirm was one of wanton savagery ; to-day local authorities
are held responsible by the State for the proper care and efficient medical treat¬
ment of all such lunatics as cannot be satisfactorily provided for by their friends.
* From the Birmingham Daily Post , May 12th, 1898.
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662
Notes and flews.
[July,
No one who has been through one of our public lunatic asylums, and noted the
liberal and enlightened lines on which it is conducted, can doubt the sincerity of
the change which has come over the national sentiment on this subject. It is
the more surprising, therefore, that no general and systematic attempt has been
made to meet the case of those who, being far removed from the pauper class in
habit and instinct, can only find refuge in a pauper asylum should mental
affliction overtake them. This is really a practical question for a middle-class
community like that of Birmingham to address itself to. There are fourteen
registered hospitals—that is to say, partially endowed private asylums—up and
down the country, but Birmingham does not possess one. Nor is it an easy
matter to obtain the benefits of these institutions for what seem the most worthy
cases. There is a strong feeling that some of them are more concerned about
adding to their wealth and magnitieence by catering for profitable patients than
they are in using their endowments in a manner more consistent with the com¬
passionate intentions in which they originated. Thus these “ registered hospitals,"
as they are officially termed, do not by any means fill the gap between the public
and the private asylums. It is true that any accommodation in our public asylums
which is not needed for pauper cases may be utilised for paying patients. The
law gives this power, and in times gone by advantage has been taken of it in
Birmingham. But in recent experience it has been found that the claims on the
available accommodation are so heavy that there is practically no chance of gain¬
ing admission save as a pauper. Strange as it seems, private patients at Winson
Green Asylum have actually had to be made paupers in order to qualify for con¬
tinued treatment in the institution. Thus by a singular perversity the community
in its corporate capacity taxes itself in order to thrust an abhorrent piece of
patronage on some of its stricken membeis. Birmingham produces about four
hundred lunatics annually, in addition to those who are treated in private estab¬
lishments. It is computed that of these four hundred at least an eighth are in
circumstances which would enable payment of something over and above the
pauper rate. Particular cases might be mentioned in which people with incomes
of over £100 a year have been humiliated to the position of paupers by the
present anomalous arrangement. Imagine the case of a small tradesman, a well-
to-do artisan, a clerk, or even a not too flourishing professional man, who loses
his reason. There is, speaking practically, no alternative but to go through the
formality of pauperising him, and consigning him to an institution erected and
partly maintained at the public expense.
“The Poor Law authorities require a certain payment towards the cost of
maintenance; but they may not accept more than the bare amount of that cost—
fixed by the standard at 9$. per week, plus collector’s commission of 10 per cent.
—and by no ingenuity can the pauper braud be averted. The same thiug happens
should the man’s wife or other relative become insane. While fulfilling its
proper obligation to lunatics of the pauper class, is it not the plain duty of the
community to give heed to the claims of those who value their independence, and
would sacrifice a good deal rather than forfeit it? It is likewise the policy of
the community, for more reasons than one, to give this latter class some alternative
to a pauper asylum. There is good reason to believe that in many cases the
friends of people seized witji insanity are *>0 reluctant to submit to what they
regard as the indignity of accepting Poor Law relief that the administration of
proper treatment to the unfortunate patient is delayed to the last possible
moment, and the chances of an early or ultimate restoration are gravely imperilled.
It is certainly not in the interests of society that this should continue."
The article goes on to sketch a scheme for the provision of the accommodation
required in connection with the projected new asylum at Hollymoor, and we
have been informed that the weekly charges will be lower than those of any
existing county asylum provided for non-pauper cases.
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Notes and News.
663
CORRESPONDENCE.
The following letter has been laid before the Council of the Medico-Psycho¬
logical Association:
Hospital for Insane, Ararat, Victoria,
18th October, 1897.
Sir,—As Honorary Secretary of the Annual Conference of the Medical Staff of
the Department of Hospitals for Insane, Victoria, I am empowered to address
your Council.
For the better working medically of our various hospitals, of which there are
six iu the colony under Government, administered by an inspector of asylums,
with the Under Secretary as permanent head of the Department under minis¬
terial (Chief Secretary) control, the medical staff as a whole, three years ago,
formed an association with u view to the exchange of medical opinions, and in
hopes of arriving at some unity in the matter of higher administration and
treatment, and reporting to the Minister the resolutions arrived at. In 1895
aud 1896 matters administrative were largely dealt with, including such
subjects as nursing lectures and examinations, uniform for nurses and attend¬
ants, the grading of the work of the nursing staff, the appointing of the nursing
staff, &c.; in all of which matters medical superintendents laboured under
disabilities, since all ranks of our department are under a Public Service Board,
who, by order of Governor in Council, make all appointments and deal with all
dismissals aud punishments over five pounds (£5). Suffice it to say that without
permission, as an officer of the Government, I cannot further particularise; how¬
ever, many of our wants on behalf of the patients iu the above particulars have
been well ventilated, and, in part, acted upon. The probationary nursing and
attendant staff must now attend lectures and pass examinations before approval
of permanent appointment. The attendance on a senior course of lectures and
examinations for certiticale is still a matter of option unfortunately, though we
hope to be permitted, hy an arrangement of regrading the work and making the
pay coincide, to largely overcome this defect without in auy way bearing harshly
on such members of the staff as may be old in the service and soon retiring, and
to this matter we addressed ourselves at our third series of meetings this month
—we have three days each year in October,—and passed resolutions urging (1)
that in the interests of treatment and discipline uniforms be worn and provided
at once after passing the probationary examination, which, with a small addi¬
tional salary, would induce a better stamp of applicant to present him- or her¬
self, and from whom more is now expected ; (2) that the salaries of the junior
medical officers are not sufficient to induce good men to join the service and re¬
main with us (the superintendents magnanimously standing back for the
present) ; and (3) that as superintendents are of opinion that existing arrange¬
ments do not give as much benefit to the patients as those existing elsewhere,
they would beg to urge suggestions in order that the Victorian asylums may not
be behind the advances of other countries.
These matters were placed before the Under Secretary by the Inspector of
Asylums and a deputation from the Medical Superintendents, and well received,
with promises to urge their recommendations on the Minister and the Public
Service Board;—the Minister I may say is at present our very kind friend, but
we are just over a General Election, and benefits to the attendants have not
always gone hand in hand with benefits to the patients, and in this lies the crux
of the whole matter. But to return to the meeting. This year we had papers
from four asylums on “ The Effects of Insanity on Bodily Disease,’* “ Delusions,
fee., in their Relation to Complaints,” “ Folie a Deux,” and " A Case of Traumatic
Insanity relieved by Trephining.”
The final step of the meeting was one of distinct advance, the Inspector
of Asylums, Dr. M‘Creevy, stating that on a recent visit to New South
Wales, having talked over the matter of our meetings with Dr. Manning, the
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Notes and News.
[July,
Inspector there, he lind now to propose—“ That Dr.- Norton Manning and the
Medical Staff of the New South Wales Lunacy Department be invited to join us
in forming a Medico-Psychological Association, the meetings to be held in each
colony alternately, and that the first meeting be held in Melbourne, Victoria, in
October of next year, ,, and that as Hon. Secretary I be asked to communicate
with the Medico-Psychological Association of Great Britain in order to ascertain
how far, in the event of New South Wales joining us, it would be possible for us
to be affiliated or become a branch of that Association; and I would ask your
kind interest in this matter on behalf of alienists at the antipodes in time for me
to prepare a statement for our next conference.
I would like to mention that in the event of New South Wales joining us we
would then approach South Australia, Queensland, Tasmania, Western Australia,
and New Zealand, the other colonies of Australasia, and that at the annual
meetings each colony would have its representatives from superintendents and
medical officers—a system we adopted from the first,—and that nothing of indi¬
vidual asylum administrative work would arise unless of general interest, this
being the more to be desired since each colony has its own governmental
methods.
The details, however, arc still to be worked out when we hear from you.
At the moment I am sorry I have not material at hand to tabulate for you the
extent of lunacy work in Australasia, but in New South Wales there are six
large asylums with a staff of thirteen medical men; in Victoria there are six
asylums with a staff of fourteen medical men ; in South Australia there are two
asylums with a staff of two medical men; in Tasmania one asylum with two
men; in New Zealand at least three large asylums with two men each; in
Queensland two asylums with three men, and of Western Australia I am not
sure.
In putting these facts before you I may only be anticipating an inquiry which
might strike your Council, and would finally state that without doubt many
general practitioners would join our Society, and in this I speak confidently of
Victoria.
You are at liberty to make journalistic use of this letter, and I trust you will
understand my difficulty in making an article of it myself, though no such
hindrance stands in the way of letter form to you professionally.
I have the honour to be, sir, your obedient servant,
W. Beattie Smith,
Percy Smith, Esq., M.D. Medical Superintendent,
COMPLIMENTARY.
Db. Nobton Manning’s Retibement.
We report, with much regret, that Dr. Frederick Norton Manning has re¬
signed the office of Inspector-General of the Insane for the Colony of New South
Wales, which he had held for many years with so much credit to himself, and so
much benefit to the colony and its insane.
The resignation of a public official of the type of Dr. Manning cannot fail to
be a great public loss, for although it is not difficult to find officials who will be
certain to discharge complex duties with adequate efficiency, it is not so easy to
ensure that the man and the office shall be in absolute and acknowledged
harmony, and this is what, by a somewhat rare combination of qualities, Dr.
Manning was able to secure in his own case.
Commencing bis medical career at St. George’s Hospital, receiving his first
appointment at the York Dispensary, and subsequently entering the navy, in
which he remained for several years, he left everywhere pleasant impressions
behind him.
While serving in the navy he lost no opportunity of visiting the various
public medical institutions which were to be found in the ports at which he
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Notes and News.
665
stopped, and he ultimately became so impressed with the (Haring defects of the
asylum system, or want of system, of the colony of New South Wales, that it
scarcely needed the urging of a friend that he should represent to its Govern¬
ment the defects and abuses which his inspections had disclosed. His repre¬
sentations were fortunately taken in good part, and the seriousness of his facts
admitted.
He was invited to enter the temporary service of the colony as a special com¬
missioner, and authorised to visit the asylums of other countries in that capacity,
with a view to suggestions as to the improvement of its own asylum organisa¬
tion. The result appeared in an excellent report upon lunatic asylums, which
was printed by the Government in 1868, and in Dr. Manning’s appointment as
superintendent of the Tarban Creek or Gladesville Asylum, and Inspector of the
Insane for the colony.
He entered upon this new sphere of work with the ability, good judgment,
and infective enthusiasm which have marked his whole career, and by the aid of
which he has secured results of the highest importance in the interests of the
insane of the colony.
At a complimentary dinner recently given to him by members of the medical
profession of the colony, and numerously attended, he summed up the changes
which have been brought about during his administration in the following
words:—"When I took charge of Gladesville the place itself was a prison; and
Paramatta, all the buildings at which had been used as prisons in the very early
days of this colony, was much worse. There were no gardens, no flowers, no
amusements, none of the amenities of life, and the officers and staff were almost
as badly housed as the patients. Few took any interest in the condition of the
insane, and if hospitals are in some sort the measure of the civilisation of a
people, then at that time New South Wales was not altogether a civilised com¬
munity. At the same time the overcrowding was alarming, and on my first
night in office, when I picked my way, armed with a big bunch of some twenty
heavy keys and a lantern, among the patients spread out upon the floor of every
room without bedsteads, and as thick as they could lie, I confess that my heart
sank within me. I had, however, put my hand to the plough, and was not going
to turn back. It was ten years, however, before even the medical superintendent
of Gladesville had a house to live in at the hospital. It was sixteen or seventeen
years before the awful old cells occupied by women at Paramatta were swept
away. We commenced with 1000 patients in two hospitals. At this moment
we have 4000 in five large institutions, the youngest and most beautiful of which,
at Kenmore, near Goulburn, will have accommodation for 500 patients. The old
buildings have been remodelled, demolished, and rebuilt. I hope we can now
show in each and all of the hospitals for the insane in this colony pleasant
grounds, airy and cleanly wards, many comforts, and wise and kindly super¬
vision. Work in connection with the insane is admittedly trying and anxious.
I think I may now with fairness, and even with advantage to the public service,
step on one side and leave the continuance of a great work to younger, to more
efficient, but not more willing hand8. ,,
Dr. Manning was then presented with a handsomely illuminated and bound
menu of the dinner, containing the names of all the gentlemen present.
THE LATE DR. WALLIS.
The following letter from the General Secretary elicited from Dr. Merson, on
behalf of Dr. Wallis* relatives, a reply expressing their deep appreciation of
the sympathy expressed by the members of the Association :
11, Chandos Street,
Cavendish Square;
March 2nd.
Dear Sib, —At the General Meeting of the Medico-Psychological Association,
held on February 16th at the West Riding Asylum, Wadsley, near Sheffield, Dr.
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Notes and News.
[July,
T. W. McDowall in the chair, it was unanimously resolved that a vote of condo¬
lence and sympathy be tendered through you to the sons of the late John A.
Wallis, M.D , one of Her Majesty’s Commissioners in Lunacy, and a member of
the Association, in their receut sudden and sad bereavement by the death of
their father.
The Medico-Psychological Association also desired to place on record the great
loss it had sustained by the decease of one of its most valued and distinguished
members.
Believe me to remain.
Dear Sir, yours very faithfully,
Robert Jones,
Honorary General Secretary.
John Merson, Esq., M.D.
NOTICES BY THE REGISTRAR.
Examination for the Nursing Certificate.
Six hundred candidates applied for admission to the May examination for this
certificate. Of this number 102 failed to satisfy the Examiners, 27 withdrew,
and the following were successful.
ENGLAND.
Warwick Countt Asylum, Hatton.
Females .—Margaret Baldock, Mary Jane Baldock, Lilian Cindery, Lucy Coles,
Lily Mary Cross, Annie Holtham, Agnes Hadden, Maria Heffernan, Rose Knight,
Elizabeth Moore, Alice M. Oldham, Ophelia F. Prout, Lillian Vale, Alice Watts,
Eljen Jane Warth, Clara Kendle.
Suffolk County Asylum, Melton.
Males. —Edward Bradbury, James Davis, Frederick S. French, James
McCallum, John Payne, Arthur F. Philpott, Walter George Sharp, John Shill,
David Turner.
Females. —Ethel Alexandra Dove, Lizzie Woolnough.
Stafford County Asylum, Stafford.
Females .—Rose Draper, Winifred Hall, Harriet Rutty, Alice M. Tavernor,
Mary E. Weaver.
Kent County Asylum, Chartham.
Males. —Aaron Message, John Walker.
Females. —Maria Brannan, Isabel Crawford, Mary Dunn, Ellen Leaney,
Matilda Newey, Annie Williams.
Oxford County Asylum, Littlemore.
Male.— Henry Nutt.
Females. —Gertrude Hickman, Annie Money.
Derby County Asylum, Mickleover.
Males. —George E. Bowins, Thomas Frankton, Bernard J. Green, Walter G.
Hopper, William Henry Hartley, Herbert A. Hines, James William Swann,
William Henry Sharpe.
Females. —Charlotte Barnett, Harriet Griffin, Lizzie Ann Hubbard, Louisa
Stanley.
Nottingham County Asylum, Shbnton.
Males. —Thomas Chambers, Joseph William Caddick, Joseph Crosby, Robert
Clarke Lord, William Wilkinson.
Female. —Emily Johnson.
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Notes and News .
667
Glamorgan County Asylum, Bridgend.
Males. —Albert Thomas Attwood, William Bevan, Edwin James Burford, John
Davies, John Daymond, David Davies, Benjamin Evans, George Evans, William
H. Jenkins, Luther Jones, Morris James, Evan William John, Alfred George
Morris, George E. Printall, John Somertoo, John William M. West, William
Williams.
Females. —Jane Burnell, Catherine Elizabeth Bray, Bessie Cornelius, Ada
Edwards, Emily Hillman, Eliza Lear, Ellen Morgan, Cecilia Phillips, Blanche
Edith Robinson, Mabel Symonds, Eleanor Selway, Annie Elizabeth Thomas,
Margaret Williams, Catherine Williams, Emily Darnell.
Lancashire County Asylum, Rain hill.
Males. —Walter Edward Dewitt, Frank Hebb, Charles James Maynard,
William Spindelow, Albert Stevenson.
Females. —Mary Bailey, Minnie Pauline Gilkes, Louisa Grimes, Annie Haynes,
Florence J. Haynes, Emma Norman, Mary Elizabeth Pointon, Margaret Pier-
point, Elizabeth Rose, Edith Russell, Clara Steaner, Clara Simmonds, Annie
Thomas.
Lancashire County Asylum, Lancaster.
Females. —Ellen Doyle, Elizabeth Heavyside, Elizabeth Hart, Sarah Jane
Heighton, Sarah Ann Kittson, Myfanwy Lloyd, Martha Lund, Henrietta Mickle-
wright, Margaret Ann Mercer, Elizabeth E. Parkinson, Elizabeth Ann Swindle-
hurst, Ann Jane Trough ton, Annie Wakefield, Annie Woodlock.
Lancashire County Asylum, Whittingham.
Males. —Edward Bishop, William Brander, George Gannon, John Hay, Allan
Hay, Arthur Mitchell, Henry Walton.
Females. —Julia Dittrich, Elizabeth Jackson, Elizabeth Keane, Elizabeth J.
Miller, Bridget McGrath, Annie Smith, Pollie Eaton Smith, Edith Mary Smith,
Nora A. Walsh.
West Riding Asylum, Wadsley.
Males. —Albert Drury, George Fisher, Charles Bland Lassey.
Females. —Lucy Maria Moore, Mary Elizabeth Parker, Helen Gertrude Price,
Florence Matilda Rider, Ada Swift, Mary Jane Thorpe.
West Riding Asylum, Wakefield.
Male. —Thomas Edward Condon.
Females. —Jennie Logan Fullerton, Rachel Hargrave, Alice Hendy, Janet
Johnson, Ada Alice Lloyd, Ida Shannon, Mary A. Summerton.
West Riding Asylum, Menston.
Males. —William Thomas Hardy, Harry Leach, John Vernon.
Females. —Zipporah Lamb, Isabella Murray, Reala Norfolk, Maria Russell,
Emily Smith.
Surrey County Asylum, Brookwood.
Females. —Jane Bragg, Ellen Bayliff, Charlotte Mary Brock, Eliza Alice
Briscoe, Edith Maria Farrow, Edith Freeman, Bertha Kelly, Mary Maitland,
Marion Moss, Gertrude Rainpton, Auue Jane Remnant, Ethel Mary Tindle, Alice
Maud Townsend.
Somerset County Asylum, Wells.
Females. —Kate Ashford, Elizabeth Collard Blackmore, Emily Francis, Ellen
E. Gadd, Alice Petheram, Caroline Simpson, Nellie Sandereock, Bessie Vine,
Edith F. Vine, Ada Whittle.
Derby County Asylum, Exminsteb.
Males. —John Bright, James Beer, William Conway, Albert Wm. Clarke,
XLIV. 44
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Notes and News.
668
[July,
Reuben Foster, William Headon, George Rogers, Walter Williams, Albert James
Wensley.
Females. —Hetty Adamson, Jessie Draydon, Jane Holberry, Thirza Lowe,
Emma Jane Johns, Sarah Kemble, Eliza Grace Musgrove, Bessie Pearse, Elizabeth
Reed, Nellie Stadden, Sarah Thomas, Elizabeth Agnes Tudball.
Monmouth County Asylum, Abergavenny.
Males. —Amos Best, Herbert Cole, William Cox, Charles Davies, Benjamin
Evans, John Evans, George Hall, William Pitt, Thomas Prosser, George Savegar,
James Turford.
Females. —Edith Church, Agnes Dickinson, Phoebe Giles, Mary Jane James,
Mary Jane .Long, Mary Elizabeth Long, Martha Elizabeth Robotham, Alice
Sayce, Mary Smith, Blanche Gertrude Walby, Annie Williams.
Durham County Asylum, Winterton.
Males .—John Musgrave Foster, Robert Alexander Hayes, Sydney Hunt
Herbert Healey, Charles McKean, John Moore, George William Manning >
Alexander Wiseman.
Females. —Lily Carter, Ada Maud Denning, Jane Ann Curry, Adelaide Sadler,
Mildred Walker, Mary Waller.
Wilts County Asylum, Devizes.
Females. —Lilian Bntler Bax, Ellen Barnard, Jane Hazel], Emma Pike, Ada
Sarah Sims.
London County Asylum, Colney Hatch.
Females .—Ida Cherry, Mary Elizabeth Cox, Lilly Louise Dodd, Annie Esther
Dear, Sarah Gosborne, Florence Heselton, Alice May Greenaway, Kate Johnson,
Maud Mary Moss, Ada Miles, Flora Gleden Warne, Bessie Woodroffe.
London County Asylum, Cane Hill.
Males. —Arthur George Bulley, James Bamford, James Mitchell, Alexander
Noble, Peter Russell, Henry John Spray, Thomas Oliver, Richard Watts.
Females. —Lucy Creemer, Emma Dennis, Sarah Denster, Ellen Florence
Marshall, Mary Wyatt.
London County Asylum, Claybury.
Males. —Charles William Brown, Alfred Cottrell, Daniel Faubel, James Henry
Finding, Nathaniel Thomas Jeffries, Lambert Edward Long, Frederick Orman,
Robert Pullman, William Privett, Thomas Shannon, George Charles Stokes,
John Sellar.
Females. —Emma Boosey, Elizabeth Canton, Ethelwynne Mary Geach, Mildred
Hutton, Lillian List, Kate McNelly, Laura Alice White.
City Asylum, Exeter.
Males. —James Henry Bushin, William Robert Gunn.
Females. —Mary Ann Elliott, Annie Ellis, Eliza Ellis, Ellen Harford, Thirza
Annie Webber.
City Asylum, Nottingham.
Male .—John William Webster.
City Asylum, Winson Green, Birmingham.
Males. —Frank Grosvenor, Thomas Hicks.
Females .—Ellen Buncle, Nellie Pearson, Rose G. Winterbottom.
City Asylum, Hull.
Males .—Thomas Dyer, David Higgins, William F. Mottley, Thomas Robinson,
Frederick Soloman, Henry Spink, Walter Thompson.
Digitized by
1898.]
Notes and News.
669
Females. —Sarah Jane Ackrill, Mary Burton, Alice D. Credland, Mary Robson,
Ellen Robinson.
City op London Asylum, Stone.
Males. —William Cross, John Hinton, Harry Beckett Robinson.
Females. —Florence Matilda Evans, Mary Louise Evans, Annie Dixon Paterson,
Sarah Ellen Sides, Alice Anne Taylor.
City Asylum, Bristol.
Males. —William Thomas Hollis, John Willett, Allen Ashton, George Beazzer
Jones.
Females. —Kate Abram, Annie Brown, Florence Bartlett, Catherine Jones.
City Asylum, Newcastle.
Males. —Michael Joseph Burns, Thomas Dalrymple, George Duncan, John,
Elrick, George Gibson, John William Stainthorpe, Peter Wright, John William
Wood.
Females. —Margaret Eliza Hutchinson, Isabella M. Johnstone, Isabella Johnson,
Mary Lindsay.
Borouqh Asylum, Sunderland.
Females. —Mary Cameron, Margaret Hasker, Agnes King.
Borough Asylum, Portsmouth.
Males. —Henry Fuller, Arthur Himinens, William James Martin.
Females. —Louisa Gough, Annie Main, Maude McKeown, Alice McKeown,
Nellie Shepard, Daisy E. Wild.
Borough Asylum, Plymouth.
Males .—Alfred James Barrett, Joseph Keily, Bertie Stockman.
Female. —Alice Maud Harper.
Borough Asylum, Derby.
Male. —Charles Cockerill.
Bethlem Hospital, London.
Female. —Florence Letitia Dormer.
Warneford Asylum, Oxford.
Males. —Ernest John Croton, Frans Reinhold Strdmback.
Females. —Kate Jones, Ida Dora, M. Packford.
Northumberland House Asylum, London.
Male. —John Peters.
The Retreat, York.
Females. —Eveline Stansfield Collier, Pollie Crossley, Lilian Mary Sidney.
Broadmoor Asylum, Berks.
Males. —Herbert John Edwards, Joseph Woodley, George Downes.
Camberwell House Asylum, London.
Males. —Charles Hillier, Fred Hutley, Arthur Massey, Charles E. Mabbett,
Louis Leon Owen.
Female. —Era Rosannah Crook.
SCOTLAND.
Stirling District Asylum, Labbbbt.
Males. —Alexander G. Beaton, John Hendrie, Alexander Robertson.
Females. —Annie Binnie, Maggie Macintyre, Annie Nicholson.
Digitized by {jOOQle
670
Notes and News.
[July,
James Murray's Royal Asylum, Pebtu.
Male. —James Cairns.
Roxburgh District Asylum, Melrose.
Males. —Andrew Eddie, Charles Rothaie.
Female. —Margaret Clapham.
Perth District Asylum, Mubthly.
Male. —James Grant.
Female. —Plicebe E. Berwick.
Royal Asylum, Gartnavel, Glasgow.
Males. —Charles Burness, Donald Chisholm, William T. McKie.
Females. —Mary Boyd Henderson, Helen Kemp, Agnes Keith Simpson.
Royal Asylum, Morningside, Edinburgh.
Males. —Alexander Keith, John Young.
Females. —Maggie Clark, May Grant, Isabella Grant, Jessie Grant, Isabella
Haggarty, Nellie Haggarty, Margaret Lindsay Jamieson, Catherine Mackenzie,
Annie Patou, Margaret J. O. Russell, Bessie West.
Woodilee Asylum, Lenzie, Glasgow.
Females. —Martha McDonald, Alice McGowan, Mary Mason, Annie Snodgrass.
Royal Asylum, Dundee.
Female. —Hannah McSweeney.
IRELAND.
Richmond Asylum, Dublin.
Males. —Edward S. Breen, Michael Higgins, Andrew Maagan, Patrick
McEntee, James M. McCue, Michael O’Leary, Charles Rogau.
Females. — M«ry Ellen Byrne, Jane Dunne, Mary Geraghty, Annie Hanna,
Mary Anne Kelly, Kate McPartlin, Martha McKissick, Ellen Reddy.
District Asylum, Carlow.
Males. —Edward Doogne, Lawrence Gorman, William Hickson, Peter McEvoy.
Female. —Annie McDonnell.
District Asylum, Kilkenny.
Males. —John Curran, Michael McDonnell, John Tynan, Michael TyrrelL
Females. —Mary Butler, Mary McEvoy.
District Asylum, Monaghan.
Males. —Felix Connolly, Patrick Kildea, Peter McGuigan, John G. McClean,
John McArdle, Patrick McQuellin, William R. Steenson.
Females. —Mary A. Cahill, Mary A. Maguire, Jane Maxwell, Katie Stephen¬
son, Marianne Treanor.
District Asylum, Letterkenny.
Males. —Philip H. Hay, Charles McCafferty.
District Asylum, Omagh.
Males. —Philip McTeggart, Alexander Patterson, John Taylor, Thomas
Ward.
Females. —Eliza Jane Beats, Margaret McGreed.
District Asylum, Clonmel.
Males. —Robert Bell, James Fahey (1891), James Fahey (1893), William
Flaherty, Edward O’Brien.
Females. —Kate Barrett, Julia Nash.
Digitized by
1898.]
Notes and News.
671
The following is a list of the questions which appeared on the paper:
1. Describe the ankle-joint, naming the bones of which it consists, explaining
its action, and stating to what order of joints it belongs. 2. Name the cavities
of the trunk. State how they are separated and what they each contain.
3. Name the various parts of the body connected with the process of digestion.
In cases of indigestion what precautions are necessary ? if these are neglected
what diseases may ensue ? 4. Detail the special points requiring attention in
the nursing of paralysed patients. 5 What is an hallucination ? What is a
delusion ? How are hallucinations divided, and what are the chief general
forms in which delusion appears ? 6. What symptoms would make you say a
patient suffered from dementia {acquired enf'eeblement of mind) ? 7. What
symptoms would lead you to believe that a patient was suicidal ? State fully the
dangers to be looked for. 8. What are the chief points to be attended to in a
case of poisoning, and what antidote would you give if a patient had taken
carbolic acid ? 9. Mention the different kinds of enemas, say for what pur¬
poses they are given, and the quantity of fluid usually ordered in each. 10. In
dealing with patients what are the qualities that make an attendant most to
be valued ?
Next Examination for Nursing Certificate.
The next examination will be held on Monday, November 7th, 1898, and
candidates are earnestly requested to send in their schedules, duly filled up, to
the Registrar of the Association, not later than Monday, October 10th, 1898, as
that will be the last day upon which, under the rules, applications for examina¬
tion can be received.
Note.
As the names of some of the persons to whom the Nursing Certificate has been
granted by the Association have been removed from tbe Register, employers are
requested to refer to the Registrar in order to ascertain if a particular name is
still on the Roll of the Association. In all inquiries the number of the certificate
should be given.
For further particulars respecting the various examinations of the Association
apply to the Registrar, Dr. Spence, Burntwood Asylum, Lichfield.
EXAMINATION.
The Examination for the Certificate in Psychological Medicine will be held on
Thursday, July 7th, 1898, at 10 o’clock a.m., in London at Bethlem Hospital; in
Edinburgh at the Royal Asylum, Morningside; in Glasgow at the Royal Asylum,
Gartnaval; and in Aberdeen at the Royal Asylum, Aberdeen. Applications for
admission to the Examination should be sent not later than Thursday, June 30th,
1898, to the Registrar, Dr. Spence, County Asylum, Burntwood, near Lichfield,
who will be happy to supply any further information on this subject.
NOTICES OF MEETINGS.
Medico-Psychological Association.
The Annual Meeting will be held on Thursday and Friday, July 21st and 22nd,
at the Royal College of Physicians, Edinburgh, under the Presidency of Dr.
Urquhart.
South-Eastern Division. —At Springfield House, Bedford, on Monday,
October 10th.
Northern and Midland Division. —At Derby, on Wednesday, October 12th.
South- Western Division. —At the Grand Pump Room Hotel, Bath, on Tuesday,
October 18th.
XLIY.
45
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672
Notes and News.
[July, 1898.
APPOINTMENTS.
Simpson, Francis Odell, L.R.C.P.Lond., F.R.C.S.Eng., has been appointed Senior
Assistant Medical Officer to the Govnn District Lunatic Asylum, Crookston, N.B.
Longwortb, Stephen F., L.R.C.P.I., L.R.C.S.I., Assistant Medical Officer,
Richmond Asylum, Dublin, to be Senior Assistant Medical Officer, Suffolk County
Asylum, Melton.
Eades, Albert I., L.R.C.P.I., L.R.C.S.I., Clinical Assistant, Richmond Asylum,
Dublin, to be Second Assistant Medical Officer, Nottingham Borough Asylum,
Nottingham.
CORRIGENDUM: MEYER ON FRAGILITY OF THE BONES OF THE
INSANE.
We desire to correct an error which appears in the April number of the Journal
of Mental Science (page 298 of this vol.). In the discussion on Dr. Briscoe's
paper on 11 The Osseous System in the Insane,” Dr. Couolly Norman is reported
as referring to the work recently done on this subject by Dr. Krause. The
reference is erroneous. The work intended is an article by Dr. Ernest Meyer
(now of Tubingen) which appeared in the third number of the 29th vol. of the
Archie fur Psychiatric, entitled “ On Fragility of Ribs in the Insane.” The
mistake doubtless arose from the fact that Dr. Krause, working in the laboratory
of Professor Ludwig Meyer, contributed to the same number of the Archie an
article on another subject, which stands next to Dr. Ernest Meyer's. In
correcting the proofs of his remarks the speaker evidently glanced at the wrong
article.
Digitized by
THE JOURNAL OE MENTAL SCIENCE.
[Published by Authority of the Medico-Psychological Association
of Great Britain and Ireland .]
No. 187. NK M: BS ’ OCTOBER, 1898. Vol. XLIV.
PART I.—ORIGINAL ARTICLES.
The Presidential Address delivered at the Fifty-seventh
Annual Meeting of the Medico-Psychological Association,
held at the Royal College of Physicians, Edinburgh,
on the 21 st July, 1898, by A. R. Urquhart, M.D.,
F.R.C.P.E.
Before addressing you, I have formally, however im¬
perfectly, to express my full appreciation of the high honour
conferred upon me at your hands in thus placing me in the
Presidential Chair of your beneficent Association. I say
beneficent advisedly, for when men have banded themselves
together for the cultivation of science and the improvement
of the condition of the insane, they associate to fulfil these
functions as practical philanthropists. These good intentions
have been realised in fruitful performance in words and
deeds, and we hold our Annual Meeting to-day with a desire,
an ability for good work that cannot fail to mark the year as
one of humane progress.
Having regard to the serried volumes of the Journal of
Mental Science, and the long list of Presidents whose names
are familiar as household words with us because of their
attainments in psychological medicine, their successors
undertake the duties with natural hesitation and much
heart-searching as to real ability to maintain the honorable
and dignified traditions of this Chair. I have once again
looked over the Presidential Addresses which have been
delivered year by year, and have now accumulated in a record
of wide research and ordered detail. They mark the pro¬
gress of psychiatry periodically and definitely, and show how
it has ever been the aim of your Presidents to occupy some
xuv. 46
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Presidential Address ,
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outpost coigne of vantage, to formulate some new phase of
medical thought, to present for your consideration ideas
which may fructify, to epitomise the events of the day in
relation to our special field of labour. The wish to produce
something worthy of the occasion has been paramount with
me, and if in the result I fail to do justice to my desire, I
crave your indulgence.
It has fallen to me, as a Scot, to bid you once more wel¬
come to this historic city—“ our own romantic town ”—and
as a Fellow of this ancient and honorable College to receive
you within these precincts where our Association has so often
found asylum.
In recalling those who have occupied this Chair in this
city, I must arouse many memories. In 1858 the great
Conolly entered upon the office of President, rejoicing that
the close of his life should have been distinguished by the
privilege of presiding in a city endeared to him by all the
recollections of a student. It was then he disclosed that it
was after an accidental visit to the old Glasgow Asylum
when he first became impressed with the importance of the
study and the treatment of mental disorders, and unconsciously
devoted to the cause of the insane. The results are familiar
to us all, but those who knew Conolly in the flesh are now
but few and scattered. Perhaps none had a higher appre¬
ciation of the man and his work than Sir John Bucknill, who
once said to me in his burly manner, €t I would have every
man who aspires to care for the insane read every word
Conolly published.”
Again in 1863 Dr. Skae laid before the Annual Meeting
the preliminary sketch of the classification of mental diseases
which he had then adopted, a classification which once for all
fixed the attention of psychiatrists on the physical basis of
mental disorders.
Later the veteran Dr. W. A. F. Browne, welcoming the
Association for the first time under the title which it still
bears, proceeded to discover that wider horizon of philosophic
thought which ought to be ours. He it was who first system¬
atically instructed attendants in their important duties, and
in his memorable book on “ Asylums as they were, are, and
ought to be,” laid the foundation of modern methods.
In 1872 Sir James Coxe spoke with no uncertain sound on
the causes of insanity, urging that it is a disease of ignorance
and should be combated by adequate instruction of the
people in the laws of mental and physical health.
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675
And, lastly, ten years ago, we had from Dr. Clouston, the
only survivor of these his illustrious predecessors, what still
remains the only systematic monograph on dementia, that
debased ruin of minds diseased.
We sadly miss one familiar face and figure from our
gathering to-day, one whose shrewd wit found unsuspected
joints in the armour of self-satisfied science, yet one whose
friendly counsel was valued most by those who knew him
best. Dr. Howden did a long day's work for the Montrose
Royal Asylum, busied to the last with schemes for improve¬
ments which he was not permitted to see accomplished. In
reminiscence for me he is linked with his near neighbour,
Dr. Jamieson of Aberdeen—slow-spoken, friendly, righteous
men, wholly devoted to their proper work in life, yet philo¬
sophic in breadth of view and catholic in sympathy with all
that is good and beautiful. The grave has closed over them,
but their memory is green and fragrant.
Another steadfast friend and tried comrade has been lost
by the death of Dr. Wallis, whose services in the county of
Lancashire and at Whitehall are so well known to all present
that I may not speak of them at length. As an old friend,
his active virtues and brave conduct of life in the shadow of
death were brought very near to me. We lament that he
has been taken from amongst us while yet in his prime.
Dr. Ringrose Atkins, too, has departed. The sincerely
appreciative account of his life which appeared in our
Journal shows unmistakably how his death affected our
colleagues in Ireland. It may be added that the writer, in
sending what he considered an unduly long manuscript;
expressed his complete inability to deal adequately with a
man of such admirable character and many-sided interests
within the narrow confines usually judged sufficient.
I cannot conclude these brief words of affectionate remem¬
brance without reference to two older members of our special
department of medicine who died in fulness of years, men
who were notable in their day and kindly thought of by
those who were associated with them in their work. Dr.
Marshall and Dr. Sheppard were charged with large responsi¬
bilities in Colney Hatch, and fulfilled their duties with un¬
flinching zeal.
Such are the inevitable losses which the revolving years
entail. It is for the survivors to close up the ranks and
stand fast against the inroads of dumb forgetfulness. And
they are assured of willing recruits, with whom the future
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Presidential Address,
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lies. The men of old time have had their day and ceased to
be. We summon ardent youth and vigorous manhood to aid
us in the ceaseless conflict with disease and death, to hold
the old positions where footing remains secure, to advance to
new conquests all along the line.
It is written that “the coneys are a feeble folk, yet they
make their dwellings in the rocks.” The founders of this
Association builded secure on the rock of humane science, but
they could hardly have anticipated that from such modest
beginnings their house would in process of time attain such
dimensions. It was a happy thought of Dr. Outterson
Wood's to present us with a lively account of that gallant
band of pioneers, clearing the forest of prejudice, cutting
away the undergrowth of darksome ignorance, letting in the
free air to disperse the miasmata engendered in a soil
poisoned by cruelty and superstition. These pilgrim fathers
enriched us with an inheritance which we, their heirs and
assignees, must not endanger.
When we last met here we numbered 450. In spite of
deaths and desertions we are now 574. Since that occasion
new life has pulsed through the Association. Germinal force
is evident in segmentation before the new creature is per¬
fected as an organism and fitted with members and parts to
complete its unity. Such cleavage has already been effective
in augmenting our potentiality for good. The new divisions
have united our scattered elements at times and places
hitherto impossible, and have elicited a consensus of opinion
which we previously failed to reach. Our colleagues in
Australasia now propose to work in concert, while uniting
with us in federate control, on the principles which are surely
moulding the imperial politics of our race.
These reflections are not to be succeeded by an apologia,
nor do I purpose sounding premature paeans of victory. In
all sobriety rather let us consider in what respect we have
done reasonably well, and what the immediate future should
hold for us. Our sharpest critics are of our own household.
The hasty judgment of the man in the street is modified
when he knows. When misfortune overwhelms him, and his
nearest and dearest are in jeopardy of losing reason, his
cheap sarcasms are forgotten. Hear Sir Henry Maine on
this old theme. “A friend of mine once said he had no
belief in medicine, it was an art which made no progress.
It may be worth while to examine the particle of truth
which makes such a view possible to highly intelligent men
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1898.] by A. R. Urquhart, M.D.
looking at it from the outside. . . . All the contributory
arts and sciences, subordinate to one master art, the art of
healing—physiology, pathology, toxicology, chemistry—are
advancing at a vast rate, and whenever all these arts and
sciences are complete, medicine will be the most complete and
perfect of all the arts. But, by the very necessities of their
profession, medical men are compelled to act as if an art was
complete which is only completing itself. We are constituted
of too frail a structure to be able to wait for the long result
of time, and our infirmities place medical men at a disadvan¬
tage as compared with other men of science, by forcing them
to anticipate a consummation which may be near but has not
yet been reached.” Partly because of this pardonable im¬
patience, partly because of the inability of the average man
to adopt the principles of preventive medicine, our work
wears the appearance of failure. We know what has been
done to ameliorate the conditions of asylum life—the im¬
proved architectural arrangements, the improved sanitation,
the improved nursing, the improved medication. Yet, in face
of the untoward cases and evident failure, we cannot but ask
if our results are really better. Admitting that the environ¬
ment has been rectified, can we show more recoveries conse¬
quent upon vast expenditure of energy and money ? Can we
grow two blades of grass where one grew before ? Have the
deaths been fewer ? Have the ravages of disease been held
in check ?
It is the stock answer to these inquiries that the kind of
patient admitted is different, that the type of insanity has
changed, that the riddle cannot be solved. It is, indeed,
extremely difficult to place exact facts on record for purposes
of comparison. Not only is there a difference in the personal
equation which renders it impossible for any two men to
classify a thousand cases exactly in the same way, but there
is an additional stumbling-block when we attempt to sort out,
from brief and imperfect histories, the facts which we now
desire to record, and the conclusions which we now desire to
draw. There is such a change in the medical attitude since
the century was young, such an alteration in nomenclature,
that backward projection of the modern mind cannot be other
than tentative. It fails to penetrate the mists. Therefore,
although we have reduced the salient facts of each case
admitted into Murray's Asylum into narrow compass, and
have attempted to diagnose the maladies in accordance with
modern ideas, much uncertainty remains.
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Presidential Address,
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Broadly it may be stated that the impressions above indi¬
cated are borne out by the medical history of the institution.
The cases received between 1827 and 1864, when the State-
supported patients left, were more actively insane, were
younger, more hopeful in prognosis, than those which have
been admitted since that decisive date. Taking the middle
years of the first-named period, and comparing them with the
years since my appointment in 1879, the acute cases numbered
65 per cent, of the admissions of the former, as contrasted
with 46 per cent, of the latter. Similarly, those over the
age of 60 were 4 per cent., as contrasted with 14 per cent.
Or, on classifying the cases according to mental condition,
the great majority in the earlier period suffered from mania,
few from melancholia, very few from delusional insanity, and
surprisingly few from dementia. The curve for melancholia
rises, with trivial remissions, year by year.
If we turn to the study of recoveries, the results are no
less in accordance with general opinion. Large assumptions
must be made in dealing with “ cures ” reported as conse¬
quent on prolonged residence—even after twenty years.
Accepting plain statements of this nature as true, the decline
in the number of cases recovered during the later decades is
sufficiently remarkable, but it is only when the recovery rate
is ascertained, by the adoption of Table IIa, as prescribed
by this Association, that an approach to truth is evolved.
Having arrived at the number of persons admitted during the
first period of thirty-six and a half years, we found that 41 *1
per cent, had been discharged recovered, as compared with
35‘1 per cent, during the last period of thirty-three years.
But on reducing these to the net recovered persons, in so far
as the Asylum statistics can show, we were face to face with
the fact that the recovery rate was more evenly approximated,
viz. 35’3 per cent, as compared with 32*9 per cent., a dif¬
ference of 2*4 per cent, instead of 6 per cent. I believe this
to be due in great measure to the number of alcoholic cases
formerly received as insane patients. Their accumulated
“ recoveries 99 bulk largely in the general total. The large
number of cases of delirium tremens and acute alcoholism,
regarding which there is no room for error in diagnosis,
owing to the history, instant classification, and brief deten¬
tion, entirely vitiates any comparison founded upon undigested
figures. The number of alcoholic cases “ recovered 99 during
the first period was practically the same as the number who
did not recover—each class, recovered and not recovered,
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by A. R. Urquhart, M.D.
679
represented 15 per cent, of the whole number of admissions.
On the other hand, the proportion of “ recovered ” alcoholic
cases in the last period was but 8 per cent., while two thirds
of the alcoholic admissions did not recover. It must also be
noted that the returns as to recoveries from an asylum de¬
voted to middle-class private patients are less favorable
than those from a county asylum, for reasons which have
been adequately explained.
Turning to the death-rate, by which our work may be
judged from another point of view, the results for the earlier
and later periods are 5*05 and 5*65 per cent, respectively.
That is a slight difference in favour of the former. The con¬
siderations which I have placed before you weigh in this con¬
nection also. When we scrutinise the constituent elements
more closely, we cannot but stand appalled at the record of
deaths owing to causes which we now consider “ preventible.”
Putting aside the great number loosely assigned to senile
exhaustion, phthisis heads the list with a formidable per¬
centage of 13 of all the deaths occurring in the first period.
Although the original design of the building included
elaborate provision for the heating and ventilation of every
room, the arrangements were practically ineffective, and
during the latter part of the first period many of the rooms
of 800 cubic feet capacity were crowded with three patients.
The deaths from diarrhoea, enteritis, and similar diseases
could not fail to be numerous. An epidemic of cholera in
1854 claimed eight victims. At that time patients of faulty
habits were secured to seats in small rooms by day, and
exchanged these for their restraint-beds at night. The
imperfect sanitary arrangements, rendered even more dan¬
gerous by the attempts of ignorant attendants to remedy
them, resulted in the accumulation of lakes of sewage under
the flooring. The water-supply was scanty and impure, and
the general management of the establishment was carried on
in face of the gravest difficulties. The suicides numbered
eleven, a heavy mortality which also must be considered
as largely preventible. The heroic treatment of even ordi¬
nary cases of mania—violent purgatives, bleeding, blistering,
setons, and the general regimen—leave a record of gangrene,
carbuncles, and other evidence of faulty methods. And
yet the death-rate was low. I conclude that the average age
and physical strength of the patients under care was more
favorable in the earlier period. The debilitated cases now
received require nursing and nourishment, and could not
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Presidential Address,
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withstand the assaults of the antiphlogistic treatment so
much in favour in former times. We retain but one survivor
of that regime, one who, while able to make his wants known,
never failed to secure a full dose of Epsom salts in spring
and in autumn, however unnecessary it might appear to
latter-day opinion.
I think that this higher level of physical condition is also
apparent in the fact that but one death from influenza was
recorded, although it is evident that epidemics did occur.
No doubt degenerative diseases of the nervous system caused
the greatest number of deaths, but the actual facts cannot be
elicited. A careful study shows that epilepsy was not un¬
common, and that general paralysis was not so rare as has
sometimes been stated. The first recorded case of general
paralysis occured in 1850, but it is evident that prior cases
had been received and had died after the usual course of
symptoms. I venture to state that the percentage of deaths
from general paralysis for the first period was 8 as compared
with 10 for the second.
I have not directed your attention to the early history of
Murray's Asylum to gain cheap applause for the manifest
improvements which later experience has permitted. The
men who founded that institution and administered its affairs
at that time were actuated by the highest, the sincerest
motives. The fundamental ideas of the management were
expressed in the first Annual Report as forbearance and
kindliness. The times were different. When Lord Chancellor
Eldon declared that there could not be a more false humanity
than an over-humanity with regard to persons afflicted with
insanity, and when Dr. Halloran recommended the bath of
surprise and the gyrating chair as humane means of treat¬
ment, the methods of the press-gang and the tyranny of
authority in high places were the order of the day. Now the
centre of authority has shifted, and that change has entailed
dangers of another kind; but we live in better times, in a
social environment on a higher plane. We take colour from
our surroundings, and can but say Tdmpora mutantur et nos
mutamur in illis.
The position now occupied by our profession is no longer
limited to the narrow confines of curative medicine. With
the growing reverence for human life in its manifold relations,
the fiat Salus populi suprema lex esto has been endowed with
a widely extended meaning. So much the more are we
bound to undertake these newer duties for which the prac-
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681
1898.] by A. R. Urquhart, M.D.
tical and enlightened education of our Medical Schools fitted
us, and for which that liberal education of professional after¬
life enlarged our abilities ; so much the more is it laid upon
us to throw the weight of our influence into all that makes
for the amelioration of our common humanity. Although
the end is not yet, the people will not despise prophesyings if
we speak plain words of common sense with sincere convic¬
tion of the importance of our calling. Much of our know¬
ledge has passed into commonplace for us, and of course we
are intimately concerned with the technicalities of our ab¬
sorbing avocation. Still, the commonplace becomes common¬
place because it is largely true, and therefore important in
the conduct of life. What is technical is esoteric, and
consequently neither popular nor widely influential. How
should our neighbours, busied with the daily work of the
world, find time to interest themselves in the minutiae of
research ? They ask for results.
I should say that the question most often put to us is, Does
insanity increase ? That is an inquiry of public importance,
and it should be answered with an indication of how the evil
may be mitigated. Experience points to prevention rather
than cure, although precept falls on deaf ears or ears wilfully
closed. I have arrived at that stage when one receives the
insane children of former patients, and can imagine nothing
more discouraging than the slow devolution of degenerate
families if attention is restricted to the immediate facts. Such
observations should rather nerve us to renewed vigour. We
have opportunity in our annual reports to repeat, even with
tiresome iteration, the lessons which are read to us year after
year; we may address the public through the many societies
which exist for the spread of scientific information; we may
find occasion to contribute to the columns of the periodical
Press; we may act in our corporate capacity as Dr. Whit-
combe has proposed this morning. It is our bounden duty to
enlarge our sphere of contact with the sane community, to be
instant in season in promulgating our teaching until tne com¬
monplaces of our specialty become the commonplaces of the
world.
I need go no further afield than my left hand to illustrate
my meaning by an allusion to the life-work of our honoured
Treasurer, who, in the intervals of his more immediate profes¬
sional work, in the brief respite from the onerous work done
for this Association, lends a willing and powerful pen to the
furtherance of worthy aims or the criticism of erroneous con-
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Presidential Address,
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ceptions, and, beyond all, gives his business experience and
energetic mind to the affairs of the county of which he is a
worthy son.
Let us for a few moments revert to Dr. Conolly's address,
delivered here in 1858. He placed before this Association
several propositions which then seemed to him of the first
importance. He pled for the due recognition of the medical
superintendent in the management of our asylums. That has
been fully granted; the controversy is extinct. He pled for
clinical instruction in our asylums, and the absolute necessity
for our medical officers having received practical training in
the department of mental diseases. The great institutions for
the insane in the neighbourhood of our medical schools are
now utilised in that manner, not only for those about to enter
on psychological medicine as the department of their choice,
but also for every student desirous of placing his name on the
medical register. Practical knowledge of mental disease is
now compulsory for all. Conolly pled the cause of the poor
private insane, and England is at length, by the law of the
land, in a position to do all that is necessary on their behalf,
and already that law has passed into active operation in
Dorset, the West Riding of Yorkshire, and elsewhere. He
pled the cause of those worn out in the service of the insane,
and we seem now to be on the eve of obtaining adequate gra¬
tuities and pensions as a legal right—for England at least.
He uttered a warning against the monstrous aggregation of
patients in overgrown asylums, and pled that these institu¬
tions should be kept of moderate size. To-day, by the kind¬
ness of the Edinburgh Parish Council, I had hoped to have
directed your attention to the latest solution of this problem.
The plans to be exhibited in the neighbouring museum next
week show how the colossal whole is broken into manageable
fragments—a more excellent way, upon which we may warmly
congratulate those who have so efficiently adopted it.
In the impatience of zeal forty years seems a long period
to wait for reforms which cry aloud for public recognition;
but if in another forty years similar progress shall have been
made, our present labours will have borne good fruit.
I ask you to consider briefly what now demands our
attention. In the present session of Parliament three Bills
likely to pass into law have special interest for us—the English
Lunacy Bill, the Habitual Drunkards Bill, and the Irish Local
Government Bill. These have been fully discussed at our
various meetings, and need not detain us long.
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1898.]
by A. R. Urquhart, M.D.
683
On reading the first-named one cannot but feel disappointed
that it contains no proposal for increasing the number of the
Commissioners in Lunacy. 1 doubt if any legislative reform
in connection with lunacy is so much required. Every year
adds to the number of insane persons under the cognizance of
the Commissioners, until the total recorded in England and
Wales has reached 101,972, as compared with 20,611 when a
permanent Lunacy Commission was first established. At that
time Lord Ashley proposed that six paid Commissioners should
be appointed at salaries of £1500 each, and observed that the
proposal would be economical in the end. Did he then foresee
that six Commissioners would be deemed sufficient to control
the welfare of five times as many insane persons as were then
reported ? I feel that some apology is required for intro¬
ducing such a threadbare subject, and repeating statements
familiar to all here present. But how does the matter stand ?
Is it not detrimental to the cause in which we are most deeply
interested that the Commissioners should be hurried from
asylum to asylum in the intervals of dealing with the affairs of
the vast organisation over which they preside ? The lunacy
administration of Scotland is fortunate in having maintained
a reasonable proportion between the number of the Commis¬
sioners and the work in hand,. so that they are familiar with
individual cases of difficulty and the details of management
of each institution.
I discern, too, in this Bill a danger threatening the
asylums of England, a policy of legal restraints which is
unwholesome and deterrent to the best work expected of
them. We have in practical management emerged from the
narrow conceptions of the past. We have discarded the
ideas of the prison, and trust to educated control and con¬
stant supervision. Rules and regulations are doubtless
necessary, but this legislation for exceptional cases and this
prescription of harassing formulae is not conducive to that
freedom of initiative which has made our asylums what they
are. Erect the lunacy administration of the country into a
great State Department, and you will fetter originality by
the red tape of bureaucratic control, and trammel the advance
of scientific opinion by the dead weight of that officialism
which is the besetting sin of asylum life. When the physician
loses himself in the official his degradation is apparent, he is
absorbed in financial details, the last litter of pigs rivets his
attention, the patients merely detain him from affairs which
would probably be as well managed by the farm-bailifE or the
Digitized by Google
684 Presidential Address , [Oct.,
house-steward. It is proverbially foolish to chop wood with
a razor.
“ The low id Hu seeks a little tliiug to do.
Sees it, and does it:
The high man with a great thing to pursue
Dies ere he knows it.
The low man goes on adding one to one
His hundred's soon hit;
The high man, aiming at a million.
Misses an unit."
I congratulate our colleagues in Ireland on their spirited
declaration in opposition to the proposal to transfer the care
of the insane to the Local Government Board, and their
suggestions for the more efficient medical service of the Irish
asylums. Mr. T. W. L. Spence has shown that ordinary
pauperism is entirely different from the pauperism which fills
our wards, and that our public asylums exist for the care and
cure of the insane belonging to more than four-fifths of the
population of the country. Whatever feeling may exist in
connection with the name “ asylum,” at least it has not been
officially placarded with pauperism in our nomenclature.
These institutions are the District Asylums, not the Pauper
Asylums of Scotland.
I have never been brought into contact with any con¬
siderable body of opinion in favour of erecting lunacy
administration into a State Department. The differences
and uncertainties of local control inevitably show flaws
inherent in all human designs, but leave freedom for scien¬
tific advance, and insure a healthy competition for the
rewards of skill and labour. Would it be advisable that
we should indent for medicines according to the regulations
of the Army Medical Department? Is it expedient that
asylum dietaries should be fixed by a central authority
without regard to local conditions ? Could we have obtained
these designs for the new Edinburgh Asylum from the Royal
Engineers, whose ideas of construction are so much in evi¬
dence in the prisons of the country ? It therefore seems to
me that we can discover an unwholesome tendency in the
tightening of authority by the Lunacy Bill now in progress
through Parliament. For instance, there is a proposal to set
apart the various wards of an asylum allenarly, as we say in
Scots law, for certain specific purposes, as if we were latter-
day Canutes, who should command disease to restrict itself
to fixed localities—saying thus far and no further. There is
a proposal to limit the uses of succursal villas, and thus to
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685
1898.] by A. R. Urquhart, M.D.
retrace steps assuredly proved to have been in the right direc¬
tion. There is no inherent superiority, in respect of cure, in
buildings of vast size and architectural pretensions. That
is a mere recrudescence of outworn ideas. The physician
can treat certain cases better in houses of small size; and
if there be any value in the private care of the insane, as
there undoubtedly is, a method which recent developments
have tended to increase, it should be adopted as part and
parcel of the system of asylum management.
The necessary preliminary, the necessary sequence, is
efficient inspection by men of skill and repute. Such men
we have had in the past, those who, while wisely exercising
judicial care and supervisory functions, effectively aided the
work done in detail in the various institutions of the country.
No doubt some of us have promulgated ideas and adopted
methods at variance with the best practice of the specialty,
and have been more or less damaged in kicking against the
pricks. The wonder is that so few deviate into disastrous
bvwavs, considering the nature of the office we have under¬
taken. For—
« Almost thence our nature is subdued
To what it works in, like the dyer's hand.”
But we recall that, in another place, Shakespeare lifts us into
a higher phase of thought:
" O benefit of ill, now I find true
That better is by evil still made better.”
The remaining Bill, alluded to the other night by Mr.
Balfour as a specially Scots measure, a Bill which may be
accepted as an instalment of legislation on a most important
subject, is that relating to Habitual Inebriates. It is the
natural sequence of the ineffectual Act of 1879, and marks a
great advance on that half-hearted measure. The Govern¬
ment has occupied a strong position, from which it can hardly
be driven by hostile criticism. To us, who are unwilling
witnesses of the havoc wrought by inebriety, these present
proposals cannot seem adequate. Men and women in thousands
make shipwreck of their lives by their abuse of stimulants
and narcotics, and are received into asylums in hopeless
condition mentally and physically. They constitute a danger
to the commonweal, their wasted lives are a loss to the state.
Yet this Bill fails to deal with them, as if their vice were
self-regarding, provided they do evade the purblind cog¬
nizance of the. police. In eighteen years I have had 85
habitual drunkards under care in Murray's Asylum, not to
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Presidential Address ,
[Oct.,
speak of those who came under my notice elsewhere; and it
does not appear that, had this Bill passed into law at the
beginning of that period, half a dozen of those persons would
have been affected by its provisions. The tale of misery
would have been all but as complete. In the nature of
things the poorer class of the insane obtain earlier and more
appropriate treatment than the well-to-do; similarly the
“ criminal ” class of inebriates will have a better chance of
reformation than the law-abiding.
That does not appear to be a nice discrimination which
regards the mere accident of the form of drunkenness, and
hastens to rescue the man who is obnoxious in his cups,
leaving the inoffensive sot to stagger on his way to perdition.
In my experience chronic alcoholism is largely hereditary,
either in consequence of predisposition to insanity, or the
neurotic disorders engendered by parental drunkenness. I
therefore urge that there should be exceptional protection
for individuals so handicapped in life's race ; and, further,
that our courts of law should be empowered to sequestrate
any man who has so lost control of himself as to be a danger
to himself and others by reason of vicious indulgence in
intoxicants. The liberty of the subject is not so wide as
when it was—
“ The simple plan
That he should take who has the power.
And he should keep who can."
and it may be confidently predicted that this specious liberty
will be yet more narrowly hedged about with wise restric¬
tions, at least till the coming of the Cocquecigrues.
I do not greatly complain that legislation progresses slowly
with us. Nay, it is a positive advantage that hasty and imma¬
ture schemes should be rejected, and that our Acts of Parlia¬
ment should be well matured and inevitable. In the United
States laws are passed with an inconsiderate rapidity which too
often results in their being left derelict in the press of affairs.
Unfortunately we know something of this here in Scotland.
By Act 25 and 26 Viet., cap. xxxv, sect. 14, the police are to
report on persons from whose premises persons in a state of
intoxication are frequently seen to issue ; but it is only
within the last few months, and apparently as the result of
local effort, that such reports have been brought before the
courts. By clearing our country of rampant vice, by enforcing
our present laws, we might do much to deter the inebriate
before he enters on an over-mastering habit; but above all
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1898.]
by A. R. Urquhart, M.D.
687
we must rely upon that higher and better education, which
has brought about a complete revolution in the attitude of
both ladies and gentlemen towards drunkenness. I fear that
this Association has not taken up this subject so effectively as
it might have done. It has not formed the subject of an
address from this chair; nor do I remember that any com¬
mittee has been appointed to report on the problems involved.
Beginning with Trotter's memorable book on drunkenness,
which, though published in 1804, had long previously been
presented to the University of Edinburgh as his inaugural
dissertation, we have indeed a great and rapidly increasing
literature, to which our members have contributed in due
proportion. The knowledge that papers on inebriety are
shortly to be presented for your consideration restrains me
from entering into details on this occasion. I do wish, how¬
ever, to press upon your attention certain broad principles in
regard to the reformatory treatment of inebriates before con¬
cluding. We have seen how habitual drunkards were rele¬
gated to the Perth Asylum, by order of the Sheriff, prior to
the present Lunacy Acts coming into force. It was appa¬
rently felt that their condition was akin to insanity, and that
they would be best placed in that kind of institution. That
method of treatment was a mere makeshift. An asylum for
the insane is not the place for inebriates. The discipline is
not of that stern stuff which is necessary; the habitual atti¬
tude of the staff is not precisely what is requisite. The great
Lord Mansfield, whose voice was ever for freedom, he who
declared the slave who touched the shore of England free,
looked upon drunkenness as a crime, and held that a criminal
act committed in drunkenness was punishable, on the ground
that one crime could not excuse another. But there is now
apparently a desire to confuse the issues, and, rather than
differentiate between vice and disease, hold that all habitual
drunkenness is a disease. The common sense of the country
revolts at such a notion.
The fundamental notion of the treatment of inebriates is
more reformative than curative. Curative it must be in the
sense that bodily disorder should be treated with skill and
solicitude; but medical treatment is of little consequence if
moral treatment is not placed in the forefront of our endea¬
vour to restore the person to his rightful place in the world.
Dr. Norman Kerr boldly states in the preface of his book
that “ inebriety is a disease as curable as most other dis¬
eases." That is so far from being even approximately true in
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Presidential Address,
[Oct 7
ray experience, that I am not surprised to find in his inter¬
minable lists of “ remedies ” but one short sentence to the
effect that it is “ the great point to have a healthy outlet in
energetic work of some kind ”—regarding which “ a word of
caution as to moderation will not be amiss.” In all his
hundred and odd pages on treatment, only this and nothing
more. But one ha’porth of bread to an intolerable deal of
teetotal sack—from the alcoholic extract of frog, through
the unintoxicating wines of Frank Wright Mumby & Co. to
the benefits of inebriates’ Homes, with their statistics of
“cures,” which we in vain attempt to emulate. I do not
believe that all drunkenness is insanity, any more than the
converse, that no drunkenness is insanity. I do not believe
that it is as curable as most other diseases. Habitual
drunkenness has its terminal dementia as inevitable as that
of more marked mental disorders, and in spite of all our
efforts fate will sweep its victims into that dreadful abyss.
The hospitalisation of the drunkard is, after all, a late
remedy and a doubtful. We have a larger hope in antici¬
pating, and so frustrating, habits of vice or disease. The
true statesman fulfils his duties in formulating precautionary
measures not less than in devising the reformatory treatment
now under review.
It would seem that the doctrine of partial responsibility of
certain criminals and certain inebriates must soon prevail.
Heredity and environment must be taken into account in the
vast complex of modern conditions of life. Careful investi¬
gations into the mental and physical state of the individual
elicit facts which operate powerfully on the awakened con¬
science of our times. We recognise that society owes a
heavy debt to the enfeebled. We recognise that drunken¬
ness is very frequently a mere symptom of mental aberration,
necessitating a revision of the statistics so confidently pub¬
lished in less critical days. We recognise that crime is
largely the expression of faulty physical organisation and
faulty habits of training. Withering sarcasms flung at the
wretched criminal from the judicial bench are no more
heard. “Ye’re a gey clever chiel, but ye’ll be nane the waur
o’ hanging! ” an outrage at the time, is an impossibility now.
“ Nane the waur o’ reformation ” is more in accordance with
the dominant note of our social life, although smart jour¬
nalists, in their flippant mode, are found to declare that “ if
murder be a disease, hanging is a cure.”
I had the good fortune lately to visit Elmira Reformatory,
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1898.] by A. R. Urquhart, M.D.
accompanied by Dr. Wey, who has served as medical officer
there tor a long period of years; but shall spare you a de¬
scription of the institution and the details of management,
for these are accessible to anyone desirous of making a study
of the work done under Mr. Brockway*s initiation and direc¬
tion for a quarter of a century. This grand experiment has
survived the jeers of the prejudiced, has emerged unscathed
from the attacks of the unscrupulous, and stands for good in
the economy of the civil life of the State of New York. It
has marked the epoch. Turn to Sir Edmund du Cane’s
article in the May number of the Nineteenth Century . In a
criticism of the Prisons Bill, while expressing the opinion
that the system adopted at Elmira does not seem to have
caught on in the United States, he suggests that a special
prison should be set apart for the younger criminals of Eng¬
land, as the most mischievous age is between 16 and 22.
Now the average age of reception into Elmira is 21, and the
whole endeavour of the institution is towards the reformation
of those who so urgently require it. Briefly, the mental and
physical characteristics of the individual are elicited, he is
first of all brought to the highest possible standard of bodily
health, he is taught a trade, and is liberated conditionally, if
that be thought proper, within the maximum term of im¬
prisonment for the crime for which he was convicted. These
are the points which I commend to your attention, reasonable
measures of treatment which cannot but meet with your ap¬
proval. In our dealings with the criminal and the inebriate,
restraint is the first necessity; but unless that restraint is
followed up by a regimen designed to insure physical and
mental health, our plans are faulty, our results will be inade¬
quate, and liberation, conditional or absolute, will merely
open the door to unresisted temptation. Work and recrea¬
tion, inseparably interwoven with worthy intention, are pro¬
foundly essential for the right conduct of life. Omit these,
and there is no true happiness, no lasting interest, no safety
for man in the plenitude of his powers. So much the more
necessary is it to lead the inebriate back to his forgotten
Eden, and to discover for the instinctive criminal satisfac¬
tions he never possessed.
I have scarcely referred to the vast improvement in methods
of research, to the enormous volume oi work which is being
done in the medical institutions of our speciality and allied
establishments. These are apparent to all good readers of
our Journal, and it is for us to profit by them. If we some-
xliv. 47
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Presidential Address ,
[Oct.,
times despair of adopting the methods of investigation of the
new psychology by reason of the morbid condition of our
patients, and the apparent impossibility of ascertaining correct
results, we may at least use the information so gathered by
the school of Kraepelin and other indefatigable observers.
At this time of day it is unnecessary to fashion the knife
before we open our oysters. Our tools are more precise, more
numerous, more effective than those of our fathers, and the
researches of specialised specialists are ours for the asking.
We have not been behind the times in this matter, and hope
that the laboratory of the Scottish asylums, which is to be
visited this afternoon, will meet with your approbation.
Started by Dr. Clouston, now, as ever, indefatigable in the
promotion of medical science, under the wise direction of Dr.
Yellowlees, with the loyal co-operation of all our medical
superintendents, opportune in the aid given by this College,
our laboratory has already been of distinct service to our
department and the interests it includes. Fortunate in its
first superintendent—Dr. Ford Robertson—we may yet hope
to see it develop into a great school of psychological medi¬
cine, complete in all its departments of anthropological,
anatomical, physiological, and clinical research—a magazine
of information, a Mecca for men of science, where the general
physician, the neurologist, and the psychiatrist will find
common interests and incite to fresh endeavours.
We feel the danger of our position in our comparative
isolation, and in our specialising in medicine at too early a
period of life. I need not enlarge upon that which is ever
E resent with us, except to urge that our efforts to keep in
ne with the general body of the profession should be in¬
creasing. We should live on terms of closest intimacy with
the neurologists, who, in dealing with less evasive forms of
nervous disease than insanity, can aid us right effectively.
An d one may be permitted to add that the neurologists
cannot afford to neglect our work, for the protean forms of
mental disorder are manifest in many of the cases brought
under their notice.
I look with great hopefulness to the results of that closer
contact with general hospitals which we should endeavour
to bring about. It is a very real reproach to us that no
psychiatrist has yet been appointed on the Staff of the
Edinburgh Royal Infirmary. We have learnt from Dr.
Rayner and Dr. Crochley Clapham that their work is no
longer in the experimental stage. Surely what has been
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1898.]
by A. E. Urquhart, M.D.
691
approved by results at St. Thomas’s and Sheffield should be
adopted here. So long ago as 1871 Dr. Sibbald showed that
the exclusion of insane patients from ordinary hospitals is a
wrong idea of recent date, and that the administrative and
legal difficulties are not insurmountable. We still await the
realisation of his ideas, and it seems to me that it is high
time for us to take action.
And now, gentlemen, to trespass on your patience no
longer, pardon me if I say, with Locke, “ The goodness of
my intention ought to be some excuse for the worthlessness
of my present. I acknowledge the age we live in is not the
least knowing, and therefore not the most easy to be satis¬
fied. . . . Every one must not hope to be a Boyle or a
Sydenham, and in an age that produces such masters as the
great Huy genius and the incomparable Mr. Newton, with
some others of that strain, it is ambition enough to be em¬
ployed as an under-labourer in clearing the ground a little,
and removing some of the rubbish that lies in the way to
knowledge.” Yes, it is given to few to be master-builders,
else would more stringent rules and additional regulations
be imposed upon us to produce a new philosophy, a new
psychology, and a new pathology with each revolving year.
This address is not laden with details of statistics or details
of observations garnered in the course of the quarter-century
during which I have been connected with the care and treat¬
ment of the insane. On such an occasion, however, one may
be allowed a word of retrospection. I call to mind experi¬
ments regarding the action of hyposulphite of soda as an
intestinal disinfectant, while serving under my distinguished
friend Professor McIntosh at the Perth District Asylum;
experiments regarding the action of gelseminum as an ano¬
dyne for mental pain—work of no moment from a public point
of view, but engrossing then, and still interesting to me
personally. I have noted the rise and fall of drugs in pro¬
fessional esteem, and hope to have arrived at a reasonable
ordering of their uses. I have seen wild speculations com¬
mitted to oblivion, and words of enduring wisdom rooted in
our practice.
We can all appreciate theories founded on well-observed
facts, reasoned conclusions which help us to realise the me¬
chanics of mind; and the conclusion of the whole matter, the
latest dictate of science, is in confirmation of the wisdom of
the ages. If we grant that the will traverses the cells and
fibres of the brain along paths that are capable of auto-
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692 Presidential Address, [Oct.,
development, and that normal man is so endowed with mental
powers as to be in truth the “ captain of his soul,” verily it
is our duty to avoid ignoble thought, and to entertain high
purposes. If Sir James Crichton-Browne spoke hard words
of a system that saps the strength of immature and feeble
minds, he also warned us of the brain-rust that finally de¬
stroys. Not least upon us, whose vocation is of the highest,
yet compassed about with horrible pitfalls, not least upon us
is laid the apostolic injunction to think on these things which
are of good report. Perennial is the command, perennial are
the rewards, written large upon individual character, and
upon the lives of those entrusted to our care.
Dr. Rayner moved a vote of thanks to the President for
his valuable address. He had listened to a great many
addresses from the Chair, and this one had pleased him more
than any. Dr. Urquhart had taken a comprehensive view of
their work, supported it in a most striking manner, and
treated it in a most interesting and able fashion. There was
one point raised which he (Dr. Rayner) would desire to bring
to a practical issue; that was in regard to the English Com¬
mission in Lunacy. He thought that they had endured the
present state of things long enough, and he was of opinion
that they should express their views as to the necessity for
enlarging that Commission to the Lord Chancellor.
Dr. Conolly Norman, in seconding, said the address de¬
served more than the usual mere congratulatory motion. The
President had given them the broad results of his observa¬
tions in connection with insanity for a quarter of a century.
He had placed before them an array of remarkable facts,
culled not only from his own personal experience, but also
from the records of the institution which he directed. He had
dealt, among other things, with a singular and striking fact,
hitherto unexplained as far as he (Dr. Norman) knew, but
surely capable of being explained; that was the curious
change in the prevailing type of mental disease which had
occurred within the last few generations. From his own
experience he could entertain no doubt that there had been
a great increase in melancholia over mania of late years. The
change applies even to the melancholic form of general para¬
lysis, and it was quite impossible if that type of general
paralysis had been formerly so prevalent as it was now it could
so long have escaped attention. He believed that there was
at the present time a danger of over-legislation in connection
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1898.] by A. R. Urquhart, M.D.
with insanity,—to this extent at least, of having the work
of the superintendent made too departmental, and too little
that of the practical physician. The departmental notion
would be the ruin of their position and of their usefulness if
over it were carried out. It had been detrimental to the
insane in every country where it had been adopted. There
was a similar tendency threatening France—an apparent
desire to make the superintendents of asylums stewards or
managers, to insist on them concerning themselves with
“beans and bedsteads” rather than with the cure of the
insane. He sincerely hoped that this tendency would be
resisted to the utmost by their Association as a body and by
themselves as individuals.
Dr. A. E. Macdonald, of New York, said that he had the
honour of presenting his credentials as representative of the
Medico - Psychological Association of America, and had
further to thank the meeting for having conferred upon him
the high distinction of election as an honorary member. He
had listened to the President's able and broad-minded address
with very great pleasure, and could endorse what he had
said in reference to the Elmira Reformatory. In his opinion
the efforts made to reclaim young criminals in that admirable
institution had been largely successful. Elmira had given
many a chance of becoming useful citizens, and he strongly
supported further development of Mr. Brockway's work in
America.
The resolution jbhat the thanks of the meeting be given to
Dr. Urquhart for his presidential address was then put by Dr.
Rayner, and cordially adopted.
A New Nissi Method.—Normal Cell Structure and the Cyto -
logical Changes terminating in Fatty Degeneration. Some
Remarks on Cell Physiology and its Relation to Insanity.
A Note on the Use of Pier o-for mol generally , and in Sevan
Lewis’s Fresh Method. Being the Essay which gained
the Bronze Medal and Ten Guinea Prize of the Medico-
Psychological Association, 1898; by J. R. Lord, M.B.,
London County Asylum, Hanwell.
I. General Remarks. — It has frequently appeared to me
that a rapid and easy method of staining according to Nissi
would be of great advantage. It has been my routine practice
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694
A New Nissl Method,
[Oct.,
to cut a fresh section and to stain according to Bevan Lewis
in every case of insanity in which an autopsy had been obtained,
and from that to record a few microscopic notes. A fairly
complete description of neuroglial changes could thus be
recorded, but only in a minor degree the changes which had
occurred in cell protoplasm, i. e. cytological changes and
various degenerations. For this one has to stain according to
the method of Nissl, a method which stands out supreme for
this purpose. But even NissPs method is by no means perfect,
and there are many drawbacks and imperfections. Hardening
in alcohol causes considerable shrinkage; in fact, the main
part of the cell is occupied by the nucleus. Alcohol also
largely dissolves out fat, and therefore fatty degeneration
cannot be shown. Again, it is not every asylum laboratory that
has equipment for NissPs method, but every asylum has the
means of making a Nissl preparation according to a way I am
about to describe.
II. Advantages of the New Method . — (a) Sections quite
freshly cut with an ordinary freezing microtome are used. This
allows of large unshrunken cells being examined in place of
the small cells, the result of hardening. ( b ) Alcohol not being
used as a hardening medium, fat is not dissolved out. As a
result I have been enabled to trace more completely the
changes that a cell undergoes prior to fatty degeneration, (c)
Simplicity of the process. There is no need for embedding.
(d) Bapidity of the process. A good Nissl preparation can be
obtained within thirty minutes of death, (e) This method
shows more accurately the degree of separation of the tissue,
*an important point in cerebral pathology. (/) Neuroglia and
blood-vessels are better stained.
III. Picro-formol as a Fixing Agent . — It was found im¬
possible to subject a fresh section to NissPs method without
shrinkage and disintegration of the section. I therefore
looked about for a suitable fixing agent. After trying many
things (amongst which was osmic acid), a mixture of picric
acid and formol was found to be the most suitable. Solutions
of various strength were tried, and the best one was found to
be—
A saturated aqueous solution of picric acid . 50 per cent.
Six per cent, formol solution in water . .50 „
This solution is a good general fixative for all processes, and a
good Nissl preparation can be obtained after some weeks*
immersion, the pieces being taken, frozen, section cut and
stained. For other methods the fixative can be washed out.
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695
1898.] by J. K. Lord, M.B.
and in my experience I have never found it to interfere with
future staining. This applies to all tissues, whether brain or
not, and there is no more suitable medium for the preservation
of tissues when found necessary to send them away for
examination. It is to Dr. Graf that I owe the idea of a mix¬
ture of formol and picric acid.
IY. The Method .—A piece of fresh brain is taken (the
fresher the better) about 2 c.c. from the central convolution
with pia adhering, and frozen on a freezing microtome (pia
towards the operator), one of the best being Fraser's modifi¬
cation of Cathcart's microtome. A little gum on the plate
facilitates freezing. Sections are cut and immediately floated
into water. They are then taken up on a slide and some
picro-formol allowed to flow on. Care should be taken that
the section floats on the fixative. The section is subjected to
this for five to fifteen seconds, and then it is floated back on
water. It is next taken up on a slide, and a *5 per cent. aq. sol.
of Nissl's methylene blue (Methylenblau patent B) is pipetted
on just in the same way as was the picro-formol. It is now
heated until the first bubble appears, and allowed to cool. The
excess of stain is washed off, and a solution of aniline oil in
absolute alcohol (10 per cent.) is allowed to flow on until no
more stain leaves the section. Dry the section by pressing
with blotting-paper, taking care to see that the surface of the
latter is smooth, or the section will be tom. Origanum oil is
next dropped on and removed, after clearing, in a similar
way. Benzine removes any traces of oil left. It was usual
to mount in a solution of colophonium in benzine in order to
obtain a permanent specimen. The benzine was burnt off by
firing. Others have recommended evaporating the benzine
gradually by gentle heat. Neither of these plans is satis¬
factory. The following is better :—Melt some colophonium
in a porcelain capsule, only adding a little benzine. Smear
the melted colophonium over the section with a glass rod used
horizontally. Now put on a cover-slip and heat until the
cover-slip is in a satisfactory position. For this purpose use
a thin sheet of asbestos mounted on wire gauze, and supported
on a tripod over a Bunsen flame.
V. Normal Structure of a Large Pyramidal Cell according
to this Method .—The cell consists of a mass of protoplasm of
a roughly triangular shape. This is not constant, as many are
distinctly stellate. The less the brain is hardened the fewer
cells appear pyramidal. It has numerous processes, the main
one being that which passes up to the outer layers of the
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A New Nisei Method, [Oct.,
cerebral cortex. Staining by methylene blue reveals a fine
fibrillation. Throughout the cell are small spindle- or rod¬
shaped bodies, which take on the stain deeply. The pro¬
toplasm about the nucleus appears to be deeper stained,
but this is due to the greater thickness of protoplasm in this
situation. The nucleus appears to have a capsule, and stains
less deeply than other parts of the cell. An intra-nuclear
network is easily made out. The nucleolus takes the stain
deeply, and a clear endonucleolus can be frequently seen. I
ought to mention that this is a more or less ideal account of
structure, founded not merely on the microscopic appearances
of human nerve cells, but also on those taken from monkeys,
dogs, cows, pigs, cats, &c. In man, although one frequently
sees cells which completely bear out this description, yet even
in an apparently sane cortex the large pyramidal cells com¬
monly show a mass of yellow material unstainable with
ordinary aniline stains—a material which I have succeeded in
demonstrating to be of a fatty nature. (See Section VIII.)
. VI. Some Further and less Definite Points of Cell Structure.
—Examination of the kitten's brain, fixed and stained imme¬
diately after death, shows points which I have never seen in
human brain tissue. These may modify our views in some
respects. The nucleus is not rounded, but irregular, in some
almost .stellate in shape. It takes the stain deeper than the
main body of the cell. The latter is seen to contain an
irregular coarse network with apparently clear interstices.
Frequently two or more deeply stained nucleoli are present.
The great majority of the cells are irregularly stellate. The
structure of the outermost layer of the cortex is beautifully
revealed, showing the occurrence of large stellate and sphe¬
rical cells with cytological structure differing from all other
nerve cells which I have examined. This will form the
subject of another paper.
VII. Changes in the Cell in Fatty Degeneration. —One of the
first changes is an enlargement of the nucleus. It becomes
darker and granular. The ovoid bodies break down into
smaller ones of varying shape. These are usually found
about the proximal part of the cell. This is not constant,
however, as sections show that any part of the cell may
undergo the same change. These smaller bodies break down
into smaller ones still. The nucleus loses its distinct shape,
and cannot be distinguished from the degenerate cell proto¬
plasm. The finer granules shade gradually into fat. As
they change the stain affects them differently; at first
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697
1898.] by J. R. Lord, M.B.
dark blue, then dark green, then light green, and finally
yellow. Finally the cell breaks down completely and bursts.
The contents escape, and there is nothing left but the stumps
of the processes. Usually in any section all these changes
can be noticed, sometimes one and sometimes another pre¬
dominating. The earliest stages are the most difficult to
recognise. Examination of a large number of sections shows
that fatty degeneration is the common fate of nerve cells in
insanity. This view is supported by the most recent results
of chemical investigation.
VIII. The Nature of this Yellow Material .—I have been at
some trouble to ascertain the nature of this yellow material.
So far, in this paper, I have assumed that it is of a fatty
nature. A difficulty (more or less imaginary) arises when
we consider the fact that very few large pyramidal cells
in thehuman cortex are without it, and the question arises,
is it normal ? I am of opinion that there is a degree of
fatty change in an otherwise normal cell due to ordinary
katabolism or natural gradual decay, but we never find in a
normal cell all the series of cytological changes above de¬
scribed. These changes are distinctly pathological. I do
not maintain that they occur only in insanity, because, as will
be pointed out, there is every reason to believe that these
cells are not the source of nervous energy, but are merely
trophic centres. It is elsewhere that the origin of nerve
impulse must be sought. Thus gross changes might occur in
these cells and the person be quite sane; while, on the other
hand, we know that such changes are commonly concomitant
with insanity.
I believe that the essential pathological change which
causes or accompanies insanity will, in the future, be demon¬
strated to occur in the outermost layer of the cerebral cortex,
a region to which great attention has of late been paid, and
justly so. But to come back to this yellow material. I had
till quite recently failed to stain it with osmic acid, but lately
have succeeded, the green stain ending where the black
begins. After fixing in picro-formol for three days, sections
were cut and placed in '25 per cent, osmic acid for twelve
hours. They were then counterstained with methylene blue,
and the black staining of the yellow material was clearly
shown. The whole of the degenerate material was, however,
only partially stained, and thus I conclude that it is an interme¬
diate product between normal protoplasm and fat. Moreover
the degenerate material found in early stages of cell degenera-
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698
A New Nissl Method,
[Oct.,
tion is not affected by osmic acid. Ether and alcohol dissolve
out a portion only, and thus confirm my opinion. From these
considerations I am convinced that the protoplasm of these
nerve cells ultimately breaks down into fat, which can be
stained with osmic acid and dissolved in ether and alcohol,
the intermediate products yielding negative results to these
reagents.
IX. Some Remarks on Cell Physiology and its Relation to
Insanity. —A most important question in cell histology is the
question as to whether the minute fibrillae of the nerve com¬
municate directly with the nucleus, or pass’ independently
through the cell, taking departure through another process.
The enormous and far-reaching change the acceptance of
this latter opinion would cause in our ideas on the function
of these cells has largely hindered this opinion from beings
accepted, but there can be little doubt as to its correctness.
I think that it has been clearly demonstrated that these
fibrillae neither end in nor have any direct communication
with the nucleus. On examining these cells with the high
power the fine fibrillation before noted is seen not to be
interrupted by the nucleus, but to pass (at all events in the
peripheral parts) straight through the cell. What, then, is the
function of the nucleus ? We can no longer hold the view
that it has anything to do with the impulse (sensory or motor)
passing along the nerve-fibre. We have no proof whatever
that it either originates or receives an impulse. We can
assign no function to it except a trophic function, having
some nutritive influence on the nerve cell and the fibres in
connection with it. We know that the first evident signs
of active degeneration occur in the nucleus, and this may
point to a trophic function. Otherwise there is no necessity
to ascribe to the nucleus any function whatever. We might,
indeed, look upon it as a relic of development, its function
having ceased when the cell separated from its parent neuro¬
blast after having performed its duty in karyokinesis. On
first beginning these investigations I thought that a certain
arrangement of chromophile granules might be associated
with certain forms of insanity; but this has failed. Further
investigation and experiment may show that certain forms of
degeneration are associated with certain forms of insanity,
but at the present I can only affirm that the commonest form
of degeneration terminates in fat.
The ovoid bodies have excited much interest, but I $oubt
very much, after examining very fresh specimens, whether
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1898.] by J. R. Lord, M.B.
they are not really the result of the splitting up of a general
protoplasmic network of the cell. On this point I am still
undecided.
If nerve cells are not the seat of nerve impulse, what is ?
This is a difficult question, and its solution is not within the
power of the author. But, as before stated, I think that it
will be found in the outermost layer of the cerebral cortex.
Many considerations support this view. Everyone knows that
gross lesions may affect large portions of the brain, and that
the person may still retain undamaged mental powers. Also
that most of the pathological changes said to occur in insanity
are found in the brain tissue of perfectly sane people, with
perhaps one exception, i.e. those changes affecting the mem¬
branes and the subjacent layer of grey matter. Even in
slight cases of meningitis delirium is soon apparent. This
is probably due to the spread of the inflammatory process to
the layer immediately below the meninges. Further, if we
grant that the nervous processes associated with mentalisa-
tion and consciousness occur in the outermost layer of the
cerebral cortex we correlate these with a vast area, an area
not only anatomically continuous, but also connected with
every part of the brain. Thus I would account for sanity
persisting in spite of wide-spread coarse brain lesions. Pro¬
cesses certainly pass outw'ards from the nerve cells in the
deeper layers, and it would appear that the minute fibrilke
pass straight through the nerve cells to the outermost layer
and there split up. The manner in which they end has not
been demonstrated. Do they come in contact with cells there,
or do they end in the matrix? As before stated, I have
noticed peculiar cells in this layer in the kitten's brain, but
have not yet demonstrated them in the human brain because
of the difficulty in obtaining pieces immediately after death.
X. Picro-formol in Bevan Lewis's Fresh Method. — Ex¬
perience shows that picro-formol can take the place of osmic
acid as a fixative in Bevan Lewis's method. It should be used
exactly in the same manner as osmic acid, and of the same
strength as for Nissl's method. It is cheaper and less difficult
to keep. The stain takes quicker, and neuroglia stains more
deeply. Otherwise it has no advantage over osmic acid.
XI. Concluding Remarks .— Thus within a short time of
the patient's death, and with very little apparatus, a complete
account of microscopic appearances can be recorded. The
piece of brain is taken, frozen’, sections cut and stained
according to Bevan Lewis and Nissl, and from these two sets
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A New Nissl Method.
700
[Oct.,
of sections changes in all the constituents of the cerebral
cortex can be fully described.*
Description of Drawings illustrating these Changes .
Fig. 1 represents the appearance of a normal cell. The nucleus (N) stains
lighter than the cell body. N O is the nucleolus with a clear endonucleolus.
lie ovoid bodies (OB) are stained deeply.
Fig. 2 represents an early stage of degeneration. The nucleus is enlarged
and granular, while one of the processes shows the breaking down of the ovoid
bodies into intermediate granules before becoming fatty.
Figs. 3 and 4 represent later stages with the appearance of fat ( F) and the
different staining of granules (G) and intermediate granules (I G). The nucleus
is scarcely distinguishable.
Fig. 6 represents a later stage still. The cell has burst, and nothing remains
but the processes and cMbris.
The Specific Gravity of the Insane Brain.f By Francis
O. Simpson, L.R.C.P.Lond., M.R.C.S.Eng.; Senior
Assistant Medical Officer, Govan District Lunatic
Asylum, Hawkhead.
This paper is only intended to be a preliminary note upon
the specific gravity of the brain in the insane, and contains
the results of experiments upon thirty cases conducted at the
West Riding Asylum, Wakefield, during the early part of
this year. Over 1400 investigations have been made upon
these brains, and as the inclusion of data from different parts
of the country might cause scientific inaccuracies, it has been
thought advisable to publish the present results separately,
prior to the initiation of a further series of experiments.
The most important work upon the subject undertaken in
this country was performed by Sankey between the years 1846
and 1852, the material used being obtained from the London
Fever Hospital. The paper in question appeared in the
British and Foreign Medico - Chirurgical Review of 1853,
vol. xi; it is of a most exhaustive nature, and is accompanied
by numerous valuable tables.
The present series of investigation were conducted upon
* Since writing this paper I have had my attention directed to a method by
Dr. Robert S. Cook, in which osmic acid was used ns a fixative, and have repeated
my experiments with osmic acid, which has failed as before to produce a good
Nissl preparation.
f Prepared for the Annual Meeting of the Medico-Psychological Association,
Edinburgh, 1898.
Digitized by t^ooQle
JOURNAL OF MENTAL SCIENCE, OCTOI'.ER,
/
To illustrate Dr. Loan’s Prize Essay on a new Nissl method.
Dale, Sons it Dankhson, Ltd., Vhr mo-Lith.
Digitized by
Google
Digitized by {jOOQle
1898.] Francis 0. Simpson, L.R.C.P. 701
fourteen male and sixteen female brains, the same regiona
being examined in every instance, viz.:
1. The middle of the second frontal convolutions.
2. The middle of the ascending parietal convolutions.
3. The middle of the second occipital convolutions.
4. The middle of the hippocampal convolutions.
The grey and the white matter of each region have been
tested from either hemisphere, and every experiment has
been performed in triplicate, the greatest precautions being
observed in ensuring the accurate separation of the cerebral
components.
The average time after death at which the investigations,
were conducted was thirty-five hours, and the average age at
death of the patients was fifty-five years for both sexes, the
females averaging fifty-eight years, and the males six years
less.
Clinically the cases might be relegated to the following
categories, viz.:
1. Five cases of general paralysis.
2. Five cases of senile dementia.
3. Four cases of organic dementia.
4. Five cases of secondary and one of primary dementia.
5. Five cases of epileptic dementia, and one of epileptic
imbecility.
6. Three cases of simple imbecility.
7. One case of chronic melancholia (omitted).
The method employed in these experiments has been as
follows:—Large pieces of the encephalon were excised from
the regions to be tested before the removal of the pia, and set
aside until the conclusion of the macroscopical examination.
It is necessary for this purpose to use a very sharp knife, the
back of which should be as thin as possible; and a straight
sharp-pointed bistoury can be conveniently adapted to these
requirements by suitable grinding. Subsequently minute
fragments (2x1 cm., or even smaller) may be detached from
the larger portions of cerebral tissue by the use of a Liebreich’s
or Critchettfs cataract knife, or a cataract spoon with
sharpened edges, thus avoiding as far as possible undue
compression of the brain matter.
The fluid used has been a saturated salution of magnesium
sulphate, to which a small quantity of pure carbolic acid was
added. The presence of the phenol renders the solution of
greater stability, and prevents the growth of fungus in the
fluid, thus obviating the necessity for its frequent renewal.
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702
Specific Gravity of the Insa?ie Brain, [Oct.,
A separate test-glass was reserved for each unit, and the
contents were adjusted each morning, care being taken to
ensure their precise accuracy: by this is meant that in the
glass labelled 1039, for example, the bulb 1038 should be
exactly at the surface of the fluid, and that marked 1040 just
touching the bottom of the tube.
All Forms of Insanity.
Examining the totals from all regions of the brain, we
find that the average specific gravity of the grey matter
of the insane brain is 1037, and of the white matter
1041. In Sankey’s paper the grey matter was stated to
be 1034, and the white matter the same as in the present
series, so that the insane cortex is of higher specific gravity
than that of the non-insane at the same age.
Next, regarding the sexes, we discover that in the insane
the specific gravity of the white matter is the same for each,
whilst that of the grey matter is 1039 in males and only
1032 in females. Comparing these figures with Sankey^s
results, we again observe that the specific gravity of the white
matter is the same amongst the sane as in our present cases;
whilst, regarding the grey substance, the specific gravity is
higher in the male insane and lower amongst female lunatics
than amongst the general members of the community.
Taking each region of the brain separately, we discover
that, when regarding all forms of insanity together, there is a
close resemblance between the specific gravity of the two
hemispheres of the brain in every part examined, whilst the
greatest differences between the white and grey matter exist
in the motor region, and such variations are precisely similar
on the two sides in the case of the frontal and occipital lobes.
The grey and white matter of the cornu Ammonis show exactly
the same specific gravity in both hemispheres.
Considering the sexes separately, we notice that in the
males the specific gravity is precisely identical in the two
hemispheres both for the white and grey matter of each
region. The greatest difference between the grey and white
substance in men occurs in the frontal regions, the least in the
occipital convolutions, whilst in the cornu Ammonis the white
matter of each hemisphere has a somewhat lower specific
gravity than the grey substance.
Amongst the females, on the other hand, the only region in
which grey and white matter show the same specific gravity in
both hemispheres is the ascending parietal convolution. The
Digitized by CjOoqL e
703
1898.] by Francis 0. Simpson, L.R.C.P.
differences between the specific gravity of the grey and the
white substance are practically the same in both frontal and
occipital regions, but these differences are much greater in the
right hemisphere than they are in the left. The specific
gravity of grey and white matter in the hippocampal region
of the females is almost identical in both hemispheres.
1. General Paralysis .
Considering the various clinical classes of insanity as sepa¬
rate entities, and starting with progressive paralysis, we find
the specific gravity of the grey matter to be 1040 and of
the white substance 1042; or, in other words, it is higher
in general paralysis, taking the brain as a whole, than
in any other form of insanity examined; and, comparing
the above figures with Sankey*s results at the same age,
we observe that in paralytic dementia the specific gravity
of the grey substance is much higher and that of the white
matter somewhat lower than amongst the sane. The average
age at which these cases were examined was thirty-five
years.
The specific gravity of the grey matter alone is also con¬
siderably higher in this affection than in any other of the
clinical subdivisions investigated in this paper.
The specific gravity of the white substance is not so high in
general paralysis as in secondary dementia, but higher than in
the other clinical classes of which we have examples, and
there is less difference between the specific gravity of the grey
and white matter in paralytics than in any other form of
insanity under consideration excepting organic dementia.
In the further examination of the paralytic dements* brains
regionally we notice a considerable similarity between the
specific gravity of the grey matter in the two hemispheres, but
the white matter is much higher in the right hemisphere than
it is in the left*
The specific gravity of the grey matter is a trifle higher in
the motor region than in the frontal and occipital lobes; in
these two latter situations it is precisely identical in each
hemisphere.
The greatest difference between the specific gravity of the
grey and of the white matter in general paralysis occurs in
the occipital regions, and the least variation is present in the
frontal lobes.
The grey matter of the hippocampal regions is of somewhat
higher specific gravity in both hemispheres than the white.
Digitized by
704 Specific Gravity of the Insane Brain, [Oct.,
2. Senile Dementia.
The next clinical form of insanity for consideration is senile
dementia, and the average age at death in the present series
of cases was seventy-five years.
The average specific gravity of the grey matter is 1037,
and of the white matter 1041, the corresponding figures in
Sankey^s tables being 1032 for the grey and 1041 for the white
substance. It should also be noticed that in seniles the specific
gravity of both grey and white substance is exactly the same
as the average specific gravity for all forms of insanity [vide
anted ).
Examining the various regions of the senile brains sepa¬
rately, we find that the specific gravity of the grey matter is
lowest in the frontal lobes and highest in the occipital regions;
whilst the greatest difference between the specific gravity of
the grey and white substance is likewise observable in the
frontal gyri and the least variation in the occipital con¬
volutions.
The white substance in this class is of a lower specific gravity
in the occipital convolutions than elsewhere, being the same
in the frontal and motor regions of both hemispheres.
The specific gravity of the cornu Ammonis is precisely the
same in each hemisphere, both as regards the white and the
grey matter.
3. Organic Dementia .
The next clinical subdivision in our list is organic
dementia, the age at death in these cases being sixty-one
years, and the specific gravity of the grey matter 1037,
whilst that of the white matter is 1038.
Sankey's results at the same age showed a specific gravity
of 1034 for the grey matter, and 1041 for the white substance.
Thus it will be seen that, in dements of this class, the grey
matter is of average specific gravity for the insane, but the
white substance lower in this respect than in any other of the
clinical classes; also that there is less difference between the
specific gravity of grey and white matter in this than in any
other form of insanity.
Next, considering this division regionally, we find that the
specific gravity of the grey matter is higher in the occipital
lobes of both hemispheres than elsewhere ; also that the white
matter shows the lowest specific gravity in this locality, which
is likewise noticeable for showing the least difference between
the specific gravity of the grey and of the white substance.
Digitized by L^OOQle
705
1898.] by Francis 0. Simpson, L.R.C.P.
When considering the cornu Ammonis we observe that the
specific gravity is identical in the two hemispheres both for
the grey and the white matter, whilst these figures are also
the lowest observed in any of the clinical forms of insanity.
4. Simple Dementia .
Simple dementia forms the next of our clinical classes,
and the age at death in this class averaged forty-nine
years, whilst the . cerebral specific gravity is 1038 for the
grey, and 1043 in the case of the white matter; that is to
say, that whilst the specific gravity of the cortex is about
average in this form of insanity, the white matter is higher
than in any other subdivision.
The figures at the corresponding age in the non-insane were
1035 for the grey matter and 1041 for the white, establishing
clearly the fact that the specific gravity of the brain is higher
in simple dements than in the general public.
Concerning the grey matter of the various regions examined
in this class, the specific gravity is noticed to be highest in
the occipital and hippocampal gyri, and equal in these
situations for both hemispheres. The specific gravity of the
grey matter is at its lowest in the frontal regions in this
clinical division.
The greatest difference between the specific gravity of the
grey and of the white matter, taking the brain as a whole, is
noticed in simple dementia, and the white substance shows the
greatest irregularity of all the clinical classes in this form. It
is rather higher in the right hemisphere than in the left for
every region examined.
The cornua Ammonis show greater variations between the
specific gravity of their grey and white matter than the same
regions do in any other form of insanity, and that of the right
hemisphere is higher than that of the left for both the cerebral
constituents.
5. Epileptic Insanity .
The epilepsies constitute our next clinical category, and
the age at death in these patients was fifty-four years, the
specific gravity of the brain as a whole being 1038 for the
grey substance and 1042 for the white,—slightly higher in
each instance than the average for all forms of insanity.
Comparing these figures with those of the non-insane at a
similar period of life, that is to say 1031 for the grey matter
and 1041 for the white, we observe that although the specific
xliv. 48
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706
Specific Gravity of the Insane Brain , [Oct.,
gravity of the white substance of the brain is but little higher
in epileptic insanity than in the non-insane, that of the grey
matter is much in excess of the corresponding figures for the
sane taken at the same period of life.
Next, taking this sub-class regionally, we notice that the
specific gravity of the grey matter is highest in the cornu
Ammonis and equal in this locality of either hemisphere,
whilst its next highest place is in the occipital gyri.
The specific gravity of the epileptic cortex is at its lowest
in the frontal convolutions, and varies but little in any region
from its fellow of the opposite side.
The specific gravity of the white substance is somewhat
higher in the occipital lobes than elsewhere, and is at its
minimum in the hippocampal regions. In epileptic insanity
the specific gravity of the white substance is rather higher in
the right than in the left half of the brain.
The cornu Ammonis in this form of insanity shows an
almost equable specific gravity for the two hemispheres, the
white matter of this region being of a higher average specific
gravity than the grey substance.
6. Simple Imbecility.
The last clinical subdivision which claims our attention is
that of the simple imbecilities, the age at death being thirty-four
years in these cases, and the average cerebral specific gravity
1037 for the cortex and 1040 for the white matter. In other
words, the cortex is of average specific gravity in this sub¬
division as compared with all forms of insanity, and the
white substance is decreased.
The corresponding figures in the sane are 1034 for the
grey substance and 1041 for the white, so that the cortex of
imbeciles is of a much higher specific gravity and the white
matter of a slightly lower specific gravity than obtains in
the corresponding regions of those who are not naturally
deficient.
The specific gravity of the grey matter is higher in the
cornu Ammonis than elsewhere, and next highest in the motor
region, whilst it is lowest in the frontal convolutions of this
class. In the case of all localities but the motor area the
specific gravity of the grey matter in imbeciles is identical in
the two hemispheres.
The specific gravity of the white substance is highest in
the frontal lobes and lowest in the hippocampal regions of
Digitized by Le
1898.] by Francis 0. Simpson, L.R.C.P. 707
this class. It is also rather higher in the left hemisphere of
the brain than on the right side.
The specific gravity of the cornu Ammonis of imbeciles is
higher, on the whole, in the left hemisphere, this being due
to a decrease in the consistence of the white matter of the
right side only. The grey matter of these regions is precisely
identical in the two hemispheres.
In conclusion it is to be regretted that no data are to hand
concerning the cerebral specific gravity of the acute and
chronic psychoses, but further investigations into this subject
will be undertaken at the earliest possible opportunity.
Sewage Disposal at Hawkhead Asylum .* By W. R. Watson,
L.R.C.S., L.R.C.P.Ed., Medical Superintendent .
The bacterial disposal of sewage has been so widely dis¬
cussed during the past year or two, that possibly some
apology is due to the Association for the introduction of a
subject that has ceased to be novel. So far as Hawkhead
Asylum is concerned the subject is still in the experimental
stage, and the brief outline of the experiment contained in
the following communication is the outcome of a corre¬
spondence with some of my friends who suggested that the
question is not without interest to asylum superintendents.
When the building of Hawkhead Asylum was under the
consideration of the Govan District Lunacy Board the dis¬
posal of the sewage necessarily received attention. Various
plans were in turn suggested and rejected. The asylum
grounds having about a thousand yards of river frontage,
obviously the simplest way would have been to run the raw
sewage directly into the river Cart, already a foul sewage¬
laden stream. This plan, at present largely followed by
private proprietors and public bodies, received no counte¬
nance from the Board. Irrigation, so efficient and economical
at Cane Hill Asylum and elsewhere, is not available, owing to
the character of the soil. Precipitation by chemicals has the
enormous disadvantage of having to deal with the sludge,
which, after all the expense and trouble, is of little or no
agricultural value. For a time a method was followed of
* Bead at the Annual Meeting of the Medico-Psychological Association, Edin¬
burgh, 1898.
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708
Sewage Disposal at Hawtihead Asylum, [Oct.,
intercepting the solids for use as manure, and collecting the
fluids in tanks for a similar purpose, but after a two years'
trial this plan was found to be inconvenient and offensive,
and was discontinued. A temporary expedient was adopted,
and a further and full consideration of the whole question
became clamant. About this time Mr. Dibdin, chemist to
the London County Council, had been publishing the results
of his investigations of sewage disposal by means of "bacteria
beds,” and Mr. Cameron of Exeter had constructed his now
famous " septic tank.” The Go van Board having very wisely
decided on obtaining further information, a deputation visited
Exeter and Hendon. At the former Mr. Cameron's experi¬
mental tank and filters were seen at work, successfully dis¬
posing of the sewage of one of the suburbs of the city
with a population of 1500. I do not propose to enter upon
any lengthened detail of this system, and merely indicate
that it consists essentially of two parts: (1) a deep dark
tank where the sewage is received, and where by bacterial
action liquefaction and other changes take place; (2) filters
of clinkers and coke breeze freely exposed to light and air.
The effluent from the tank is distributed on the filters, where
it is further clarified by filtration and bacterial action, and
discharged into the river bright and clear, and free from
liability to putrefaction. I satisfied myself of this, having
kept a sample for many months. At Hendon the "Ducat
filter” was in use, also experimentally. It is simply a deep
filter of cinders or coke, with very free admission of air in all
directions by means of drain tiles. The filtrate seemed free
from objectionable characters, such as odour or colour. When
in London two months later I had the opportunity, by the
courtesy of Mr. Dibdin and Mr. Wootten, or the Sutton Urban
Council, of inspecting the new sewage works at Sutton in
Surrey, where what is known as the " Dibdin ” or " Sutton ”
system is in operation. This consists simply of filters of
burnt ballast and coke breeze freely exposed to light and air,
through which the sewage gradually passes, and in its pass¬
age is attacked by myriads of bacteria and changed in
character and appearance, the effluent passing out quite
clear. The system is at once so simple and so effective that
I was most favourably impressed, and anxious to apply it to
the sewage problem at Hawkhead. With the object of sub¬
mitting the matter to the test of experience, permission was
readily obtained from the Board to apply the system to the
sewage of a number of cottages belonging to the asylum, but
Digitized by t^ooQle
1898.] by W. R. Watson, L.R.C.S. 709
situated at too low a level to admit of their inclusion in a
general sewerage scheme for the institution.
Owing to the situation of the cottages favourable con¬
ditions of fall and depth of filters were unattainable, but
even with these disadvantages the results have been en¬
couraging. The small scheme carried out by Mr. Crawford,
the Clerk of Works at Hawkhead, may be shortly described
as follows :—An ordinary drain carries the sewage into a
man-hole, where a screen is placed to arrest any foreign
substances and allay the passage of paper until it becomes
pulpy and easily broken up. At some distance from the
man-hole, and connected with it by a drain-pipe, two concreted
tanks are formed. Care has been taken in the construction to
allow a minimum area of one square yard for every 500 gallons
of sewage. The floor of the tank slopes to the centre, form¬
ing a channel. Over this is placed a cover perforated to
admit of the passage of liquids. Two other tanks of similar
construction but of smaller size are placed so that the upper
margin is a little lower than the floor of the upper tanks.
The upper tanks are filled with furnace cinders of a size to
just pass a one-inch mesh to the depth of 30 inches, and
the lower tanks are filled with coke breeze to the depth of
20 inches. Had it been possible to get double the depth
of filtering material, even better results would have been
obtained. On the surface of the cinders are radiating
wooden channels leading from a central shallow trough, and
so arranged as to secure an equal distribution of fluid. By a
penstock arrangement in the man-hole the raw sewage is
permitted to flow upon either of the two upper filters, or the
“ bacteria beds,” to use Mr. Dibdin's phrase. The changes
already referred to take place in the passage of the sewage
downwards. By the channel in the floor the fluid is con¬
ducted to the surface of the lower tank, where a similar
contrivance for equal distribution is placed. After its pass¬
age through the coke breeze the effluent, free from colour
and smell, is discharged into the river. From a series of
experiments I found this effluent to contain on an average as
much oxidisable organic matter as “ absorbs ” ’42 grain of
oxygen per gallon. This result must be considered under
the somewhat unfavourable conditions as satisfactory.
The advantages claimed for the “ Sutton ” system just
described, and it seems with some reason, are—
1. Simplicity of construction. This follows from the ab¬
sence of expensive machinery, such as is frequently seen at
Digitized by kjOOQle
710
Sewage Disposal at Haivkhead Asylum , [Oct.,
sewage works. Nothing more is needed than the requisite
area and depth of cinders and coke breeze for the volume of
sewage to be dealt with.
2. Moderate cost of maintenance and supervision.
3. The disappearance of the sludge. In methods by pre¬
cipitation, either by chemicals or simply by subsidence, the
sludge has to be disposed of in some way. Local authorities
have found its disposal by no means an easy matter. Its
agricultural value is very small indeed, and in some localities
the farmers will not take the trouble to cart it away.
The question of how long such “ beds ” and filters as I have
described will work effectively without renewal cannot yet be
answered from our own experience at Hawkhead; but when
I was at Sutton those in use had been acting for nine months
without any indications of failure. An important point is
not to overtax the beds. They must be rested, and hence
the arrangement by which two or more can be alternately
used for short periods. The surface of the beds ought to
be turned over from time to time to the depth of a few
inches. When this is done the slight odour given out is very
much that of rich garden mould. So far as I am aware there
is no experience of any lessened activity in these filters.
Beyond occasional small additions of fresh material any
expense for renewal may be left out of account. The super¬
vision required is very slight, but care must be taken that the
distribution is good, and that the proper periods of action and
rest are observed.
If such works as I have described be attended to, no odour
can be perceived even close at hand, and by judiciously
planting shrubs the whole can very effectually be concealed
from view. Where asylums and similar institutions are
situated in the country, away from systems of common drain¬
age, the disposal of the sewage in an inoffensive way and at
moderate cost is an obvious advantage. This, I think, can be
secured by the method now under consideration.
Note .—Since the above paper was read the Govan District
Lunacy Board have decided to treat the whole of the sewage
of the Asylum and Hospital at Hawkhead by “ bacteria beds,”
and as the general conditions are favourable, good results may
be looked for.
Discussion.
Dr. Spbncb said he wished to draw their attention to a system of sewage treat¬
ment that was perhaps a little newer than Dr. Watson’s. It had been brought
into prominence by the Engineer of the Wolverhampton Sewage Works, approved
Digitized by L^ooQle
711
1898.] by W. R. Watson, L.R.C.S.
by the Medical Officer of Health for Staffordshire, and was now being introduced
into the Lichfield Sewage Farm. The Garfield system was simply a series of tanks
filled with common coal—placed in layers of different sizes of slack. The solids
were first removed, and the supernatant fluid left to filter through the coal, the
effluent being perfectly clear. It would not decompose after having been kept for
months. The patentee did not explain the action of the coal. Some said that
stones might answer the same purpose. The coal had been examined after having
been used in the filter, and no changes, chemically or physically, could be detected.
The fact remained that the effluent from the sludge tank, after passing through the
coal, became chemically and bacteriologically pure. The coal could be used over
and over again. At first, of course, many tons of coal were required, but the cost
for renewal was very small.*
Dr. McDowall said that at Morpeth they were then increasing their bacteriolo¬
gical tanks. They had tried coal, and found it of no advantage. Small stones or
brick (porous material) were better. They only required to form an extended
surface for the growth of bacteria, which destroyed the albuminous material. They
had gut very good results, and now that they were increasing their tank accommo¬
dation they had no trouble except as to the disposal of the semi-fluid sludge. Both
patients and attendants strongly objected to work in it. He had been advised by
an old Yorkshireman to excavate a tank and line it with porous bricks, and to allow
the sludge to stiffen in it to the consistency of cheese, the residue being removed
from the surface and spread on the ground, forming excellent manure.
Dr. Watson said that there was some slight misapprehension as to the sludge.
At Hawkhead it disappeared entirely, as if it were manure put in the earth. The
raw sewage was run upon the bacteria bed, passed through, and produced no sludge;
even paper became a pulp and vanished. This went on month after month without
any special attention except the alternate use of one or other set of beds, and
turning the surface of them over occasionally. If the experimental system turned
out as successful as it promised they would try for the whole asylum.
The Mismanagement of Drunkards. + By George R. Wilson,
m.d.:
“ It is to be hoped and expected that with the spread
of knowledge and education alcoholic intemperance may
come to be regarded always and everywhere as vicious and
* We hope to publish a more detailed account of this process in a future number
of this Journal.—E d.
f Read at the Annual Meeting of the Medico-Psychological Association,
Edinburgh, 1898.
} Misunderstandings and misquotation have made it desirable to enlarge
upon some of the opinions expressed in the abstract of this paper which
was rend to the meeting in Edinburgh. There are many verbal changes as well
as additions. The former are inevitable in so far as a written statement must
differ from what is spoken, and the latter seem desirable because of the nature
of the attention which these views have received. Most of the disagreement
which has been expressed is from misunderstanding, due to the shortness of the
statement which the conditions of a meeting, called together for discussion,
imposed. Nothing which was said then, or which has appeared subsequently,
has induced me to alter, in the slightest, the significance of what I said. On the
contrary, much proof has been forthcoming that the paper expressed, however
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712 The Mismanagement of Drunkards, [Oct.,
reprehensible. It is a grievous matter that it should be
lightly regarded in any quarter as a venial offence, and I
should gladly support some more rigorous form of punish¬
ment for the vice of occasional intemperance than can now be
meted out.
“ I think the possibility of some legally enforced personal
stigma would prove deterrent and wholesome if early applied.
“ Inasmuch as many careless and vicious drunkards cannot
be made to smart in their conscience, I believe that the
infliction of corporal punishment would be useful against
repeated lapses from sobriety.
“ Vice should always and everywhere be punished, and the
present tendency to minimise punishments is unwholesome,
and indicative of a general flabbiness and sentimentalism
in society which is quite unwarrantable and mischievous.” *
This question of how to combat the intractability of
drunkenness is one which has exercised many of us for
many years, and in 1893, writing of the ill-constituted
drunkard, for whom strong measures had been recom¬
mended, I used the words: “ While out of justice to society
it may be necessary that our treatment of him should be
severe, it is only fair to himself that it should also be
appropriate.” That may be taken as the text of this
present effort. It must be our aim to determine what kind
of deterrent and curative measures are really appropriate
in the management of drunkenness.
(It may seem unnecessary, but events have shown it to be
desirable, to explain that, while the ordinary man knows quite
well what one means when one speaks of a drunkard, physi¬
cians must at least be informed what one does not mean. By
the term drunkard, as here used, I do not mean a lunatic,
nor any other kind of invalid whom our courts regard as, on
account of illness, not responsible for his actions. All the
same there are many patients, admittedly not responsible, for
whom much more rigorous moral treatment than is usual in
our asylums would be found to have curative value. On the
other hand, there are some who, though perhaps justly called
imperfectly, the opinion of n very large number of those who seriously study the
problem of drunkenness.
Since the meeting Sir Dyce Duckworth has been good enough to remind me
of his address on the subject, published in 1893, and a passage in it is so apposite
that I substitute it for the greatly less authoritative quotation with which the
paper opened.
* The Relation of Alcoholism to Public Healthy by Sir Dyce Duckworth,
M.D. London, Eyre and Spottiswoode.
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1898.] by George R. Wilson, M.D.
drunkards, do not manifest the perversions and weaknesses
presently to be discussed, and, in so far as they do not, the
remarks which are applicable to the ordinary drunkard do not
apply to these individuals. Nothing is of so much importance
as that we should regard each case on its own merits.)
To determine what are the kind of ideas and the kind of
measures which are appropriate in the treatment of drunken¬
ness, we may consider a few of the many disabilities which a
study of our patients* ideas and feelings and conduct lead us
to regard as the characteristic perversions and weaknesses of
the class.
One of these —the loss of the power of direction —will be
considered more fully presently, and something will be said
of what can be done in the present imperfect state of the law.
Physicians as a whole have for many years been convinced
that this defect is so great and so important that it can only
be satisfactorily dealt with when powers are given to the
Bench to confine and detain habitual drunkards in institutions
specially organised for the purpose. It is the members of the
legal and the political professions who are to blame for the
backward state of the law on the subject. Their opinion
seems to be that any man and every man is entitled to all the
liberties and privileges of a free life until he happens to be
caught in the act of breaking the law. And so the drunkard
has been taught to believe that the British instinct which so
carefully regards the liberty of the subject will allow him to
make himself as great a danger and nuisance to society as he
pleases until some chance carries him into a transgression of
the law. If that were the attitude of the law towards insane
persons, if no sheriff might detain a homicidal maniac until
he had committed murder, if suicidal insanity must prove its
existence by the act of suicide, Parliament might at least have
the satisfaction of being consistent in its mistaken sense of
justice. But I need not dwell upon this subject, because it is
a commonplace with our profession that compulsory powers'
for the treatment of habitual drunkards are urgently called
for. I may, however, be allowed to draw public attention to
the fact that this reform is seriously threatened with delay
because the Government has chosen to select the most hopeless
and refractory kind of drunkards for their promised legis¬
lation. As this is more or less in the nature of an experiment,
it is a pity that compulsory treatment should be perhaps held
to stand or fall according as it succeeds or fails with a class
made up of men and women who are the least likely to derive
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The Mismanagement of Drunkards, [Oct.,
permanent benefit from any kind of treatment whatsoever.
It readily occurs to one, for instance, that it will not be easy
to induce these people to forego their habits of idleness and
indolence, and it is difficult to see how the very rebellious are
to be coerced. I should therefore like to see a clause in the
Bill which would make provision for corporal punishment (such
as flogging) of refractory drunkards with the precautions
necessary to prevent its abuse. The new institutions ought to
be regarded as houses of correction rather than as hospitals or
retreats. They will, of course, be under careful and periodic
inspection. Any abuses of the powers given to the superin¬
tendents could be as well prevented as are abuses in asylums
in matters such as the use of restraint or of seclusion, which
the law allows us to use in the case of insane patients.*
One of the most obvious features in drunkenness is self-excuse.
The victim of the habit is, even more than his sober neighbours,
too prone to find excuse and not ready to accept blame. You
will rarely meet a drunkard who acknowledges his vice fully
and who is quite alive to his blameworthiness. It therefore
becomes physicians and society to try to bring the facts of his
case home to him and to offer him just as little excuse as is
strictly just. The public mind is very ready to hear and to
repeat anything that doctors say about diseases, and still more
what we say about vices. That is the fashion of our time. A
few years ago—in Scotland, at least—public opinion was much
more guided by the pulpit, and then it was the inclination to
be very severe and to find no excuse for drunkenness. More
recently, when the subject of alcoholism came into promi¬
nence, physicians discovered some quite valid excuses for a few
drunkards, and now the tendency is to offer these excuses on
behalf of all. Those who are called upon to treat patients
* At this point it may be well to make clear that the physician’s view of
punishment must be dissociated from that of those who administer the law to
ordinary persons. The latter punish as a penalty for offences committed. We
must have nothing whatever to do with that view of punishment. We must
put all idea of retribution far from our minds. Punishment must be used on
our initiative only as corrective. If the question, for example, arises whether
such an one should be dogged, we have not to ask whether the thing that he
has done deserves dogging or not, we need not even ask whether he was fully
aware of what he did and fully responsible for it. Our only question should be,,
is this person one who requires dogging, in the sense that nothing short of
dogging will affect him, and it is likely that dogging will produce the desired
improvement ? I do not think we are justided in tbe use of such severe measure*
as a warning to others, for the physician has more regard to the individual and
less to society than has the judge or the sheriff. But—to return to the point—
there are some criminal drunkards who would be improved by dogging and by
nothiug short of it.
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1898.] by George R. Wilson, M.D.
who are addicted to alcoholic excess must feel how serious
this difficulty is, and especially those who are at once engaged
in the treatment of insane persons and of drunkards. We
have learned too well the lesson which our teachers had need
to teach us—that the mental and moral symptoms of insane
folks are quite as much the results of physical impairments
as are their paralysis or their convulsions. And now, when we
come face to face in the wards or in private dwellings with
alcoholic patients who, perhaps, have bodily symptoms which
mask their vice, we too readily forget that the law still regards
them, and that society rightly ought to regard them, as respon¬
sible for what they say, and think, and do; for the more a
man's sensibilities are blunted by the nervous impairments
which his vice has brought on, and the more remote he is from
ordinary incentives and ordinary discipline, the more need
have we to devise measures which may be extraordinary and
unusual, and which may also be severe, provided always that
they are appropriate, that they are calculated to cure. The
same determination which taught the surgeon to amputate in
many cases which long ago would have perished because
opinion was too ignorant or not daring enough must inspire us
to discover how to deal with vice which may have become
mixed up with disease.
One excuse we have given the drunkard by our too indiscri¬
minate belief in the importance of heredity. It would be out
of place to discuss that question abstractly here. To do so
would be to raise an almost purely academic discussion; for,
having regard to the fact that the environmental factor is
almost never eliminated in those cases which are quoted as
proving the first importance of heredity, I differ widely from
current opinion on the subject. But granting, for the sake of
argument, that a tendency to drunkenness is inborn in the
offspring of drunkards much more than in the children of the
sober, what has society gained by the information ? The
drunkard has learned his part of the lesson aptly. He has
readily grasped the fact, and makes use of it, that this teach¬
ing gives him an excuse for his vice. From the time that he
learns that some one of his forebears was a drunkard he
begins to regard himself as a victim of an unfortunate law
of nature—an object of pity rather than, as he ought to be, an
object of scorn. Also our teaching has done considerable
harm in its suggestion to the sons and daughters of drunkards.
I speak from observation and not at random. Several cases
occur to me which prove that young people who have a drunken
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The Mismanagement of Di-unkards , [Oct.,
family history are, to their hurt, taught to expect that they
will likewise become drunken. One striking case came under my
notice recently. He is a man nearing the prime of life, several
of whose relations have been drunken even to the point of
death. For thirty years he has been sober in a very tempting
environment. Now at last—from sheer carelessness and foolish¬
ness, as I take it—he has begun to drink to excess. It is what
the well-informed among his friends have taken for granted
all along. It has been at. the back of his own head all these
years that he was expected to go to the bad, and, more than
that, he knows that his family history will be regarded by
society as his excuse. Our teaching should be all the other
way. A bad family history is a good excuse for total absti¬
nence : it is no excuse at all for promiscuous drinking. It would
be quite as sensible if a man who slept in a ditch explained his
illness by a reference to a rheumatic or a phthisical family
history. A person who has any such idiosyncrasy should be
guided and corrected with greater severity, and not with less,
than the normal individual. Let us impress on such an one
as strongly as we can how important this matter is for him.
Let us warn him that there will be no excuse for him; but let
us not be so misguided as to tell him that he is likely to be¬
come what his father became because there is something in
his nature which makes for drinking. Let us tell the son of a
drunkard that he must not touch drink until he is twenty-five
years of age, and let his guardians in his youth flog him
severely if he does. If he is going to drink, let his begin¬
nings be as carefully made as when we begin to administer any
drug to a patient who is supposed to have an idiosyncrasy for
it. If a medical man were invited to observe the effects of
such a youth's first taste of alcohol, and if all his early drink¬
ing were carefully watched, the risks, such as they are, would
be greatly lessened.
Another plea which drunkards use with great effect, in
Scotland at least, is what I have no hesitation in calling the
myth of the " crave '' for alcohol. I know no better illustra¬
tion of the evil of what one may call the gossip about medical
facts for which the public are so greedy. Cases of a real
crave have, of course, been described, and are a very interest¬
ing fact. But ever since someone wrote of the man who cut
off his finger in order to get the brandy which he knew would
be prescribed, and of the schoolboy who wore his fingers to
the bone in midnight excavations towards his master's cellar,
nearly every drunkard in Scotland has been credited with a
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1898.] by George R. Wilson, M.D.
crave. For my part I have never seen a case which exhibited
what I would dignify by the name of an alcoholic crave.
That it exists there can be no doubt. But its frequency has
been enormously exaggerated. Very many alcoholic cases
suffer from a gastritis which their habits have induced, and the
discomfort of which they call a crave for drink ; others have
induced a disorder of the lower nervous mechanisms which
gives rise to a want of the normal feeling of well-being. Let
us then teach that a crave is really nothing to boast of, that
only ill-constituted persons and those whom showmen call
“ freaks,” ever have it. Let us treat the digestive disturb¬
ance by a blister over the stomach, and let us apply a very
stimulating plaster over the spine to relieve the feeling of
malaise, and 99 per cent, of the craves in Scotland will dis¬
appear.*
Disturbances of the functions of control are prominent
characteristics of drunkards. The habit which they have
acquired is one of very general effect. Intoxication is
a state which invades the whole realm of consciousness in
greater or less degree. Repeated acts of intoxication, which
we designate as a habit of drunkenness, lead to cerebral
changes which affect the whole mind. Memory, judgment,
reason, imagination, sentiment, all become modified both by
the effect of the drug on the brain substance and by the
* Many people seem to have some difficulty in understanding what we really
mean by a crave for alcohol, and why it is not true that every one who wants a
drink may be said to exemplify it. But there is no very great difficulty in the
subject. In an act or choice, and in a habitual act or choice, there is, on the one
hand, desire or impulse, and on the other direction or control. The act may
become automatic and ungovernable, either because of excess in the desire or
impulse (as in a man who has been for days at sea without water), or because of
reductions in the functions of control. In nearly all drunkards it is the control
which is at fault. That is what Hughlings Jackson calls the primary or negative
lesion. It is in the nature of a want. The drunkard takes to drink immediately
he feels wrong, not because he has an excessive susceptibility in the part of his
brain which represents drink, but because he has closed the avenues of other
lines of conduct; he has shut the door on his freedom of choice. The excess of
sensation which constitutes a crave is of the nature of a hypertrophy or overgrowth
in the organs of sensation, and it is extremely rare. An alcoholic crave proper
is characterised by its exclusiveness; nothing but drink will satisfy it. It is
generally periodic, coming on at stated intervals. It is due to a peculiar nervous
constitution, and not to disorders of the bodily organs. It is generally idiopathic,
and not induced (though it sometimes follows severe injuries); that is, it is
usually a development of the man’s original nature, like a taste for music or an
extraordinary interest in colour. As a rule it manifests itself not later than the
end of adolescence, und is of irresistible intensity whenever it has realised itself
in the taste of alcoholic drink. So one need hardly add that all states of general
restlessness and excitability are not a crave at all, but primarily due to impair*
merits in the functions of control.
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The Mismanagement of Drunkards , [Oct.,
functional changes in structure which follow from a prolonged
subservience to any one interest. Most of all, the will—the
function of rational choice—becomes seriously limited. The
drunkard's will ceases to be as free as that of a man who has
been moderate. The disability of which I wish particularly
to speak may be called a loss of the faculty of direction . In
business, in social and in domestic relations, the drunkard is
incapable of behaving wisely and of ordering things aright.
Yet we find it an almost invariable rule that, because of his
gift for making things unpleasant, he is allowed to have even
more of his .own way than are those who behave properly.
It seems to me quite the most immoral effect of drunkenness
that it leads to the complete demoralisation of the home. Be
the drunkard father, or son, or brother, all the domestic
arrangements are suited to his perverted tastes. People wait
up for him far into the morning hours, meals are kept late,
every one else is put to discomfort in order to please him.
Worse than that, the whole household must learn to shield
him, to deceive, to pretend, to lie, rather than admit the facts
of the case. This is a mistake for which, of course, the
friends are most to blame. It is natural to them, especially
to the more tender and sympathetic sex, to sacrifice both
their comfort and their consciences to the erring member.
But we doctors might inculcate a better way. I do not know
what is the general practice in such cases. But when I am
asked to treat a drunkard at home, one of the first things I
insist on is that there shall be an end to all pampering of the
patient. He must be plainly told that he has clearly demon¬
strated his unfitness to direct his own life, much more his
incapacity for the headship of a household. He is by habit
over-exacting; he must be prevented spoiling other lives.
He is already too self-indulgent; he must be compelled to
accept unpleasant things. He is irregular and unpunctual;
he must take things when they are due or go without them.
He is unkind, inconsiderate, cruel, and sometimes brutal and
violent; he should be ignored until he learns to give as well
as to take, and if need be he must be cut adrift or forsaken.
In short, the mother or father, the wife or sister, the brother
(who by the way less often needs the instruction) must be
instructed how not to deal with a prodigal in the time of his
prodigality. For the fatted calf, which suits the repentant
home-comer, is most unwholesome food for the incorrigible
and impenitent.
This question of shielding the drunkard and practising
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1898.] by George R. Wilson, M.D.
deceit and lying on his behalf is a difficult and important
one. An obvious disability of the drunkard is his want of
a sense of sin, and a great dishonesty about his vice. I am
convinced that* it is largely due to impairment of memory.
He does not recall the facts of his intoxication; he does not
remember how often or how much he has been drinking;
he has a very imperfect recollection of the various acts of
misconduct to which his drunkenness has given rise. What¬
ever the reason, the fact remains that the drunkard does not
appreciate the badness of his case. That is one of the greatest
difficulties in treatment, and it -wants careful consideration.
It is, again, a symptom to which the relatives pander by their
management of the case; and we are called upon to point,
out the mistake of shielding the patient from the ignominy
and other unpleasant effects of his vice. This is a good
example of what I mean by saying that the drunkard, by
reason of his disabilities, requires more, rather than less,
severe treatment than an ordinary offender does. Any
ordinary bad habit need only be mentioned, and the offender
will think upon it for days ; the word of correction will
rankle in him; the subject will be a tender one for a long
time, and will be avoided by anyone with tact and genero¬
sity. But generosity is quite out of place with the drunkard,
and to spare his feeling is to do just the worst thing possible.
All the evil and the danger of his vice should be brought
forcibly home, not in a petty way, but in a manner which will
be impressive and permanently convincing. I believe that a
great step to the reformation of any drunkard would be taken
were he persuaded to admit publicly—that is, to make no
secret of it in society, that he had been addicted to the vice.
And if he will not do so himself, the next best thing, in my
opinion, is that his friends should expose him. Let the
publicans be told the facts of the case, and let a careful state¬
ment be made to relatives, friends, and casual acquaintances
in the nature of a warning that the patient must not be
encouraged to take drink. Let it be understood that it is a
shameful thing to offer drink to him, or to drink with him,
and let us have no hesitation in saying what we think of those
who encourage him. There is no question of ill feeling at all
towards the patient when we insist that he shall bear the full
brunt of the consequences of his drunken acts and that they
shall be exposed rather than concealed. It does not matter
who calls such treatment cruel or barbarous, provided only
that it induces the patient to take thought and mend.
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The Mismanagement of Drunkards, [Oct.,
The feelings of relatives are the chief barrier to such a
method of managing drunkenness. If the truth were told
they need have little scruple in acknowledging the facts; for,
as a rule, the patient's habits are known to all his acquaint¬
ances, and, moreover, there is nothing at all exceptional in
having a drunken relative. There are very few people who
have not some such acknowledgment to make concerning near
or distant kinsfolk, and we may safely rid our minds of the
idea that vice in one member of a family implies evil potencies
of an extraordinary kind in each of the other members.
The difficulties of managing a drunkard at home follow
him to any institution where he is sent for cure. Not only do
the disabilities of the patient prevent successful treatment, but
the mistaken kindness of relatives is also in the way. People
are anxious that the poor man should have plenty of amusement,
whereas one wishes him to learn how not to be amused. He
is of idle habit, but he and his people seem still to think work
unnecessary, if not an injustice. For years the man has been
a slave to his palate and to his appetites, but his friends are
still very anxious that he should be richly fed. He has made
a long practice of the art of lazy comfort, and still it is
expected of us that we should provide a lap of luxury for him
such as might be fitting for a worn-out and conscientious
martyr to good works. To be appropriate, it seems to me that
institutions for drunkards should teach habits of regularity,
hard work, and forgetfulness of bodily states, except in so far
as is necessary to health. A well-conducted monastery would
be a good place for a drunkard, or such a regime as used to be
prescribed for an athlete about to undergo a severe trial of his
powers. Similarly, his mental state should be treated so as in
every way to induce him to see the nature of his vice, to
realise his weakness of will, to sink his own selfish desires,
to rid him of self importance, self pity, and self confidence.
Meanwhile drunkards would not stay in such a place, and the
law says it is wrong to compel them. The public also will not
stand views so severe, and would condemn anyone who tried to
put them to the test.
Now and again one comes across relatives who have the
sense and the courage to coerce the drunkard into obedience.
Nearly all who become addicted to drink become cowardly;
but most of them are at the same time either of a bullying or
cringing manner, and it really requires a great deal of pluck,
especially on the part of wife or mother, and a great deal of
resolution, to deal wisely with them. On several occasions,
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1898.] by George R. Wilson, M .D.
and sometimes with excellent results, relatives have been per¬
suaded to intimidate the drunkard into obedience. One wife
I remember who was told by her husband that if she rebelled
against what was considered good for her the house would be
shut to her, and her children denied to her; the police would
be instructed to take her in charge if she was importunate in
her attempts to resume her place in the family ; public repu¬
diation of responsibility for her debts would be made;
relatives would be instructed as to the facts of the case, and
requested not to acknowledge her or give her any assist¬
ance ; and, if need be, her acquaintances and neighbours
would be informed as to her habits, and the reasons for
the treatment proposed. In the case of husbands I have
advised similar measures; and especially in the case of
young men who have an employer, men who hold public
offices, and those who have farms, &c., on lease, the further
step has been taken of enlisting the employer or landlord
in the attempt to coerce the drunkard. It is also of value
to let it be understood that business men and others will
be told the truth about the patient, should they think of
giving employment or other assistance.
When such things are threatened—and it should be done
in the form of a letter from a law agent—it need hardly be
said that the drunkard may generally be trusted to choose
the easier course, and to comply with the demands of relatives.
He is generally a coward, and his fear of public opinion, the
dread of inquiry and exposure, as well as the occasional
lingering affection for those who seem about to abandon him,
induce him to acquiesce. But it may be added that, if the
drunkard can be proved so, and if he resist such steps as
have been suggested, even to the extent of going to law, the
law, in Scotland at least, is largely on the side of those whom
he has wronged.
What can be done by spiritual ministrations for the victims
of the alcoholic habit it is not for me to say. We are all
familiar with cases of complete and permanent reformation
following a religious experience of an impressive kind. As
was said in the eloquent speech by the clerical guest at the
dinner of the Association, ministers are learning that there are
states of mind, even in those who are still sane, which the
physician can most effectually deal with, and there are cases,
even within the walls of our asylums and retreats, who most
require the help and guidance of a pastor. But the clergy
are not without blame in this matter of too lax a view of
xliv. 49
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The Mismanagement of Drunkards, [Oct.,
drunkenness. They also have learned the lesson which our
too easy doctrines have taught. And if we are to call in the
minister to help the drunkard, we must see to it that he is
one who will not be afraid to speak the truth as his religion
teaches it without any importation of mildness from medical
and scientific doctrine. The teachings of the great Calvin,
whom we might call relentless in his views of sin and in his
practice, who more than “ shared the common opprobrium of
all European Christendom” in prosecuting Servetus to the
death for blasphemy, who regarded all men as born to con¬
demnation because of innate sin, who refused to entertain
any hope for any man, however unfortunate, except he repent
and be regenerated and sanctified, who would regard all
constitutional disability as a warning and a danger but never
as an excuse—such a teacher has scant support from the
compassionate and easy-going doctrines of to-day. But in so
far as modem teaching repudiates moral responsibility be¬
cause of “ flaws in the flesh ” or “ taints in the blood,” it is an
instruction which is only harmfnl to the victim of vicious
habits. Here again we have a good example of the necessity
for exceptional severity in that, while a more mild theology
may be best for the man of ordinary uprightness, it takes
something like the fear of hell or of the pains of purgatory
to convert a drunkard instantly and for ever from his sin.
The subject is endless, the side issues are without number.
It is not to be supposed that one can lay down a law for all
sorts and conditions of drunkards. But at least we can
indicate a point of view and a method which will determine
the general lines of treatment of usual cases, and which can be
modified in detail to suit the peculiarities of the unusual. I
would reiterate the text with which I began—that we must see
to it that, in our severity, our treatment of the vice is appro¬
priate. The only criticism which is important is that which
says that this does not effect the end in view—to induce a sober
life. For years we have taught that vice is partly a disease,
and I do not for a moment repudiate the general doctrine.
But it is not enough to discover the disease, or even to give it a
name. Let us caricature the situation and suppose that our
able pathologist has discovered that sin is a specific disease.
He has made cultures of the germ, and he finds that, when he
inoculates others, all the characteristics of the disease are
forthcoming. What have we gained unless the pharmacist
or the bacteriologist devises a drug or a serum which will
make the sin germ of no effect ? Let us call vice disease if
Digitized by
723
1898.] by George R. Wilson, M.D.
you will, let us say that we are only treating symptoms when
we try to reform the drunkard; but, until we have got at the
root of the whole evil, and have discovered the treatment
effectual for it, surely it remains true that a specially strong
discipline is required for a specially weak nature.
We shall be told without fail that, in promulgating such
views as these, we are going back upon the scientific view of
vice which a generation of wise physicians have propounded.
One may be pardoned if he think, on the contrary, that he is
going a step further. In the beginning of this century
drunkards were probably of very much the same nature as
they are to-day. But, at that time, they had not been care¬
fully observed by medical men, and they were not understood
and described as they are now. We have certainly learned a
very great deal as to the causes and the conditions, the nature
and the effects, of drunkenness. But surely no one will claim
that we have made proportionate advance in the treatment of
it. Excluding those who arrive at the stage of insanity or
other malady which necessitates asylum or hospital treat¬
ment, drunkards are in as hopeless a position as regards cure
as they were fifty years ago. This is to be accounted for, I
believe, by the fact that, having put the vice on a scientific
basis, and having demonstrated its neuropathic relations, we
have stopped there, forgetting that after all it is the moral
functions which are chiefly impaired, and that therefore strict
moral treatment is called for. In our analysis of the physical
causes of drunkenness we have discovered the importance of
heredity, of a constitutional susceptibility to alcohol, and of
other factors which predispose to excessive drinking. It is
high time to deal with these factors seriously and vigorously.
And in our analysis of the drunkard's state of mind, in so
far as we find him defective in shame, in honesty, in self-
respect, in respect for others, weak in memory, foolish in
judgment, silly in imagination, blunt in his affections and
impotent in control, surely, whatever be the physical im¬
pairments which accompany these symptoms, it is sound
therapeutics to take active steps to arrest the intellectual
degeneration and to re-establish the moral functions.
Dueuttion.
Dr. Stewart (Clifton) made bold to enter the lists with such an excellent autho¬
rity as Dr. Wilson because he thought it was a dangerous thing if an association
like theirs should in any way countenance the opinions he had formulated, or go back
from the position that he believed medico-psychologists bad hitherto occupied in
regard to the subject of inebriety. He had been the unhappy victim of an
Digitized by L^ooQle
724
The Mismanagement of Drunkards, [Oct.,
onslaught by one of the giants of this Association, Sir John Bucknill, who said that
he (Dr. Stewart) was a faddist; that he was one of those who would fain ignore the
vice of drunkenness. When in this city the Medico-Psychological Association dis¬
cussed the definition of insanity, Sir John Bucknill was one of those who was
most in favour of the simplest definition, to the effect that it was a disease of the
brain which had gone so far as to affect the mind. He asked in what way he was a
visionary if, similarly, he asserted that inebriety was a disease of the brain which had
gone so far as to affect the will power. He wanted to know in what way Dr.
Wilson's arguments would help them as physicians to deal with an injured brain. If
they sanctioned such “ Calvinistic ” treatment, if they gave it any support, they
would be putting the hand back years and years, and would discredit the name of
the Association.
Dr. Clouston said that they needed some such talking to as Dr. Wilson had
given them, and he trusted that what he had said would be spread abroad, and
would take hold of the medical profession and the general public. There was no
doubt whatever that they had to some extent lost sight of the true nature and
right treatment of some early cases of drunkenness. In reading some books on the
subject one got sick of the mawkishness, the want of vigour, the absence of any
real scientific method. They had something different from Dr. Wilson. He did
not say that he agreed with everything which Dr. Wilson had said, but he affirmed
that they required some such vigorous ethical statement in regard to the treatment of
the man who had thus lost his self-control. There was no doubt that the medicine
they required for the early drunkard was not to be poured out of a bottle, but was to
be brought from some such laboratory as Dr. Wilson had indicated. He had no
hesitation in saying that a number of the persons who became disgraceful inebriates had
at one time passed through a stage when they might have been saved if they could
have received such treatment as Dr. Wilson had recommended. He had watched
the effect of it on men who had begun going on the down grade. He had appealed to
such a man for the sake of his honour, for the sake of his wife and family, and he
had said, “ You are going to lose your income and to fall into social disgrace. For
my part, I shall have nothing more to do with you if you do not at once reform
and he had seen the man reform out of pure fear. The ethical point of view was
in no way inconsistent with the medical, which regards the man as weak, wanting
in courage, inhibition, and other moral qualities from a brain defect that will soon
become a disease. He most heartily sympathised with the greater part of what Dr.
Wilson had said, and thanked him very heartily for his admirable paper. If it did
not cover the whole ground it hit the nail on the head in regard to many cases.
We nfust in medicine apply the physic that will cure, no matter how strong it
may be.
Dr. Rayner said that it seemed to him that Dr. Stewart was wrong in looking at
disease as an entity, which it certainly was not. Disease was only abnormal physi¬
ology, and therefore the treatment of a child diseased and the treatment of a person
who begins to get diseased were to be dissociated. In practical experience what
Dr. Wilson had said, and properly said, in regard to the point was often borne out.
He remembered a very striking inebriate case who laboured under hallucinations.
One medical certificate was signed, and he (Dr. Rayner) was sent to complete the
second. Rather than go to an asylum he promised that the man would attempt to
control himself. After removal from his pernicious surroundings he did control
himself, and had continued master of himself ever since. He (Dr. Rayner) had
also been very much struck with the rarity of the “ drink crave.”
Dr. Conolly Norman agreed with a great deal that Dr. Wilson had said, but he
could not approve of his ** Calvinism.” He thought that was about the worst pos¬
sible solution of the difficulty; not Calvinism, but casuistry was the true guide in
dealing with drunkards. It was the treatment of the individual case that they were
chiefly concerned with, and not the laying down of hard and fast principles, chiefly
inapplicable when they came to deal with men and women seriatim . He came
from a country where they heard so much of high principles that he did not hesi¬
tate to say that he had no principles at all; or if he did possess any principles in
Digitized by vjOOQle
725
1898.] by George R. Wilson, M.D.
the treatment of drunkards he was extremely inconsistent in carrying them out. He
thought inconsistency in the present state of their knowledge was the truly scientific
attitude. He himself, taking certain risks, occasionally told a man that he would not
let him out of the asylum until he had taken the pledge. The pledge was generally
taken, and sometimes kept. He could not quite agree with Dr. Wilson on another
point. He had talked of the sense of right and wrong being absent in drunkards.
No doubt on the whole he was right, and there were great numbers of confirmed
drunkards who had lost their sense of right and wrong. That did not help them
much in dealing with early cases. The backslider who was constantly conscious
that he was giving way appealed to them to help him ; the speaker at least saw such
cases frequently. He often saw drunkards whose sense of right and wrong seemed
to be as acute as any one's, and entailed the greatest mental suffering. He supposed
that when Dr. Wilson referred to flogging it was meant as one of those pleasant
elaborations which served as sauce to season the argument. He would be afraid of
the ensuing delirium traumaticum, erysipelas, death, coroner's jury, which would
follow on its application in real earnest. He did think, however, there was a great
deal of truth in what Dr. Wilson had said in regard to heredity. It had become
such a gigantic generalisation that it included everything, and so included nothing,
and left them hopeless of progress. They heard a great deal about the heredity
of drunkenness ; because our grandfathers drank too much, therefore we were bound
to be drunkards. The absurdity of this kind of twaddle is apparent, and the more
they discouraged it the better for the world. They should encourage drunkards to
think, what they all needed to remember, that “ man is man, and master of his fate."
Dr. Macdonald (New York) said he had been very much interested in the
paper. They had gone through all the stages of treatment of drunkenness as a
disease in America. The hospital system had been abandoned on account of its
weakness and failure, and the fact that the patients could not be so detained after
the early stages of recovery. These hospitals consequently became refuges for
drunken husbands or wives, or those whose relatives wished to keep them out of
the public view. He thought that the solution of the question was to be found
along similar lines to those which Dr. Wilson had suggested. The change which
had come over the popular treatment of drunkenness was more effective than any
other agency. The feeling on the part of the people, and especially on the part of
the women, that drunkenness would not be tolerated now as it used to be, that it
was not so excusable as it used to be, had done more to bring about the change
than either medical treatment or absolute compulsion.
Dr. McDo wall (Morpeth) said he agreed with Dr. Wilson. In their treatment
of early cases of drunkenness their present method was altogether absurd. Men
were taken up to the police court and fined a paltry sum, and with a hardened
sinner that soon became a farce. If these men knew that they would have a very
sore back every time they got drunk instead of being fined half a crown, they
would very seldom go into the public-house. They ought to have recourse to cor¬
poral punishment, and he certainly approved of a vigorous treatment of drunkards.
Dr. Hayes Newington held that what Dr. Wilson had said was partly true, and
what Dr. Stewart had said was partly true. There were some cases of drunkenness
which were not pathological, and there were other cases that were undoubtedly
pathological. What was a drunkard ? A great many men went to the public-
house every Saturday night, and there misspent their wages. Were they drunkards ?
How much was a man to drink before being thought worthy of corporal treatment ?
All the whipping in the world would not save some of them. They all knew
drunkards who had cast happiness to the winds. Again, how were they to deal
with the head of a household, who held the purse and created physical fear ?
Flogging could not be the remedy there. No amount of flogging could cure
those cases, known to all doctors, who lived like decent Christians for some
months, and then without apparent cause, though with absolute regularity, wallowed
in drink like pigs, until, having satisfied their impulse, they again became decent.
The difficulty of dealing with a subject of this kind lay in the definition.
Digitized by {jOOQle
726
The Mismanagement of Drunkards, [Oct.,
Dr. Ykllowlkks said that Dr. Wilson had mixed np two totally different classes.
The ordinary drunkard was often a mere scoundrel, and ought to be punished
accordingly. He did not come within their province as physicians, but a great
deal of what Dr. Wilson had said applied solely to him. The man who deliberately
made a nuisance of himself, and caused his friends and neighbours to suffer, ought
to be punished; and corporal punishment ought to be awarded to a great many
others besides drunken scoundrels. Why were there such cases in Mavisbank at
all ? That was not a place of punishment. If they were not cases of disease, it
seemed extraordinary that they should be sent to Dr. Wilson’s care. He had
laid down the extraordinary principle that the more a man’s nature was blunted and
perverted the more severely they must deal with him. None of them could accept
such a principle. Dr. Wilson would not act upon it himself, and he was very
sorry that Dr. Wilson had thus mixed up vice and disease. Then he told them
that he never could recognise the crave for drinking. He did not understand that
statement—unless, of course, there was no brain disturbance at all. The habitual
drunkards, who had weakened their nervous system so far as to come under medical
care, had periodical attacks, when they became restless, sleepless, irritable,
troublesome, unable to settle to employment, quarrelsome with their neighbours,
and in such a state that one knew that they were longing for liquor, and that if
they were within the reach of their special temptation they would at once succumb
—these cases were familiar to all of them. And yet Dr. Wilson said that he had
not seen the crave for drinking. He was quite sure they must treat what he had
described as phenomena of disease, and not as mere vice which could be cured by
flogging. They all knew that drunkenness was terribly hereditary; but it was entirely
a new doctrine, and one that he must deprecate, that they encouraged the evil when
they pointed out its hitter and disastrous results. It was quite true that the friends
of patients were foolish in that respect. They encouraged him, and comforted
themselves by saying, ** Poor fellow, he can’t help it.” A great deal of Dr. Wilson’s
paper was addressed to such foolish friends, and would do them infinite good if they
would act on the wise principles he laid down. But when told they were not to
say to the son of a drunkard, as he (Dr. Yellowlees) had said many a time, “ You
must never touch intoxicants; see what they have done to your father,” because it
would be an encouragement to drinking, he could not agree. There were cases of
moral deterioration which were the gradual result of drunkenness, or the result of
brain disease irrespective of drunkenness, or complicated with it. For such moral
degeneration this treatment by punishment—why called Calvinistic he did not know
—could not result in any good; rather the reverse. Coercion and intimidation,
he thought, were often quite useless. They might threaten whatsoever they pleased
to a degenerate drunkard, and he would not care. Moral reformation could only
be attained through moral regeneration, and self-respect and self-control were not
produced by punishment. Dr. Wilson had expressed vigorously and earnestly what
many of them felt, especially in regard to the friends of drunkards, but he did not
make the necessary distinction between the scoundrels and those whose moral
deterioration must be attributed to disease. It was a distinction which certainly
existed, though often exaggerated and abused, and he should be sorry if that paper
went forth with the imprimatur of the Association.
Dr. Carlyle Johnstone could not say, and he did not suppose that any of them
could say, that they were prepared to agree with Dr. Wilson’s principal conclusions;
but with his general maxims he expressed his sincere sympathy, and to a great extent
his concurrence. In the end of this nineteenth century there was a great deal too
much of spurious humanitarianisra, which received directly or indirectly a consider¬
able amount of support from the medical profession. While as physicians they had
to minister to disease, their first duty was to minister to the community, to protect
the commonweal; there was too much of pampering and cherishing a man’s weak¬
ness and sin, and too little exhortation, admonishment, and chastising of the
sinner. Dr. Wilson would admit sin required treatment, and punishment was the
proper treatment of sin. Dr. Wilson had given them a good word in calling it
Digitized by ^ooQle
727
1898.] by George R. Wilson, M.D.
CalvinUtic treatment. The President had quoted a saying to the effect that murder
might be a disease, but hanging was the cure. He thought that drunkenness was a
disease, and that occasionally flogging was the cure.
Dr. Clapham said that although the will was not free, action was free. They
could not help willing to do a thing; it was the action that had to be dealt with.
As regards the treatment of vicious drunkards, a Yorkshire magistrate had effected
considerable improvement in his neighbourhood by saying to the prisoner before him,
“ You will be fined so much this time, and you will be sent to prison for so many
days if you do not abstain for such and such a term/’ Although they did not define a
drunkard, they all knew a drunkard when they saw him. He approved of measures
of a drastic character.
Dr. Hislop (Pietermaritzburg) said they had experimentally tried homes for the
treatment of drunkards in South Africa. So far detention in these institutions had
not been compulsory, and the institutions had been failures. They had been con¬
sidering whether they should have a portion of his asylum set apart for inebriates,
and he thought that would not be a bad plan. The South African Medical Society,
however, unanimously resolved that the various Governments should be advised
that separate institutions should be established for the compulsory detention and
treatment of inebriates.
The President said that when a member brought a strongly opinionative paper
to a meeting of the Association he was apt perhaps to occupy a somewhat extreme
position, but there was nothing which elicited a better discussion than bold, crisp
views, which caused them to consider if after all they were right, and to give reason
for the faith that was in them, although, on the other side, in reply, they too might
say more than they intended. He did not think that the last word had
yet been said on the preponderance of vice or disease in habitual drunkenness. It
had been begun, as Dr. Stewart reminded them, by Sir John Bucknill, who made a
strong speech as to the vicious nature of drunkenness at a temperance meeting at
Rugby. Dr. Clouston went over a number of cases in Morningside, and showed
that a great proportion of them were hereditarily insane or hereditarily alcoholic,
although he admitted that there was a number who were primarily if not entirely
vicious. Sir John Bucknill took a somewhat extreme view, recognising very few
casesof true dipsomania ; and they must all feel that in his strong common sense he
was largely right. It fell to them in the actual practice of their profession to advise
in regard to affairs not entirely medical, and so they might have to aid in the treat¬
ment of vicious drunkards; but in his experience they had also to deal with a large
residuum of insane drunkards—persons who were first of all insane, and afterwards
drunken. It was often most difficult to discriminate between these classes in
regard to individual cases. He himself was very strongly of Sir John BucknilPs
and Dr. Wilson’s opinion, that there bad been too much nonsense promulgated in
reference to vicious drunkards, as he had stated in his address from that chair. He
did not wish to detain them with theological arguments, but he wanted to say a
word on the great Calvin, who constructed a logical system of theology which hung
together from the first to the last statement, and which was based upon the concep¬
tion of the inevitableness of human destiny and the innate moral corruption of the
race. Now Dr. Wilson asked them to adopt “ Calvinistic ” treatment, and vet he
denied that the doctrine of predestination applied to drunkenness. They could not
break with Calvinism in one particular only, nor could they shut their eyes to the in¬
evitable doom of so many habitual drunkards, whether they were considered from the
point of view of Calvinists or Psychiatrists. If they were going to use Calvinism as
the hangman’s whip to keep the wretches in order, they must also use it in the full
knowledge that it predicates a state of matters in the individual which has been
preordained from all eternity. Calvinism was not responsible for what had been
suggested to-day. It was a vulgar error to speak of it as the doctrine of eternal
damnation. There was far more in John Calvin than that. [Dr. McDowall: Far
more than that.] He could not subscribe to Dr. Wilson’s theology ; still less could
he subscribe to his psychology. What they had got to deal with was the person.
Digitized by
728
The Mismanagement of Drunkards, Oct.,
Those unfortunate persons who were to be treated with such summary vengeance were
so often the darlings of somebody—of somebody who would shield them from fresh
disgrace, whatever philosophic advice might be tendered. The President went on to
describe the discipline of the prisoners in Elmira Reformatory, and showed that even
these incorrigible offenders were protected from flogging by public opinion, except in
the extremest cases. He did not believe for a moment that this country would
authorise the flogging of drunkards, habitual or occasional. It was plain that unless
a man had done something of the nature of robbery with violence, unless he was
guilty of the gravest forms of crime, he would escape the degradation of the cat. He felt
assured that the Association would not subscribe to that proposition of Dr. Wilson's
—(Hear, hear)—nor would they, he thought, approve of his system of “ intimida¬
tion,” partly, no doubt, because of its inherent weakness in threatening what the
drunkard already lived in fear of—the results of his vicious conduct; but still
more because they could not be assured that the suggested threats would be put in
force or prove in effect successful. They in asylums found difficulty in replying to
patients who made a wrong use of the Bible. “ Here,” say the melancholiacs, " in
this chapter and in this verse is my condemnation.” Were they, therefore, to argue
that the Book of books was to be abandoned in asylum life because some of their
patients made a bad use of it? What they had got to reply in these circumstances
w*as that they were mistaken in regard to their opinions, and that they must refer
to passages of larger hope. And similarly, if medical doctrines of heredity and of
insane irresistible impulses are misapplied, it is their duty to point out opposing
opinions founded sure on experience. In treatment of the early stages of habitual
drunkenness they had been too lax as a nation. When they considered the vast
and increasing influence of “ the trade," by reason of that influence greatly, and by
their own inability as a profession to exercise that amount of political influence
which they ought to have, medical men had not done what they ought to have
done and what they might have done to deter the inebriate from entering on his
vicious career.
Dr. Wilson, replying to the discussion, said he had spoken in no spirit of levity,
but had really expressed views which were uppermost in his mind as he went
about among the drunkards under his care. He was particularly sorry that Dr.
Yeljpwlees had misunderstood him, and could not remain until that stage of the
discussion. There were two or three points which Dr. Yellowlees quite failed to
appreciate, no doubt because he (Dr. Wilson) had felt constrained to speak hurriedly
to save time, and had been compelled to present his paper in the form of a brief
synopsis. He should never think of desisting from saying to certain persons, "For
God’s sake don’t you touch liquor.” But to say to the son of a drunkard,
"There is a great chance of your becoming a drunkard,” or to say to him
that drunkenness was hereditary, was, in his mind, quite wrong, although this
was promulgated in their writings and sometimes uttered in the consulting room.
Regarding the “crave,” all he meant to say was that the "crave,” as they under¬
stood the word, w T as exceedingly rare. That he adhered to. When he spoke about
drunkards he was referring to patients who came to them as so-called habitual ine¬
briates noton account of insanity, but because, as he believed, they had got into the
class of “ blackguards.” They had wrecked their homes and shattered their healih.
He did not for a moment refer to the insane in Mavisbank. In reply to Dr. Stewart,
who said that he (Dr. Wilson) was going back from the position that drunkenness, or
inebriety, or alcoholism was a disease, he, on the contrary, was one of those referred
to by Dr. Clouston and Dr. Norman who had contributed to the mawkish literature
of the disease in question. They had been writing and talking about the disease of
drunkenness. Now let them have the therapeutic side. It seemed to him that the
lesion was largely connected with the mechanism of the initiative. The drunkard
had not vigour or will in new and right directions. Dr. Stewart would agree with
him that that was due to some sort of degeneration of the centres of the higher will,
whatever that might mean. There was no part of the brain which was isolated, and
there was a reflex action between these higher cerebral centres and the skin which
Digitized by L^ooQLe
729
1898.] by George R. Wilson, M.D.
might be excited by flogging. If a drunkard could not of his own free will go out
and do bis morning work, that was, he held, the true therapeutic for criminal
drunkards. It was said in the debate that harsh measures could not apply to the
head of a family, but he had seen them effective even in the case of him who held the
purse and dominated the household. With reference to what the President had said,
some of his observations had expressed exactly what he (Dr. Wilson) desired to com¬
bat. The President said he had no doubt whatever that there were cases of marked
hereditary alcoholism when the patient was foredoomed to drunkenness and failure in
life. It might he so, but he (Dr. Wilson) held that that was not the attitude for them
to adopt. To set forth a conception of the hereditary factor in disease which
some authorities believed to be false, and to say here is a disorder which is due to
devolution, and here is an unfortunate victim of abnormal degeneration, was wrong.
He did not think they had any right to say to any man that he is born to be a
drunkard.
The Normal Histology and Pathology of the Cortical Nerve-
cells (specially in relation to Insanity)* By W. Ford
Robertson, M.D., Pathologist to the Scottish Asylums;
and David Orr, M.B., C.M., Assistant.
It was originally our intention to cover the whole ground of
the pathology of the cortical nerve-cells in relation to insanity.
But in the course of our more recent investigations we have
been strongly impressed with the fact that there are certain
as yet little known, but very grave fallacies, into which
investigators in this field are in danger of running; and it
seemed to us in the first place imperative to clear these up
before formulating conclusions regarding the relation of
cortical nerve-cell changes to insanity.
We shall therefore now deal only with these fallacies,
with the occurrence of chromatolysis, varicose atrophy of the
protoplasmic processes, and varicose hypertrophy of the axis-,
•cylinder process in acute insanities.
We must first, however, briefly refer to present opinions
regarding the normal structure of nerve-cells, and to the ex¬
perimental production of the above-named lesions in these
cells.
Normal Structure of the Nerve-cell. —The theory according
to which each neuron or nerve-cell is a separate unit, com¬
municating with other neurons only by contiguity of processes,
and never by continuity of them, though it continues to be
•opposed by Golgi and others, is still maintained by the great
majority of authorities. The question as to whether the
# Read at the Annual Meeting of the Medico-Psychological Association, Edin¬
burgh, 1898, and illustrated by a microscopical demonstration.
Digitized by kjOOQle
730 Histology and Pathology of Cortical Nerve-cells , [Oct.,
protoplasmic processes subserve merely a nutritive function in
relation to the remainder of the cell (as maintained by Golgi),
or are also special receptive organs of nervous impressions, is
one that is still in dispute. With regard to the appearances
presented by nerve-cells in preparations stained with basic
dyes, it is becoming clear that most other authorities are un¬
able to accept Nissl's elaborate classification in all its
detail as either of practical utility or warranted by the facts.
Some of the terms he has suggested are, however, coming
into general use. His division of nerve-cells into somato -
chrome and karyochrome is one that appears to have largely
commended itself. In the somatochrome cells the protoplasm
is well developed, and presents in preparations by Nissl's
method numerous deeply stained bodies. In the karyochrome
cells practically only the nucleus retains the stain, the proto¬
plasm remaining clear. In the former group are contained the
great majority of nerve-cells, including most of those of the
cerebral cortex. The karyochrome cells have as yet been little
studied. On the other hand, the somatochrome cells have
during the last five or six years formed the subject of elaborate
research by a very large number of investigators. It is now
recognised that the protoplasm of somatochrome cells is com¬
posed of two different structural elements, namely, (1) the Nissl
bodies (chromatic, chromatophile, or chromophile part), which
stain deeply with basic dyes, and (2) the achromatic part, which
is not stained by basic dyes. The chromophile part consists of
elements which are generally spindle or rod-shaped. They
occupy the greater portion of the cell-body, and in the large
cells extend some distance into the protoplasmic processes.
They are never observed in the axis-cylinder process, or in the
xone from which this arises.
The achromatic part is in the processes composed of
numerous distinct and exceedingly delicate fibrils; in the cell
body of a network of similar threads, many of which are con¬
tinuous with those in the protoplasmic and axis-cylinder
processes. These fibrils lie embedded in an unorganised mass,
which likewise does not stain with basic dyes. According to
Lugaro and others the chromatic elements are lying in the
spaces of the fibrillar network. Van Gehuchten, on the other
hand, maintains that they are rather to be regarded as an
incrustation upon the fibrils.
It is now universally conceded that the fibrils are the con¬
ducting portion of the neuron. Various views have been
expressed regarding the function of the chromophile elements,.
Digitized by k jOOQle
1898.] by W. F. Robertson, M.D., and D. Ore, M.B. 731
but the general consensus of opinion seems to be that they
constitute a store of material which is utilised during the
activity of the cell. The nucleus of the nerve-cell has lately been
shown to have an exceedingly complex structure. As this
matter is one that has no immediate bearing upon the changes
to which we wish alone to draw attention, we shall not enter
into it here. Suffice it to say that in sections from tissues
fixed in corrosive sublimate and stained with a basic dye the
nucleus of the nerve-cell presents a deeply-stained nuclear
membrane, a comparatively pale intra-nuclear network, and
one, or occasionally two, very dark nucleoli, situated generally
about the centre.
Chromatolysis .—In 1894 Nissl described certain changes
which he found to occur in the cells forming the nucleus of
origin of the facial nerve after section of this nerve. To
these changes, which, it has been found, can be similarly pro¬
duced in other centres, Marinesco applied the name chromato¬
lysis —a term which, though in certain respects a very
unfortunate one, has since been so largely employed that it
is not now likely to be replaced by any other. Chromatolysis
implied originally merely disintegration of the chromatic
elements of the protoplasm. When the term was first used
the great importance of the fibrillar portion of the nerve-cell
protoplasm had not been realised. Since this has been made
the subject of careful study in normal and in pathological condi¬
tions chromatolysis has come to be employed in a much more
extended sense, destruction of the fibrils, and also changes
in the nucleus when accompanying or following disintegration
of the chromophile elements of the protoplasm, being now
regarded as part of the same pathological process.
Chromatolysis is seen perhaps in its most typical form in the
corresponding cells of the anterior horn of the spinal cord
after section of the sciatic nerve. The elucidation of the
process we owe chiefly to the labours of Marinesco and
Lugaro. About two days after the section the chromophile
elements in the neighbourhood of the cone of origin of the
axis-cylinder process begin to break up into fine granules, and
to lose their affinity for basic aniline dyes. This change gradu¬
ally extends to the remainder of the cell-body. In many of the
cells it is followed by displacement of the nucleus to the peri¬
phery, and disintegration of the primitive fibrils of the proto¬
plasm. In advanced stages the nucleus also disintegrates and
becomes pale. The nerve-cells are not all affected equally by
these changes. Many of them, indeed, remain perfectly
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732 Histology and Pathology of Cortical Nerve-cells , [Oct.,
normal. Different degrees of chromatolysis may be seen side
by side. The cells most severely affected become entirely
disintegrated. Others, after three weeks or so, begin to
undergo repair, and are restored to their normal state in from
twelve to fourteen weeks from the time of section of the
nerve.
Changes of an essentially similar kind, though often differ¬
ing in many particulars, have now been shown to occur in the
nerve-cells of the cord or brain in a very large number of
different forms of poisoning produced experimentally. They
have also been observed after ablation of certain organs, in
experimental anaemia, inanition, artificial elevation of tem¬
perature, deprivation of sleep, &c., as well as in numerous
affections of the nervous system in the human subject. In
such cases chromatolysis may be partial or complete; it may
be peripheral, perinuclear, or diffuse; it may involve the
fibrillar portion of the cell, or leave it intact; and it may or
may not be accompanied by changes in the nucleus, either in
the form of displacement or disintegration. Lugaro, who
has been the pioneer in the study of the morbid changes
affecting the fibrillar portion of the nerve-cell protoplasm,
believes that, while the alterations of the chromatic part are
reparable, those of the fibrillar part are irreparable. Altera¬
tions of the nucleus are, he says, the last to occur, accom¬
panying only the more grave alterations of the cytoplasm.
He thinks it is probable that they are only determined when
the resisting power of the cell lias become exhausted. These
conclusions, deduced from careful and laborious experimental
observations, have, as we shall presently point out, very im¬
portant bearings upon the pathology of nerve-cells in relation
to insanity.
Varicose Atrophy of the Protoplasmic Processes .—The patho¬
logical value of many of the changes which have been de¬
scribed by various observers as recognisable by means of
Golgi's method, has lately been seriously questioned. The
observations of Hill and others have shown that the absence
of gemmulpe in such preparations is not necessarily a patho¬
logical change. Lugaro,* who has all along expressed doubt
as to the pathological character of the slight changes, such as
swellings in the form of a rosary, recognisable by means of
Golgi's method, has recently taken up a much stronger posi¬
tion in regard to the question. He says that personal ex¬
perience has rendered him still more diffident regarding the
* liivista di Palologia Nervosa e Mentale , 1897, f. 2.
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1898.] by W. F. Eobertson, M.D., and D. Ore, M.B. 738
value of these varicose atrophies. He states that he has
been able to prove that such varicosities can be produced in
enormous quantities by imperfect fixation, and that he thinks
that it is also probable that mechanical maltreatment of the
pieces of tissue, and even short action of the air upon them,
are able to produce similar modifications. Even in normal
preparations, treated with all possible precautions, he has
sometimes found prolongations with the characters of the
so-called varicose atrophy, changes which he thinks must be
due to some cause which has escaped observation. In the
face of this uncertainty of interpretation which the positive
observation of protoplasmic varicosity presents, negative ob¬
servations assume a greater value. In the course of his work
upon the nerve-cell changes resulting from poisoning by
arsenic and lead,* he has been able to establish the fact that
even when the nerve-cell presents marked cytological altera¬
tions the external form of the element, as revealed by Cox's
modification of Golgi's method, may appear quite intact.
When alterations do appear in preparations by Cox's method,,
they affect specially the cell-body and large protoplasmic
trunks, and, notwithstanding their presence, the fine branches
and the gemmulae may be preserved. He concludes that the
methods of metallic impregnation do not reveal alterations
except in their more advanced phases, when already it is
possible to demonstrate distinct alterations by cytological
methods. He is of opinion that it may be excluded that the
alterations demonstrable with these impregnation methods
begin in the fine protoplasmic branches, or that they are
preceded by loss of the gemmulae. It will thus be seen that
Lugaro does not deny the occurrence of varicose atrophy as a
pathological condition, but he recognises as such only a
change which has characters of a somewhat different kind
from those which have been described by many writers. It
seems to us that these opinions regarding varicose atrophy
expressed by Lugaro—than whom there is certainly at present
no more reliable observer in the field of experimental
neurology—are deserving of entire credence. We had our¬
selves long felt difficulty in accepting many of the views that
were expressed regarding the significance of abnormal ap¬
pearances to be observed in Golgi preparations, and even
before reading Lugaro's paper above referred to we looked
upon that form of varicose atrophy which he has observed in
# Loc. tit.
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734 Histology and Pathology of Cortical Nerve-cells, [Oct.,
experimental lead poisoning as the only one that could be
regarded as of a genuinely pathological character.
Varicose Hypertrophy of the Axis-cylinder Process .—With
respect to this morbid appearance the matter seems to stand
in much the same position. Little varicosities in the form of
a rosary are certainly not exclusively produced by disease.
We are inclined to recognise as pathological only a change of
a much more gross character, consisting in a more general
though still irregular swelling of the process, extending not
infrequently to some of the collaterals.
Occurrence of these Morbid Changes in Cases of Acute
Insanity ; Histological Methods ; Sources of Fallacy ; Occur¬
rence of Chromatolysis in Persons dying in General Hospitals .
—We come now to the question of the occurrence of these
changes in the acute insanities. That they do occur in the
cortical nerve-cells in such cases has already been demon¬
strated, but we are not aware that any systematic research
upon the subject has yet been recorded. We can scarcely
include the recent work of Turner* in such a category, as it
deals only with the giant-cells of the cortex; and we would
further remark that the fresh methylene-blue method which
he has exclusively employed is one upon which very little
reliance can be placed for pathological research. It is
capable of revealing with some distinctness the chromatic
structure of the giant-cells, but we are certain that the same
cannot be said of it with regard to the smaller nerve-cells. It
is a noteworthy fact that very little work has been recorded
upon the pathological changes in the nerve-cells of the cerebral
cortex in comparison with that which has been published
regarding the nerve-cells of the spinal cord. The principal
explanation of this fact lies, we believe, in the circumstance
that observers have experienced the greatest difficulty in
satisfactorily applying to the small nerve-cells of the brain the
staining methods which have proved so successful in the case
of the large cells of the spinal cord and root-ganglia. Using
Heidenhain's method of sublimate fixation, paraffin embedding,
and staining with methylene blue, thionin, and toluidin blue,
according to the technique now generally employed, we have
seldom succeeded in obtaining clear views of the structure of
the human cortical nerve-cells, more especially of that of the
smaller cells. Moreover, in many instances we have found
that the preparations are not permanent, fading to a serious
‘extent even after a few days. Working for a long time
* Journal of Mental Science , July, 1898.
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1898.] by W. F. Robertson, M.D., and D. Orr, M.B. 735
with both methods, we have become more and more thoroughly
convinced of the superior value for the cortex of the methyl-
violet method, which was first described by one of us in the
Journal of Mental Science, last year.*
This method, when successfully carried out upon tissues
fixed in sublimate, gives a view of the chromophile elements of
the protoplasm which far exceeds in clearness and sharpness
of detail any of the pictures which we have been able to
obtain with the modified Nissl methods (Fig. 1). The smallest
cells are as distinctly shown as the large ones. We have
never seen the preparations deteriorate in the slightest
degree. The method permits of the study of chromatolysis
to very great advantage. It picks out with remarkable clear¬
ness ghost-cells and fragments of disintegrating cells, which
for the most part remain quite invisible in Nissl preparations.
We have recently ascertained several important conditions
upon which the success of this method seems to depend. In
the first place methyl violet 6 B should be alone employed. The
iodine solution must be fully saturated. The necessity of
thoroughly drying the sections upon the heater has already
been insisted upon; indeed, the reaction entirely depends
upon the complete removal of water at this stage. Higher
temperatures than 60 ° C. cause the methyl violet and iodine
compound to decompose. With attention to these points we
are now able to obtain practically constant results with this
method. The following is a full description of the process as
we now employ it for the cortical nerve-cells:
Fix very thin slices of tissue in saturated solution of corrosive sub¬
limate in *5 per cent, salt solution (Heidenhain) for twenty-four
hours. Wash shortly in water. Place overnight in 80 per cent,
alcohol to which has been added a sufficient quantity of alcoholic
solution of iodine to give it a dark sherry colour. Change to
methylated spirit (or alcohol of corresponding strength) with a
similar quantity of iodine added. Renew this fluid next day.
On following day change to methylated spirit without iodine.
Cut sections preferably by the dextrine freezing method. It is
essential that they should be very thin. Transfer the sections
from alcohol to 1 per cent, methyl violet 6 B in water. Allow to
stain for from five to ten minutes. Wash shortly in water. Place
in saturated solution of iodine in 2\ per cent, potassium iodide in
water for ten minutes. Wash sections in water. They may re¬
main in this for an hour or so without suffering harm. Take a
section up from the water on a perfectly clean slide. Carefully
* W. F. Robertson, “The Normal Histology and Pathology of the Neuroglia/'
Journal of Mental Science , October, 1897.
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736 Histology and Pathology of Cortical Nerve-cells , [Oct.,
remove water from around it by means of a towel. Next, with a
piece of smooth blotting-paper (folded double) firmly blot the
section in the same way as one blots a sheet of wet manuscript.
Immediately afterwards, without allowing the section to dry in air,
pour over it some drops of a mixture of equal parts of turpentine
and benzole. Place the slide upon a hot plate (described below),
and thoroughly dehydrate the section at a temperature not exceed¬
ing 60° C. If the turpentine benzole tends to evaporate off the
section, add more by means of a pipette. When dehydration is
complete the previously black and opaque tissue assumes a dark
blue and faintly translucent appearauce. Generally from 10 to 15
minutes are required. When the section seems dehydrated re¬
move the slide from the hot plate, allow it to cool, and then pour
off the turpentine benzole. Decolourise with aniline benzole (1 to
2). The aniline oil must be perfectly anhydrous. Renew aniline
benzole two or three times. When colour ceases to come out
wash the section in several changes of pure benzole, and mount in
balsam in benzole.
It is essential that the section should be completely dehydrated.
Any spot in which moisture has been allowed to remain will be
almost completely decolourised by the aniline benzole. On the
other hand, it is important that the slide should be removed from
the hot plate as soon as dehydration is completed, as the colour
then begins to come out to some extent. While the preparation is
being dehydrated on the hot plate the slide should rest on two
parallel metal bars placed on the plate, so that the heat is trans¬
mitted only to the two ends of the slide. Such an arrangement
will be found to prevent the turpentine benzole running off the
section. A small spirit lamp placed below a metal plate resting
on a tripod, can be made to give a sufficient amount of heat to dry
the sections satisfactorily.
We have also used Heidenhain’s iron-haematoxylin method
and staining with Delafield's liaematoxylin, with a view to
studying changes in the fibrillar portion of the protoplasm.
They have not, however, been of much service to us for this
purpose. Lugaro, who has chiefly advocated the use of these
methods, has admitted that they do not succeed so well with
the nerve-cells of the cortex as with those of the spinal
cord and root-ganglia. We have also tried the method of
chrome-oxalic fixation which Graf* has recently declared to
be of such high value for the demonstration of the fibrillar
portion of the nerve-cell. In our hands his solution has given
results which are far inferior to those obtained by sublimate
fixation. We notice that Graf has not recorded the results
of any comparative observations of fixation by chrome-oxalic
* State Hospitals Bulletin , 1S97, p. 368.
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and by Heidenhain's sublimate, which is at the present day
the reagent that is generally regarded as the best fixative for
nerve-cells. After chrome-oxalic, as with sublimate fixation,
normal nerve-cells stained by the iron-haematoxylin method
present the chromophile elements so deeply coloured that the
primitive fibrils are quite obscured except in the axis-cylinder
process. It is only in cells that have undergone a certain
degree of chromatolysis that these fibrils can be seen in the
body of the cell by this method of staining. We are con¬
vinced, therefore, that the figure given by Graf as represent¬
ing the appearance of a normal human nerve-cell stained by
the iron-hsematoxylin method, after chrome-oxalic fixation,
must have been drawn from a cell which had undergone a
degree of chromatolysis. It seems to us that this chroma¬
tolysis is sufficiently explained by the mode of death of the
subject, who was executed by electricity.
Following the recommendation of Lugaro, of the many
Golgi methods now in use we have employed solely the
modification of Cox.
Before describing the morbid changes which we have found
in the cortical nerve-cells in cases of acute insanity we have
still to endeavour to explain the sources of fallacy to which
we have referred. They depend upon the fact that there are
certain causes which give rise to chromatolysis, or to con¬
ditions which more or less closely simulate it, in the cortical
nerve-cells in all persons dying natural deaths. It is, there¬
fore, essential to thoroughly understand the nature of these
changes in order to be able to discount them, before attempt¬
ing to draw any deductions as to the relation of acute insanity
to chromatolysis. One factor which, it appears to us, we do
not require to discount is that of structural modification due
to functional changes in the nerve-cell. These have been
shown by Lugaro to be of so slight a character that they
may safely be neglected in pathological observations on the
human subject. The alterations which it is essential to dis¬
count may be grouped under three headings:—(1) post¬
mortem changes; (2) senile changes; and (3) morbid changes
which arise during the last few days of life in cases of death
from natural causes apart from insanity.
It is only recently that post-mortem changes in nerve-cells
have received the attention which they deserve. Several
Italian neurologists* have recently made careful experimental
inquiries into this subject. The results which they have
* A. Neppi, RivUta di Paiologia Nervosa e Mentals, 1897, f. 4; O. Barbacci
and G. Campocci, ibid., 1897, f. 8; Giulio Levi, ibid., 1898, f. 1.
XLIV. 50
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788 Histology and Pathology of Cortical Nerve-cells , [Oct.,
recorded are in agreement as regards essential details, and it
is therefore now possible to give a reliable description of
these post-mortem changes. Our own observations so far as
they have gone are entirely in harmony with the results
obtained by these Italian observers. It will be readily under¬
stood that the rate of such changes depends largely upon
atmospheric conditions, and will therefore vary considerably
at different times. In the protoplasm the alteration takes
the form of a gradual fragmentation of the chromophile
elements, so that the cell assumes a powdery aspect (Fig. 2).
Frequently there is a running together of the chromophile
elements into several large masses. Before these changes
have proceeded very far the chromophile elements begin to
show diminished affinity for the basic dye, until after two or
three days they entirely cease to retain the stain (Fig. 3).
The most important change in the nucleus is that it stains
deeply and diffusely. Only after three or four days have
elapsed does it begin to disintegrate and become pale. The
nucleolus retains its affinity for the stain for a still longer
period. It will be seen that these alterations differ in some
essential respects from chromatolysis. In post-mortem change
the fragmentation of the chromophile elements is not in the
first instance attended by diminished affinity for the stain.
Indeed, Giulio Levi describes a preliminary hyperchromic
S hase. Further, the fragmentation and pallor always occur
iffusely throughout the cell, and generally to an equal
extent in all the cells. But the most important distinguishing
feature, in the cortex at least, seems to us to be the deep
diffuse staining of the nucleus. Chromatolysis in the cortex,
except at a very early stage, is in our experience invariably
attended by pallor of the nucleus. In their early phases at
least, such as we commonly see in the human brains we
examine, post-mortem changes in the cortical nerve-cells are,
we therefore think, in most instances capable of being dis¬
counted without serious difficulty. We venture to suggest
that some at least of the examples of “ granular degeneration
of the chromophilic material ” recently described by Turner
were of this post-mortem character. Two of the observers
who have studied post-mortem changes experimentally have
also used the method of Cox (Barbacci and Campacci). The
results which they have obtained go to show that varicose
atrophy, having the characters that we have referred to as
being probably alone of an undoubtedly pathological cha¬
racter, is not shrfulated by such changes.
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Fig. 2.
To illustrate article by Dr. Ford Robertson and Dr. Orr.
Bale, Sons & Danielsson, Ltd., Uhrono-Bilk.
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1898.] by W. F. Kobertson, M.D., and. D. Orr, M.B. 739
Hodge* observed in the course of his studies on the nerve-
cells of honey-bees that with advancing age there are not only
alterations in the nucleus and in the form of the cells, but at
the same time a diminution in the number of existing cells.
Lutzenbergert has found that in the healthy guinea-pig some¬
times nearly one in every thousand nerve-cells shows evidence
of disintegration, and he has suggested that in normal adult
life a certain number of nerve-cells are always undergoing
involution, or are in a regressive phase. It seems to us that
there are the strongest anatomical grounds for believing that
this theory is in accordance with actual fact. Probably the
more advanced the age, the greater is the number of cells in
a regressive phase, until in senility quite a high percentage is
reached. We have recently had the opportunity of examining
the brain of a woman who died at the age of ninety from
senility uncomplicated by any serious organic disease recog¬
nisable at the post-mortem examination. Most of the cortical
nerve-cells showed a large collection of yellow pigment in
their interior, often replacing the greater portion of the proto¬
plasm. A large proportion of these cells appeared otherwise
perfectly healthy, showing very clearly marked and abundant
Nissl bodies in the remaining protoplasm, and a normal
number of processes. Very many of them, however, showed
further changes of a disintegrative character, the stages of
which appeared to be as follows. The protoplasmic processes
slowly atrophy and disappear. At the same time the body of
the cell gradually shrinks and loses its angular form. The
Nissl bodies begin to break up and to lose their affinity for
methyl violet. The nucleus begins also to disintegrate and to
stain faintly. Finally there are seen only a few violet
granules representing the remains of the nucleus and Nissl
bodies, accompanied or not by some scattered granules of
yellow pigment. Certainly not less than sixty per cent, of
the cells in this case presented these disintegrative changes,
and probably about ten per cent, had reached the last stages
that can be recognised. It is further to be observed that
there was an evident paucity of nerve-cells in the cortex,
showing that many of them had entirely disappeared.
It is well known that pigmentary changes occur in the
cortical nerve-cells in certain morbid conditions quite apart
from senility. But to discuss this question would be to go
beyond the limits that we have prescribed for this paper.
* Journal of Physiology, 1894.
t Annali di Nevrologia, 1897, f. 5.
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740 Histology and Pathology of Cortical Nerve-cells , [Oct.,
We wish merely to direct attention to these senile regressive
changes, and to insist upon the necessity of discounting them
in studying the nerve-cells of the brain from any case in
which senility is a factor.
We have made a careful study of the cortical nerve-cells of
sixteen patients who died in one or other of the general
hospitals of this city. In every instance we have found that
chromatolysis was present, sometimes indeed in as many as
from 10 to 15 per cent, of the cells. This may seem on first
view a very surprising statement, but a moment's reflection
upon some of the results which have been obtained in the
experimental production of chromatolysis should, it seems to
us, be sufficient to satisfy anyone that the occurrence of such
changes in these cases is exactly what we should expect. An
almost endless number of poisons, including many bacterial
toxines, have been shown to produce chromatolysis in one or
other of its forms, in a larger or smaller proportion of nerve-
cells. Should we be surprised, therefore, that patients who
die from such conditions as septic pneumonia, acute or chronic
tuberculosis, exophthalmic goitre, or malignant disease, present
a certain amount of chromatolysis in their cortical nerve-
cells ?
During the last few hours of life there is frequently a rapid
invasion of the tissues by septic organisms. It has been
shown that toxines such as they form are capable of pro¬
ducing chromatolysis with great rapidity. Chromatolysis
has also been demonstrated to occur from inanition, want of
sleep, experimental uraemia, and experimental anaemia; and
Ballet and Dutil* found it in the cells of the spinal cord after
occlusion of the abdominal aorta for only a few minutes.
With the knowledge of experimental results such as these,
we should certainly expect to find that a considerable per¬
centage of the cortical nerve-cells of patients dying in general
hospitals should show well-marked chromatolysis. But there
is still in many cases another factor at work producing a
similar change to which attention must be specially directed.
Lugaro has recentlyt shown that experimental pyrexia causes
complete disintegration of the chromatic portion of the pro¬
toplasm of cortical and other nerve-cells without producing
any other very marked changes (Fig. 4)« He found that all
the nerve-cells were affected equally. Goldscheider and
Flatail, who had previously studied these changes as they
* Neurolog. Centralbl., 1897, p. 915.
t Rivieta di Palologia Nervota e Mentale , 1898, f. 5.
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JOURNAL OF MENTAL SCIENCE, OCTOBER, 1P08.
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1898.] by W. F. Robertson, M.D., and D. Orr, M.B. 741
occur in the cells of the spinal cord, have observed that the
condition is one that is. capable of being repaired in the
course of a few days. The important bearing that these
observations have upon cortical nerve-cell pathology in the
human subject must be evident to everyone. We have our¬
selves examined several brains, both from the insane and
mentally sound, in which this diffuse change was a marked
feature. It seems to us probable that the five cases described
by Turner, in which he found the chromophilic material com¬
pletely absent from the giant-cells, were cases in which this
pyrexia change had occurred. It is particularly to be noted
that in this chromatolysis from pyrexia the nucleus remains
practically intact. It is therefore easy to distinguish the
condition from chromatolysis of toxic origin, which in our
experience is always, in the cortex at least, attended by
marked changes in this portion of the cell.
A large number of careful observations upon the brains of
patients dying in general hospitals is still required before it
will be possible to fully discount in cases of insanity the
cortical chromatolysis which is caused by the toxic substances
generated in the course of other diseases. It is mainly the
strong conviction that we have of this fact that has caused us
to hesitate for the present to record the results of our obser¬
vations upon the occurrence of chromatolysis in all the cases
of insanity that we have studied. It is only in the acute
insanities, and in general paralysis, that we have found a
percentage of chromatolysis so high as to completely separate
the cases off from those of the mentally sound.
The number of cases of acute insanity that we have been
able to examine is six. All of them died from exhaustion,
accompanied in some instances by hypostatic pneumonia.
Three of them were acute manias, two acute melancholias,
and the sixth was a remarkable case of severe recurrent
mania in which an attack was followed by death from ex¬
haustion. In the acute manias we estimated the number of
cells affected by chromatolysis at about 50 per cent, in one
case, 80 per cent, in another, while in the third every cell
appeared to be involved. In the case of recurrent mania
about 60 per cent, of the cells were affected. In the acute
melancholias the percentage was much lower, being in each
about 25 per cent. But the difference presented by the
cortical nerve-cells in these cases as compared with the general
hospital cases was not merely one of percentage of chromato¬
lysis. There were also differences in the character of the
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742 Histology and Pathology of Cortical Nerve-cells , [Oct.,
chromatolysis. It was in general far more advanced, cells in
the last stages of disintegration being abundant (Fig. 7). At
the same time the pale ghost-cells (Fig. 8), almost devoid of
any stain, which are specially well brought out by the methyl-
violet method, were present in far larger proportion in relation
to the total amount of chromatolysis than in the general
hospital cases. These features point distinctly to a much
longer duration of the morbid process. It is further to be
noted that, in some of the cases at least, there was an appre¬
ciable loss of a large proportion of the nerve-cells. We have
already referred to the difficulty of studying the condition of
the primitive fibrils of the cortical nerve-cells, owing to the
want of a satisfactory method of demonstrating them. But
the observations of Lugaro justify us in assuming that in all
those cells which show distinct disintegrative changes in
their nuclei the achromatic part of the protoplasm has also
undergone disintegration. Such cells are irreparable and
virtually dead. They cannot resume their functions, but must
inevitably disintegrate and disappear.
We believe that in this complete disappearance of a large
percentage of the cortical nerve-cells, and not in the mere loss
of processes or in any peculiar morbid appearances of existing
cells, we have the essential anatomical fact in the pathology
of secondary dementia. We have certainly seen several cases
of secondary dementia in which it could be demonstrated that
at least 50 per cent, of the nerve-cells had entirely disap¬
peared.
Regarding the causes of this very severe degree of chro¬
matolysis in the cortical nerve-cells in these cases of acute
insanity we hesitate to express any definite opinion. We
would only point out that the form of the chromatolysis corre¬
sponds closely with that which has been found to occur in
lower animals from the action of various toxic agents.
With regard to the occurrence of varicose atrophy of the
protoplasmic processes of the cortical nerve-cells in the men¬
tally sound and in the insane, the results of our observations
have been exactly those that the experimental work of Lugaro
would lead one to expect, viz. that in cases in which with
Nissl's method, or with the methyl-violet method, there are
found examples of very advanced chromatolysis, there are
also to be observed examples of varicose atrophy of that form
which, as we have already stated, can alone be relied upon as
being of a genuinely pathological character (Fig. 10). We
have found the condition in the brains of general hospital
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1898.] by W. F. Robertson, M.D., and D. Ore, M.B. 743
patients as well as in those of our cases of acute insanity, but
to a far greater extent in the latter.
We have similar conclusions to record as to varicose hyper¬
trophy of the axis-cylinder process (Fig. 11); but, regarding
the significance of this change, we feel that it is necessary to
speak as yet with still greater reserve.
Description of the Illustrations .
Fro. 1.—Normal pyramidal nerve-cell of human cerebral cortex. Methyl-violet
method. ( x 800.)
Fig. 2.—Pyramidal nerve-cell of human cerebral cortex, showing post-mortem
changes. Methyl-violet method. ( x 800.) The nucleus is stained deeply and
diffusely. The chromophile elements of the protoplasm are partially disintegrated.
Fig. 3.—Pyramidal nerve-cell of human cerebral cortex, showing very advanced
post-mortem changes. From a case upon which the post-mortem examination was
made three days after death. Methyl-violet method. ( x 800.) The chromophile
elements of the protoplasm have entirely disappeared. The nucleus still stains
deeply and diffusely. It shows slight vacuolation.
Fig. 4. —Pyramidal nerve-cell of human cerebral cortex, showing the type of
morbid change that has been found to be produced by experimental pyrexia.
Methyl-violet method. ( x 800.) The chromophile elements of the protoplasm have
disappeared, and the fibrils are abnormally prominent. The nucleus is stained
deeply and diffusely, probably owing to post-mortem change.
Fig. 5.—Pyramidal nerve-cell of cerebral cortex from a case of acute mania,
showing apical chromatolysis. Methyl-violet method. ( x 800.) Note m that the
nucleus is involved in the morbid change.
Fig. 6.—Pyramidal nerve-cell of cerebral cortex from a case of chronic tubercu¬
losis of kidneys and bladder, showing advanced chromatolysis. Methyl-violet
method. ( x 800.)
Fig. 7. —Group of three pyramidal nerve-cells of cerebral cortex from a case of
acute mania, showing very advanced chromatolysis. Methyl - violet method.
( x 800.)
Fig. 8.—Pyramidal nerve-cell of cerebral cortex from a case of severe melan¬
cholia, with death from exhaustion, showing very advanced chromatolysis. Methyl-
violet method. ( x 800.) This is a ghost-cell, or a cell which, while its original
form is fairly well preserved, presents no affinity for stains. In many instances
such cells are perfectly colourless in preparations in which other healthier cells in
the immediate vicinity are deeply stained.
Fig. 9. —Nerve-cell of cerebral cortex of dog, showing protoplasmic processes
with gemmulse, axis-cylinder process, and collaterals. Cox-Mirto method.
( x 500.)
Fig. 10.—Pyramidal nerve-cell of cerebral cortex from a case of chronic tubercu¬
losis of kidneys and bladder, showing varicose atrophy of protoplasmic processes.
Cox-Mirto method. ( x 500.)
Fig. 11.—Axis-cylinder process of cortical nerve-cell from a case of exophthalmic
goitre, showing varicose hypertrophy. Cox-Mirto method. ( x 500.)
Digitized by
744 Histology of the Choroid Plexuses of the Brain , [Oct.,
Observations on the Normal and Pathological Histology of the
Choroid Plexuses of the Lateral Ventricles of the Brain .*
By John Wainman Findlay, M.D., Pathologist to the
Crichton Royal Institution, Dumfries.
I have lately been engaged on a research into the normal
and morbid histology of the choroid plexuses of the lateral
ventricles.
This inquiry, begun at the suggestion of my colleague.
Dr. Gilmour, would have failed but for Dr. Rutherford
supplying necessary instruments, placing unlimited time at
my disposal, and generally facilitating the work, in the course
of which I examined microscopically the choroid plexuses in
sixty-five cases. Of these fifty-nine were from the insane, and
the remaining six were from patients dying in a general hos¬
pital, while for the further study of the normal structure I made
preparations from several absolutely fresh choroid plexuses
of the sheep, ox, and calf. Forty-nine of the plexuses from
the insane were given me by Dr. Ford Robertson, to
whom I am also indebted for much valuable help; while Dr.
Sutherland, of the Glasgow Western Infirmary, kindly sup¬
plied me with the six plexuses from the sane. I also desire
to express my thanks to Dr. John Reid of Milngavie for
many practical hints in photo-micrography.
Some of the results attained I now have the pleasure of
bringing before you, and shall pass in review a few of the
•more salient features in the anatomy and pathology of the
choroid plexus. A demonstration of this nature, however,
must necessarily be incomplete, and I shall be unable to do
more than glance at the theories and opinions of those who
have already made a study of this subject.
Normal Histology of the Choroid Plexus. —It is generally
accepted that the choroid plexus is formed of pia mater,
while the velum interpositum is composed of two layers of pia
mater, between which arachnoidal tissue and blood-vessels
are contained.
As the choroid plexuses are only fringes of the velum
interpositum, one would expect to find arachnoidal tissue here
also; but such is not described, the generally accepted view
being that they are composed of pia mater alone.
Lately, however, Middlemass and Robertson have formu-
* Read and illustrated with lantern slides at the Annual Meeting of the Medico-
Psychological Association, Edinburgh, 1898.
Digitized by
745
1898.] by John Wainman Findlay, M.D.
lated the view that in the soft coverings of the brain two
distinct membranes do not exist. They hold that there is
essentially only one structure throughout, and therefore only
one membrane, which they propose to call “ pia-arachnoid."
To my mind, after an examination of Dr. Robertson's
sections, this contention of the oneness of structure of the
pia mater and arachnoid has been proved, and it seems to me
that the basis of the choroid plexus consists essentially of the
same structure as the pia-arachnoid covering the surface of
the brain, and likewise resembles a spongy lymph sac.
The basis, then, of the choroid plexus is delicate white
fibrous tissue. The white fibres are gathered together into
bundles or trabeculae of varying thickness and length. These
bundles interlace with and cross over one another after the
manner of a network, forming numerous spaces of all shapes
and sizes. These spaces, inaccurately placed above and
alongside of one another, form freely communicating cavities
containing fluid, and are lined throughout by a single layer
of flattened endothelial cells with large oval nuclei.
In the pia-arachnoid on the surface of the brain these
spaces are largest in the centre of the membrane, where they
form the so-called “ subarachnoid spaces," or about the base
of the brain the “ arachnoid cisterns."
Much the same condition may be seen in the more central
parts of the “ glomus " of the choroid plexus—the fusiform
swelling of the plexus regularly found at the junction of the
body of the lateral ventricle with the descending horn,—
where these cavities often attain a considerable size. (See
Photograph I.) This might be taken as evidence that the
choroid plexus consists of two distinct structures, viz. an ex¬
ternal layer of pia mater and a central mass of arachnoidal
tissue. Such, however, I cannot believe. It seems to me that,
as in the case of the pia-arachnoid on the surface of the brain,
there is only one structure throughout. Most marked in the
centre of the “ glomus," the spaces get smaller and smaller as
we pass towards the surface, till it becomes difficult to make
them out. But even here in many cases it is possible to do so,
and at most these relatively dense portions of the plexus are
nothing more than loose areolar tissue formations lying along¬
side distinct and easily recognised sinuses.
The choroid plexus is a very vascular structure, and has
been described by some authors as an erectile or cavernous
tissue. Appearances very suggestive of such a condition are
seen, more especially in the glomus, but these are, I feel sure,
Digitized by Google
746 Histology of the Choroid Plexuses of the Brain , [Oct.,
due to nothing more than the remarkable tortuosity of the
veins and arteries. (See Photograph II.)
The surface of the plexus is beset with a large number of
highly vascular villous projections. These are of all sizes,
and the largest may branch and subdivide many times before
the ultimate villi are formed. Each larger villus has an
afferent artery and efferent vein, which open into a capillary
network lying near the surface. In the smallest villi a capil¬
lary loop in the form of a bow may be seen close under the
epithelium which everywhere covers the plexus. The greater
part of the villus structure consists of epithelium and capil¬
lary, the smaller remainder being made up of homogeneous
connective tissue, with a few oval, spindle, or ramifying cells.
The free surface of the villi is everywhere covered by an
epithelium. This epithelium is described by all authors, with
the exception of Luschka, as being composed of a single
layer of cells. Luschka, however, has described this epithe¬
lium as approaching the stratified formation, recognising not
only two or three layers of cells situated above one another,
but also different developmental forms.
In many cases it can be demonstrated that only a single
layer of cells is present, but then just as often three, four, or
more layers of such cells may be seen, the two conditions
lying alongside one another. Haeckel regards the latter con¬
dition as due to pathological proliferation, but such seems
almost too common for a pathological change, being found in
all my cases, in parts without exception, and likewise in the
choroid plexuses of sheep, calves, and oxen examined.
The individual cells vary in size, ranging from *01 to *015
mm. They are irregularly rounded or polygonal in shape,
and fit closely by means of delicate processes which interlock
between neighbouring cells. In the deepest layer small and
slender processes pass down from the angles of the cells into
the subepithelial layer. It seems to me that this point is of
great importance as tending to support the view that the
choroid plexus epithelium is homologous with the ependymal
epithelium, which has such processes even in adult life. The
protoplasm of the epithelial cell is very granular, and contains
a large spherical nucleus. In addition there is usually present
in the protoplasm a clear yellowish, or even brownish-coloured
highly refractive globule, sometimes approaching the dimen¬
sion of the nucleus itself, but as a rule only attaining a half or
a third of that size. By means of an oil immersion lens, how¬
ever, it may be seen that the granular appearance of the
Digitized by
Google
Fig. 2. Glomus showing usual distribution of veins. Alcoholic Insanity.
(x 26.) a. Veins; b. Arteries ; c. Open trabecular arrangement;
d. Hyaline concentric bodies.
To illustrate Dr. Findlay’s Paper.
Printed and Efi/^dved'by Bale d Danie/sson. Ltd.. Londoi
Digitized by LjOOQle
747
1898.] by John Wainman Findlay, M.D.
protoplasm is in reality due to an immense number of small
globules, which appear of the same nature as the single large
one. Where there are several layers of cells in situ it may be
made out that this vacuolation increases steadily as we pass to
the free surface until cells are reached entirely transformed
into globules, and showing no nuclear staining. Beyond this
again the cells discharge their contents by breaking up, some¬
times leaving an empty cell membrane to indicate where they
have been. Before the cell actually breaks up the globules
may run together to form a single large sphere. Drops and
globules similar to those met with in the epithelial cells them¬
selves may be demonstrated in the ventricular fluid. Pro¬
bably, however, they do not remain as such for any length of
time, but break down or become dissolved.
There is no doubt to my mind that the choroid plexus is an
actively secreting structure, discharging its secretion into the
ventricular cavity. This secretion is formed by a constant
proliferation of the epithelial cells, which elaborate in their
interiors peculiar mucin-like globules, and only seem capable
of doing so once. The cell wall ultimately gives way, and
these globules are discharged into the ventricular fluid. Such
transformation and discharge is continually going on, and the
outermost layers of epithelium are practically dead structures.
They have fulfilled their purpose, and may be said to have
died in doing it.
Pathological Histology of the Choroid Plexus .—Passing to
consideration of pathological appearances met with in the
choroid plexus, we take first the hyaline concentric bodies,
which constitute a border-land between the normal and
the abnormal. W. F. Robertson, who has investigated the
origin and nature of these bodies in the dura mater and pia-
arachnoid, is of opinion that they exist normally, but that they
are found in a profusion in the insane that they are never met
with in the mentally sound; and I may say that I am of like
mind.
The usual form of these bodies is round, and as a rule each
is surrounded by a well-marked hyaline capsule, or even a
capsule of fibrous tissue. They are marked with concentric
rings, these markings varying in intensity and number in
individual bodies. The round is not the invariable shape:
many different forms may be produced from several spheres
coming together. Thus we may have dumb-bell, trefoil, or
very irregularly shaped figures, the interior showing distinct
concentric bodies with rings of their own, while beyond these
Digitized by LjOoq Le
748 Histology of the Choroid Plexuses of the Brain } [Oct.,
is a surrounding stratification common to the whole structure.
Rod-shaped bodies are occasionally found, but they are
decidedly rare. (See Photograph III.)
These concentric bodies are not merely deposited from the
tissue fluids, as Virchow and others state. They are the result
of proliferative and hyaline-degenerative changes in the endo¬
thelial cells lining the connective tissue trabeculae of the
plexus, as W. F. Robertson has shown in the dura mater and
pia-arachnoid.
The endothelial cells swell up, lose their affinity for nuclear
stains, and finally assume the form of a homogeneous hyaline
sphere, staining faintly with eosine in haematoxylin and eosine
preparations. Each may attain a very considerable size. One
of them may form a small concentric body, but as a rule
several spheres, probably of a semi-fluid consistence, coalesce
to form the more usual concentric body. The concentric
markings appear subsequently, and, as W. F. Robertson sug¬
gests, are most likely due to shrinkage. The fibrous capsule
so frequently present is added later, after the manner in which
nature encapsules all foreign bodies, and in all probability
the fibrous tissue is developed from the still healthy endo¬
thelial cells.
While the above is the most common mode of development
of concentric bodies, I do not think that it is the invariable
one. When hyaline degeneration attacks the arterioles it may
obstruct them and convert them into hyaline rods. Venules
and capillaries, the walls of which are thickened by hyaline
degeneration, also form concentric bodies, the ultimate
occlusion of the vessels being brought about by a proliferation
of the endothelial cells lining the vascular tube. (See Photo¬
graph IV.)
In conclusion, the hyaline material is an exceedingly un¬
stable substance, causing considerable variations and anomalies
in staining. In senile cases, however, these bodies are usually
found to be impregnated with lime salts, as proved by
effervescence on addition of hydrochloric acid. Moreover it
seems not at all unlikely, from the reaction with osmic acid,
that they, previous to calcification, undergo retrogressive fatty
change, as so frequently happens in the case of calcifications
elsewhere.
Still on the border-land of the pathological are the cysts of
the choroid plexus. These cysts are so commonly found that
Faivre, writing in 1855, described them under the name of
"choroid vesicles,” as normal and peculiar to the human
Digitized by kjOOQle
JOURNAL OF MENTAL SCIENCE, OCTOBER, 189ft.
Fig. 3. Irregular forms of hyaline concentric bodies.
Puerperal Insanity. ( x 120.)
Fig. 4. Development of hyaline concentric bodies. Wall ^ ^
of venule enormously thickened from hyaline degener- _'
ation, proliferation of the endothelial cells. General
Paralysis. (x 240.)
To illustrate Dr. Findlay’s Paper.
Printed and Engraved by Batf^dMinjefsson. Ltd.. London.
Digitized by VjfOOyLv,
Digitized by t^ooQle
749
1898.] by John Wainman Findlay, M.D.
subject. I found them in fifty-seven per cent, of cases
examined.
These cysts may be little larger than a pin's head, or they
may reach the size of a pea. In some cases they are few in
number, in others they are very numerous, the whole glomus
being converted into a cluster of cysts like a bunch of grapes.
The walls of the cysts are very delicate, and numerous fine
vessels may be seen coursing over their surfaces, which
display a fine white dotting, due to concentric bodies
embedded in them, or to small aggregations of cells filled
with fatty granules. The surface of the cyst, moreover, is
very often destitute of an epithelial covering. Near the base
of such a cyst the epithelium may be quite distinct, but as the
summit is approached the cells become scattered with a bare
patch here and there, till finally a portion is reached where no
epithelial cells can be seen. The interior of the cyst is made
up of a very open network of connective-tissue trabeculae,
which are lined by degenerated and degenerating endothelial
cells, scarcely one of which presents normal features. The
spaces are filled with a thin fluid, in which float cells in
different degrees of degeneration. Concentric bodies are of
very frequent occurrence throughout the cyst. All around
this looser and more open network, and gradually blending
with it, is a dense tissue in which there has been very exten¬
sive proliferation of the endothelial cells lining the trabeculae,
and associated with this usually some thickening of the
trabeculae themselves. (See Photograph V.)
I have arrived at the following conclusions as to the origin
of these cysts. Hyaline concentric bodies and hyaline spheres
are very commonly found in them. The degenerative process
in the endothelial cells of the trabeculae in cystic formation
is very similar to that which precedes the development of con¬
centric bodies. Indeed, so close is the resemblance that it is
very questionable if we are entitled to discriminate between
them. Still, to my mind there is no doubt that cells
break down into fluid in the cysts in a manner that never
occurs apart from them. But this degeneration of cells alone
does not seem sufficient to account for the development of
these cysts, though there is no doubt that the fluid found in
them is in part due to this bursting of the endothelial cells
affected with colloid or hyaline degeneration. In all the
cysts which I had an opportunity of examining the fluid was
quite limpid. Colloid cysts with gummy viscid contents
have, however, been described by Wallmann and Hoffmann.
Digitized by CjOoqL e
750 Histology of the Choroid Plexuses of the Brain , [Oct.,
■#
It seems more than probable that there are two processes
engaged: firstly, a proliferation and degeneration of the
endothelial cells, frequently associated with hyaline changes
in the trabeculae; and secondly, a resulting condition of
oedema.
Through the spaces of the choroid plexus there must be a
CQnstant circulation of lymph. This proliferation and de¬
generation of cells in many cases completely fill up these
spaces, and must constitute a serious obstacle to the flow of
lymph. Hyaline spheres may also eventually block them up.
Concentric bodies must have the same effect, and these are
never present in any numbers without a concomitant develop¬
ment of cysts. There exist, then, very numerous points of
obstruction, behind which the lymph stream is constantly
pressing. There is, in short, an obstructive oedema. The
spaces of the pia arachnoid become more and more distended
with the lymphatic fluid, and larger spaces still are produced
by the breaking down or absorption of intervening tra¬
beculae, while the cyst itself results from a number of such
spaces lying adjacent to one another. The degenerating
endothelial cells add to the fluid, and where the tendency is
for the cells to rupture, then are the contents of the cyst
colloid. In other cases, again, where the greater number of
the degenerated cells goes to the formation of concentric
bodies, the cystic fluid tends to be thin and limpid. Finally,
such a collection of fluid may be shut off from surrounding
parts by the occurrence behind the fluid accumulation of the
same changes which led to the obstruction in front; and the
frequency with which dense tissue is found all around the
cyst seems to point to such a conclusion.
Among the truly pathological alterations met with in the
choroid plexus, the hyaline fibroid change in the vessels is
perhaps the most important. This condition may be found
in all the vessels, but it seems to affect mainly the arteries
and capillaries. Of the arteries, the smaller ones and the
arterioles show this degeneration to the greatest extent. The
adventitia alone, or the intima and media together, may be
affected, but by far the most common condition is to find the
whole three coats involved.
Hyaline degeneration of the adventitia consists in a homo¬
geneous thickening of the longitudinally running fibrous
tissue. This swelling may be slight or considerable, stains a
faint pink with eosine, and, as a rule, is devoid of granu-
Digitized by L^OOQle
JOURNAL OF MENTAL SCIENCE
Fig. 5. Cysts of choroid plexus.
Fig. 6. Section of arteriole, showing several layers of
elastic lamina*.
To illustrate Dr. Findlay’s Paper.
Printe$MW^$$'MwtfwMhfe { & Danielsson Ltd.. London.
Digitized by t^ooQle
751
1898.] by John Wainman Findlay, M.D.
larity. In the normal condition in the arterioles the ad¬
ventitia is only made out with difficulty, whereas the diseased
adventitia alone may be two or three times the thickness
of the original wall. The adventitia never becomes much
thickened without the muscular coat showing similar changes,
as shown by the loss of nuclear staining in the media and the
presence of dilatations.
The muscular coat of an artery, as a rule, is only involved
secondarily to a hyaline degeneration of the intima, the ex¬
planation of this being that the media derives its nourishment
from the interior of the vessel, and not from without as in the
case of the adventitia. Consequent on the intimal thickening
a starvation of the muscular fibres is brought about, and this
leads to their degeneration. The nuclei of the muscular fibres
lose their property of staining with haematoxylin, and ulti¬
mately a homogeneous, finely fibrillated, or granular mass
results, staining faintly or darkly with eosine.
Normally in the arterioles, when cut longitudinally, the
intima appears as a thin even band of tissue. The intima
rarely becomes so much thickened and swollen as the adven¬
titia. In some cases this hyaline thickening is very irregular
on its external surface, dipping down into the degenerated
muscular layer, and pushing the elastic lamina before it. In
no case, so far as I have seen, does the elastic lamina itself
undergo this hyaline change. It may become absorbed and
disappear, but when present it continues to separate the
intima from the media, dipping down into the latter, and
forming in it numerous loops in order to fulfil its purpose.
The hyaline thickening of the intima is ultimately replaced
by fibrous tissue, mixed up with which may be seen elastic
fibres or bundles, and instead of the single normal fenestrated
membrane there may be several elastic laminae, two, three, and
four being met with. (See Photograph VI.) In these endar-
teritic vessels the wavy course of the elastic lamina becomes
still more wavy, and the lamina itself is increased in thick¬
ness. In other cases, again, it looks almost as though the
entire intimal thickening was due to an hypertrophy of the
elastic lamina, with only a few cellular elements separating
the different layers.
Under normal conditions, in any of the arteries in the
choroid plexus the elastic lamina appears as if composed of a
single layer of elastic tissue, this layer varying in thickness
with that of the artery. Still it may be possible that even
here, as in the case of the larger arteries elsewhere, the elastic
Digitized by L^ooQle
752 Histology of the Charoid Plexuses of the Brain , [Oct.,
lamina is made up of two or three layers, though such cannot
be demonstrated.
That the extra elastic laminae owe their origin to a bursting
asunder of these layers by new-formed tissue, as held by Carl
v. Rad and Rumpf, seems not at all unlikely. Thus two
elastic laminae are explained by the division of the primary
layer, three by a further division of the secondary lamina,
and so on. But it seems to me that the process, though in
part, is not altogether mechanical, for there is no doubt that
in many cases the elastic lamina is very distinctly hypertro¬
phied. It becomes thickened and lengthened, so that its
normal sinuosity is much increased. If the elastic lamina
did not play an active rdle the thickened intima would tend
to obliterate the normal windings, making the elastic layer in
parts quite straight.
Heubner has observed several elastic laminae in syphilitic
endarteritis, and explains their occurrence as follows :—“ When
the endothelium is no longer caused to proliferate cells from
syphilitic irritation its normal function begins. It forms a
fenestrated membrane over the new-formed tissue, as it
formed the same in young organisms over the muscular layer
This further explanation of Heubner appears to me to be in
accordance with the facts, and has more lately been supported
by Lowenfeld. It accounts most satisfactorily for those cases
in which a secondary elastic lamina is found immediately
under the endothelium, separated by a considerable distance
from the original lamina by new fibrous tissue, and, so
far as can be seen, in no way connected with the original
lamina.
As already mentioned, cases are occasionally seen in which
the entire intimal thickening seems to consist of elastic tissue.
From a consideration of these we must, I think, conclude that
the elastic lamina is a vital structure, and that under certain
circumstances it is capable of proliferation and growth.
Little fusiform dilatations and sacculations, of the smaller
arterioles especially, are frequently met with, and these,
without doubt, are closely related to and dependent on
hyaline degeneration in the vessel coats. A form of this
is what Lowenfeld calls "die Rosenkranzform des Mus-
cularisrohres,” from its resemblance to a rosary. There
is throughout the arteriole a mild degree of hyaline de*
generation and thickening of the intima, and this, though
slight, has been sufficient to interfere with the nutrition of
the muscular layer. The elastic lamina is present through
Digitized by LjOoq Le
753
1898.] by John Wainman Findlay, M.D.
practically the whole length of the section. Wherever the
media has degenerated, as shown by the loss of nuclear
staining in the muscular fibres, the vessel wall has yielded to
the pressure of the blood, leading to the formation of a little
fusiform dilatation. Moreover where sacculation has occurred
it may be noted that the thickening of the adventitia—like¬
wise hyaline in this case—is less marked, while at the one
point where the vessel presents a narrowed lumen this thicken¬
ing is more extreme.
Such an arteriole may become occluded, more usually by
thrombosis occurring on the altered vessel wall than by the
hyaline thickening alone. The thrombus ultimately becomes
hyaline, and it is impossible to distinguish it from the original
wall of the arteriole.
Very rarely the “ Rosenkranzform ” dilatation becomes more
and more extensive, till ultimately a miliary aneurism is
formed. The development of such an aneurism must have
been gradual, allowing sufficient time for a reparative process
to take place in its walls. This would be brought about first
of all by the proliferated endothelial cells invading the hya¬
line mass, till a condition of endarteritis would be produced.
But the growth of the aneurism would not be arrested here.
So long as the tissue was incompletely formed dilatation
would go on, and would only cease with the complete conver¬
sion of the granulation into fibrous tissue. These miliary
aneurisms are true aneurisms, and not merely, as Eppinger
holds, examples of ectasis or dilatation in which all the coats
of the vessel are present. No muscular tissue can be de¬
tected in the wall of a miliary aneurism, and the arteriole
entering shows hyaline degeneration of both its intima and
media.
So far as my experience goes, vascularisation of either the
hyaline or fibrous thickenings does not occur to any extent.
Newly formed capillaries are not infrequently found in the
thickened adventitia, but never have I seen new-formed
vessels in the thickened intima of the arteries and arterioles
found in the choroid plexus.
In the time at my disposal I have been unable to overtake
more than the pathology of hyaline concentric bodies, cysts,
and blood-vessels. The two former are due, in the main,
to proliferation and degeneration of the endothelial cells
lining the trabeculae, which may, however, proliferate and
degenerate otherwise. In conclusion I may state that all the
connective-tissue and endothelial changes commonly found in
xliv. 51
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754 Histology of the Choroid Plexuses of the Brain . [Oct.,
the pia-arachnoid of the insane are similarly met with in the
choroid plexuses of the lateral ventricles.
Discussion.
Dr. Ford Robbrtson said he agreed so fully with Dr. Findlay that he had no
criticism to offer, but he had to express the very great pleasure they had in seeing
those beautiful photographs, and to follow his description of the pathological changes.
He had quite demonstrated that the choroid plexus was a secreting gland. That
was of the highest importance in neurology.
The Correlation of Sciences in Psychiatric and Neurological
Research* —By Ira Van Giesen, M.D., Superintendent of
the Pathological Institute of the Commission in Lunacy
of the State of New York.t
Before this body it is unnecessary to revert to the inade¬
quacy of conducting scientific investigations in psychiatry
along the restricted plan of confining the research to material
found within the asylum by some one exclusive department of
investigation, such as the routine governed and mechanical
methods of microscopical research. This restricted plan has
largely governed psychiatric research up to the present time.
Now, however, that many of the sciences tributary to psychia¬
try have attained a growth and capacity to be of service in
psychiatric research, the restricted plan of research may be
relegated to the past.
The phenomena of insanity are manifold, and the compre¬
hension of them can only be grasped when viewed from many
different standpoints—from the standpoints of many sciences.
A co-operation of many sciences will bring forth a rich return
* For presentation to the Annual Meeting of Medico-Psychological Association,
Edinburgh, 1898.
f Iu an official report of thePathological Institute of the New York State
Hospitals to the State Commission in Lunacy for transmission to the legislature,
the writer has endeavoured to urge the necessity of a more comprehensive view
of study of the science of psychiatry. This report is composed of the following
sections:
1. The beneficial results of scientific investigation of insanity.
2. The inadequacy of the present methods of investigating nervous and
mental diseases.
3. The correlated branches of research in the scientific investigation of
insanity.
4. The unclassified residuum.
5. General remarks on the organisation and conduction of the Pathological
Institute.
From its nature this report had to be written in an untechnical form. This
paper embodies in substance Sections 3 and 4 of this report.
Digitized by LjOOQle
Ira Van Gjesen, M.D.
755
1898.]
of theoretical and practical results. A many-sided compre¬
hensive scientific investigation of insanity is at present an
imperative necessity. We are on the threshold of a new era
in the study of the nervous system in both its normal and
abnormal manifestations. The inauguration of this era
requires the many-sided investigation of the phenomena of
insanity. Different branches of science must be co-ordinated
and focussed together as a search-light on the mysteries of
mental diseases. They must all work hand in hand. They
must be linked together and correlated, otherwise the whole
aim of the work is defeated ; the investigation will become
one-sided and restricted, and what few facts are gained will
not be open to comprehensive interpretation.
In accordance with the tenor of these introductory remarks,*
the director has established several departments of scientific
research at the Pathological Institute for the investigation of
insanity, and each of these departments is presided over by
an associate who has made a life study of the subject under
his charge.
Without further preface I may invite your attention to the
plan of the correlation of sciences in the investigation of
nervous and mental diseases, a plan which brings psychiatric
research into the great broad domains outside the province of
the asylum, and which at the same time does not neglect the
value of many important scientific problems within the sphere
of the asylum. If, on the one hand, protests are made here
and there against the exclusive plan of restricting psychiatric
research to asylum material, on the other hand a corresponding
endeavour has been made to indicate the more inviting fields
of psychiatric research open to the comprehensive plan of the
co-ordination of many branches of scientific investigation.
This glance at the value of the correlation of sciences in the
investigation of mental diseases may perhaps be presented by
reviewing the several departments of investigation established
at the scientific centre of the New York State Lunacy System.
Such a review must be made exceedingly brief, and touch
only on salient features. These several departments which
have been deemed necessary for a broad, comprehensive
investigation of mental diseases are as follows:
I. Psychology and Psycho-pathology.
II. (A) Normal and (B) Comparative Histology of the
Nervous System.
* This refers to Section 2 (“ The Inadequacy of the Present Methods of In¬
vestigating Nervous and Mental Diseases 1 *) of the report from which this paper
is extracted.
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The Correlation of Sciences in Research, [Oct.,
III. Cellular Biology.
IY. Pathological Anatomy, Bacteriology and Physiological
Chemistry.
V. (A) Experimental Pathology and (B) Hasmatology.
YI. Anthropology.
It will now be in order to review these several departments
in their serial order, to consider how their investigations bear
on insanity, and their relation and combined value in solving
some of the problems in mental and nervous maladies.
I. Department op Psychology and Psycho-pathology.
The crowning glory of psychology in these days is its
emancipation from metaphysics. Psychology has become a
science. It has finally shown that the phenomena of the
human mind are not vague and mysterious, but that their
understanding is to be gained by methods of investigation
such as are pursued in elucidating the phenomena of the
world of life and matter generally ; by means of the same
general methods of investigations which we use in gaining
knowledge of a distant star or tiny organism. Modern
psychology is hard at work at the laboratory table, gathering
facts, using instruments of precision, conducting experiments,
assimilating similar work from kindred branches of science.
In brief, modern psychology is one of observation and experi¬
mentation as against speculation on the nature of the soul.
It is building a foundation of facts to rest the superstructure
of its doctrines and generalisations and laws of phenomena of
the mind. All this has been brought about practically by the
development of the science in this century. Weber and
Fechner introduced scientific and inductive methods into
psychology. They founded psycho-physics. Fechner in¬
vented new methods to study the laws governing the relations
of the intensity of sensations to their stimuli. Helmholtz
contributed much to psychology by his psycho-physiological
studies on sensations. His magnificent intellect enabled him
to apply the methods of a whole group of sciences, for he
was mathematician, anatomist, physiologist, and a brilliant
worker and technician with the microscope in unravelling the
tangled fibres of the nervous system. Wundt introduced
into psychology the most valuable of all methods in science,
namely, the experimental method, at the Psychological
Institute at Leipsic. In England John Stuart Mill, Bain,
Spencer, Ward, Sully, and others, in Italy Mosso and others,
have contributed their share to psychology. The names of
Digitized by
757
1898.] by Ira Yan Giesen, M.D.
Professor James and Professor Munsterberg are not to be
omitted in this hasty sketch of the evolution of psychology
into an exact science.
If the labours of general normal psychology have grown more
scientific and practical, the work of psycho-pathology, em¬
bracing the psychological study of abnormal or pathological
cases, has turned out to be of special importance not only from
a theoretical standpoint in revealing the inner organisation of
mental life, but also from a purely practical standpoint, since
it has furnished the key to the understanding and even the
treatment of functional nervous and mental diseases. The
results of psycho-pathology, some of which were obtained in
our Institute, are brilliant in the extreme; they may be con¬
sidered a treasure for medical science in general and for psy¬
chiatry in particular. No psychiatrist, no neurologist, can be
efficient in his respective science without a knowledge of
psycho-pathology. Functional neurosis, that pons asinorum
of the neurologist and psychiatrist, and of the medical pro¬
fession in general, can only be intelligently studied and suc¬
cessfully treated through the medium of psycho-pathology.
Psycho-pathology is the sine qua non of the science of insanity,
because insanity is a manifestation of more or less persistent
pathological phenomena of consciousness, and psycho-pathology
alone possesses the methods of investigating these pathological
phenomena.
The work of the French school is particularly important
because of its remarkable contribution to the science of
S sycho-pathology. The French school, with Ribot, Binet, and
anet at its head, hasbeen studying man’s subconscious domain,
a subject of the most profound importance, not only in that it
touches the heart of man’s social attributes, but that the
understanding of the nature of the subconscious is absolutely
essential for any intelligent conception of the cause and course
of mental maladies.
Finally the brilliant psychological and especially the psycho-
pathological studies of Dr. Sidis, on dissociations in conscious¬
ness , linked with the parallel physiological dissociation of different
realms of the brain , mark an important stage in the progress
of psychology , and particularly psycho-pathology . In Dr.
Sidis’ researches and studies of psycho-pathological cases,
parts of the brain were dissociated from each other, and the
parallel psychic manifestations could be studied by themselves.
Such experimental and clinical investigations help not only to
understand, but also to treat the similar isolated fields of
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758 The Correlation of Sciences in Research, [Oct.,
consciousness in different forms of nervous and mental
diseases.
Psychiatry is especially indebted to psycho-pathology, be¬
cause it is only through psycho-pathology that psychiatry has
any hopes of becoming a science relevant to its subject matter,
and of having practical methods of treatment based on a solid
scientific foundation. In fact, we believe that psycho-patho¬
logy will ultimately replace the present would-be science of
psychiatry. This sounds paradoxical, for psychiatry is
generally considered to be the science of insanity. It claims
the insane as its own. Unfortunately, psychiatry is a science
in name only; it endeavours to be scientific, but fails in its
attempt.
Psychiatry, in a certain sense, is an overgrowth of applying
the methods of investigation of bodily diseases to those of the
mind. Now it is absolutely hopeless to expect that methods
applied to investigations of symptoms of somatic diseases are
fit to apply to the investigation of mental maladies. These
methods are absolutely incompetent, and even to a certain
extent irrelevant.
The observation of the abnormal phenomena in insanity
relates to two groups of manifestations—the somatic and the
mental. The somatic or abnormal phenomena of the body,
including the abnormal manifestations of the lower parts of
the nervous system, such as paralysis and the coarser and
more obtrusive abnormal symptoms of the sense organs, may
be observed by the clinical methods of investigation. But in
the study of abnormal mental phenomena, the disturbances of
the higher forms of consciousness, and the whole domain of
psycho-motor phenomena concomitant with dissociations of the
higher spheres of the brain (where the nerve-cells reach their
highest complexity of organisation in communities, clusters,
and constellations) lie beyond the scope of clinical methods of
observation, and fall within the province of pathological
psychology or psycho-pathology .
It should be more universally realised that there is a sharp
dividing line between the efficacy of clinical and psycho-
pathological methods of investigation in the study of insanity.
This is an important matter, and one about which we should
have clear and definite ideas in order not to make the mistake
of believing that mental phenomena may be competently
observed by clinical or somatic methods of investigation.
Psychiatry, obeying the natural laws governing the general •
progress of science, is still clinging to clinical methods of
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759
1898.] by Ira Van Giesen, M.D.
investigation, in attempting to explore a territory beyond
their scope. No fault is to be found with psychiatry for this
state of affairs. If any criticism were justifiable, it should be
regarded unfortunate that the psychologist has been so back¬
ward in taking up the study of pathological psychic pheno¬
mena, or psycho-pathology, and paving the way for the
psychiatrist.
In discussing advance work in the study of abnormal
organic life in the hospital, let us relegate clinical methods of
investigation to their proper province, and not attempt the
impossibility of stretching them over into the domain of
abnormal mental phenomena, which can only be efficiently in¬
vestigated by the methods of psycho-pathology. This same
distinction between clinical and psycho-pathological methods
of investigation deserves reflection in the study of nervous
diseases . Psychiatry ought to embrace both fields of research
in the study of insanity, the mental as well as the somatic;
namely, the investigation of the abnormal somatic phenomena
and the pathological phenomena of the lower parts of the
nervous system by clinical methods, and the investigation of
the pathological mental phenomena by the methods of psycho^
pathology.* It would seem appropriate, however, at present,
to pin psychiatry down to the former domain where it
belongs, and assign the latter to its proper sphere, patho.-
logical psychology or psycho-pathology. It is questionable
if the psycho-pathologist would concede that even the patho¬
logical manifestations of the lower parts of the nervous
system (and the effects of disease of these lower portions
upon the higher ones), especially in functional diseases, can be
properly and completely investigated by the clinical methods
of neuro-pathology and psychiatry. For all parts of the
nervous system are too intimately inter-related in an organic
whole to expect that the normal or pathological manifesta¬
tions of these lower parts of the nervous system may be
thoroughly comprehended by being isolated from the rest of
the system and studied by themselves ; or that the pheno¬
mena of any part of the system may be fully explained with¬
out a comprehensive knowledge of the phenomena of all other
parts, the highest, the lowest, as well as the intermediate
parts. Viewed in perspective, the foreground of consciousness
* These methods and their application to the investigation of pathological
mental manifestations are described by Dr. Sidis in a work coming from the
Department of Psychology and Psycho-pathology, now in press for a coming
number of the Archives of Neurology and Psycho-pathology .
Digitized by
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The Correlation of Sciences in Research, [Oct.,
looms up beside the activity of the highest spheres of the
brain composed of the superlative constellations of neurous,
while the vanishing point stretches away far down beside the
activities of the lower and lowermost parts of the nervous
system composed of mere elementary chains and series of
nerve-cells. Thus psycho-pathology dealing with the patho¬
logical manifestations of consciousness comprises a study of
the phenomena of the lower parts of the nervous system as well
as the higher portions, and embraces especially the inter¬
relation between the two sets of phenomena in functional
diseases .
In the natural evolution of medicine, symptoms of bodily
disease were worked out and differentiated first; then, after a
wearisome halt behind all other departments of medicine, in¬
sanity was finally recognised as the symptom of abnormal
conditions of the brain, and the methods of studying bodily
symptoms were dragged over into the field of mental
symptoms.
Psychiatry is an art and poses as a science. As an
art it has done much. The simple recognition of the fact
that insanity is a symptom of abnormal brain conditions, and
the beating down of the ignorance of superstition which held
the insane to be possessed of devils, accomplished an enor¬
mous amount of good, and resulted in an enlightened care of
their material welfare in our present hospitals for the insane.
But we ought not to mistake these advances in the art of
psychiatry and think that they are scientific advances. In
its wider sense, the art of psychiatry attends to the welfare
of the insane as a dependent and helpless class upon the
community.
The science of psychiatry deals with the whence and where¬
fore of mental diseases. The answer to these questions, how¬
ever, psychiatry as a science has utterly failed to accomplish.
A very simple and most elementary stage in the science of
psychiatry was the recognition of the general fact that in¬
sanity is the symptom of pathological brain processes. This
recognition rescued the insane from social revenge, at a
later period from social indifference, and finally stimulated
the active interference on the part of society for their wel¬
fare and humane treatment in the modern hospital of to-day.
If all this progress in the art of psychiatry has been born of
such an elementary and embryonic stage in its evolution as a
science, how much more are we to expect in the prevention
and cure of insanity in the future progress of this science ?
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1898.] by Ira Van Giesen, M.D.
For as a science psychiatry is yet unborn, and can be brought
into tho world only by the aid of psycho-pathology. We
now realise clearly the fact that writings from the standpoint
of psychiatry as an art must not pass for scientific disquisi¬
tions.
The psychiatrist on account of the incompetency of his
methods is driven into the art field of psychiatry under the
delusion that he is doing scientific work. Many in the field
of psychiatry unconsciously bear out the criticism that
scientific methods of investigating the symptoms of mental
disease are merely an overgrowth of the methods used for
investigating symptoms of bodily disease, by writing fine
descriptions of the bodily ailments of the insane. Fractures
and dislocations of the insane, the formation of their teeth,
their palates, their hair, the occurrence of various complicat¬
ing body diseases, are published in detail because the present
psychiatric methods of investigation are better adapted to
this sort of observations than for the investigation of in¬
sanity itself. Others find an opportunity for writing on
medico-legal matters relating to the insane; still others
find distraction in the elaboration of statistics; others, again,
in the field of therapeutics. Therapeutics, it is true, based
on empirical knowledge of drugs, has the recommendation of
much common sense, because the knowledge gained thereby
is founded on experience ; but experience without reason is
blind. Tho administrations of drugs, particularly in the
insane, must rest on a rational basis, and this rational basis
cannot come until we have an understanding and scientific
explanation of insanity. When that time comes we may
give fewer drugs, and probably in less quantities.
The pointing out of the unscientific character of this kind
of literature may be unwelcome or unpleasant to many who
#re in daily touch with the insane. But if larger, broader,
and more inviting fields of real scientific investigation are
indicated, no fault ought to be found with this presentation
of the status of psychiatry. This should be reserved for those
who criticise the work of the psychiatrist unintelligently, and
who offer no new pathways tor the old ones. It must not be
understood that this pseudo-scientific psychiatric literature,
substituted for scientific work now possible by the advance of
science, has no value. It has its peculiar interest; the only
trouble with this psychiatric literature is that its fields of
investigation are harrowed out.
The investigation of the somatic phenomena of the insane
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The Correlation of Sciences in Research, [Oct.,
is of the most vital importance not only theoretically but
practically in their treatment, because from the body is
derived the nourishment and the source of energy of the
nervous system. It is therefore of the utmost consequence
to understand the relation of disorders of the body to the
interferences with the food supply of the nerve-cells and the
exhibition of toxic agents to these cells. The general somatic
symptoms in insanity should be re-written and revised as often
as there are new discoveries and new theories in the progress
of the pathology of bodily symptoms. Moreover, the bodily
symptoms in each case in the hospital as an individual,
irrespective of its class grouping or particular form of insanity t
should receive detailed investigation because of the primal
importance of the relation of the body to the brain.
We must be in possession of all the knowledge possible
regarding the bodily ailments of the insane and of those
things that pertain to psychiatry as an art, but most of them
are indicating a tendency towards stereotyping in the journal
literature; and, frankly speaking, gynecological matters,
sprains, dislocations and fractures, the symptomatology of
mere secondary complicating diseases of the body, such as
fever, &c., are really rather roundabout ways of getting at the
scientific investigation of the explanation of the mental
symptoms in insanity .
As an example of the tangle in which psychiatry finds
itself at present, one may point to the hydra-headed classifi¬
cations of mental diseases with fifty-four varieties of mania,
and an equal number of melancholia, given in a standard
compendium. There must be something wrong tvith a science
that finds itself in such straits. Psychiatry has no methods
appropriate for the investigation of abnormal mental pheno¬
mena. It must broaden out. As a science, psychiatry is
absolutely dependent upon psychology and psycho-pathology
and their co-relative branches of science. Psychology and
psycho-pathology have developed the real methods for gaining
the facts, observing the phenomena, and conducting the ex¬
periments that psychiatry needs. The great value, then, of
the Department of Psychology and Psycho-pathology at our
Institute is paramount in reviving the suspended animation
of psychiatry.
It is equally unfortunate that both neurologists and psy¬
chiatrists have a tendency to view psychology as so much
metaphysics, or to sum up the whole practical utility of
psychology and psycho-pathology with the word hypnotism,
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1898.] by Ira Yan Giesen, M.D.
as though the sum total of the immense value of its methods
of investigation and practical lessons of their teachings are
bound to be centred about the phenomena of hypnosis. If
there is to be any ultimate, tangible, and firm basis for the
understanding of mental diseases, and a consequent rational
treatment and classification of them, it is surely to come as a
result of the use of the methods of psychology and psycho¬
pathology. Space forbids any more than an allusion to the
great value of understanding the psychic phenomena of the
normal individual by studying the disordered psychic pheno¬
mena in abnormal individuals. Scientific researches of normal,
mental, and nervous processes seldom have their full value
without the observation and experiment of pathological cases,
themselves nature’s experiments. Iu many forms of insanity
nature is performing experiments, more ingenious and valu¬
able for study than the psychologist, restricted to the study of
the phenomena of the normal consciousness, could ever devise.
Normal psychology has much to learn and profit by in ex¬
ploring the domain of pathological psychology.
In one instance, at least, under the direction of Kraepelin
at Heidelberg, the results of studies in pathological psycho¬
logy have been most satisfactory in clearing away some of
the mystery surrounding the origin of mental diseases. The
extensive experiments at this school on the subject of fatigue
of the nervous system have already stimulated a more exact
and broader view of the study of the symptoms of insanity.
But even this school has failed to study mental diseases
directly at their fountain-head ; it is only through such a
work that we can get an insight into the nature of mental
aberrations. The Department of Psychology and Psycho¬
pathology at our Institute devotes its time mostly to the study
of pathological cases.
It will not be inappropriate here to make a mere allusion to
three prominent cases in which the Department of Psychology
and Psycho-pathology has not only cleared up much of the
explanation of the symptoms, but worked out the laws of the
disease, the methods of cure, and applied them successfully.
Psycho-pathology yielded definite tangible results of the
highest value.
The first case was from the Binghampton State Hospital,
and was studied in conjunction with Dr. William A. White.
The case presented limitation of the field of vision, accom¬
panied by occasional attacks of delirium and many other
phenomena of mental dissociation. The case was closely
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764
The Correlation of Sciences in Research , [Oct.,
studied experimentally; very important phenomena were
elicited, and a general method for the investigation and cure
of similar cases discovered.
The second case was sent to the Institute through the
courtesy of Professor B. Sachs, of New York city. It was
one of functional hemianaesthesia and ataxia complicated
with organic disorders. Investigation controlled and elimi¬
nated the functional disorders, which were of long standing,
and had previously resisted all attempts at improvement.
The third case, known under the name of “ general irre¬
traceable amnesia and double consciousness,” yielded theo¬
retical and practical discoveries of the most brilliant nature
to science in general and to psychology and psycho-pathology
in particular. From the investigation of this case were
deduced laws guiding treatment for future cases, which, up
to the time of these researches, were left to the care of
providence as lying beyond the ken of human knowledge.
All of these cases were quite beyond the use of drugs, and
far beyond investigation by any of the methods which neuro¬
logy and psychiatry make use of, and in both cases the
treatment based on theoretical studies in psycho-pathology
was crowned with complete success.
The Department of Psychology and Psycho-pathology also
works in the lines of cellular psycho-pathology, correlating the
different psycho-motor manifestations with the varied affections
of the 'neuron and fluctuations in neuron energy. This is an
attempt, and the first of its kind, to bring into one compre¬
hensive scheme and embrace in one formula expressed in terms
of the fluctuations in neuron energy with the concomitant
psycho-motor states the infinite number of bewildering pheno¬
mena met with in nervous and mental diseases.* Along with
it the laws and principles of inter-relation of the neurons are
worked out ; these, we hope, in due time may lead to the
formation of some important laws for the scientific basis of
pathology in general, and of pathology of the nervous system
in particular.
This same department in connection with that of physio¬
logical chemistry is also undertaking work in comparative
psycho-pathology. Diseases like catalepsy, paralysis agitans,
or epilepsy, for instance, we are endeavouring to induce
artificially in animals ; the manifestations are closely studied
and experimented upon, and are then correlated with nervous
* Vide “ Neuron Energy and its Concomitant Psycho-motor Manifestations,”
Archives of Neurology and Psycho-pathology , April, 1898.
Digitized by L^ooQle
1898.] by Ira Van Giesen, M.D. 765
diseases in men that give like symptoms under the same con¬
ditions of experimentation.
Enough has been said to insist upon the maintenance of a
Department of Psychology and Psycho-pathology at the
Scientific Institute of the New York State Hospitals, as the
one the most closely affiliated with, and in faot of paramount
importance in, the study of insanity.
This department is provided with a reasonable outfit of
instruments. It is provided with sphygmographs, cardio¬
graphs, pneumographs, chronographs, ergographs, reaction-
timers, &c. Some of these instruments have been made to
order ; others bought in Europe have been much delayed by
correspondence. In fact, the equipping of the Department
of Psychology and Psycho-pathology takes an amount of
time which seems unintelligible to those who might expect
work to come forth from the Institute with all the haste that
characterises the completion of a business enterprise in this
country. The apparatus of this department is as yet rather
meagre, and it serves only its most fundamental requirements.
In the course of time other instruments will have to be
added, as the department and its work will grow and develop.
It has been thought unwise, therefore, to add apparatus to
the equipment of the department beyond what is absolutely
indispensable for the carrying on of the work on hand. The
same is to be said of every other department in this Institute.
The Department of Psychology and Psycho-pathology is under
the charge of Boris Sidis, Ph. D. (Harvard).
II (A). Department of Normal Histology of the Nervous
System.
The first and very meagre insight into the marvels of the
structure of the nervous system begins with Descartes. The
keenness of perception of this remarkable man enabled him,
long before the microscope had been invented, to portray
the structure of the nerve-fibres, both in diagrams and in text.
He considered them as minute tubules which conveyed the
animal spirits from the brain to the muscles. If we substitute
for the word animal spirits the modern phase nervous impulse,
Descartes, in his idea of the nerve-fibres, was not so very far
behind our conception of this structure at the present day.
In the early part of this century the microscope demon¬
strated that the nerve-fibre was not hollow, but contained a
solid core, or axis. A little later investigators discovered that
the brain not only contained untold numbers of these nerve
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The Correlation of Sciences in Research , [Oct.,
tubules, but myriads of nerve-cells. Workers in microscopical
anatomy were unable to solve the riddle of the relationship of
the cells to the fibres. No one knew where the fibres came
from, or where they ended, nor was any one able to make out
the least connection of the fibres themselves. It was, there¬
fore, impossible to obtain any idea as to how this greatest
marvel of creation did its work.
In the early thirties the minute anatomist had to study his
material in fresh condition. He had no methods of preserva¬
tion, nor did he enjoy the advantages of being able to cut
thin, diaphanous slices from the brain to view under the
microscope. To-day we have the whole armamentarium of
the chemist to preserve the brain in a hundred different ways,
which give as many variations of methods of study. The
whole record of progress in the structure of the brain in¬
variably goes hand in hand with a similar record of improve¬
ments in the microscope and other apparatus and in technical
methods of investigation.
During the forties and fifties investigators began to shed
some light on the obscurity of the structure of the nervous
system by discovering that the cells and fibres were not inde¬
pendent of each other, but that the fibre was a prolongation
of the cell, an outgrowth of its body. This at least cleared up
the question as to the origin of the fibre, and physiologists
derived comfort from this fact, in that they had a reasonable
explanation of how, in a fundamental fashion, the nervous
system operated. The nerve-cell, so to speak, was the head¬
quarters of nervous operations, and its enormously long out¬
stretched arm in the form of a fibre, was a device to carry the
impulse to some distant part. This important fact as to the
connection of nerve-fibre and nerve-cell did not contribute as
much toward advancing knowledge of the nervous system as
might have been expected, and until fifteen or twenty years
ago the structure of the nervous system was still a puzzle.
The whole nervous system was an inextricable maze of an
entangled network, and its unravelling seemed impossible.
There was endless controversy, born of hypotheses which had
an unstable foundation of facts. But within the past ten
and fifteen years the obscurity that enshrouded the nervous
system has been replaced by a clear and definite insight that
is almost startling.
In 1873 a distinguished Italian investigator discovered a
method which has revolutionised our whole knowledge of
the structure of the nervous system, and has opened boundless
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767
1898.] by Ira Van Giesen, M.D.
fields of research in manifold directions. From the results
of this method of investigation we have a final solution of
the structure of the nerve-cell, the nerve-fibre, and their con¬
nections. Thus it appears to-day that the nerve-cell is like
a tiny octopus. Like this animal it has a body whereby it
attends to the process of digestion and assimilation. In this
body a food supply from the blood-vessels is elaborated into
materials which enable the cell to do its work. Like the
octopus, too, from one end of the body of the nerve-cell spring
out an enormous number of branching arms or tentacles;
from another part of the cell body arises another arm, but
different from the shorter arms or tentacles in that it is of
exceedingly great length, and passes away from the body to
distances hundreds and thousands of times the diameter of
the cell itself. This very long outstretched arm of the nerve¬
cell octopus—the nerve-fibre—sometimes passes to the outer
parts of the body, where it may receive messages from the
eye or ear, or other sense organs; sometimes the long arm
passes out to other parts of the nervous system, to transmit
a particular impulse from one part of the nervous system to
another. These nerve-cell octopi are ranged together in
series, groups, clusters, and communities of exceeding com¬
plexity, even up to the form of constellations. A given nerve¬
cell octopus passes its long outstretched arm so as to touch
the tentacles or shorter arms of a second octopus. The
second one, in turn, passes its long arm to the tentacles of
the third, and so on through an infinite set of combinations
which have their highest complexity of arrangement in the
highest spheres of our brain, which are the last parts to
develop, both in the evolution of species as well as the
individual, and which are ever unstable and prone to disin¬
tegrate by reason of this very process of retraction of the
nerve-cells. In the lower parts of the nervous system
retraction and the corresponding dissociation of the function¬
ing groups of nerve-cells is less liable to occur under the
influence of pathogenic agencies. For here the functions are
phylogenetically older and tend to approach more or less
stereotyped nature; and since stability of organisation of parts
of the nervous system depends on the frequency of the im¬
pulses transmitted through the group of neurons, the lower
parts of the nervous system are more firmly united than are
the highest spheres of the nervous system.
The most interesting feature of this latter-day conception
of the make-up of the nervous system, is that the nerve-cell,
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like the octopus, possesses power of movement over its shorter
arms* or tentacles. While the long arm of the nerve-cell is
probably fixed, its short arms, like the tentacles of the octopus,
may be thrust in or out. Consider for a moment what
happens when the nerve-cell retracts its tentacles. The
message can be no longer transmitted. The nerve-cell
has thrown itself out of the circuit of the long arms of its
fellow associates in a given group or community; they are
no longer in contact with the retracted tentacle. But we
should conceive that as a rule whole groups, communities,
clusters, and constellations of nerve-cells functionally cor¬
related retract en masse rather than individual cells. Cells
cannot work as isolated individuals in the higher parts of
the nervous system; they are invariably members of as¬
semblages which have been physiologically linked together
by education, use, and function. There may be partial
retraction (qualitative retraction) of the individual members
of one functionally linked assemblage of neurons from
another assemblage, but in the phenomenon of retraction
we are to picture it occurring in a mass of nerve-cells
belonging to some particular assemblage, and occurring
more or less simultaneously.
A message can no longer be delivered and transmitted
from one part of the nervous system to another, if a mass
of these nerve-cells break the circuit by retracting their
arms. This is the secret of many a puzzle and mystery
enveloping a very great mass of psycho-motor manifesta¬
tions of the human nervous system. The object which the
nerve-cell apparently has in view in retracting its arms is to
avoid overwork and withdraw itself from hurtful stimuli.
Retraction, apparently, of the arms of the nerve-cell is a
signal of exhaustion. This retraction and expansion of the
arm of the nerve-cell, in groups, systems, and communities
of brain cells, drawing it in or out of the circuit of trans¬
mission of nervous impulse, is the final unveiling of the
secret of a whole host of mental phenomena which hitherto
have seemed mysterious to the last degree. These attributes
# Future observations, I think, are liable to show that this view is not correct.
From a study of the identity of differentiation which the general structure of
the neuron undergoes in the neuraxon in the form of long parallel filaments
incorporated with distinct microsomes with analogous modifications of the cyto-
reticulum in other somatic cells (muscle cell, ciliated cell, leucocyte, chromato-
phores, &c.) subservient to motility, my own observations incline me to believe
that the axon is the retractile and expansive structure of the neuron rather than
the dendrons or gemmules.
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of extension and expansion of the nerve-cell cannot fail to
attract even those with the most casual interest in the
operations and development of the human mind, and hold
one spellbound in the vast flood of light shed upon the
explanation of insanity. Mysterious cases, for instance, of
individuals who sometimes from a blow upon the head or
other causes wake up aud find their past lives a blank,
and who virtually begin to live their lives over again as
it were in a new world, such as a case recounted in Dr.
Sidis* book upon the psychology of suggestion, may serve
as a fair example. These cases of double consciousness, so-
called, receive their only explanation in retraction and
expansion of the tentacles of the nerve-cell octopus, dis¬
sociating functioning associations of cells .
The phenomena of hypnosis, hysteria, and of the whole
great important groups of psychopathic functional diseases
are to be explained in the same way. Some of the violent
manifestations of insanity seem to be due to the retraction
of the highest constellations of nerve-cells that dominate and
control the lower parts of our nervous system. The lower
centres being unloosed from the control of the higher ones,
give rise to the phenomena found in some forms of mania
(psychopathic). Discrimination as to significant and insig¬
nificant stimuli is cast aside, so the maniac is prone to
respond to any passing zephyr of stimulus with a storm of
excitement. His subconsciousness lacks the normal control,
and is most prominently in the foreground.
The phenomenon of retraction of the neurons is also, I
most firmly believe, the explanation of the cardinal symptoms
of epilepsy in the manifestations of the fit. Here the
retraction of the constellations and clusters in the higher
parts (association centres of Flechsig) from a given stimulus
is very sudden ; the lower portions of the brain (sensory
spheres of Flechsig, particularly tacto-motor zone) being
suddenly loosed and dissociated from the inhibition and
control of the higher portions, the energy of the neurons of
these lower portions of the cortex is suddenly liberated with
the corresponding psycho-motor phenomena.
Every one is familiar with those forms of insanity in
which the patient seems oblivious to his outside environ¬
ment, shown in some forms of melancholia (psychopathic).
There are, again, instances where the whole foreground of
consciousness has been partially split off by a retraction of
the nerve-cells constituting the higher spheres of the brain.
xliv. 52
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These spheres are asleep. A cleft lies between them and the
rest of the nervous system, caused by this phenomenon of
retraction. Depending upon the qualitative degree of retrac¬
tion between various assemblages of neurons in the brain
some forms of psychopathic mania or melancholia might
result. Thus we see that one part or another of the brain
may be dissociated from the rest, and naturally the parallel
manifestations of the mind are thrown out of gear.
This hasty sketch of the department devoted to the ana¬
tomy of the nervous system, perhaps, shows best of all a
faint glimpse of the directions we are striving in to contribute
something toward the investigation and explanation of
insanity.
I should not, however, be guilty of conveying the impres¬
sion that merely because the anatomist has discovered these
wonderful facts about the shape of the nerve-cell and its
connections, or that some evidence from my own studies tends
to prove the phenomena of retraction, that the phenomena of
mental operations may be postulated therefrom. The most
perfect knowledge, even down to the understanding of the
very molecules of the nerve-cell, would not help the ana¬
tomist or the chemist to postulate the laws and phenomena of
thought and consciousness , for these are not products of nerve¬
cell activity. The brain does not secrete thought, as the
kidneys secrete urine ; thought is not a material thing ; it
can neither be weighed nor measured. A sensation of colour,
for instance, as experienced by the eye, has no material exist¬
ence in the physical world. We can only speak of the
phenomena of consciousness as running parallel or being
concomitant with the workings and metabolism of the nerve¬
cell, lest we drop into the pitfall of psychologicalmaterialism,
which has been utterly abandoned long ago.
To the psychologist belongs the study of the phenomena of
consciousness parallel to the physics, physiology, and anatomy
of the nerve-cells in the states of these associations and dis¬
sociations. The physiological process of retraction and the
changes in form which the nerve-cell undergoes, causing
these dissociations in consciousness, fall within the sphere of
the anatomist. The object of reverting to the department of
psychology and psycho-pathology is briefly to point out the
incongruity of setting forth the claims of any of these depart¬
ments of our institute investigating insanities as distinct,
isolated methods of research. They must all be linked
together and work hand in hand. A concrete example of
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this is the apportionment and yet linking together of the
work in the departments of psychology and normal anatomy
of the nervous system. The psychologist, for instance, studies
the manifestations concomitant with the physical process of
retraction of the tentacles of the nerve-cell octopus. Work¬
ing conjointly, the psychologist and the anatomist show, in
an ideally scientific way, the stages of the parallelism of the
physical process in the nerve-cell and the corresponding
psychic phenomena. Thus while the knowledge of nerve-cell
anatomy and physiological mechanism does not postulate a
knowledge of mental phenomena, the value of seeing the
parallelism between the material processes and the psychic
phenomena should be strongly insisted upon by the conjoint
work in these two departments.
In the next section, devoted to the status of the science of
pathology in investigating the nervous system, the same
feature crops out again. In the abnormal anatomy of the
nervous system as well as in the normal anatomy the neces¬
sity for correlated work with psychological and psycho-patho¬
logical investigation is still more evident.
The anatomist, however, is not by any manner of means in
a position to write the last words about the structure and
architecture of the human nervous system. This goal will
not be attained for many years to come. He has only been
able thus far to straighten out the intricate structure and
connections of the comparatively elementary chains and
series of nerve-cell octopi in the lower and simpler parts
of the nervous system. The unravelling of the connections
and associations of nerve-cells in the highest parts of the
nervous system, where the cells are evolved in enormous com¬
plexity of connections in the form of constellations, hardly
has been begun. By studying the developing infant, how¬
ever, and patiently working at the brain of the growing child,
we hope to attain in the future our best light upon this
obscure domain of the anatomist.
Professor Flechsig has, however, after twenty years of
work, formulated a plan of architecture of the brain which,
it seems to me, is the key for a final solution of the intricacies
of higher brain architecture. This plan was studied out in the
brains of human embryos, children at birth and growing infants,
and children where the different parts of the nervous system
can be identified because they make their appearance in a
progressive series from the simple, fundamental, and phylo-
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genetically oldest parts to the more complex, highly organised,
and most recently evolved portions.
In accordance with this plan of Flechsig, but a small
portion of the brain cortex—only one third—comes in contact
with the outside world through the chains and series of nerve-
cells connecting the sense organs, while the great mass of
the brain cortex—the remaining two-thirds—has no direct
connection with the outer world, but connects and associates
the scattered brain areas connected with the sense orgalns or
muscles.
This division of the brain into these two parts—the smaller
portion known as the sensory spheres and the larger the
association centres—gives a wonderfully clear view into many
forms of insanity if we take into account the concomitant
psycho-motor phenomena produced by different degrees of
dissociation of these parts, but especially by dissociations
occurring in the association centres themselves by retractions
of communities, clusters, and constellations of nerve-cells.
The sensory spheres are scattered about in the surface grey
matter of the brain. A patch at the occipital end of the brain
is the sensory sphere for vision, another corresponding to the
sensory sphere for sound is situated near the apex of the
temporal lobe. Similarly olfactory, gustatory, and tacto-motor
sensory spheres are located in other parts of the cortex.
Between the sensory spheres are interpolated the association
centres. The more fundamental portions of the association
centres operate to render possible a simple order of recogni¬
tion of the impressions received in the sensory spheres by
associating them together. In the higher regions of the
association centres a still more complex order of recognition
of sensory and motor impressions is possible. Finally, the
constellations of nerve-cells in the frontal lobes afford a basis
for the highest forms of syntheses of consciousness. This is
the association centre of association centres.
It is in these association centres and in their connections
with the sensory spheres that the phenomena of retraction of
the nerve-cell play such an important part. One can well
conceive the chaotic condition of ideas, or imperfect power of
recognition, and a host of other abnormal mental phenomena,
when retractions occurring in the groups, communities, clus¬
ters, and complex constellations of nerve-cells split off the
association centres from each other or from the sensory
spheres, and produce the corresponding dissociations in con -
sciousness. In the lower animals the association centres grow
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smaller and smaller, and finally, say, for instance, in the lower
mammals, the sensory spheres lie contiguous with hardly any
vestige of the association centres between them.
For the study of insanity the understanding of the structure
of these higher spheres of the nervous system is of the most
vital importance. It is the instability of these highest parts
of the nervous system which is the essence of the whole
question of insanity. Hence when we consider this aspect
of the value of the department of normal histology of the
nervous system, we find that its offices are absolutely im¬
perative.
With the exception of the discovery of the neuron theory , Sidis?
conception of the dissociations of consciousness , the theory of
neuron energy fluctuation , the theory of the retraction and
expansion of the neurons , and Flechsig's plan of the association
centres and sensory spheres of the brain , are the greatest dis¬
coveries which have ever been put forth in the history of our
knowledge of the nervous system . The effect of the application
of these four great hypotheses (for observations* at present,
in my own belief at least, are increasing their validity) will,
indeed, be revolutionary in the domain of mental and nervous
disease.
Observers in this department should pursue studies of the
normal histology of the nervous system only after a very
thorough antecedent study of the minute anatomy of all other
parts of the body.
II (B). Department op Comparative Neurology.
The value of the comparative study of the nervous system
in both health and disease has already been hinted at in the
argument for the practical value of the department of cellular
biology in the scientific study of insanity. Man’s nervous
# Apathy’s theory of the concrescences of the neurons in the lowest parts of
the nervous system is perfectly tenable. But we should remember that the
stereotyped function existing through eons of time in these lowest parts of the
nervous system presupposes a fixed relation of the neurons to each other. In
the evolution of the higher centres, however, such as the association centres and
probably the sensory spheres, the individual neurons have become independent
anatomically, and the impulse is transmitted by physiological contact.
Retraction does not take place in the lowest parts of the nervous system, but
must be postulated for the phenomena of the highest portions of the brain.
Apathy’s theory, in my judgment, should not create distrust in the neuron
theory; his theory does not apply to the whole nervous system, but to its lower¬
most parts, such as pertain to the most automatic and vegetative functions.
The homologue of the lowest parts of the human nervous system is found in the
leech and other invertebrates that Apathy has studied.
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system is a recapitulation of the progression of development
of the nervous system in animals. This recapitulation of the
nervous system, embracing its evolution throughout the whole
animal kingdom, is too complex to be understood without
going back to the prologue in the history of the development
in the lowest animals that possess nervous organs. Apparently
the first nucleus of a nervous system is found in the fresh¬
water hydra. This creature can expand and retract a portion
of its substance by a very simple mechanism, which is the
combination of both the nervous and muscular systems. It
appreciates stimuli from the external environment by means
of a most elementary sensory apparatus, the foreshadow of the
nervous system in higher animals, and reacts by means of a
primitive muscular mechanism. These two sets of mechanisms
are not differentiated, as in the higher animals, into two
distinct organisations, but are so alike and undifferentiated
that it is difficult to distinguish the one from the other. In a
somewhat higher form of development, as in an ascidian, the
motor and nervous systems have become differentiated. This
creature has an outer tunic, an inner digestive coat, and a
muscular sac lying between the two. The nervous apparatus
is exceedingly simple. It is merely a chain composed of very
few nerve*cells, one end of which touches the outside tunic,
and the other end the muscular coat. When stimuli from
the external environment are conveyed to the tunic, the
creature, by means of this nervous system, transmits the
impulses to the muscular bag, and responds by muscular
movements to these stimuli. The very simple nervous system
in this creature is the fundamental basis for the building up
of the nervous system in the higher animals. This tiny arc
of nerve-cells passing between the muscle and the skin in the
ascidian is the starting point which nature builds upon in
evolving the wonderfully complex nervous apparatus in higher
animals and in man himself. Roughly speaking, the difference
between man’s nervous system and that of the ascidian is not
in any essential distinction in the shape and constitution of
the nerve-cell, but in the fact that man possesses numerically
millions and millions more, in infinitely complex adjustment,
of these tiny nerve-cell arcs found in the ascidian.
Passing upward in the scale of evolution from the ascidian,
as more and more of these nerve-cell arcs make their appearance,
*ind are evolved into increasingly complex adjustment to each
other, the animal gains more and more highly developed
functions. In the lowest forms of animal life possessing the
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nervous system, the nerve-cells are arranged in simple chains
or series ;* as the evolution of the animal grows more complex,
the simple series make a greater variety of combinations with
each other, so that they become gathered together into groups.*
As the scale of evolution becomes still higher, groups of nerve-
cells make increasingly complex adjustments in the form of
clusters* In still higher forms of animal life, the adjustment
of clusters of nerve-cells become complicated into communities.*
In man we find all the evolutionary series compounded into
one complex whole. The elementary form of the nervous
system in the lower animal represented in a simple chain or
series of nervercells, is present in the lower and more funda¬
mental parts of his nervous system, such as the sympathetic.
The more complex forms are built up into groups , clusters ,
communities , and ultimately in the highest parts of man's
brain the communities are gathered together in such a variety
of combinations as to form an infinite number of highly com¬
plex constellations*
In building up this plan of the nervous system from the
lowest to the highest creatures, nature makes no sudden
strides or leaps. It is a steady progression of piling up the
simple series of nerve-cells, such as found in the ascidian, in
increasing numbers and complexity of combination until we
reach the form of constellations in the highest portion of
man's brain. His intellectual attainments, his highest form
of consciousness, his self-control, and dominance of the lower
parts of his nervous system, run parallel with the activities of
these constellations.
Comparative anatomy of the nervous system is invaluable
as a method of going back through past ages and of witnessing
how man's nervous system has been built up from the simple
to the complex. All the chapters in the history of brain
evolution are to come from the researches of comparative
neurology. We must not expect to comprehend the archi¬
tecture and phenomena of man's nervous system by considering
it as something apart from the nervous system of the creatures
whence he is derived. Nature did not make man's nervous
system by a special fiat, nor in evolving it did she consider
him to be any more or less than the final member of a con¬
tinuous series in the progression of the evolution of life
forms.
Man is to be looked upon as a creature of the past. For
nature, in the evolution of the nervous system, has built man
* See Sidif*, Psychology of Suggestion, chap. xxi.
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on the same fundamental plan with that of an ascidian. Man's
nervous system is a magnificent organisation, but in plan of
structure it is the same in the ape, the dog, or even the earth¬
worm.
Comparative anatomy of the nervous system has often given
us the most striking answers to complicated questions in man's
brain. For instance, when certain animals leave their aquatic
habitat and spend the rest of their existence leading a terres¬
trial life, special sense organs become useless and disappear
during the terrestrial life. The following out of the changes
of the brain incident to the loss of these sense organs has
thrown most important light upon some of the complicated
questions of the nerves in man’s brain. The enfeebled
development of eyesight in the mole, and the deficient de¬
velopment of his portions of the brain concerned with its
visual impressions, have helped us in understanding the central
mechanism of vision in man's brain. The enormous develop¬
ment of the sense of smell and of the parts of the brain
devoted to the reception of olfactory impressions in the lower
animals has been of much service in contributing to the know¬
ledge of the structure of the parts of man’s brain connected
with his delicate but uncomprehensive sense of smell. In
fact, in the study of man's brain we are constantly driven
back into the past, when it was in a simpler form, in order to
understand its mechanism and operations.
Comparative neurology is of value, not only in helping us
to understand the architecture of the nervous system, but it
is also destined to be of great importance in imparting know¬
ledge of the organisation of the nerve-cell as an individual,
through the study of comparative cytology of the nerve-cell . An
individual nerve-cell, a single one of the myriads and myriads
composing man’s brain, is a microcosm taken by itself. We
are far from knowing, aside from the problem of how nerve-
cells are connected with each other in the brain, how they
work as individuals, how they live and die and pass through
their whole life history. If we had the most perfect know¬
ledge of all the combinations, adjustments, and associations of
the countless hosts of nerve-cells in the brain, in short a
perfect knowledge of the architecture, it would be of com¬
paratively little value in the study of insanity, unless we
understood the nerve-cell as an individual . No one could
build a bridge, even with the most perfect and detailed
working plans, without knowing the constitution of the
building materials. So it is with the nervous system. We
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may know much as to its architecture, and in fact are actually
daily gaining more and more of this kind of knowledge by a
great variety of methods, but we know comparatively little
of the working units of the nervous system, the nerve-cells.
The internal constitution of the nerve-cells is the most
pressing question of the day in the study of insanity. The
all-important question is how the nerve-cell works as an indi¬
vidual, how it conducts nervous impulses, how it assimilates
food, its mechanism of elaboration of energy from the
crude food-supply which the nerve-cell obtains from the blood¬
vessels. If there be one all-important question in the pro¬
duction of insanity, it relates to the balance between food-
supply of the nerve-cells and the work performed or withdrawal
of nervous energy. This is a practical question, because every
one knows that if more energy is drawn off from the nerve¬
cell than can be produced from its food-supply, the result is
bankruptcy of the nervous system. Any one may see this in
his daily walk of life in the man who overworks and over¬
fatigues his nervous system. We see this bankruptcy of the
nervous system everywhere about us in the endeavour to
cheat time in the pressure of hurry and haste in the activity
of large cities. People expend more energy from their
nervous system than they supply through food and rest.
Yet such a vitally important question as to the details of the
cycles of expended energy of the nerve-cell with relation to
food-supply is almost unknown. Here again we must have
recourse to the aid of the comparative neurologist. We must
ask him to tell us the internal structure and constitution of
the nerve-cells in the lower animals, because here the problem
may be studied under its simplest condition. We ask him to
make experiments, and to select some favourable animal to
illustrate the changes of fatigue in the nerve-cell, to tell us
what happens when the nerve-cell is deprived of its food-
supply, to recount to us the changes in the constitution of
the nerve-cell when it is called to expend more energy than
it receives in nourishment. Such questions as these are of
the utmost importance. As a concrete illustration I might
mention an off-hand example in some work which we had
undertaken some three years ago in the electric torpedo to
determine what happened in the nerve-cell when over-fatigued.
Two torpedoes were placed side by side. One was irritated
at regular intervals with a sharp instrument, until his electric
shocks became less and less and finally disappeared. Thus
the nerve-cells in the brain governing the electric organ were
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completely tired out and could no longer work. Without
giving these nerve-cells time to recuperate, or to gain new
energy by assimilating food from the blood-vessels, the
animal was killed and the cells compared under the micro¬
scope with those of the second torpedo, which remained
completely at rest. Thus we had side by side under the
microscope, the overworked fatigued cells, and those in a
perfectly normal resting condition, which had a full supply
of energy. The problem was' to determine not so much any
outward changes in the form and shape of the cell, as its
interior mechanism. Definite changes were found between
the two sets of cells, changes that throw some light upon the
all-important problem of how the nerve-cell does its work,
and carries on its life operations.
The guidance of this department is under C. Judson
Herrick, M.S. (Denison University, Ohio).
III. Department of Cellular Biology.
The science of the cell has accomplished marvels within
the past few years, and from the days of Schleiden,
Schwann, Purkinje, von Mohl, and Muller there have been
vast strides. Inasmuch as the whole body is a vast
assemblage of these tiny cells, some working together in
a community, as in the kidney, the liver, and the brain, it
ought to be easy to understand that the ultimate solution
of the workings of the body, both in health and disease,
resolves itself into a study of the changes of the individual
cells. Virchow, fifty years ago, forecast that the ultimate
study of disease processes, particularly in their beginning and
essences, must be so devoted. The student of cellular bio¬
logy looks upon the cell as a microcosm in itself, and his
investigations have solved, at least to a large degree, the
problem of the physical basis of heredity.
In studying the egg-cell, just after it has started on its
growth to produce a new member of the species, the biologist
has found that equivalent and equal amounts of a certain
element of the cell are derived from both the father and
mother. He has shown, furthermore, that these elements are
by a most intricate process distributed in equivalent amounts
to every cell in the whole body. It is on this ground that
Huxley says the entire organism may be compared to a web
of which the warp is derived from the female, and the woof
from the male. We stand at last face to face with some
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intelligent and fact-supporting basis of the mechanism of
heredity, and can now have some glimpse of how immutable
are the laws of heredity. This material—the germ-plasm—
transmitted to the new individual, will surely pass on
damages incurred by the ancestors. If a man exposes his
germ-plasm to the poisonous influences of alcohol, or still
worse syphilis, such damage is not confined to his individual
life only, but passes on to the next generation. This
damage plays a part in subtracting from the full develop¬
ment of the organism, especially in the most complicated
tissue of the body, the nervous system. This subject of
heredity is of most enormous importance in the study of
insanity, but it were well that discussions of heredity in
insanity might more generally rest upon the scientific basis
of our present knowledge of the germ-plasm.
Cellular biology has also another province which cannot
be disregarded, for we cannot expect to understand the
diseases of the nervous system until we have a knowledge of
the architecture and functional organisation of this system
in the normal individual. The most reliable method of gain¬
ing this knowledge is to watch growth of the nervous
system in the successive stages of development of the
embryo, and thus realize the functional value of different
parts of the nervous system. First, the lowest and most
fundamental parts of the nervous system appear, those
which have to do with the mere organic and vegetative
functions of the body. Little by little the higher and more
complex parts appear in their turn, so that we can trace, in
the growth of the embryo, chapter by chapter, the whole
story of evolution in a recapitulated form. The early stages
of this study of the embryology of the nervous system
naturally fall within the province of cellular biology, for it
is in the developing egg that this science has gained its
most brilliant achievements.
The province of cellular biology in regard to insanity is
so intimately linked with the scope of pathological anatomy
that it is difficult to dissociate the two sciences and to discuss
them separately. Briefly stated, pathological anatomy , or the
science which treats of disease processes in the body, can
make further progress only on condition of using the science
of the cell . The whole study of changes wrought by disease
processes in the nervous system is absolutely dependent upon
the principles and methods of cellular biology.
Perhaps the strongest argument for the value of cytology
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or cellular biology in the study of the pathology of mental
diseases can be realised when we perceive that NissPs method
itself is really an outgrowth and an application of the
principles and exact methods of cellular biology to the ner¬
vous system. Without in the least detracting from the fame
of its discoverer and the value of his great work, NissPs
method is to be considered more as an extension of the
general cytological methods of cell study to the nervous
system than as an innovation in a particularised technical
method.
NissPs method and its congeners should be viewed as
methods of cyto-pathology which expose the morphology of
the whole interior organisation of the nerve-cell in contra¬
distinction to the crude and restrictive methods of the older
pathological anatomy. These latter methods merely brought
to light the external form and shape of the cells, and gave
an account only of the coarser and grosser morbid changes
which were so far advanced as to be destructive, inducing
obtrusive changes in the external form and contour of the
cells. NissPs and the cytological methods generally (for
NissPs method of staining is but one of many of these cyto¬
logical methods), however, exposing the internal organisation
of the cells, present a hitherto entirely hidden view of the
whole normal and pathological metabolism of the nerve-cell;
that is, as far as the process can be comprehended from a
morphological standpoint unaided by the conjoint application
of physiological chemistry of the cell. It is herein that the
Nissl type of method is so valuable for investigation of the
diseases of the nervous system, for we are able to see the
beginning stages of disease process in the interior of the
nerve-cell.
The whole life history of all forms of mental and nervous
disease, except the last chapters, courses hand in hand with
morbid changes in the internal organisation of the nerve-cell.
When the morbid process has gone on so far as to induce
defects in the external configuration of the nerve-cell, it
marks the closing scenes of its life. The nerve-cell then
passes over into the grave, for these changes are beyond
reparation; its life history is closed, its cycles of metabolism
have ceased; its delicate mechanism, subservient to the ex¬
penditure and restitution of nervous energy, is irrevocably
damaged, and no further expenditure of energy is possible
except that issuing from the organic dissolution of the cell
manifested in non-nervous energy or energy liberated in
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the form of heat, or chemical reactions of organic de¬
struction.
Future advances on the whole province of the pathological
anatomy of mental as well as nervous diseases, depends upon
the application of the principles and methods of cellular
biology.
One exceedingly important topic also falls within the pro¬
vince of cellular biology, when linked with the investigation
of medical sciences, and this is the study of disease processes
artificially induced in the lower animals. The lower animals,
even down among the invertebrates, offer us opportunities
for elucidating wider and more fundamental truths concerning
the cell microcosm than the higher animals, especially man.
Experiments in these lower animals, made up of relatively
small colonies of cells in a simpler and more elementary form,
constitute one of the most fruitful fields of inquiry as to the
behaviour of the cell in the environment of disease processes.
In man, and even in the higher animals, when disease pro¬
cesses are experimentally induced the conditions are much
more complex, so much so as to frequently hide the funda¬
mental changes of the reaction of the cell as an individual.
Since man is simply an aggregation of cells, the same laws
that govern the individual cell must also govern his organi¬
sation.
The experimental induction of disease processes in the more
elementary organism, with a view to study the reaction of the
cell in abnormal environment of pathogenic stimuli, under the
simplest conditions, seems again, at first glance, to be straying
from our proper pathway, the study of insanity. This, how¬
ever, is not so. The nervous system is made up of myriads
and myriads of the same kind of cells, marvellously organised
into one organic whole. No other cell in the whole body can
compare with the nerve-cell for complexity of shape and
internal organisation. It is not sensible to attack the problem
of cell-dissolution by selecting for study the most complicated
cell in the whole body. It is plain that the proper way is to
study first the course of disease processes in the simpler cells.
Having learned this, we can forecast what ought to happen in
the complicated differentiation of the ordinary type of somatic
cell into a nerve-cell, and be prepared to understand what the
changes in the nerve cell mean when it comes in contact with
abnormal stimuli inducing disease processes.
We may be sure of one thing, that the nerve-cell was at
one time much like any of the simpler cells of the body, and
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that all these complex structures in the nerve-cells are not
new creations or fiats in its evolution from the simple cell,
but are merely devices and modifications of the structures
present in its simply organised ancestor. In other words, a
cell of simple structure like the general type of somatic cell,
in undergoing the phylogenetic evolution into the nerve-cell,
has not created new and specific elements in order to accom¬
plish the duties of a nerve-cell, but has used its old and elemen¬
tary structure, and by differentiations and modifications made
them fit to accomplish the offices of the nerve-cell. In studying
the cyto-pathology of the nerve-cell, one should hold in mind
that, notwithstanding the marvellous adaptations of the cyto-
reticulum and cyto-lymph of the nerve-cell wrought by evolu¬
tion out of these fundamental cytologic structures common to
all cells, the nerve-cell should not be considered apart from
the other cells of the body. The neuron is not a specific
cellular creation, its structures are homologous with other
cells of humbler organisation in the body, and obey the same
general basic laws governing normal and pathological meta¬
bolism. The laws which govern pathological processes (and
some day these, it is to be hoped, may be expressed in terms
of cell energy) operate uniformly for all of the cells of the
body. Disease is a single process, but this process mani¬
fests itself in a great variety of phases corresponding with a
protean expression of symptoms often grouping themselves
in a distinct type as a distinct malady. One is, therefore,
liable to wrongly consider the phases of the single process as
individual entities and distinct processes. Hence various
kinds of inflammations and cellular degenerations and other
pathological processes are spoken of as individualised pro¬
cesses, whereas these are merely phases of the same single
process.
The more cellular biology is used in the study of patho¬
logical anatomy, the less tenable becomes the idea of indivi¬
dualising specific morbid processes with specific diseases.
We find it advisable to recommend that provisions should
be made for the associate who has the responsibility of this
department to visit marine biological laboratories during a
part of the summer season at least. Unfortunately, we have
in this country, as compared with Europe, but few of such
laboratories. Few, however, as they are, they are to be con¬
sidered as the home and fountain-heads of knowledge in
cellular biology. In these marine laboratories are found the
best opportunities for extending knowledge of the cell.
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Here is to be found a great variety of lowly organised, simply
constructed marine organisms to study and experiment upon
in the living condition.
Those who are studying the all-important problems of cell
organisation by confining their investigations to the cell
under normal environment only, hardly take the broadest
conceptions of this problem. The normal cell can never be
fully understood without studying the abnormal and diseased
cell . In exposing the cell to the environment of disease
processes, nature is conducting an experiment a hundredfold
more ingenious than the student of normal cytology could
ever devise. It will do no harm to repeat that in the sciences
dealing with life phenomena the pathological method is the
most fruitful.
Modem specialisation among the branches of science is
creating gaps and clefts which contain more important fields
for investigation than the individual departments of science
themselves. He who can bridge over the rifts between the
border lines of several of these sciences will discover the
richest domains of investigation and gather in a good harvest
of scientific truths. Unfortunately, few can occupy two
fields of science, and cover the gap between. A most un¬
fortunate gap, for instance, lies between cellular biology and
the pathological anatomy of the human body—cyto-pathology
—a term but newly coined. I do not hesitate to say that the
overlapping of cellular biology and pathological anatomy
opens the richest of all domains for the future progress of
medical science.
The Department of Cellular Biology is under the charge of
Arnold Graf, Ph.D. (University of Zurich).
IY. Department op Pathology, Bacteriology, and Physio-
, logical Chemistry.
The departments of pathology, bacteriology, and physio¬
logical chemistry are so intimately linked together in the
investigation of insanity that they may be dealt with collec¬
tively.
Pathology, comprising the sum total of human scientific
knowledge concerning the origin, course, and results of
disease, had very simple beginnings. At first noxious and
evil humours were supposed to gain access to the blood,
and to cause the departures from health. If we translate
the term “ humours*’ into the modern expression of toxic
substances circulating in the blood, the “ humours ” of the
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older pathologists are not so far from the truth. But whence
the humours arose and how they gained access to the blood
was all guesswork and speculation, and “ humoral ” patho¬
logy was a mere makeshift to define an unknown something
which circulated in the blood and caused the phenomena of
disease. In later days those who were concerned in the
investigation of disease processes observed with the naked
eye what they could of the changes in the body after death
from any given disease, and were able to see that many of
the symptoms corresponded to gross, coarse, and destructive
changes in the various organs. As the microscope improved,
and ideas of the cell as the elementary unit of the whole body
became more definite and coherent, the pathologist studied
these coarser and grosser changes in the organs under the
microscope, but even here he saw results rather than begin¬
nings of the processes. Professor Prudden quotes a line from
Oliver Wendell Holmes, in which the work of the earlier
pathologist is compared to an inspection of the fireworks on
the morning after the show.
In those days the practising physician was also the patho¬
logist. He combined both functions. He observed disease
in the living, and sought to find out its havocs amid the
body structures after death. His methods, however, were
limited only to a study of the topography of the lesions
of the disease, and not to the pathological processes themselves
constituting it. In short, he saw results, but knew not
whence and how they came. For the real solution of the
origin of these processes lay hidden, not in the gross and
terminal changes in great communities and masses of cells,
but within the subtle recesses of the cells as individuals.
For many years the pathologist was bewildered by the
phenomena of inflammation. He was able to describe with
much precision facts and observations, but he failed to
understand their significance. Meanwhile cellular biology
progressed with rapid strides and disclosed the marvels of
the cell microcosm. The older pathologists neglected the
beginning and saw only the end.
What, perhaps, puzzled the pathologist most before he
had learned to peer into the cell microcosm for the solution
of his problems, was the great number of important and
serious diseases of every-day occurrence which seemed to
leave no traces whatsoever upon the body. This was
especially the case in many diseases of the nervous system.
It was exceedingly perplexing, for instance, to understand
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1898.] by Ira Van Giesen, M.D.
how such a dramatic and dreaded attack of the nervous
system as hydrophobia should leave no traces after death.
These the pathologist set down as diseases “sine materia ”
or cast them into the makeshift category of “ functional ”
or idiopathic diseases. To-day, however, we understand
why no traces may be left in the body from such serious
diseases as these. The secret lies in changes in the very
inmost recesses of the nerve-cells themselves.
The older pathologist concerned himself but little with the
cell as an individual. If its shape, form, and contour were
unchanged, it passed muster as being sound and normal,
without regard to a whole world of changes which might be
present in its internal organisation. In scrutinising the
effects of disease in the interior of the cell, he looked at the
outside of the cell, and not at its vital organisation within,
as one might attempt to understand the contents of a book by
looking at its binding. Thus, naturally enough, the know¬
ledge of a whole host of diseases, particularly of the nervous
system, was passed over unnoticed.
At the present time the pathologist in studying the diseases
of the nervous system is actually peering into the mechanism
of life operations going on in the laboratory of the cell. He
is endeavouring to study the changes in the body of the
nerve-cell—changes going hand in hand with its assimilation
of food and elaboration of energy. He is able to study the
changes which happen within the cell when its food-supply is
interrupted or interfered with. When the food-supply of the
nerve-cell is by slight increments qualitatively or quantita¬
tively diminished, or, on the other hand, the nerve-cell
expends more energy—-jn states of pathological fatigue—
than can be recruited from the food-supply in the blood
plasma, the nerve casts off dead material , which is removed by
the lymphatics. The excretion of these particles— the meta¬
plasm granules *—is most important in presenting a physical
basis and a measure of the slow destructive pathological
metabolism of the nerve-cell which is such a prominent factor
in the genesis of very many mental and nervous diseases.
When the nerve-cell begins to excrete these particles it is an
indication of a lack of balance between the crude food-supply
of the cell from the blood-vessels and the expenditure of
energy. This excretion of the nerve-cell is also the indication
of senile degeneration, and it is most interesting to view this
* Van Giesen, “ Toxic Basis of Natural Diseases.” State Hospital Bulletin ,
1897.
xliv. 53
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The Correlation of Sciences in Research, [Oct.,
indication of senility of the nerve-cell advancing prematurely
in a host of mental and nervous diseases where the expendi¬
ture of energy of the nerve-cell has been of a pathological
and persistent character.
The pathologist is now busily seeking the degenerations
occurring in the interior of the ganglion-cell when exposed to
poisons, especially to those generated in the great mass of
general body diseases. In the poisoning of the nervous
system from general body disease, the pathologist is able to
show changes within the interior of the nerve-cell which
account for the delirium in cases of typhoid fever, influenza,
sunstroke, &c. We are able to study the changes in the
nerve-cell wrought by fatigue, to watch the nerve-cell grow
old, and the signs that indicate the approach of its decadence.
It is particularly interesting to watch the premature senility
and shortening of the life of the nerve-cell by chronic
alcoholism and syphilis .
Definite laws of the manifestation of energy of the nerve-cell
in both health and disease, the expenditure of energy of the
diseased nerve-cell , its restitution of energy in recovery from
disease, with their concomitant psycho-motor manifestations
formulated at the Pathological Institute ,* are helping to clear
away the mystery of the modus operandi of a whole host of
mental and nervous diseases .
The rise of bacteriology is too familiar and of too recent
occurrence to need any detailed account of its relation to
pathological researches in the nervous system. Bacteriology,
in its great public practical services to sanitation, its appli¬
cation by boards of health in the prevention of infectious
diseases, the almost miraculous practical outcome of bacterio¬
logical studies in the antitoxin treatment of diphtheria, its
great service in protecting and forewarning the healthy
against disease,—all these services of bacteriology ought to
make it clear that the latter is one of the most important de¬
partments in medicine for contributing practical measures to
the prevention of disease.
The department of bacteriology, it should be expressly
understood, does not undertake to carry on researches in the
whole domain of the biology of bacteria in general, but
restricts its energies to useful ends in the study of insanity,
namely, the identification of bacterial poisons which are asso¬
ciated with nervous or mental diseases. This department
purposes, however, to keep in constant touch with the broader
# Vide Archives of Neurology and Psycho-pathology, April, 1898.
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1898.] by Ira Van Giesen, M.D.
aspect of bacteriology in general as a science, and to keep
cultures of many forms of bacteria for the purpose of deter¬
mining experimentally the action of their poisons upon the
nervous system of animals.
When the pathologist beheld the action of these disease-
producing bacteria, he at last began to approach the proxi¬
mate explanation of many morbid processes, and perceived
their origin. He now sees that these disease processes are
nothing more nor less than chemical reactions between the
forces of the body on the one hand and poisons upon the
other. The process of disease should in the future be dis¬
cussed in terms of fluctuations of cell energy . For it was soon
learned that bacteria are not harmful as a rule by their mere
mechanical presence, but on account of the powerful poisons
which they give rise to. It is now seen that inflammation is
very often the expression of a conflict between the cells of the
body and the bacteria with their associated poisons.
The conservative nature of disease processes is most
beautifully shown in inflammation. Inflammation is found
to be a protective mechanism in the struggle of the organism
for its life existence, and is the outcome of a long series of
adaptations on the part of the cell. This protecting mechanism
against the proximate causes of diseases extends throughout
the whole scale of animal life, even to the amceba. Were it
not for this protective adaptation on the part of the body
cells, the highly organised forms of animal life, as well as the
human race, could not exist, for by long odds the conditions
producing disease, especially in civilised life, are in the
ascendant over those contributing to normal health.
We must not over-estimate the direct bearing of bacteriology
on the study of insanity. Bacteria are very seldom directly
responsible for mental maladies, and comparatively rarely for
nervous diseases. They do not attack the brain directly, nor
is it to be supposed that there are specific bacteria for indi¬
vidual diseases of the nervous system. The action of bacteria
in damaging the nervous system is indirect. The brain is so
well protected against their incursions that they generally
attack some other part of the body : but the nervous system
is injured by the 'poisons which bacteria give rise to. The
bacterial products enter the circulation of lymph spaces, come
in contact with the nerve-cells, and poison them. Not an
inconsiderable share of diseases of the nervous system in
general take their primary origin in bodily diseases. These
general body diseases, such as typhoid fever, pneumonia.
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The Correlation of Sciences in Research, [Oct.,
syphilis, smallpox, influenza, scarlet fever, &c., either by
their poisons or by interference with the food supply of the
nerve-cell, cause it to degenerate. In short, bacteriology
and pathology are closely interrelated. It is not alone suffi-
.cient for the pathologist to recount the subtle changes
occurring within the nerve-cell in disease, and render an
opinion to the effect that these changes are due to the action
of a poison. We must know what the poison is, and where it
comes from. In the solution of this question bacteriology is
indispensable.
The physiological chemist goes far deeper than the bac¬
teriologist in identifying the proximate pathogenic stimuli.
The devotees of medical science, particularly of pathology,
are turning in eager anticipation for the ultimate solution of
the question of cell degeneration to the science of physio¬
logical chemistry. What the pathologist observes under the
microscope, even in the most delicate changes of cell organi¬
sation, is really far short of a causal explanation of disease
processes. Behind all these morphological changes in the
cell is a series of most complex chemical adjustments.
All disease processes are caused by disturbances in the
chemical activities of the normal cell. The science of the
chemistry of the cell is in its infancy, and the ultimate solu¬
tion of the occurrence of disease processes can only be
explained by the physiological chemist. For it is by means
of this science that we can have any hopes of discovering the
chemical composition of the cell; the reactions of the cells to
poisons; the nature of these pathogenic poisons themselves,
their origin, their interference with the food supply provided
by the blood to the cells for the elaboration of their energy.
When all these problems are solved, the abnormal changes
in cells seen under the microscope will be more fully
explained.
Physiological chemistry has its specific role in investi¬
gating insanity. Few of us realise the fact that at every
moment of our lives poisons are generated in the body itself,
which in health are obviated and eliminated. When, how¬
ever, some slight hitch occurs in the delicate equilibrium of
the chemical reactions going on in the complicated laboratory
of the body, wide-spread havoc may occur. A poison gene¬
rated within the body may escape into the blood, and while
it may do comparatively little damage in the body, to the
more lowly organised and more resistent body cells, it may
still work harm to the sensitive and highly organised nerve-
Digitized by LjQOQle
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1898.] by Ira Van Giesen, M.D.
cells. The nervous system is the most sensitive of all parts
of the body to pathogenic toxic substances in general, but it
is a most exquisite index of the presence of these poisons
arising within the body itself. The conviction is daily gain¬
ing ground that many forms of insanity which arise so in¬
sidiously are due to self-poisoning. The microscope may
show us traces of these poisons, but their source and nature
can only be discovered by the method of physiological
chemistry. Beyoud a certain region of morphological re¬
search into the mechanism of the nervous system, the micro¬
scope alone proves an utter failure. These poisons generated
by the body are of such subtle origin that it would seem
almost beyond the power of science to identify or trace them.
The physiological chemist attempts to identify them by exa¬
mining the secretions or the blood. If unable to identify
and separate them directly from other components of the
body fluids, he is still able to indicate their presence: he
injects the body fluids into animals and watches the physio¬
logical effects, by which he is enabled to tell whether the
body is generating poisonous matters.
In identifying the poisons associated with bacteria the re¬
searches of the physiological chemist have been attended in
many instances with brilliant success. In tetanus or lock¬
jaw, for instance, the bacteriologist at first identified the
bacteria of tetanus, has studied their whole life history and
habits, and has even found this germ in the wilds of Africa,
where the natives smear their arrows with mud of certain
swamps which become partially dry during the summer
season. This earth contains the spores of the tetanus
bacillus, and thus the strange fact explains why the victims
struck by their arrows often die of tefanus.
The physiological chemist, however, has gone further than
this. He has succeeded in isolating the poisonous principles
associated with the tetanus bacillus, and is actually able to
separate them in the form of a powder, so that one might
carry round in his vest pocket the real agent of tetanus, were
it not so sinister a substance and so extraordinary a poison,
for 0*065 of a gramme is absolutely fatal to animal life.
Such a poison transcends in intensity almost anything that
we know of among drugs and inorganic poisons. A little of
the tetanus bacillus poison goes a good way, and it is not
unlikely that many other bacterial poisons are almost as
powerful. The poisons formed within the body itself seem
to be less fulgerant in their action, of milder intensity and
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The Correlation of Sciences in Research , [Oct.,
insidious character, but unfortunately they offset this mildness
by their tendency to remain persistent, and this presents a
great barrier to the restitution of the nerve-cell, for it is
deprived of an opportunity to rest and recover its pathological
expenditure of energy.
Seeing that a not inconsiderable volume of mental diseases
is caused or prepared for by action of poisons upon the
nervous system, especially those of general bodily disease, it
is of the utmost importance to trace them and use, as far as
possible, practical measures against them. I think, therefore,
that pathology, bacteriology, and especially physiological
chemistry, need no further words of commendation in the
investigation of insanity.
With all of these wonderful avenues of investigation so
recently opened in the research of nervous diseases, the
pathologist, physiological chemist, and bacteriologist can
go but little beyond the mere description of facts and obser¬
vations. The real meaning of the great majority of all these
changes in the nervous system , especially in mental maladies,
their significance and the manifestations associated with them
during the life of the patient , can only he made clear through the
science of psycho-pathology.
A curious division has arisen between the practical fields of
nervous diseases and mental diseases, which, having extended
into the scientific investigation of both, has created a very
unfortunate and artificial gap. However important it may be
from a practical standpoint to separate nervous diseases,
which do not interfere seriously with the intelligence, from
mental diseases which require a radically different treatment,
the division in the scientific investigation of the two sets of
diseases has been a distinct drawback in the progress of both
sciences. The progress of knowledge of mental maladies has
suffered the most in being considered a field of investigation
apart from that of the nervous diseases. The damage in
nervous diseases involves the lower and more simply con¬
structed parts of the nervous system, and were the under¬
standing of these simpler conditions applied to the domain of
mental diseases, more progress would have resulted. One
distinct aim of the Institute in many of its departments is to
BRIDGE OVER THIS ARTIFICIAL SCIENTIFIC HIATUS BETWEEN NERVOUS
AND MENTAL DISEASES.
Now we find that the nervous system (even in its highest
spheres) behaves like other parts of the body in the presence
of disease processes. It was suggested in the preceding
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791
1898.] by Ira Van Giesen, M.D.
section that the nerve-cell may exercise a protective agency
against hurtful stimuli by retracting its arms, which also
provided a period of rest for the cell to recuperate patholo¬
gical expenditures of energy. When the hurtful stimulus
becomes more intense, as in the case of poisons coming in
contact with the nerve-cell, notwithstanding its superlative
organisation, it behaves just like its humbler associates in the
liver, the kidney, and elsewhere. It may undergo changes in
its internal organisation in contact with the poisons of disease;
its food supply may also be interfered with. We then per¬
ceive, under the microscope, signs of degeneration of the
nerve-cell, as witnessed in other parts of the body when their
cells are exposed to the influence of poisons. But even under
the influence of poisons the nerve-cell has a wonderful degree
of vitality and a large capacity for restitution, when the
disease-producing poisons are withdrawn. It is a very im¬
portant view to consider that the brain behaves like other
parts of the body in disease processes. In studying, there¬
fore, the changes in diseases of the nervous system, one must
always hold fast to one fundamental truth, that the brain in
disease must not be regarded as something apart from the
rest of the body, and must not be isolated as an organ sui
generis, having inaccessible mechanisms and mysterious
powers.
It must be borne in mind that even the highest constella¬
tions of the brain are not composed of elements distinct or
different from the humblest parts of the nervous system, or
even the simple nerve which pursues its pathway anywhere
throughout the whole body. The fundamental structure of
the constituent elements is the same in each.
The study of pathology in the nervous system, then, in our
Institute must always be guided by a most comprehensive
knowledge of general pathology of the whole body. It is,
however, extremely difficult for any one individual to have a
working knowledge of disease processes in the body in general,
and at the same time know enough of the nervous system to
extend into this field the broad conceptions of general patho¬
logical research. This is the reason why the department of
pathology at the Institute is at a great disadvantage; the
department has not enough men to cover the whole field of
pathology in its relations to the nervous system.
This insufficiency of working force in the department of
pathology has also been a very serious drawback in the
acquisition of that particularly valuable kind of material for
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792 The Correlation of Sciences in Research , [Oct.,
investigation which is not to be found within the asylum.
The opportunity for acquiring this material, so valuable in
tfao investigation of insanity, largely determined the seat of
the Institute in the great metropolitan city of the State.
This material is derived from autopsies on cases in which the
nervous system is damaged by the great host of general
bodily illnesses. The making of autopsies; the acquisition
of autopsy material of nervous diseases; the preservation of
. 8 material with the requisite great care and detail,—all
involve an enormous amount of work, and we have been
unable to take full advantage of the very opportunity which
led to the inauguration of the Pathological Institute in New
York city, namely, the acquisition of material and facilities
for the study of the first stages of insanity, the importance of
which was emphasised in the introductory paragraphs of this
The department of bacteriology is in charge of Henry
Harlow Brooks, M.D. (University of Michigan).
department of physiological chemistry is in charge of
Phoebus Levene, M.D. (Imperial University at St. Peters-
Bedin) RUSSia )' and S ‘ Bookman > Ph - D - (University of
V (A). Department op Experimental Pathology.
I have endeavoured to show that in these days of great
specialisation it is out of the question for any individual to
have the capacity to cover the entire territory. Twenty,
per aps even ten years ago, when methods of investigation
in pathological research were in a comparatively elementary
stage of development, and used uniformly for the investiga-
tmn of disease processes in all parts of the body, a single
individual could master the whole territory, and was a general
practitioner and physician to boot. He could observe sym-
P °™ s during the patient’s life, bridge over the chasm of
death, as it were, and write the sequel of the story of the
disease by observing the changes in the organs under the
microscope. At the present time the problems of pathological
research have grown vastly more complex. The examination
ot different constituents of the body forms a distinct aud
specialised territory of research, each having particular
and intricate methods adapted for its special purpose, which
be used uniformly for the investigation of all parts of
the body. Thus the changes in the blood alone, associated
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1898.] by Ira Van Giesen, M.D.
with disease, constitute a distinct field of research with
specialised methods of investigation, and within the past few
years an extensive literature has grown up emphasising the
importance of specialised microchemical investigation of the
blood.
The study of the general changes linked with disease
processes throughout the body at large, including the study
of tumours, constitutes a very wide field of research, and is
more or less subdivided into distinct branches of investiga¬
tion. The study of morbid processes in the nervous system
constitutes another field of pathological research, which is in
turn subdivided into many specialised branches of investiga¬
tion. And the investigator who would explore this field
must first traverse the domain of general pathological anatomy,
must then learn the intricate architecture and construction
of the nervous system in order to apply to it his knowledge
of the general nature of disease processes.
Experimental pathology in its turn constitutes a highly
important and specialised domain of pathological investiga¬
tion. Studies in this field of research which seek to induce
disease processes experimentally require special skill in
conducting operations on animals, and of watching the
abnormal physiological manifestations of the animal after the
experiment has been performed. It can be seen then that
this territory merges over into that of physiology. If
pathology be restricted to the mere observation of changes in
form within the organs and their constituent cells during the
processes of disease, its power of investigation terminates
quite abruptly in very many directions. We must not only
observe the changes in form and structure within the cells
during disease processes, but also attempt to study the
changes in the functions of the organs and of the cells them¬
selves. In brief, experimental pathology takes into account the
abnormal physiology of organs when exposed to environment
simulating that of disease. This most important branch of
research in pathology, respecting the abnormal physiology of
the organism during disease, is best conducted from the
standpoint of experimental pathology. Experimental patho¬
logy fills up the gaps in knowledge of disease processes
gained by studying them in the human subject alone.
Pathology embraces not only pathological anatomy and
pathological chemistry, dealing respectively with changes in
the structure and chemical reactions of organs, but must also
take into consideration pathological physiology. Pathological
Digitized by
794 The Correlation of Sciences in Research, [Oct.,
anatomy and pathological chemistry have already been
touched upon in their relations to general pathology, and it
is now in order to emphasise the important bearing of patho¬
logical physiology in the study of morbid processes in general,
and of the nervous system in general.
As normal physiology deals with the functions of the
different tissues or organs in the normal organism, patho¬
logical physiology investigates the abnormal functions in the
diseased organism. But the questions which pathological
physiology has to decide are much more complicated than
in those of normal physiology, because of the protean aspects
of disease and the great variety of phases of the process of
disease. Disease is very seldom so simple a phenomenon as
the expression of the abnormal functioning of a single organ
of the body. The body is a united whole, and the various
organs so indissolubly interrelated that abnormality of
functioning in one organ may produce a wide-spread effect
on the functions of the other organs. Disease is a whole
complex of abnormal functions of various organs, although
primarily it may result from the departure of a single organ
or tissue from its normal structure, chemistry, and functions.
In disease the pathological physiologist is confronted, as a
rule, with a whole complex group of abnormal functions of
several organs, and he has to sort out and differentiate how
far the abnormal functions of each organ contribute to the
general symptomatology, and to discuss the interrelation of
the abnormal functions of the several organs.
Observation at the bedside is, to a large extent, a practical
application of pathological physiology, but in most instances
such observation can only state the substance of the question
as to the nature of disease processes, namely, the origin,
cause, and course of the disease, and is seldom able to answer
it. Pathological anatomy may demonstrate that a given
disease is followed by certain lesions in certain parts or
organs of the individual, and may further show that the
same lesions are always associated with the same disease,
thereby making a certain relation between the two factors
quite probable. But in order to change probability into
certainty other methods of investigation are essential. It is
necessary to reproduce the disease experimentally and arti¬
ficially in animals. If the pathological lesions found in a
given disease can be initiated experimentally in an entirely
healthy organism, and disturbances in the functions of the
organs similar to those of the disease result, the chain of
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1898.] by Ira Van Giesen, M.D.
evidence demonstrating the association of the symptoms and
lesions is complete. This plan is the great aim of patho¬
logical physiology.
In this experimental method, not only in pathology but in
all biological science and natural sciences generally, lies the
great power and advantage of modern methods of investiga¬
tion over the ancient lines of research. In some instances
the experimental method in the study of disease may be
applied to human beings, more particularly in methods of
treatment. In fact, all of our empirical knowledge of the
action of drugs has been gained through experiments in
pathological physiology. In fever, for instance, the modifica¬
tions induced in the abnormal functions of the body by
antipyretics or a cold bath are useful applications of the
experimental method in pathological physiology. The op¬
portunities for using experiment in abnormal physiological
manifestations of human beings in disease are seldom
afforded. Hence we have to make use of experiments on
animals and compare the results with the phenomena of
morbid processes in man. It may be said that pathological
processes induced in animals cannot be compared with those
occurring in human beings, for the organisation of each is
different. This is certainly true to some extent. There are,
for instance, pathological processes of the gravest import to
human beings which, as yet, we have not succeeded in repro¬
ducing in animals, such as tumours, syphilis, epilepsy, the
smallpox group, &c., and many diseases of the nervous
system. There are certain factors vaguely grouped together
under the terms predisposition and immunity, which make
an individual of the human species prone to a disease process
and shields an animal from the same process, and vice versa .
Still the idiosyncrasies of man to many diseases from which
animals seem shielded only go to show how much we still
have to learn uf predisposition, immunity, and the factors of
heredity and vulnerability in disease. These facts in them¬
selves, on the other hand, emphasise all the more the im¬
perative necessity of the more extensive application of the
experimental method in pathology, for the diseases which
seem beyond the reach of the experimental method were
formerly and are now precisely the very ones which are most
obscure and unsatisfactory of explanation. The exclusive
privilege which man exercises over the rest of the animal
kingdom in making himself heir to many diseases speaks
volumes for the theory which I have advanced above, that
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the predisposition of man for these diseases is due to de¬
generation (toxic) of his germ-plasm, and civilisation’s abro¬
gation of the laws of survival of the fittest in man.
In many instances, fortunately, one is quite justified in con¬
sidering the abnormal functions of the organ in an animal,
when a given disease process is induced experimentally, as
equivalent to the abnormal functions in a human being in
that disease.
The cardinal functions of the corresponding organs are the
same in all animals with higher organisation, and the struc¬
ture of these organs resembles each other remarkably closely.
If then, having produced in an animal the same lesions in an
organ corresponding to the ones such as are found in the
human cadaver, and that animal manifests the corresponding
set of symptoms, the causal relations of the abnormal func¬
tions to the structural changes rest upon a firm basis. This
is the way that the brilliant and practical results of bacterio¬
logy have been achieved. Without the use of experimental
pathology, bacteriology would indeed have been a sterile
science in the practical domains of medicine. It would have
resulted in a piling of Pelion on Ossa of mere facts of the life
history of bacteria, and their all-important pathogenic quali¬
ties would have remained comparatively unexplored. We
should not strive always to experiment on animals which, by
the high and complicated development of their organisation,
are more or less related to human beings, but, on the con¬
trary, greater extension of the experimental method in patho¬
logy should be made in the lower animals where the brilliant
work of Metchnikoff has given the key to the explanation of
the phenomena of inflammation. The less complicated the
organisation of the animal, the less complicated are its func¬
tions, and the easier it is to comprehend its structure and
functions in either health or disease. But this field, experi¬
mental pathology in the lower animals, belongs to or is shared
with the province of cellular biology, and has already been
alluded to. From these studies it will then not be difficult to
progress to the understanding of the aspects of disease in
more complicated organisms. For our purposes, experiments
to produce disease processes on the more highly organised
animals belong more properly to the territory of experimental
physiology.
When morbid processes are induced experimentally in
animals, to compare the equivalence with disease in the
human subject, the services of physiological chemistry, bac-
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1898.] by Ira Van Giesen, M.D.
teriology, and pathological anatomy must be called upon; the
secretions and excretions must be examined; the physical
methods of examination used in the clinic or laboratory of
normal physiology must also be taken into account. In ad¬
dition, the tissues of the animal are to be examined by the
microscope after death. To a casual observer it might seem
then that pathological physiology, having no methods of its
own, could hardly be called an independent branch of medical
science. This is as little true of pathological as of normal
physiology. The aims of pathological physiology, the ques¬
tions it has to study and decide upon, are necessarily of its
own kind, notwithstanding the fact that it applies methods of
research used in other branches of medicine. Still this branch
of science has an individual method, namely, animal experi¬
mentation conducted along a certain line peculiar to patho¬
logical physiology alone.
Like every other branch of medicine, experimental patho¬
logy or pathological physiology is closely, even organically,
related to the other branches. It is a connecting link between
pathological anatomy , physiology , bacteriology , and physiological
chemistry on the one hand, and clinical medicine and hygiene
on the other. Its work is indispensable, not only for progress
in the treatment of disease, but none the less for advances in
the highest art of medicine—the prevention of disease.
The study of the pathology of the nervous system is more
dependent upon pathological physiology than any other
system in the organism. All the other organs of the body
differ from each other by the anatomical structure and by
their functions simultaneously, while different parts of the
central and peripheral nervous system have the same anato¬
mical structure, and still their functions are entirely different.
We can hardly see, for instance, any morphological or
chemical difference between some parts of the brain, the
irritation of which produces contractions of the muscles, or
other parts of the brain, the irritation of which produces
contractions of the circulatory system, rise of temperature of
the body, and so on.
The fact that every part of the brain has only to perform
a certain part of mental or nervous work in the physiological
division of labour in the nervous system was shown first by
Hitzig and Fritsch by the aid of animal experimentation.
They contributed a valuable part in enabling the physicians
to find in a living man a tumour of the brain, and the surgeon
to direct the knife to its location with almost mathematical
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accuracy. Experiments of this kind corroborated the differen¬
tiation between focal and essential epilepsy, and it is to be
hoped that the day is not far distant when the simulacrum of
epilepsy may be artificially induced in animals through the
labours of experimental pathology. If the simulacra of
epileptic phenomena could be experimentally and permanently
induced in animals, it would furnish the key of the explana¬
tion of this obscure process. All the facts which the patho¬
logist and physiological chemist have gained in the study of
this dire malady give no explanation at all of the process
which gives rise to the epileptic phenomena. The key to the
explanation of the process—the modus operand!—of epilepsy
has only been given by the great genius of Hughlings Jack-
son.
Animal experimentation has also proven that extirpation of
certain portions of the cortical part of the brain always pro¬
duces a degeneration in the same nervous fibres, proving
thereby the neuron theory and showing the location and topo¬
graphical distribution of different groups of functionally
related neurons. Many more examples could be added
showing the value of pathological physiology for the study of
the nervous system.
Morphology and chemistry alone are not now, and never
will be, able to explain all the phases in the actions of the
nervous system, not only because we are unable to differentiate
morphologically or chemically one pathological process in the
brain cell from another, but also because the same patho¬
logical process of two different parts of the brain, if their
functions are different, can have a different influence upon the
organism as a whole. It is, therefore, not sufficient to study
the morphological and chemical changes of the nervous system
in its pathological state. We must also see what influence
such a diseased nervous system has upon the different systems
of the organism, such as the action of the heart, the blood
pressure, the respiration, the general metabolism, and so on,
as these all depend upon the nervous system, and must be
changed when the latter is changed. Conversely the effects of
changes in circulation, respiration, general metabolism, and
changes in organic and vegetative somatic functions upon the
higher parts of the nervous system must also be taken into
account . But this latter topic must be studied by the patho¬
logical physiologist and pyscho-pathologist conjointly. We
can illustrate this best by the plan of studying the influence
of drugs or poisons on the nervous system. Let us suppose
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1898.] by Ira Van Giesen, M.D.
that we introduce into an animal certain drugs that produce
convulsions or sleep; no matter whether we find morpho¬
logical or chemical changes in the Dervous system or not, we
will not know thoroughly the nature of the action of these
drugs until we examine, by all the physical and physiological
methods at our command, the influence of the drugs upon the
nervous system itself and all other systems of the body, the
action of which is regulated by and depends upon the nervous
system.
From one particular standpoint, however, this branch of
research deserves special emphasis, for it relates to some
questions of ultimate and practical importance regarding the
insane. One of the specific roles of experimental patholo¬
gical investigation, in psychiatric research, lies in the deter¬
mination of «the action of drugs upon the nervous system.
It must be confessed that in the treatment of the insane our
knowledge of the effects of drugs upon the metabolism of the
nerve-cells is very obscure. No one will deny that it is of
the utmost importance to know what we are doing to the
nerve-cells in administering drugs to the insane. At present
our knowledge of the action of the drugs given to the insane
is simply that of their general physiological effects; we know
nothing of the chemical reaction between the constituents of
the nerve-cell and the drug itself. Our knowledge of the
action of drugs on the nervous system is empirical to the last
degree.
Epilepsy seems to be due to the action of some stimulus
which, though mild in intensity, may by its persistence act
in the higher spheres of the brain. The stimulus may come
from a variety of places in the body. It may arise from the
intestines in the form of a mild poison, which may escape into
the blood from some departure in the complicated chemical
operations attending digestion; it may travel up one of the
many nerves of the body from some irritation which involves
the ends of these nerves ; it may be due to the irritation of a
splinter of bone pressing on the brain after a blow upon the
head, &c. In an individual of inherent instability of brain,
this constant stimulus finally causes a sudden dissociation of
this part of the brain from the lower spheres beneath, by means
of the retraction of the tentacles of the nerve-cells. These
nerve-cells in the upper spheres of the brain become
fatigued through the constant reception of the stimulus, and
retract their arms to avoid the noxious impulse. But in the
sudden retraction of the upper spheres of the brain, which
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The Correlation of Sciences in Research, [Oct.,
grasp and control the lower portions, the energy of the latter
is suddenly unbridled and loosened, and the epileptic fit
results. Now it is a question, if in deadening and benumb¬
ing these upper spheres of the brain by the use of bromides,
so that they no longer exhibit a sense of fatigue to the stimu¬
lus, that in the course of time much harm may be done. It
is quite true that the symptoms of epilepsy may be controlled
in this way, but are we not poisoning the nervous system to
gain this end ? It were far better to ascertain the cause of
the epileptic fit—the persistent stimulus coming from some
distant place in the body—and attempt to remove this
rather than to injure still further the highest spheres of
the brain by benumbing their sense of fatigue with a
poison.
If large and continuous amounts of bromides be given to
animals, as has been determined in one of the New York State
hospitals, the result is manifested by the phenomena of de¬
generation. While the drug is not given in epilepsy in such
poisonous amounts as in these animals, nevertheless it must
act in the same way, though to a less degree. If a perfectly
sane man were continuously loaded with bromides, it would
seem almost certain that in the course of time he would begin
to show a dissolution of the higher spheres of the brain,
whose activities are concomitant with the manifestations of
the highest forms of mental operations and consciousness. It
must appear, then, from this single example, how important
it is to know the action upon the nerve*cell of these drugs
which are given in insanity. Hence I enter a plea for
experimental pathological work at our institute, and have
mapped out an extensive series of experimental researches to
determine the action on the nerve-cell of the drugs used in
the treatment of insanity.
We have no one on the staff at present who has the
requisite time or specialised training to undertake and stimu¬
late work in the field of experimental pathology. This
associate should be able, in addition to his own special
investigations, to perform all the operations on animals
desired by the other associates in the course of their re¬
searches, and to devise new operations and experiments as
may be necessary in the course of psycho-pathological,
pathological, bacteriological, or chemico-physiological investi¬
gations. In addition to this he should conduct all the
physical and physiological parts of the examination, transfer
and apportion the morphological, chemical,and bacteriological
Digitized by k jOOQle
1898.] by Iba Van Giesen, M.D. 801
material to their respective departments for detailed investi¬
gation after the experiment has terminated.
V (B). The Investigation op Blood in Insanity.
The investigation of the blood in insanity derives its
importance as a distinct field of research from the fact that
this is the medium of conducting the food-supply to the
nerve-cell. When the* nerve-cell works it expends energy,
and the elaboration of energy is carried on within the body
of the nerve-cells from crude food materials derived from the
blood-vessels. The theory has lately become more and more
substantially founded upon facts and observations, that not
an inconsiderable share of mental and nervous diseases are
due to the actions of poisons upon the nerve-cell. These
poisons, which comprise a very large group, are sometimes
bred within the interior of the body ; they are often derived
from bacteria, and frequently taken into the body from
extrinsic sources. But there is danger of carrying this
explanation of the action of poisonous substances upon the
nervous system too far, and thereby under-estimating the
equally important factors of deficient food-supply and patho¬
logical fatigue of the nerve-cell in the production of nervous and
mental disease. In observing the actions of poisonous re¬
agents upon the nerve-cells, the concomitant impairment of
their food-supply in relation to the work they perform must
also be jointly taken into account, particularly where the
poisons, although mild in intensity, are of a dangerous
character from their persistence and chronic action.
Investigations of the blood in the living patient, then, are
of paramount importance, because in changes in the blood we
have a barometer, so to speak, of the fall or adulteration of
the food-supply of the nerve-cells. We have not only to
consider the specific action of poisons upon the nerve-cell, but
the secondary factor of the interference and adulteration of
food-supply of the nerve-cell, which this poison causes by
circulating in the blood.
In one of the commonest forms of insanity—general paresis
—constituting 40 per cent, of the patients in the hospitals
near the large cities, the cause of the disease seems to be a
slow, gradual, unrelenting process of diminishing the food-
supply brought by the blood, thus inducing starvation of the
nerve-cells.
The investigation of the blood of insanity has proved of
xliv. 54
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The Correlation of Sciences in Research , [Oct.,
such practical importance as to enable one to base on it
therapeutic measures, and to indicate th'e percentage of cases
that may be benefited by a particular line of treatment.
Herein is certainly a practical application of the value of
investigation of the blood of the insane. If there be one
factor more important than any other in the production of
mental and nervous diseases, with the exception of toxic
agents, it is the quantitative and qualitative impairment of the
food-supply carried to the nerve-cell * in the blood-vessels .*
Much important work remains to be done in establishing
more definitely the factor of impairment of food-supply to
the nerve-cell, in relation to the genesis of mental and
nervous diseases, and our Institute can ill afford to neglect
this branch of research, and provide for a systematised extension
of this work in the hospitals .
This once more may serve as a good example to show the
inefficiency of the working force of the Department of
Pathology in having only one associate. Pathological re¬
search work covers so many specialised fields of inquiry
that a staff of at least three associates is required. I trust,
however, to find that the Department of Experimental Patho¬
logy and the investigation of the blood of the insane may be
carried on by a single investigator.
To sum up the requirements that are necessary to pursue
pathological research in the investigation of the insane, three
sub-branches should be provided for, each under the charge
of a single associate; these sub-divisions are —
I. General pathological anatomy.
II. Special pathological anatomy of the nervous system.
III. Experimental pathology, including the pathological
histology of the blood.
VI. Department of Anthropology.
The importance of heredity as a factor in the production of
insanity has been hinted at several times in this text. The
facts of the relation of heredity to insanity are to be inter¬
preted only by applying to them the remarkable advances
of cellular biology into the nature of the germ-plasm. The
* The details of chronic over-fatigue of the nerve-cell with normal food-
supply, or work of the nerve-ceU under conditions of deficient food-supply,
involve too many technicalities to be presented in this text. Some of these
details respecting the significance of the excretion of the metaplasm granules
from the nerve-ceU in relation to pathological expenditures of energy are pre¬
sented in “ The Toxic Basis of Neural Diseases/’ in press for a future number of
the Archive* of Neurology and Psycho-pathology .
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1898.] by Ira Van Giesbn, M.D.
whole essence of the problem of heredity in insanity lies in a
thorough appreciation of these definite researches on the germ-
plasm, and the psychiatrist who does not familiarise himself
with these researches in a sister*science can hardly expect to
gain any clear insight into the factor of heredity in insanity.
The discussions of this subject, frequently carried on with but
vague and hazy recognition of the present status of cellular
biological researches into the physical basis of heredity, bear
testimony to the desolate isolation of some workers in psy¬
chiatry from all other branches of science.
What are the agencies which damage the germ-plasm and
cause departures from its normal constitution ? Precisely the
same agencies, to a certain extent, which cause degenerations
or induce disease processes in other cells of the body besides
the germ cell. These agencies may be summed up as poisons
and other factors which depreciate the food-supply of the
body cells.
While in their whole life history the germ cells are set
apart from the rest of the body cells for the distinct and
sole office of propagating the species, it is not possible for
nature to isolate them so completely as to shield the germ
cells from the damage inflicted by poisons or deficient
nourishment. Thus, for example, the poison of syphilis and
chronic and persistent poisoning by alcohol, both of which
seem to operate largely by diminishing quantitatively or
qualitatively the food-supply of the body cells, not only cause
degeneration of the nerve-cells, but damage the germ cell as
well. This is the reason that the progeny of parents whose
nervous systems are poisoned by alcohol and syphilis is
notoriously defective in the weak organisation of the super¬
lative and most intellectually endowed spheres of the nervous
system. For if a very slight defect or chemical change occur
in the germ-plasm as a result of the action of these poisons,
the effect in the next generation will crop out in the highest
and most* complexly organised parts of the body rather than
in the more lowly organised and comparatively undifferen¬
tiated parts. This is why the nervous system, and, above all,
its most lofty portions, are found wanting in perfection when
the germ-plasm is in a pathological condition.
According to the degree of pathological changes in the germ-
plasm do the effects of development of the progeny pass suc¬
cessively from higher to lower and lower planes of organisa¬
tion in the nervous system, so that all grades of degeneracy
and mental instability may be witnessed down to the weak-
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The Correlation of Sciences in Research , [Oct.,
minded imbeciles and idiots. The exceedingly complex
molecular constitution of the germ-plasm, and the compli¬
cated process of reduction or halving of the germ-plasm in
maturation of the egg and sperm cells in relation to the
action of toxic agents and deficient cellular nourishment is of
such urgent importance that T have made plans for the De¬
partment of Cellular Biology to approach the problem from
the experimental standpoint among invertebrates which afford
good opportunity of applying toxic agents to the germ-plasm.
During childhood such inherited incapacity of the energy
of these higher parts of the nervous system does not always
appear, unless the hereditary effects due to damage of the
germ-plasm be gross and severe, for at this period such
higher centres are comparatively little used. During
adolescence and later life, however, when these higher
centres of the nervous system are called upon for the
greatest and most extensive expenditures of energy, they
may fail. We then perceive the outcrop of hereditary de¬
fects. It becomes worse in the next generation, for the
reason that this unstable brain energy in the first generation
is liable to cause the individual to commit excesses, to set
aside moral laws in decent, wholesome living, to tamper with
the nourishment of the body, and introduce alcohol or other
poisons into the circulation of the blood. Thus the germ
cell in the second generation becomes still further degene¬
rated. Degeneration of the germ-plasm is liable to bring
about pathological conditions in the nerve-cells and other
somatic cells, disturbing the general metabolism of the body ;
and once established, tends to set up a vicious circle increas¬
ing the degeneration in each successive progeny. The third
generation becomes still more unstable in the energy of the
higher portions of the brain which hold the lower ones in
check. It is from this or succeeding generations that are
recruited the inmates of the prison, of the lunatic asylum, of
the reformatory, and of the hospital for the epileptic. We
are, however, among the masses, in such a backward state of
general knowledge of all these phenomena that we cannot
seize these things in the beginning, where they ought to be
taken in hand, but must wait for the end, so that the State
has to spend millions, taking care of sickly and incurable
degenerates. Spontaneous variation and environment must,
of course, be taken into consideration in the march of de¬
generacy. But from whatever sources or combinations of
these sources the degenerate and the candidate for the
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1698.] . by Ira Van Giesen, M.D.
prison and the asylum springs, we must identify him and
have knowledge of him in the first and early stages of his
pathway.
Now as to the use and purpose of anthropology. The re¬
lation of anthropology to medical science is somewhat vague.
No one seems to define clearly and exactly just what anthro¬
pology is to do, or what results we may expect from it; con¬
sequently one may avoid the ponderous definitions usually
given, and attempt to explain in simple language the use of
anthropology in the science of medicine. Anthropology is
simply a convenient term to indicate that two or three
sciences are made use of collectively to study not only indi¬
vidual cases, but also large bodies of men. In this way the
science simply makes use of anatomy, physiology, and psycho¬
logy, more or less simultaneously, in investigating normal
and abnormal phenomena of human life.
Now our object with anthropology is to conduct these
anatomical, physiological, and psychological investigations to
determine the characteristics of men with abnormal nervous
systems as compared with the normal. We wish to identify
the degenerate; we wish to learn departures in the physical
and psychical characteristics of men at various stages along
the pathway toward the prison and the asylum. At the
asylum we already know fairly well what departures the
insane show from the average normal man. In the asylum,
however, only the last stages of mental and physical abnor¬
malities preponderate, and we depend on anthropology to
work out the initial and intermediate stages in the course of
degeneracy.
In determination of the mental characteristics of dege¬
neracy, anthropological investigation must be under the
guidance of psychology and psycho-pathology. The great
difficulty encountered in this investigation is the selection of
a normal standard whereby to measure the abnormal depar¬
ture. In America, where the population is so heterogeneous,
we are immediately confronted by the difficulty of finding a
standard race type to measure by, and in fact we can find no
absolute standard. A perfectly normal man is a creature of
the imagination. Only a standard varying between certain
small limits can be used.
I ask that our constituents be reasonable in expecting
immediate results from this department. The amount of
work falling within the scope of authropological investiga¬
tions of the early phases of insanity is stupendous. It can
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The Correlation of Sciences in Research, [Oct. #
only be done little by little, and must grow and develop in the
course of years.
The expectation is also cherished that the commission will
see the advantage of extending this work by a larger staff,
not by spending more money on the department, but by
allowing us to bestow honorary associations with the Institute
upon those who may prove themselves proficient in doing
scientific work in this department and desire to avail them¬
selves of its opportunities for investigation. Any work to be
of value must be most carefully planned. It cannot be forced
along with undue haste in accordance with what American
enterprise demands in all other walks of life. Scientific work
must be exempted from this pressure of haste. I must
therefore ask patience in expectation of results from this
department, the more so since we have no established pre¬
cedent to follow in our investigation. We are doing pioneer
work, and this, as a rule, meets with failures, and often has
to begin over again, profiting by its mistakes, and has fre¬
quently to readjust its plan and methods of work.
A very interesting piece of work now in progress in the
Department of Anthropology is a study of the correlation of
the mental and physical growth of some young boys in a dis¬
ciplinarian school. This has been undertaken in conjunction
with Doctor Downing, of Brooklyn, N. Y. Fortunately
we have an opportunity of studying these boys for several
years, in order that we may fully record the relationship
of psychical and physical growth, and also identify those
among them who tend to deflect into degeneracy. It must be
seen how important is some attempt at gaining a coherent
knowledge of the insane before they make their way into the
hospitals. When this is known it is bound to be of practical
benefit and yield economical returns by instituting some form
of control of insanity before it reaches its more hopeless stages.
In brief, one prominent purpose of anthropology at the
Institute is to ascertain the proportion of cases of insanity
occurring in normal individuals—in individuals who have no
hereditary predisposition toward insanity—and to compare
this proportion with the other cases of insanity complicated
with or resulting from hereditary predisposition. For in the
former class of cases insanity is more or less of an accident,
and in the great majority of cases recovery is to be expected;
whereas in the latter class with predisposition recovery is
much less liable to occur. The determination of the question,
it is plain, is most important and practical.
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1898.] by Ira Van Giesen, M.D.
The instruments required for this department are compara¬
tively simple and inexpensive. It has apparatus for testing
the acuteness of the senses (all of which have to be determined
in the various phases of degeneracy) and sundry instruments
for physical measurements of the human body; two instru¬
ments to measure the diameter and contour of the skull, one
in duplicate for the use of the State hospitals; measures for
determining the cubic contents of the skull; a stereograph for
tracing contours and profiles of the skull, and an anthropometer
used for taking general measurements of the body.
We hope also in the course of time to make a collection of
skeletons of the insane, in order to study the stigmata of
degeneracy in the osseous system. The Anthropological Insti¬
tute at Paris is very proud of their collection of the complete
skeletons of 13 epileptics, because their histories and behaviour
during life are accurately known. Seeing that the histories
of our patients at the hospitals are scrupulously kept, we
ought to be able in the course of time to have one of the best
collections in the world for studying the osseous systems of
epileptics, criminals, and lunatics. The value of this collection
does not lie in the fact that it is a mere conglomeration of
bones, but that it should be possible to study each skeleton in
connection with the life history of its possessor.
The Department of Anthropology is in charge of Alois
Hrdlicka, M.D.
Section 4.—The Unclassified Residuum.
In conclusion, a paragraph from one of Professor James’s
essays* is most appropriate :
“The great field for new discoveries/’ said a scientific
friend to me the other day, “is always the unclassified
residuum. Round about the accredited and orderly facts
of every science there ever floats a sort of dust cloud of
exceptional observations, of occurrences minute and irregular
and seldom met with, which it always proves more easy to
ignore than to attend to. The ideal of every science is that
of a closed and completed system of truth. The charm of
most sciences to their more passive disciples consists in their
appearing, in fact, to wear just this ideal form. Each one of
our various ologies seems to offer a definite head of classifica¬
tion for every possible phenomenon which it professes to
cover; and so far from free is most men’s fancy, that, when
* “ Whet Psychical Research Iihs accomplished’* in the Will to Believe and
other Essays in Popular Philosophy , p. 299.
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808 The Correlation of Sciences in Research, [Oct.,
a consistent and organised scheme of this sort has once been
comprehended and assimilated, a different scheme is un¬
imaginable. No alternative, whether to whole or parts, can
any longer be conceived as possible. Phenomena unclassifi-
able within the system are therefore paradoxical absurdities,
and must be held untrue. When, moreover, as so often
happens, the reports of them are vague and indirect, whether
they come as mere marvels and oddities rather than things
of serious moment, one neglects or denies them with the
best of scientific consciences. Only the born geniuses let
themselves be worried and fascinated by these outstanding
exceptions and get no peace until they are brought within
the fold. Your Galileos, Galvanis, Fresnels, Purkinjes, and
Darwins are always getting confounded and troubled by
insignificant things. Any one will renovate his science who
will steadily look after the irregular phenomena. And when
science is renewed, its new formulae often have more of the
voice of the exceptions in them than of what were supposed
to be the rules.”
From the scientific standpoint the disordered states of
consciousness in insanity form a very large “ unclassified
residuum/’ In correlating these branches of sciences we
have avoided the danger which Professor James indicates of
restricting a branch of science to some set, fixed, and narrow
limits of observation. If a branch of science be thus re¬
stricted it soon becomes walled up within itself. It travels
in a rut, repeats its old observations over and over again,
trying to make them appear new by merely setting them
forth in new words; it finally becomes worn out and mummi¬
fied. On the other hand, if a branch of science seems to be
nearing the limits of its capacity to formulate new generalisa¬
tions, seems to have completed its possible activities in pre¬
senting the ideal closed system of truths to which there seems
nothing to add, such a science when stretched out to the
outlying domain intervening between a sister science may
have to begin its investigations all over again in a new and
broader light. It is the value of the domains between the
various medical and other ologies that we have endeavoured
to bring out into prominence in the study of insanity. It
should not be considered that our Institute has overreached
itself in bringing unnecessary or irrelevant departments of
science to bear upon the problems, or that in taking a stand
against the restricted study of insanity it has gone to the
opposite extreme in too greatly diversifying this research.
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1898.] by Ira Van Giesen, M.D.
In fact a practical working force of but one Associate for the
comprehensive Department of Pathological Anatomy and no
representative for the Department of the Normal Histology of
the Nervous System shows that this projected plan of the
correlations of branches of scientific research in insanity at
this Institute is still not completely developed.
We have seen some of the natural shortcomings of
psychiatry, inevitable in the evolution of its progress; let us
now behold the greatness of its future.
It would be a carping and disrespectful form of scientific
lese maje8te to point out these shortcomings as a stigma on the
name of psychiatry, for it is truly destined to be the most
majestic of all the biological and medical sciences.
These shortcomings of psychiatry only serve to show the
greatness, comprehensiveness, and difficulties of the science.
The other sciences in medicine and biology are elementary
beside psychiatry. They are but stepping-stones to physio-
logy, psycho-pathology, and psychiatry. For the three must
be worked together in the study of the abnormal phenomena
of consciousness. Psychiatry should never be so narrowly
viewed as being tied down only to insanity , but to abnormal
phenomena of consciousness in general, the domain of pyscho-
pathology. The study of abnormal manifestations of con¬
sciousness presupposes a knowledge of normal psychology,
while at the same time it is the only key to an understanding
of normal mental phenomena.
It is not strange that psychiatry, the most difficult and com¬
prehensive of all medical and biological sciences, has been one
of the last to begin its scientific progress. Psychiatry has not
lagged behind of its own accord; it has been held back and
had no choice but to wait until its stepping-stones might be
built. It has had to wait for the growth of psychology
in general and psycho-pathology in particular; for cellular
biology, pathological anatomy, neural anatomy, and their
affiliated branches of research to attain sufficient development
to cope with its difficult problems. When it is perceived how
far these subsidiary sciences have had to develop before
attaining the capacity to be of service to psychiatry, we can
gain some idea of the eminence of psychiatry among the
medico-biological sciences.
The spiritual trinity, psychology, psycho-pathology, and
psychiatry, is destined to form the loftiest pinnacle of the temple
of science. The scientific story of the rocks holds one spell¬
bound ; the history of the egg or the mechanism of a tiny
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organism has its fascination; mathematics and the laws
which command the courses of the stars are awe-inspiring,
but none of these sciences or their allies have the grandeur
or are so deeply and essentially human as the three sciences,
psychology, psycho-pathology, and psychiatry, for they unveil
the greatest marvel of the universe, the human mind.
We may say with the great Scotch philosopher, "In the
world there is nothing greater than man, and in man there is
nothing greater than mind.” A knowledge of mind, both of
its normal and abnormal manifestations, is the science of
sciences.
Psychiatry for the short history of its existence has done
its utmost with the imperfect methods at its disposal, and is
now looking for new methods to fertilise its soil, highly
fruitful but difficult to till. Common neurologists and patho¬
logists, in their mistaken nature of the true function of
science, more and more lose sight of what lies beyond their
microscopic field of vision. What is still sadder, they are
absurdly proud of their narrowness, making a virtue of their
shortcomings. They highly value the process of groping
aimlessly in the dark for new details. It is only the best
thinking men among them who begin to look for the light of
a broad horizon. The psychiatrist, on the contrary, by the
very nature of his studies, is forced more and more to broaden
out the basis of his science. Nothing short of a co-operation
of all the sciences is what psychiatry requires. The en¬
lightened psychiatrist looks for an organisation of the dispersed
and dismembered parts of medical science. Fortunately this
enlightened spirit found a foothold in the Commission and
Representatives of the New York State Hospitals,*and for the
first time in the history of medical science was an institute
established on a broad scientific basis, an institute whose aim
is to till the field of psychiatry by means of instruments and
methods obtained through an organised federation of the
most important and most vital branches of medical science.
Such a federation will help the growth not only of psychiatry,
but also of all the other branches of medical science. Science
ought to be grateful to the psychiatrist for the mere fact
that he is the first to call for a general unified activity of the
many branches of medical science. For unification, general¬
isation means the discovery of laws, the true aim of science.
I may well acknowledge an inability to do justice to the
future grandeur of psychiatry as a science, and its deep
sympathy with humanity as an art. For this might better be
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811
1898.] by Ira Van Giesen, M.D.
traced by a pen—if there be another—like the one which
has wielded the most stately periods on traits of normal and
abnormal human nature in the English or any other tongue
—that of Henry Maudsley.
CLINICAL NOTES AND CASES.
A Case of Chorea Gravis,* reported by J. W. Geddes, M.B.,
C.M., Assist. Med. Officer, and T. Aldous Clinch, M.D.,
Pathologist, Durham County Asylum.
The interest of the following case centres in the severity of
the lesions, both macroscopic and microscopic, which were
found post mortem.
The patient, aged 26, six or seven months pregnant with her
first child, was admitted to the Durham County Asylum shortly
after midnight, 17t.h May, 1898, in a state of continuous bodily
movement and confined in a strait-jacket.
Family history .—An aunt is an inmate of this asylum. A
father’s half-sister died of phthisis. Several sisters died before
the patient was born ; one of these was very young, and succumbed
to “ brain fever.”
Life history .—Previously healthy; has never sufEered from
chorea, fits, or insanity.
Present illness .—About two months before the illness began
she moved with her vicious husband from one home to another,
which, with systematic maltreatment and starvation, caused con¬
siderable depression. A month later choreic movements commenced,
but she was not seen by any medical man till three days before
her admission. Dr. Gordon Bussell found her sane, but unable to
walk owing to chorea, which increased in severity, while her mental
state deteriorated jpari passu. He recommended her removal to
the workhouse infirmary, where she was certified insane and re¬
moved at once to the asylum.
On admission the choreic movements were wild and uncontrolled
to an extreme degree, not limited to the limbs, but affecting the
head and trunk also. Her face was flushed; she was bathed in
perspiration ; her limbs were considerably bruised. She paid no
attention to questions, and only made inarticulate sounds.
# Read at the Annual Meeting of the Medico-Psychological Association,
Edinburgh, 1898.
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812
Clinical Notes and Cases.
[Oct.,
About 12.30 a.m. two drachms of paraldehyde were administered
by the nasal tube. She slept till 3 a.m. In the forenoon of the
same day she tossed wildly about, held in bed, for five or ten
minutes, then she lny in an apparently comatose condition for
about five minutes alternately. Paraldehyde again procured sleep
till the afternoon. The lungs were then found to be congested,
and the heart showed a mitral systolic murmur. On waking she
fell into the same state as before. At six p.m. abortion com¬
menced, and at 6.15 the membranes containing a dead foetus were
expelled unbroken. The uterus contracted well. Her strength
rapidly failed, and she died at 8 p.m.
Postmortem report .—Sectio cadaveris 18£ hours after death.
Body well nourished. Rigor mortis passing off ; lividity very
marked, blotches on face and anterior aspect of trunk and limbs.
Head .—Scalp thick, tough and congested. Skull-cap thin, hard
and very congested. Dura mater congested, otherwise normal.
The great longitudinal sinus contains clot; the other sinuses
contain fluid blood.
Beneath the dura on the right side, and practically corresponding
in extent with the temporal bone, is a large blood-clot—soft and
friable, evenly coloured throughout, and perfectly free in the
subdural space. Its thickness at the centre is about 1*6 cm.,
and its volume, taken by the displacement method, is 28 4 c.c.
Interiorly it extends over the right side of the middle fossa and
over the floor of the whole posterior fossa, descending into the
spinal canal as far as the first cervical nerve-roots anteriorly.
The source of this, haemorrhage was probably the posterior branch
of the middle meningeal artery, but, except at the one point where
it is injured, the vessel wall appears perfectly healthy.
On the left side there is a similar haemorrhagic extravasation
over the posterior half of the parietal lobe and over the external
surface of the occipital lobe ; no apparent source of this haemor¬
rhage could be found. It therefore appears probable that it arose
from numerous minute points.
The pia arachnoid presents a smooth shining surface, en¬
gorged with fluid blood and intensely congested. In the pia
arachnoid are many small haemorrhages on tbe left side, chiefly at
the anterior and posterior extremities of the hemisphere. It is
slightly (Bdematous, very friable, but not thickened, leaving the
cortex with difficulty, yet without tearing it.
There is very little speckling of the surface from bleeding
points when the membranes are removed. The convolutions are
but little wasted; on section the cortex is reddish brown, while
the alternating areas of pallor are not so well marked. The white
matter is only slightly congested, and of firm consistence. The
ventricles are not dilated and the ependyma is noijnal; basal
ganglia normal save for slight yellowish mottling of the optic
thalami. The hemispheres are of equal weight.
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Clinical Notes and Cases .
813
1898.]
The cortex presents a mottled appearance; areas of deep con¬
gestion alternate with areas of pallor, each being roughly of the
size of a sixpence. One large patch of anaemia extends over the
lower three quarters of the left motor area. Cerebellar cortex is
congested. Medulla, pons, and basal vessels are normal.
Thorax .—Pericardium normal. Heart muscle firm, left ventricle
slightly hypertrophied. Mitral valve slightly thickened; no vege¬
tations.
Lungs congested and cedematous.
Abdomen.—Peritoneum normal. Liver , small patches of acute
fatty change. Spleen normal. Kidneys normal. Uterus firmly
contracted.
Microscopical Report. —Second left frontal convolution hardened
in absolute alcohol and in formalin 10 per cent. Sections stained
by Nissrs, Held’s, Golgi’s, and the Weigert-Pal methods, and with
hematoxylin and eosin.
By NissVs Method when hardened in Absolute Alcohol. —In the
first layer of the cortex a few of the granule cells appear to be
provided with longish processes, which are varicose and curly. In
some preparations it is difficult to say whether or not these appear¬
ances are due to staining of the fibre of the tissue in the neigh¬
bourhood, but iu others high magnification convinces us that these
are genuine cell processes. The cells of the second layer show very
marked degenerative changes, most of them presenting complete
destruction of the chromophile elements. The nucleus generally
shows a tendency to over-staining, and the perinuclear membrane is
distinct. Held’s method likewise reveals no structure where chro¬
mophile elements are absent. In many cells the nuclei have been
destroyed, or dislocated, or dislocated and partially destroyed. It
may be that these various lesions are due to faulty methods. In
the’ third layer the destruction of the cells is less complete.
Chromatolysis to a greater or less extent can be found in nearly all,
and normal cells are only found with difficulty. Both layers like¬
wise show cells or nuclei, which overstain and are shrunken, and also
very thin, attenuated, and badly stained dendritic processes.
Sometimes the cells are vacuolated.
In formalin specimens the methylene blue stain does not com¬
pare favorably with the alcohol-hardened, but in the former brings
out the yellowish pigment, which is not at all conspicuous, and cer¬
tainly not in excess.
In the hsematoxylin specimens the cells -are very badly differenti¬
ated from the surrounding matrix, but reflect the appearances of
the Nissl method. In addition to this, however, they give a
splendid picture of the axis-cylinders, which appear perfectly
normal. The blood-vessels are distended with corpuscles, and
there are a few capillary haemorrhages. The walls are in many
instances much thickened, and the nuclei do not stain normally, but
Digitized by {jOOQle
814
Clinical Notes and Cases .
[Oct.,
appear as somewhat lighter dots in the vessel wall (longitudinal
section). Other appearances which suggest stasis are seen, such as
the non-staining of the vessel contents, appearances like blood-
plates, loss of distinctness of the corpuscles. In some of the larger
vessels fibrin is distinctly seen spreading in threads among the
corpuscles. The perivascular spaces are dilated, and in many
instances granular dibris can be seen in them.
The Weigert-Pal preparations stain very badly ; the whole tissue
appears speckled with minute blue dots resembling myelin, but too
small to give a double contour. They are most common in the
white matter, and gradually diminish in number toward the surface.
The myelin sheaths scarcely take the dye at all when the fibres
have left the white matter, and they appear broken and uneven;
the usual varicose beaded appearance is never seen, probably
because the myelin takes the stain so badly that it is not visible in
so small a bulk. On the other hand, the vessels are stained ex¬
ceedingly well, or rather the corpuscles in them are, and they stand
out as clearly on the yellow background as the cells in a Golgi pre¬
paration. As in the case of the h©matoxvlin specimens, minute
hmmorrhages are to be seen occasionally. The pia mater is infil¬
trated with corpuscles, which do not seem to be enclosed in vessel
walls.
Golgi's method shows evidence of departure from the normal, the
value of which it is more difficult to decide. There is a thick
deposit of silver chromate in the first layer of cells and superficial
part of the second one. Below this the second layer of cells on
the sides of the convolutions is almost entirely unimpregnated,
and impregnation gradually grows more perfect as the top of the
convolution is reached, though even here it never reaches the same
degree of perfection as the third layer. This layer, which is well
impregnated, shows the following changes:—There are cells the
bodies of which are swollen and rounded, giving off attenuated
apical and other processes ; there are other cells presenting a great
diminution in the number and size of the processes. The absence
of thorns is a common occurrence, and often renders recognition of
the axis-cylinder no easy matter. Processes are often indicated
merely by a series of fine dots, and in such cases no thorns or any
appearance which suggests them are ever present. In other cases
thorns may be represented by a row of fine granules at a distance
from the processes corresponding with the end of a thorn; these
dots in a few cases may have intermediate dots between them and the
process; indeed, one finds stages between the complete thorn and
the dot, and the dot may probably be regarded as the next stage to
no thorn at all.
The changes so far described apply to the pyramidal cells. The
next one we have seen only on the cells with the short or
ascending axis-cylinder. This change consists of elliptical swell¬
ings or bulgings along the side of the dendrites. They are gene*
Digitized by
Clinical Notes and Cases.
815
1898.]
rally small, and may occur at the bifurcation of the process. In
these cases the cell shows no thorns. They appear to be the same
change, only less advanced, as that described by Berkeley in Brain ,
1895, as occurring in the brains of alcoholic rabbits. Nearly all this
type of cell show these changes. In a few instances pyramidal
cells have been seen with a deep depression in their wall extending
three quarters of the way across the cell; this appearance may
possibly be due to defective impregnation.
Apart from cellular lesions, two other abnormal appearances
have been shown by this method, and by no other. The one con¬
sists in globular swellings on the vessels like miliary aneurisms,
and the other in large black globules like the ordinary amyloid
corpuscle, but about twice their diameter. They look like osmic
acid fat globules, but no osmic acid has been used in this method.
This completes the detailed account of the abnormalities found
in this case, but we do not wish to suggest that all of them,
more especially those seen by the Golgi method, are necessarily
directly in relation to the disease.
To conclude, we find great congestion of the meninges,
which has resulted in severe haemorrhages. We note that the
congestion diminishes in both directions as we depart from
the arachnoid. The fact that the basal ganglia show no con¬
gestion to the naked eye is most interesting when it is
considered how many high authorities consider them the seat
of the disease. The yellowish pigmentation of the optic thalami
is so constant that it cannot be regarded as having any causal
relation to the disease. Microscopically we have noted severe
degeneration of the cells and of the myelin sheaths of the
axis-cylinders, a process also diminishing in intensity in
relation to distance from the membranes. The appearances
noted are, however, probably to be considered as a result
rather than as a cause of the symptoms observed. Indeed,
they bear a close resemblance to those reported when animals
have been killed by depriving them of sleep. One change
strikes us as unexpected, viz. the thickening, and that to no
slight degree, of some of the blood-vessels. It is not confined
to one coat of the vessels, but affects the media and externa
chiefly. The appearances are those of a degenerative change
occurring in previously diseased vessels, and the question arises
as to the relation of this disease to the cause of death. Have
these vessels, with their narrowed calibre, induced changes in
inhibitory or regulating centres, which may have assisted in
the provocation of chorea, or have they had no influence
whatever ?
The relation of rheumatism and chorea is one of perennial
Digitized by AjOOQle
816
Clinical Notes and Cases.
[Oct.,
interest. In the present case we have no history of rheumatism ,
but a systolic murmur was •present , and we venture to state
that, had this patient lived, the diagnosis would have been
chorea with endocarditis. There was, however, no evidence
of recent changes in any of the cardiac valves.
In conclusion, we draw attention to the acute fatty
degeneration around blood-vessels of the liver, which may
readily be overlooked. This points to a toxic cause, whether
the toxin is introduced from without, or is produced by the
body itself, or is manufactured by organisms within the body.
If these latter had their seat in the cortex they would
probably have been demonstrated by the methylene blue
preparations, but we find no such appearances.
Our thanks are due to Dr. Gordon Russell and Dr. Win-
grave for their kind assistance in endeavouring to obtain a
complete history of the case.
Addendum on Methods employed .—In this work so many
modifications of practical value have been introduced that it
may be of interest to pathologists if I detail them as briefly
as possible.
NissVs Method. —Hardening in my own practice has always
been accomplished by alcohol which is rapidly increased in
strength till absolute* The tissue is then fastened on a
wooden block by melted paraffin, and cut under absolute
alcohol on a sliding microtome as thin as possible. Paraffin
embedding alone will give thinner sections than can be
obtained in this way. As an alternative the alcohol may be
washed out, the piece soaked for a few hours in dextrine, and
then cut on a freezing microtome. After freeing the sections
from alcohol or dextrine they are stained in the following
fluid:
Methylene blue B. X. (patent Griibler) . . 3’75 grammes.
Green potash soft soap (Venetian) . . . 1*25 „
Water. 1000 c.c.
The employment of soap is necessary for the cortex, though
good results may be obtained from the cord without it. The
special methylene blue is absolutely necessary.
For the cortex decolorisation is best accomplished by
absolute alcohol alone. To facilitate mounting, the sections
may pass from the dye for a few seconds into water. They
* 60 per cent, alcohol . . .24 hours.
90 „ . . . 118 „
Absolute „ ... tiU hard enough to cut.
Digitized by Le
Clinical Notes and Cases.
1898.]
817
are then decolourised on a slide, cleared with xylol, and
mounted with Canada balsam.
The methylene blue stain gives results which are in my
opinion unsurpassed by thionine or methyl violet, while the
method with the correct dye is simple in the extreme.
Formalin as a hardening agent gives poor and dubiously
permanent results.
Held's method demands such thin sections that in general
paraffin embedding is resorted to. Nissl long ago pointed
out that this process destroyed or disorganised the chromo-
philic elements, and I have experimented in this direction with
the same results. Much work has been published which
loses a great part of its value because of this defect. By
mixing equal parts of Nissl's blue solution with a *75 solution
of erythrosin a beautiful double staining is obtained : the Nissl
granula are blue, the achromatic substance pink, the nuclear
membrane and substance red, the nucleolus and intra-nuclear
network purple. Decolorisation is obtained in absolute
alcohol.
Golgi’s Method. —After hardening for one or two months in
formalin the pieces are placed in Muller's fluid for a week, and
then with the usual precautions in 1 per cent, solution of
silver nitrate (Bolton).
The silver is then thoroughly washed out by repeated
changes of distilled water, the tissue soaked in gum (or dex¬
trine) and cut on the freezing microtome. The embedding
medium being washed out, the extraneous deposit of silver
chromate is partially removed by strong potash (Bevan Lewis),
which does not destroy these preparations as it does those
hardened with osmic acid; they are then washed free from
potash (at this stage, if desired, toning processes of various
authors may be used), cleared with carbol-xylol (1—3), and
mounted on cover-glasses in gum dammar. When thoroughly
set these glasses may be turned upside down over a slide, the
corners being supported by common glass beads fixed with
gum dammar, for the slide must not come in contact with the
mountant.
Weigert-Pal Method .—The method described by Bolton
(Journal of Anat. and Physiolog ., Dec., 1897) has been
followed, except that a mixture of bichromate of ammonia
and chrome alum is used as the mordant, 1 per cent, of each,
and that the sections are stained till very brittle, as short of
this stage full impregnation of the cortical nerve-fibres is not
obtained.
xliv. 55
Digitized by {jOOQle
818 Clinical Notes and Cases. [Oct.,
If the sections are supported throughout on small pieces of
tissue-paper the fragility forms no obstacle to success.
The steps are, harden in formalin, cut sections on freez¬
ing microtome without embedding or washing, dye in
Kulschitsky's acid haematoxylin, differentiation by Pal's
fluids, washing, dehydration, &c.—by these means the tracing
of fibres in the cortex is rendered very easy.
Discussion.
Dr. Clap ham asked upon what grounds was the patient sent to the asylum?
He had a similar case in Sheffield, which he admitted into the Royal Hospital. It
differed in the fact that it was not fatal, but there was no difficulty in treating the
casein the ordinary wards of a general hospital.
Dr. Ford Robertson, with regard to the use of alcoholic fixation, said that Con¬
tinental observations upon nerve-cells had been made almost entirely with the
sublimate fixation, and by those authorities alcohol was always said to be practically
of no use. He himself did not see that the nucleus could by any probability be
fixed, and he was sure that the post-mortem changes would be very great. He was
entirely in favour of sublimate in the fixation of nerve-cells.
Dr. Clouston desired to express great thanks to the reader of this paper. It
made them realise how all-important pathological work was, and how much they
were indebted to the younger members of the Association. In regard to the causa¬
tion of such an acute case, his (Dr. Clouston’s) choice would have lain in the
diagnosis between acute rheumatism and the toxic effects of the dead foetus. He
was not aware that a dead foetus could cause chorea. Such a cause might produce
convulsions, and undoubtedly it could cause pneumonia, but it would be a new fact
if poisons from a dead foetus could cause chorea; while, on the other hand, they
knew that rheumatism was intimately connected with chorea. If there had been
a record of high temperature he would have favoured the diagnosis of rheumatism.
Dr. Aldoub Clinch said he stated expressly that it was only in ihe study of the
cell that he regarded alcohol fixation as sufficient. He made no reference whatever
to the complete stjidy of the nucleus in his paper.
Clinical Cases. By F. Graham Crookshank, M.D.Lond.,
Assistant Medical Officer, Northampton County Asylum.
1. Post-epileptic Hysteria.
A man, E. C—, aged twenty-eight, is at present a patient
in the Northampton County Asylum. This man has since
childhood suffered from epilepsy, and although at one time
the fits were for several years in abeyance, just now they are
frequent and often severe. The attendants, who have known
him for many years, state that while the severe fits are
of the usual type, the lesser ones are often followed by
"antics" and "playing the fool." In one of these less
severe attacks, which I witnessed recently, the convulsions
had all the characters of a genuine epilepsy, and were fol-
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Clinical Notes and Cases .
819
1898.]
lowed by the usual stage of stertorous passivity. But this
stage was of short duration only, the patient suddenly
springing up and adopting the “ segment of a circle” posi¬
tion, the occiput and heels alone touching the ground.
Suddenly relaxing, he then raised his trunk from the ground
and bent forwards towards his feet five or six times in suc¬
cession. Then, falling on his back, the knees were flexed and
the thighs drawn up on the abdomen, and then as rapidly
stretched out. This he repeated several times. Drawing up
the thighs again, he placed his hands on his buttocks and
rocked backwards and forwards, shouting loudly a stave or
two of "We won't go home till morning.” Finally he burst
into a loud laugh, gesticulated extravagantly, got up from
the ground, picked up his hat, and sat down complacently
on a bench. These last movements were performed quite
automatically, and without the least evidence of conscious
appreciation. In fact, he continued for some hours in a
dreamy state, and not till the next day was he fully and
clearly conscious. I have no doubt at all that the convulsion
was a genuine epilepsy, and it is quite obvious that the subse¬
quent performance corresponded in detail to the series of
movements demonstrated by Richer in hysteria major.
In most text-books very little is said of the connection
between true epilepsy and hysteria. The occasional occur¬
rence of post-epileptic hysteria is noted, but nothing more.
Such cases as this, in which phenomena usually regarded as
hysterical occur as part of the series of phenomena of a true
epilepsy, are both interesting and important. Surely it is
of more than academical interest to inquire whether these
“ posturings ” are simply phenomena naturally allied to the
automatism and somnambulism which, as we know, may occur
indifferently after hysterical or epileptic convulsions; or
whether these posturings are essentially hysterical, and hysteria
a mental condition accompanied by somatic disturbance, one of
the causes of which is epilepsy. At any rate a knowledge of
the occurrence of these symptoms of “ la grande hysterie ” in
males after epileptic convulsions must lead to considerable
diffidence in denying, even in women, the epileptic nature of
fits succeeded by “ clownism ” and “ zoopsea.”
2. Congenital Aberrations of the Epiblast in an Insane Man .
An elderly man was a few months ago apprehended in
Buckingham Palace Yard as a lunatic wandering at large.
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820 Clinical Notes and Cases . [Oct.,
He eventually became an inmate of the Northampton County
Asylum, where he at present remains. He is a perfectly
happy, merry, and well-behaved old man, who believes that he
has some claim to the throne of England, and is content to
await the public recognition which he is persuaded will not
long be denied him. There is some reason to state that he has
always been of an eccentric and singular turn of mind.
Such interest as may attach to his case is due rather to his
cutaneous than his mental eccentricities. The whole of
this man's skin is thickly studded with warts, sessile and
pedunculated, and with little nsevoid growths. His ears are
long, narrow, with the satyr's point well marked, and with
an abundant growth of hair on the inner surface of each
tragus. On the posterior fold of the left axilla is a well-
formed mamma about the size of a pigeon's egg, and pre¬
senting a well-developed virginal nipple. Over the sacrum
and the lower part of the lumbar curve is that localised
growth of abundant and coarse hair so often associated with
spina bifida occulta, and so frequently represented in a con¬
ventionalised form on classical statues of fawns and satyrs.
On the knees and elbows are patches of inveterate psoriasis,
a disease from which he has sufFered throughout life. The
palatal arch is wide and flattened out, and the whole facial
expression irresistibly suggests that of a kindly and humorous
ola satyr.
When noticing, as in this case, the correlation of the
insane diathesis with cutaneous abnormalities, one cannot
forget that the central nervous system is, no less than the
skin and its appendages, of epiblastic origin. There is,
therefore, rational justification for acceptance of the clinical
teaching that cutaneous abnormalities frequently indicate
the “ insane diathesis."
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821
OCCASIONAL NOTES OF THE QUARTER.
The Annual Meeting of the Medico-Psychological Association .
Under the presidency of Dr. Urquhart, the Association met
this year in Edinburgh after an interval of ten years.
The meeting was probably the most successful that has
taken place since our annual meetings changed their character.
The attendance was large, and several of the contributions
were of high merit.
The members of our specialty who practise in less favoured
countries visit Scotland with satisfaction. They see there
much good feeling among fellow-workers, and an amount of
kindliness and confidence on the part of the profession gene¬
rally and on the part of the public towards the labourers in our
somewhat thankless branch which are often absent elsewhere.
The forenoon of the first day (July 21st) was occupied with
business which will be found fully reported in the proceedings.
Dr. Beveridge Spence, who has served the Association so
ably as Registrar since the formation of that office, was unani¬
mously chosen President elect. Mr. Hine, the well-known
architect to the London asylums, Professor Magnan of Paris,
and Dr. A. E. MacDonald of New York were elected honorary
members.
The auditors , report shows that the finances of the Associa¬
tion continue in a satisfactory condition.
Proposals with regard to the treatment of incipient insanity
were discussed, and a resolution adopted after some opposition.
We cannot think that these proposals are altogether retro¬
grade, even if it should appear that they are not quite in
harmony with the much too rigid existing provisions with
regard to the care of the insane in England.
In the afternoon Dr. Urquhart, having taken the chair,
delivered the Presidential address. It is already before our
readers. Addresses from the chair, when they do not deal
solely with some one definite question, are very generally
hortatory and improving, or retrospective and self-applaud¬
ing. Our President on this occasion has avoided the common
stumblingblocks of such discourses, and in his well-balanced
address has been instructive without being didactic, has been
retrospective without either exultation over the present or
derision of the past, and has dealt with present problems in
an earnest, sensible, and enlightened manner. He pointed
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822
Occasional Notes of the Quarter. [Oct.,
out that the chief great reforms for which Conolly cried from
the chair at the Edinburgh meeting in 1858 had now been
accepted. His summary of the deductions to be drawn from
the statistics of the Murray Asylum, which must have cost
infinite labour to prepare, is most interesting, and shows that
every generation has its own problems in treatment and
management just as it has in pure science.
A very remarkable point on which Dr. Urquhart dwelt is
the absurd disproportion between the increased amount of
work to be done by the English Lunacy Commissioners and
the stationary personelle of the Commission. This dispropor¬
tion suggests that the law does not regard the work which
the Commissioners have individually to execute as of much
importance. Every year which passes sees an increase in the
number of the insane, and every fresh enactment which is
adopted increases the amount of restrictive routine, until it
will become impossible to work the department save as a
piece of State machinery, the ultimate direction of which
must inevitably fall entirely into the hands of Civil Service
clerks. Individual treatment is probably just as essential for
us and for our institutions as it is for our patients, and
insanity can no more be treated wholesale than any other
disease. The notion of bulking insanity and pauperism,
against which the President protests, evidently rests on the
old belief that insanity is a social state, and not a disease.
Nous avons change tout cela . That belief is dead if not
buried, and before long not even the most ignorant of the
public will endure legislation founded thereon.
The President notes with just satisfaction the closer rap¬
prochement of psychiatry and general medicine. The mem¬
bers saw a striking exemplification of this in Edinburgh,
where next door to the Pathological Laboratory of the
College of Physicians stands the Pathological Laboratory of
the Scottish Asylums, tokens alike of enlightened liberality,
of zeal for knowledge, and of kindly co-operation. Dr.
Urquhart, however, is not the man to be content with this.
He calls attention to the work of the psychiatric physicians
attached to St. Thomas's Hospital, London, and the Sheffield
Infirmary, and holds that it is a real reproach to Edinburgh
that there is not a similar provision there. In this, no doubt,
our President strikes a true chord. Never will the insane
derive the best benefit from medical advice till they can
receive it early and under conditions similar to other sufferers,
before such time as their infirmities have separated them from
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823
1898.] Occasional Notes of the Quarter .
the rest of humanity. It is not enough for us to deplore the
horrors of the old asylums. The past in this aspect may
bury its dead. The danger in modern days is not premature
confinement in a Bastille, but destruction of mental power
resulting from neglect of early curable conditions, with all
the misery which this destruction involves. We are confident
that sooner or later (the sooner, let us hope, for our exertions)
the people will see this for themselves, though mountains of
prejudice may have to be moved, and acres of statutes re¬
pealed “ drawn from the musty rolls of Noah's Ark."
Among recent enactments that are not to be regarded as
sufficient or apt is that relating to habitual inebriates. The
President discusses this subject in his usual broad-minded
way. He is not afraid to say plainly what many of us, per¬
haps, have been painfully thinking for some time past, that
our Association has not taken up this subject as vigorously as
it should have done. He notes that it has not formed the
subject of an address from the Chair. We are behind our
Continental and American brethren in this particular. In
spite of the frequent charge of hypocrisy levelled against the
Englishmen by Continental writers, the truth is that, in this
matter at least, we in our Association are too much afraid of
posing among the rigidly righteous, are too shy lest we may
be deemed “ faddists," too much dread the reproof of adopt¬
ing the nonsense of the “ teetotalers." Yet our French
brethren devote a division of almost every number of the
Annales Meddco-psychologiques to “ Les M4faits de l'Alcool,"
and surely we see not less of these misdeeds than they. Is it that
we have grown accustomed to the horrors of alcohol, which
have only more recently become generally known in more
southern countries ? If so, the sooner we imitate our Scan¬
dinavian colleagues and enter the lists against alcoholism the
better. At least as much could be done here as has been
done in the great northern peninsula—at least as much is
wanted.
Dr. Ford Robertson read a paper of the utmost interest
on "The Normal Histology and Pathology of the Nerve-cell in
relation to Mental Disease." The work of the Italian school,
especially of Lugaro, on the condition of post-mortem change
in the nerve-cell, and on the histological results of certain
poisons, which seems so full of promise, is being closely
followed in the Laboratory of the Scotch Asylums, and Dr.
Robertson's original work is inferior to none that has been
done in this department of science.
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824 Occasional Notes of the Quarter . [Oct.,
On the second day (July 22nd) further business was dis¬
cussed. On the motion of Drs. Whitcombe and Rayner a
committee was appointed to consider and report upon the
question of the prevention of insanity, and the reports of the
Nursing Handbook and other committees were considered.
An interesting paper on “ The Mismanagement of Drunken¬
ness ” was read by Dr. G. R. Wilson, of Mavisbank, which
gave rise tp much discussion. It was probably the desire of
the reader of the paper to startle his hearers a little by the
promulgation of views not now generally abceptable, and in
this he succeeded. He was understood as denying almost
absolutely the existence of the drink craving, and as minimis¬
ing hereditary influence to such a degree as to almost forbid
the assigning of this condition as a cause of alcoholism. It
was also suggested that drunkenness could be checked by
measures of a vigour which might be called Draconian. For
purposes of discussion it is perhaps well that such views
should be stated, but they are certainly not the last word on
this important and difficult subject. However desirable it
may be to check the tendency to mawkish sentiment with
regard to drinking, however necessary it may be to inculcate
self-restraint, it is clear that if the only method of dealing
with alcoholism is by punitive measures, the treatment of
drunkards will rightly pass out of medical hands, and we
cannot think that that is a consummation to be hoped for.
Dr. Watson read a paper on “ Sewage Disposal,” detailing
the method adopted at the new asylum at Hawkhead.
An excellent paper by Dr. Findlay, of the Crichton Institu¬
tion, on the “ Choroid Plexuses of the Lateral Ventricles of the
Brain,” brings our knowledge of these important structures
thoroughly up to date. Dr. Aldous Clinch contributed a case
of chorea gravis, and a case of imperfect porencephaly. The
latter was carefully worked out, and forms a most important
addition to our knowledge of this condition. These papers
were read in the laboratory of the Scottish asylums, and were
illustrated by demonstrations.
The annual dinner of the Association was held on the 21st
July in the Balmoral Hotel. There was a large attendance,
and the speaking was notably good. Dr. Sibbald, in respond¬
ing to his health, made manly and touching reference to his
approaching retirement from his seat on the Scottish Lunacy
Board, a subject of universal regret among our members.
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Occasional Notes of the Quarter .
825
The British Medical Association .
The annual meeting of the British Medical Association
was held in Edinburgh in the week succeeding the Medico-
Psychological meeting. The meeting was one of the most
successful that the B.M.A. has ever held, whether as to
numbers of members attending or as to the quantity and
importance of the matter discussed. Edinburgh possesses
many advantages as a place of meeting. The fame of its
great medical school is world-wide, and it is full of ardent
workers who are determined to maintain and extend its
ancient renown as a centre of medical teaching. The social
amenity and the accessibility of the northern capital render
it specially attractive to the southron.
Elsewhere we summarise the work done in the psychology
section. Much interesting work was done in the section of
neurology. A discussion of the treatment of cerebral tumours
was introduced by Professor Ferrier ; a discussion on the in¬
fluence of micro-organisms and toxins in the production of
diseases of the central and peripheral nervous system was
introduced by Dr. Buzzard. Both subjects were very fully
discussed.
The meeting of 1898 witnessed also the birth of some
new sections. Notable among these is the section of tropical
diseases, a class of affections hitherto strangely neglected
in England, although so much of our mighty empire lies
within the tropics. Many tropical diseases have points of
special interest for the neurologist and the alienist, while
the labours of Dr. McDowall have familiarised us with
the feeling that the ever-present problem of the care of
the insane is as pressing in the tropical as in temperate
climes.
The Correlation of Sciences in the Investigation of Nervous
and Mental Diseases .
In the present number we publish an interesting article by
Dr. Ira Van Giesen, Superintendent of the Pathological
Institute of the Commission in Lunacy of the State of New
York, upon the above subject. The necessity for a many-
sided, comprehensive study of insanity is earnestly represented
by Dr. Yan Giesen. It is very much to the credit of the New
York State Lunacy Commission that it has recognised the
importance of the collaboration of skilled workers in various
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826
Occasional Notes of the Quartei\ [Oct.,
departments of science for the elucidation of the problems
of mental and nervous disorders, and has established an
adequately equipped institute where the work can be efficiently
carried on. Each department of the institute is in charge of
a trained investigator, and the whole is under the supervision
of a Director. We question very much whether the like of
this institute is to be found on the Continent—we refer, of
course, only to the special department of work with which it
is concerned. As for our own country, it may confidently be
stated that we have nothing to compare with it. In London
and Edinburgh the pathological laboratories in connection
with the asylums are within easy reach of the great hospitals,
where correlated branches of work are in vigorous existence;
but this is a very different thing from having the several depart¬
ments in association at a single scientific centre, in charge of
officials working under one authority. Several inconveniences
must attach to this dissociation of branches of work. Never¬
theless we recognise the propriety of an attitude of grateful
appreciation in respect to these departures. They certainly
constitute a long step in advance of the condition of things
obtaining elsewhere in the kingdom. Elsewhere local autho¬
rities have provided a mortuary in connection with their
asylums, and of late we believe that a room “for the finer
histological work ”—a phrase somewhat familiar in official
reports—has in many instances been added thereto. Im¬
mured therein the pathologist too often finds himself in need
of the sympathy of workers in the sister sciences. Problems
arise upon which he would fain have the light of bacteriology,
of physiological chemistry, of animal experimentation, and
his work must frequently remain stunted for the lack thereof.
Such an institute as that now referred to is doubtless a costly
undertaking, and could scarcely be expected from any local
authorities in this country but the most wealthy, or from com¬
bination of the less wealthy. We anticipate that the Hospital
for Acute Cases in the West Riding of Yorkshire will be opened
shortly, and if, as we believe, there are to be in connection
therewith various departments of investigation, this may per¬
haps with justice be described as the first step in this country
in the direction of the ideal institute. Such a departure
cannot fail to be watched with the greatest interest by those
engaged in the treatment of mental diseases.
In Dr. Van Giesen’s brief review of the work of the various
departments of investigation at the scientific centre of the
New York State Lunacy System we find abundant evidence
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827
1898.] Occasional Notes of the Quarter .
of progress, and an instructive illustration of the stand¬
point of the psychologist of to-day. From psycho-physics and
anthropometry to histology and experimental pathology the
tendency is constant towards observation and experimentation
in contradistinction to speculation. It is no part of our pur¬
pose here to criticise the views and suggestions put forward
by Dr. Van Griesen on cerebral pathology, but we are unable
to pass over his comparison of the nerve-cell to an octopus.
The statement is made that the nerve-cell, like the octopus,
has power of movement over its “ tentacles.” To quote
Dr. Van Griesen, “ this retraction and expansion of the arm
of the nerve-cell, in groups, systems, and communities of
brain-cells, drawing it in or out of the circuit of transmission
of nervous impulse, is the final unveiling of the secret of a
whole host of mental phenomena which hitherto have seemed
mysterious to the last degree.” Again, “ These attributes of
extension and expansion of the nerve-cell.hold one
spellbound in the vast flood of light shed upon the explanation
of insanity.” We are told that among the phenomena to be
explained by “ retraction and expansion of the tentacles of the
nerve-cell octopus ” are those of double consciousness, hyp¬
nosis, hysteria, and of the “ whole great important groups of
psychopathic functional diseases; ” also the cardinal sym¬
ptoms of epilepsy in the manifestations of the fit, and some of
the violent manifestations of insanity. What may be Dr. Van
Griesen's basis for these remarkable statements and hypotheses
we know not, but we are certainly impatient to learn upon
what evidence they are grounded.
Criminal Evidence .
At last the Evidence in Criminal Cases Bill has become law.
It is not necessary to say more of the statute itself here than
that it makes every person charged with an offence, and the wife
or husband of such person as the case may be, a competent witness
for the defence at every stage of the proceedings, under the con¬
ditions specified in the Act. The arguments for and against
this measure, which we believe to be a pre-eminently salutary
one, have been agitated in this country for many years, and
are familiar to every educated section of the community. The
combatants on both sides will now be content to wait to see
their predictions verified, or the reverse, by the event. The
great danger against which the judiciary will have to guard
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828
Occasional Notes of the Quarter . [Oct.,
in superintending the administration of the new statute will,
in our opinion, be the possible abuse by counsel, from excess
of zeal, of the right of cross-examining prisoners electing to
give evidence on their own behalf. But from the admirable
manner in which the judges have confirmed the right of
“ summing up ” enjoyed by counsel for the prosecution under
Denman’s Act, within safe working limits, we have no fear of
the result of the fresh test to which the Legislature is now
submitting their firmness and capacity.
Prison Reform .
Whether the flogging of prisoners in gaols for breaches of
discipline is good policy or not is a question in regard te
which experts may and do entertain very different opinions.
But there will be little disposition in any quarter, we should
think, to criticise adversely the provision of the new Prisons
Act that such punishment shall only be inflicted in cases of
mutiny and violence, and then after judicial inquiry by a Board
of visiting justices, with a stipendiary magistrate to act with
them if necessary, and after ratification of the sentence by the
Secretary of State. This reform in the law will achieve
several desirable ends. It will confine what is, under any
circumstances, a brutal punishment to cases of real gravity and
brutality ; it will protect prisoners against the whims to which
even visiting justices are subject; and it will secure that
uniformity of practice in regard to prison floggings which
has hitherto in England been conspicuous by its absence.
Inebriates Act .
The Inebriates Act of 1898 marks a very distinct and
important advance in the treatment of habitual drunkards.
The power given to courts to order the detention of
habitual drunkards guilty of crime, in an inebriate reforma¬
tory for not more than three years, will go far to end the
“ Cakebread ” class.
Crimes of alcoholic origin, too, will be probably consider¬
ably reduced. Alcoholic homicides, for example, are com¬
monly the result of a prolonged course of alcoholic violence,
and such cases, it may be hoped, will in future be arrested
before attaining their full development.
The inebriate reformatories which the Act empowers the
Secretary of State to establish, or which may be established
by the councils of counties and boroughs, will need to be
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829
1898,] Occasional Notes of the Quarter .
very promptly formed if they are to cope with the number of
cases that will probably require detention very early after
the bill comes into operation on the 1st of January next.
The number of habitual inebriates coming periodically before
the courts is very considerable, and if these are at once dealt
with under the Act the existing accommodation would be
utterly inadequate.
The application of the powers given by the Act, although
very full and extensive, will no doubt give rise to many
questions of difficulty, and we shall watch the progress of its
use with interest. The Act promises to prevent a very large
amount of suffering at present inflicted by the habitual
drunkards on their families without check or hope of re¬
dress, and there can be little doubt that beyond this there
may follow a considerable reduction of casual inebriates.
The popular mind will soon recognise that the law regards
drunkenness as criminal, and this, it may be confidently
predicted, will result in drunkenness being considered, not
as a harmless indulgence, but as a moral offence against law
and order—a result greatly to be desired.
The Lunacy Bill.
The Lunacy Bill of the past session, after passing the Lords,
was withdrawn in the House of Commons, owing to the late¬
ness of the session.
Time, therefore, still remains to this Association to exert
itself in influencing the coming legislation. The late bill,
owing to our action and influence, was undoubtedly modified
and improved, but much remains to be done, especially in
ensuring a favourable reception of the pension clauses, in the
House of Commons. In this direction individual members
can do much in putting the special claims of the specialty in
this respect before those members of Parliament with whom
they are associated in any way. The bill will almost cer¬
tainly pass next session, and if this opportunity is missed,
many years will probably elapse before another is offered.
The Law of Settlement .
(The Plymouth v. Axminster Guardians.)
This case before the House of Lords was an appeal from
an order of the Court of Appeal affirming an order of the
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830 Occasional Notes of the Quarter. [Oct.,
Recorder of Plymouth on a case stated by him. The question
in dispute was whether a female pauper lunatic was settled in
the appellants* union. The lunatic was born at Plymouth, but
had gained no settlement of her own; her mother, a single
woman, was born in the defendants* union, and had acquired
no settlement.
Although the mother probably had a derivative settlement
from her father, the Recorder decided that this could not be
inquired into, and that the settlement of the lunatic was in
the appellants union in which she was born.
Lord Herschel gave judgment in support of this decision.
He expressed the opinion that the limitation of inquiry into
derivative settlements was intended by the Act to prevent the
undue expenditure which such inquiries led to.
The righteousness of the decision is shown, for the cost of a
disputed inquiry into the settlement of the grandparent of a
lunatic might easily amount to more than the cost of the
maintenance of the lunatic for many years. Decisions such
as this, which limit the possibilities of litigation, are to be
hailed with satisfaction by all interested in the true economy
of poor law administration.
Lunacy Certificates.
Are two medical certificates necessary for a “ not a pauper,**
lunacy case ? The Lancet (July 30th, 1898) draws attention
to a statement made by a correspondent that “the justices of
his district are in the habit of signing removal orders for
lunatics of the working and artisan class on one medical
certificate only.**
This action can only be taken under section 18 of the
Lunacy Act, and on that portion of it which justifies the
signing of an order on the ground that the person is “in
such circumstances as to require relief for his proper care.**
Section 13, clause 2, however, provides that in the case of
lunatics not under proper control two medical certificates
shall be obtained.
The question would appear to rest on the manner in which
the justice is to determine whether the lunatic is “in such
circumstances as to require relief for his proper care;** but
in regard to the decision of this no guidance is given.
Justice demands that the presumably “not a pauper**
lunatic should have the benefit of the doubt, and the ad¬
vantage accruing from double certification would seem to be
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1898.]
Occasional Notes of the Quarter .
831
very desirable in all cases removed directly to the asylum.
Recent cases before the courts seem to render this advantage
of tangible value.
The law's uncertainty in this matter ought assuredly to be
set at rest. This might be done by a case brought before a
court of law; or the Commissioners in Lunacy, having their
attention directed to such occurrences, might reject or con¬
firm the procedure. Many such admissions have evidently
occurred, and have been accepted as valid; so that the
question may be asked whether these do not act as precedents
confirmatory of the practice.
The Act, however, evidently intended, in the 13th clause,
that there should be the safeguard of the double certificates
in these cases, and it is to be regretted that this should
be abrogated by a clause referring to another category of
lunatics.
Hypnotism and Will-making.
The recent will case, in which the possibility of undue in¬
fluence by means of hypnotism was raised, is concluded, and
the questions in relation to this possibility can now be con¬
sidered apart from any reference to that particular case.
These questions would appear to be (a) whether a will
could be obtained in an hypnotic condition; (/3) whether
a suggestion made in an hypnotic state could lead to the
subsequent execution of a will; and (y) whether repeated
hypnotism can induce in the person hypnotised a feeling
towards the hypnotiser of fear or affection which could fairly
be considered “ undue influence."
That a person in the hypnotic state might be induced to
sign a document purporting to be a will is probable, but that
a lawyer, acting in good faith, would draw a will for a person
in such a state is most improbable, and the same improbability
applies to the second proposition of will-making by sug¬
gestion.
“Undue influence" may be exerted over weak-minded
persons quite apart from hypnotism, but there can be no
doubt that persons who have been frequently hypnotised by
the same physician often conceive a great liking for, or have
an excessive belief in the powers of, that physician. It is
therefore much more probable that such a person would be
more susceptible to “ undue influence " on the part of the
hypnotiser. This is probably a result of the mental deteriora-
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832
Occasional Notes of the Quarter . [Oct.,
tion which hypnotism produces, and which is so markedly
seen in what a recent writer naively describes as “ fully de¬
veloped” cases of hysterical disorder—cases that have been
habitually treated by hypnotism over considerable periods.
Hypnotism as a direct basis of “ undue influence ” is
probably a very untenable allegation, and one which it
would be difficult, or almost impossible, to conclusively estab¬
lish, although the fact of its having been habitually used
might be advanced in support of such a contention. In the
case already alluded to there does not appear to have been
any proof of the testator having been actually hypnotised,
and the allegation consequently altogether failed.
English law regards with great suspicion all wills made in
favour of priests or lawyers, and the French law forbids a
doctor attending a testator during a last illness from becoming
heir to the estate.
This question of “ undue influence ” is probably much more
one of “undue susceptibility to influence” than judges are
apt to consider.
When a testator has made a variety of wills, first be¬
queathing property to this person and then to another, there
can be little doubt that the disposition of the property rests
solely on the accident of the particular person who is most in
evidence for a time preceding death, and it becomes a question
whether the services rendered or the affection engendered
during that time are really commensurate with the reward.
Many aged testators would certainly will their property to
any kindly person with whom they were more or less com¬
pletely isolated, or on whom they were dependent for care
and attention. Yet it is certainly often unjust that such a
great reward should be given, to the exclusion of the claims
of kinship and of long-standing affection, even if this has been
latterly disturbed.
The ease with which dissension is sown between a wealthy
testator and the natural heirs, by the designs of the would-be
inheritors, is also too little appreciated; the facts of the
dissension are patent, but the ways in which they have been
brought about are not seen. These family quarrels are, it is
to be feared, often allowed too much weight in the judicial
decision.
Hypnotism, as a direct means of obtaining a duly drawn
and attested will, must be regarded as almost an impossibility,
but that habitual hypnotism might end in the establishment of
“ undue influence ” must be conceded as a probability.
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Medical men, whether hypnotists or not, who are aware
that they are inheritors, however deservedly, from a patient
would do well to remember the French law, and obtain the
aid of a colleague during the final illness. In this way only
can they avoid the suspicion which so readily attaches to such
an inheritance.
Lead Poisoning .
The public attention has been of late very much directed to
the subject of the ill effects resulting from lead intoxication in
industrial workers brought into contact with this poisonous
substance.
The injurious effects are much more numerous than even
the most alarmist of these reports show; for beyond the
striking and obvious cases recorded are many of more in¬
sidious nervous deterioration, besides the cases of abortion
traceable to this cause, and the less frequent but undoubted
occurrence of idiocy and imbecility in the offspring of lead-in¬
toxicated parents.
That legislation safeguarding the use of this noxious sub¬
stance may follow on this direction of popular attention is to
be hoped, but these outbursts of interest in health subjects
are, unfortunately, but too easily forgotten. It is the duty,
however, of our profession to periodically stimulate the social
memory, and we must endeavour not to neglect the perform¬
ance of this function.
Hypnotism .
The section of Psychology at the British Medical Associa¬
tion meeting again discussed this subject, but apparently
nothing novel of actual fact was adduced.
The bold attempt of Dr. Milne Bramwell to prove that
there are no drawbacks to the therapeutic use of hypnotism
is, however, a challenge which should be promptly met.
Very many observers have seen cases in which hypnosis has
been followed by very definite and distinctly evil results.
Many instances of this kind have been recorded, and good
service would be done by their collection and tabulation, as
a check to future assertions of this kind.
Hypnotism is an abnormal state of the brain, and although
it may result in apparent benefit to less highly developed
portions of the organism, the question remains whether this
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benefit may not be too dearly purchased. Such conditions
may be produced in a fairly healthy brain for a few times
without any very tangible results, but in cases in which
ill-health already exists there can be little doubt that very
considerable harm may follow. Hysteria plus hypnotism,
for example, probably develops into forms of complicated
disorder which it very rarely reaches in cases uncomplicated
by this form of treatment—a degree of disorder which a
recent writer on this subject pithily described as “ fully
developed.”
Therapeusis admits the principle that a lower tissue may
be sacrificed to save a higher. Thus the skin may be blistered
for the advantage of an underlying organ, or the leg ampu¬
tated to save life; but it is distinctly bad practice to harm
the higher organ to release the lower, as it appears to us is
the case in hypnotic treatment.
Mr. Myers* speculative theories are interesting, but give no
ground for his conclusion that hypnotism develops organic
concentration and recuperation. If this were true it would
be obvious that the simplest way to promote human evolution
would be to habitually hypnotise all humanity.
Pathologically hypnotism is related to somnambulism, hys¬
teria, lata, and stupor, and is therefore worthy of the most
careful scientific investigation. Hypotheses as to its nature
may be useful, but should be carefully based on known facts,
and not complicated by dialectical subtleties, such as the
“ subliminal consciousness.**
Therapeutically, hypnotism is related to the various varieties
of faith-healing, the limitations of which are fairly well known
and recognised. The assertion that it unlocks or re-develops
some latent organic endowment is beyond possible proof,
and is opposed to all evidence of organic evolution.
Hypnosis, from the point of view of our specialty, is a
temporary disorder and weakening of the power of self-
control, which by repetition must inevitably tend to be con¬
firmed and increased. It is, indeed, a temporary shunting on
one of those side-tracks of disordered mental function of
which insanity is the terminus.
Priest and Physician .
In a recent number of the Zeitschriftf Psychiatrie (published
in May, 1898) Mobius devotes an article to the memory of
Heinroth (dead now fifty-five years), who is chiefly famous for
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the doctrine which he taught that mental disease arises from
sin. He was, Mobius tells us, the first clinical teacher of
psychiatry in Germany. It may therefore well be that he
exercised an injurious effect, and that he was, as Krafelin
says, a dangerous enemy to the school of scientific psychiatry,
then recently founded by Esquirol. Mobius, however, en¬
deavours to point that he had nevertheless his merits. To
us the matter is chiefly interesting as marking time. Such
and such things a physician taught sixty years ago, and in
the very next number of the journal which contains Mobius’s
historical notice we find how a priest writes to-day. In the
Zeitschrift f. Psychiatrie published in June, 1898, there is a
short review by the editor, Laehr, of a little work on
“ Pastoral Psychiatry ” forming one of the volumes of an
encyclopaedia of Catholic theology, and setting forth views on
sacerdotal work in asylums, which are published “with the
approval of the Venerable the Vicariate-General of Freiburg,
and of the Episcopal Ordinariate of Regensburg.” The
author, Laehr tells us, frankly begins by saying that the
physician must take the first place in dealing with the insane,
and must have the direction of the treatment. Insanity is
described as a disease of the brain, and the causal connection
of the mental processes with brain conditions is said to be
demonstrable by psycho-physics. The author modestly claims
that there should be for every large asylum a special chaplain,
so circumstanced that he could devote the necessary time to
his work and spend as long as possible in the institution, for
(the italics are ours, and they feebly express our feelings)
“ the acquisition of the necessary knowledge is not very easy ,
and the mode of intercourse with the various patients is not to
be learned off-hand .” It is a pity that this sensible sentence
could not be engraven on the tablets of memory for those
occasional asylum committee-men who conceive that mere
election on an asylum Board makes them familiar with the
last results of science, and capable of teaching his business
to the physician who has devoted his lifetime to the
work. And we must earnestly commend to our older
judges, and especially to those venerable denizens of the
Gilded Chamber who are finally appealed to as the infallible
exponents of the common law of England, the following
excerpts from Father Ignatius Familleris work as given by
Laehr :—“ In all the many intermediate stages between mental
health and complete insanity the freedom of the will is always
limited in the same degree as the mind is affected. Therefore,
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Occasional Notes of the Quarter . [Oct.,
such a person cannot be held entirely accountable for his
actions, and is only responsible to a limited degree. If serious
disturbances dominate any one region of mental activity, then
complete irresponsibility must be held to exist, for the morbid
errors of one mental sphere are almost never corrected by the
part remaining in a better state, but on the contrary bring
about a morbid condition of the entire personality ” (das ganze
Thun und Lassen krankhaft bestimmen). In a chapter " De
Sacramentis” the author makes a most interesting distinction
"between those lunatics who have been insane from their
earliest infancy, and those who have been stricken by insanity
after a longer or shorter period of sound mental health.
The sacrament of Extreme Unction should never be adminis¬
tered to the former, for the possibility of committing a sin is
taken from them by their irresponsibility. On the other hand.
Extreme Unction must be administered to the latter when at
all possible.”
We think we may also recommend a course of Father
Familler to those Evangelical clergy who during recent years
have been making such nuisances of themselves in connection
with the insane in some North German provinces.
Asylum versus Hospital .
Under this title Dr. James Russell, of the Hamilton Asylum,
Ontario, read a paper before the American Medico-Psycho¬
logical Association, and published it in the Canadian Prac¬
titioner for June of this year. He tells us thftt there is a
growing tendency on the American continent to drop the
term " asylum ” in favour of the less suggestive title " hos¬
pital.” In the recently published transactions of that Asso¬
ciation it would appear that the designation "hospital” is
applied to ninety-three institutions, as against "asylum,”
which is only used forty-eight times. In a peroration ex¬
tending to nearly fourteen closely written pages. Dr. Russell
inveighs against the disuse of the term " asylum.” His
paper is redundant with digressions, which touch almost
every conceivable point in the domain of psychiatry; many
of his statements are highly controversial, while his dis¬
cursive argument is open to destructive criticism both from
those who differ from his conclusions and those who, for
other reasons, adopt them. It is not, for instance, because
we are afraid of " trusting too much to scientific methods,”
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as opposed to the use of the more general influences of
occupation, recreation, and environment, which ordinarily
abound in modern establishments for the care of the insane,
that we prefer the name “ asylum; ” nor is it because we
agree with Dr. Russell that an asylum hospital is an insig¬
nificant portion of the institution—amply large for the
treatment of physical disease alone if it accommodate five
per cent, of the asylum population—that we reject the
general term “ hospital.” On the contrary, we feel that we
cannot have too much of “ scientific method,” and we believe
that an asylum of the present day ought to be largely an
hospital in which from thirty to forty per cent, of the inmates
are actively treated, medically observed, and constantly nursed.
It is unnecessary, even if it were for edification, to follow
Dr. Russell in his simple but crude classification of the in¬
sanities and his extraordinary therapeutic theories. We do
not gather by what recondite means, apart from the humble
medical appliances at our disposal, he proposes to “ recharge
the exhausted brain batteries of the melancholic with the
electric current of thought,” or “ chain and harness the over¬
charged batteries of the maniac to some mental or physical
process.” We are far from agreeing with him when he
asserts that because the pathology of systematised delusion
has not yet been elucidated, it has therefore no morbid
histology, no basis for medical treatment, and that it is
merely an exaggeration of a condition which he unwarrant¬
ably asserts is only too common in “ a world teeming full of
paranoiacs everywhere.” Such opinions are not altogether
novel. We have heard them more moderately, if not more
ably expressed, but never perhaps with such wanton ardour
and glorious disregard for contemporary opinion as distinguish
their latest exponent.
After all this, to agree with Dr. Russell's main contention
that we should not abandon the term “ asylum ” in favour of
any other, however euphonious, may appear paradoxical.
Yet it is here that our author reveals his innate power of
discrimination. By whatever name it may be called, an
asylum will always combine two functions,—a place for the
care and shelter of those who are incapable, owing to mental
infirmity, of taking care of themselves ; and a place for the
care, treatment, relief, nursing, and study of recent and
acute forms of insanity and their accidental syndromes.
Those who wish to change the name of such an institution
from asylum to something else must be influenced solely by
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Occasional Notes of the Quarter . [Oct.,
the desire to remove prevalent prejudices arising from past
abuses and present deficiencies by a species of transparent
subterfuge. There is that of ingenuousness and na/ivet6 in
the proposal which might enlist a certain amount of sym¬
pathy were it not for its patent offensiveness. Moreover
its futility is apparent. Were it possible with the wand of
a magician to remove lunatic asylums from the face of the
earth to-morrow, the prejudice against insanity and the in¬
sane would not vanish with them. As Maudsley puts it,
“ there always has been, and for a long time to come there
will no doubt still be, a feeling of distrust of, and repugnance
to, the anti-social unit who has fallen from his high rational
estate; ... he will lie under a social ban, and the family
to which he belongs will feel the reflected stigma.” Might
it not be added, “ And so will the institution in which he is
confined, christen it ever so skilfully ” ?
The faithful and arduous labours of our predecessors, and
the remarkable scientific achievements of our contempo¬
raries, have been to a large extent effectual in diminishing
the strength of the hostile criticism and of the popular
prejudices to which asylums have all along been subjected.
Whatever the workers of the immediate future may do in
this respect, their success will certainly not depend upon a
desire to appear other than they really are. The views of
Dr. Russell, as expressed in the following sentence, could
scarcely be improved upon. He says, “I take no stock in
that scientific sentimentalism which seeks to popularise itself
with a name. Words are but symbols of ideas, and unless a
name has behind it the merit of good works to commend it
to popular favour, it will be but as a tinkling cymbal and a
term of reproach.”
PART II.-REVIEWS.
Die Darstellung Krankhafter Geistzustande in Shakespeare’s
Dramen. Von Dr. Hans Laehr. Stuttgart, Neff, 1898.
Demy 8vo, pp. 200. Price 3s.
A good many years have passed since any author in this
country conversant with insanity has written anything of note
upon the personifications of mental derangement to be found
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1898.]
in the plays of Shakespeare. It requires some courage to try
to add to a subject which has been treated by such writers
as Bucknill and Conolly. Some of their essays may be
found in the early numbers of this Journal, and all interested
in such inquiries ought to read the studies of Dr. Gasquet on
“ The Madmen of the Greek Theatre,” in vols. xviii, xix,
and xx.
Germany has done much towards a critical study of Shake¬
speare^ works, and in the book under review we have a
volume devoted to the study of the exhibitions of mental
derangement in the works of the great English dramatist.
To such inquiries it may be objected that these characters,
which to our mind appear to have so vivid a reality, are but
the figments of a poet's mind. Persons who never lived
could not have been insane. Beyond the written words of
the poet we cannot go, as the finest painting is no deeper than
the canvas. Nevertheless no other dramatist ever held the
mirror so faithfully up to nature, and we may fairly ask,
Were the portraits of Lear, Timon of Athens, or Ophelia
intended to be representations of ordinary insanity, and are they
correct representations ? Dr. Laehr, in a learned chapter,
shows how much Shakespeare drew, or might have drawn,
from the medical writers of his time ; but in whatever way
the poet gained his knowledge, his method of exhibiting it is
necessarily different from that of a physician. He could only
take those aspects of insanity which are fitted for representa¬
tion on the stage, or which would work in with the actions and
events of the play. Moreover, though Shakespeare's know¬
ledge of human nature is always profound, yet he sometimes
does not hesitate to sacrifice realism to stage effect. For example,
he makes Desdemona speak some words of excuse and forgive¬
ness of Othello before she dies of suffocation, and this was cer¬
tainly not because Shakespeare was ignorant of the nature of
asphyxia. The most learned physician that ever lived could
give no more accurate description of a strangled man than
that given by Warwick in the Second Part of “King Henry VI.”
Shakespeare could not deal with the physical or organic causes
of insanity, even if he had been conversant with them, but
he exhibits the passions which unhinge the mind—love,
jealousy, hatred, fury, revenge, remorse, grief, doubt, and
despair. In some scenes characters approach, if they do not
pass the limits of sanity; in others it has been a matter of
debate whether they could be called deranged, and in several
of his dramas we have grand delineations of full-blown
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insanity. The characters considered at length in Dr. Laehr's
book are King Lear, Ophelia, Hamlet, and Lady Macbeth.
This does not cover all the mad folk of Shakespeare. There is
left out the maniacal misanthropy of Timon, the frenzy of
Constance, and the blind fury of Othello. Nor does Dr.
Laehr consider the amusing variety, all true to nature, which
Shakespeare gives to the fools whom he places on the stage.
But what Dr. Laehr gives us is well done. His remarks
upon the dramatic touches which indicate the growth of
insanity in King Lear are both true and subtle, such as only
a skilful alienist could have noted. One is somewhat startled
by the remark which he makes at the end, that the madness
of Lear and Ophelia belong to the same type, “ Akute Ver-
wirrtheit," that is acute confusional insanity.
Our author cannot deny himself the luxury of an analysis
of the character of Hamlet, which fills one third of the book.
None of Shakespeare's dramatic creations have attracted nearly
so much attention as the Danish prince, and some critics and
actors have believed him to be insane throughout. We have
to recall that Conolly held this view to prevent us treating it
with disrespect. One should not throw away the clue fur¬
nished by the dramatist himself, in which Hamlet, after
the terrible revelation given by his father's ghost, warns
Horatio not to be surprised at what he might do:
As I, perchance, hereafter shall think
To put an antic disposition on.
It might be objected that this resolution appeared to be
too sudden, but in a play the action must be rapid. Even
without this clue, an attentive perusal of the play should
convince the reader that Hamlet is simulating insanity. To
the king Claudius and his sycophants he indulges in wild
words, through which, however, there runs a purpose that
they themselves suspect. While he does not entirely deceive
the king and Polonius, to Horatio, and at last to his mother,
Hamlet talks not only like a sane man, but with surpassing
wit and eloquence. He even argues with his mother that he
possesses his entire reason in a way which shows a ripe know¬
ledge of insanity:
My pulse, as yours, does temperately keep time,
And makes an healthful music: it is not madness
That I have uttered: bring me to the test,
And I the matter will reward; which madness
Would gambol from.
In “ King John," Constance replies to the Cardinal Pan-
dulpho's speech:
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841
Lady, you utter madness and not sorrow.
I am not mad; I would to Heaven I were!
For then, 'tis like, I should forget myself:
Oh, if I could, what grief should I forget!
Preach some philosophy to make me mad,
And thou shalt be canouised, Cardinal;
For being not mad, but sensible of grief.
My reasonable part produces reason
How I may be delivered of these woes.
And teaches me to kill or hang myself:
If I were mad I should forget my son.
Or madly think a babe of clouts were he.
It seems clear that Shakespeare must have observed curiously,
seen, and noted not a few mad people to describe the sym¬
ptoms of insanity so correctly. Dr. Laehr has a learned in¬
quiry where the poet could have got his lunacy lore; but a
genius like Shakespeare gains knowledge through the very
pores of his skin, which ordinary men fail to apprehend
through their eyes and ears. Dr. Laehr’s chapter on the
personifications of insanity in the dramas of Shakespeare’s
English contemporaries shows much acquaintance with the
literature of the time. He concludes with a resume of the
principal essays upon the psychology of the poet, in which
he reviews some thirty contributions to the literature of
this interesting subject. Amongst them Dr. Laehr’s own
work is entitled to take a high place.
Arbeiten aus dem Gesammtgebiet der Psychiatrie und Neuro-
pathologie. Yon R. v. Krafft-Ebing. Leipzig : Johann
Ambrosius Barth, 1897. 8vo, pp. 165.
The first of the papers in this volume appeared in 1883.
It treats of transitory insanity supervening on neurasthenia
brought on by cerebral excitement from mental overstrain.
It would, however, serve no purpose to present to our readers
a condensed form of these descriptions. As far as our
experience goes, neurasthenia is not often followed by insanity,
but that this occasionally should take place seems likely
enough. Dr. Krafft-Ebing describes five cases in which he
assumes an anaBmic condition of the brain to be the cause of
attacks of transitory insanity. He is inclined to believe that
this brain anaemia is owing to spasm of the cerebral vessels,
as indicated by the weak and compressible pulse, the wide
and slowly reacting pupil, and the stuporose condition which
disappears with an improvement in the circulation. He
observes that every neurologist knows that epileptoid attacks
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are every-day symptoms in many nervous diseases, especially
in persons afflicted with neurasthenia. These symptoms
include distress with outbursts of perspiration, precardial pain
with appearances of spasm of the vessels, and disturbance of
consciousness down to fainting with special spasmodic phe¬
nomena, dependent upon disturbances of the circulation
in the brain. It is possible other physicians might say that
these are the pathological substrata and symptoms of epilepsy
itself, and call his epileptoid attacks epileptic ones. Some
pathologists make a distinction between what they call
true epilepsy and what they are pleased to exclude as
epileptoid or epileptiform symptoms, a distinction which
seems to me sometimes to be purely formal.
The third observation is curious. A man of forty-one,
railway employe, without marks of degeneration, but in poor
health with symptoms of neurasthenia, suddenly took it into
his head that he had been made station-master, and went to
take command of the office, whence he was roughly driven
away. He was treated by the railway doctor. One morning
after a good sleep he announced to his family that his fixed
idea had disappeared. He confessed that he had dreamed
that he was made station-master, and that the order appointing
him was in a box. On awakening he had been content to
assume this as true without taking the trouble to assure him¬
self by looking. This Krafft-Ebing explains as owing to the
incapacity of the exhausted brain to correct the belief acquired
in a dream.
Dr. Krafft-Ebing’s observations lead him to believe that
the view of Samt that we may recognise an epileptic basis
from the mental symptoms alone is untenable.
The chapter on Hemicrania and its connection with epilepsy
and hysteria is quite a little museum of rare clinical observa¬
tions. Dr. Krafft-Ebing's views are illustrated by rapid
descriptions of a score of cases. He holds that we may have
hemicrania in the simple form of hemicrania ophthalmica. If
more severe, it may be accompanied by contraction of vision
or scotoma, or even by temporary aphasia or paraphasia.
Such attacks of hemicrania have generally an hereditary origin.
Where it is acquired the prognosis is more serious, as the
affection may be symptomatic of deep-seated brain disease,
tumour, lues cerebri, paralysis, or tabes. Dr. Krafft-Ebing
describes several cases in which the hemicrania ushered in an
epileptic attack. It might be regarded as an aura, or, as some
neurologist has described, as a sensory attack of epilepsy. In
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1898.]
certain cases described the disorder began with the sight of a
bright spot or ring, sometimes a red spot succeeded by pain
in the side of the head, and ending in a regular epileptic
attack. Here is one of his observations. Miss V—, eighteen
years old, no hereditary neurosis, has suffered since puberty
with ophthalmic hemicrania, which at first used to last an
hour and a half, and of late extended to four hours. When
the pain was at its height, about half an hour after the
appearance of light and of the scotoma, there was a feeling
of powerlessness in the face, tongue, and arm on the same
side as the pain. The day after the attack the patient com¬
plains of giddiness, is forgetful, confused, depressed, is awk¬
ward with the hand, paraesthetically affected, and lets things
fall. She has only a dull remembrance of events during this
stage. In the intervals she is quite well. The paper on
transitory insanity with hemicrania is full of interesting
clinical observations. Here is an abridged sketch of one case.
Mrs. N—, fifty-five years old, labourer’s wife, had suffered
for eleven years from ophthalmic hemicrania. It begins with
a broad perpendicular streak in the vision field of the right
eye, which disappears in ten minutes, to be replaced by a
scotoma, then bright yellow tufts and stars which last half an
hour. She found that when she lies upon the right side she
can shorten the duration of this stage. Shutting the eye
causes the bright objects to be more apparent, the stars
become bigger, then smaller till the apparition disappears.
This is succeeded by acute boring pain in the right temple,
which extends to the eye. Shortly after there appear faces,
statues, pagodas, always in motion, lasting about ten minutes;
when the patient shuts the eyes they still persist; if the left
eye alone is shut the figures appear on a dull background.
This is commonly succeeded by the apparition of golden stars
which soon pass away. After this the patient feels senseless;
she does not know herself, nor recognise her husband; has a
fear of approaching insanity, and that she is followed by some
one. During this stage, which lasts about five minutes, she
cannot utter a word. She does not lose consciousness, but
has a very painful feeling that her understanding is passing
away. This state is generally succeeded by vomiting, and
the descent of the neuralgic pain into the cheek and chin.
Other graphic sketches remain, for which the reader must
go to the original book. Dr. Krafft-Ebing draws with a
skilful hand, reproducing essential features and passing over
immaterial details. No one, however experienced in psychi-
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844 Reviews. [Oct.,
atry, can read this work without materially increasing his
knowledge.
Die Heil - und PjlegeanstaltenfurPsychischkranhe des deutschen
Sprachgebietes, in J. 1890. Yon Dr. Heinr. Laehr. Mit
geographischer Karte. Berlin : Heimer, 1891.
It would be a useful undertaking if some one would write a
similar account of the asylums and hospitals for the insane in
the British Isles and colonies; another would be needed for
the asylums in the United States. We need not enlarge upon
the use of this handbook in German-speaking lands. Dr.
Laehr’s own countrymen have already shown their apprecia¬
tion of his useful work. The first edition was published in
1852; there was another in 1865, and we possess the one
issued in 1875, which contains 183 pages, whereas the present
book has 230 pages; the increase is mainly owing to the in¬
creased number of asylums and other institutions for the
treatment of insanity and idiocy. We advise all members of
our profession interested in the treatment of the insane who
may be travelling in Germany, Austria, or Switzerland, to get
a copy of Dr. Laehr's handy little volume. By consulting the
map the tourist may know when he is in the neighbourhood of
an asylum, which otherwise he might pass by. There are few
such asylums from which something may not be learned. In
those which we have visited we have always been received
with courtesy, and it may be added that, owing to the linguistic
attainments of our German colleagues, ignorance of their
language is often compensated by one or other of the resident
medical staff. The principal merit of German asylums con¬
sists in the large proportion of medical officers, the diligent
study of each case, and the persevering endeavours at medical
treatment. The notices of each asylum seldom exceed a page,
often they are less. Dr. Laehr deserves praise for his clear
and concise statements, and the judgment he displays in the
selection of details. We give a short translation from the
summary at the end.
In the following States of the German-speaking lands (Ger¬
many, German Austria, Switzerland, the Baltic provinces of
Russia, and Luxemburg), with 67,742,109 inhabitants, there
are 296 asylums for the insane, with 692 physicians and 70,028
patients (35,443 males and 34,585 females), and also 162 public
asylums, with 489 physicians and 56,168 patients (27,977 males
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and 28,191 females), and 134 private asylums, with 203 phy¬
sicians and 13,860 patients (7466 males and 6394 females).
Amongst these there are 56 institutions specially for idiots and
epileptics.
The German Empire, with a population of 46,855,704, has
121 public asylums, with 366 physicians and 42,751 patients
(21,197 males, 21,554 females), and 114 private asylums, with
172 physicians and 12,983 patients (7032 males and 5951
females). Altogether, 235 asylums, with 538 physicians and
55,734 patients (28,229 males and 27,505 females). There
are also, in special asylums, 7537 idiots and epileptics (4116
males and 3421 females). There are therefore, for 100,000
of the population, 118 patients in asylums, to every 104 of
these one physician. The establishments for inebriates and
public hospitals are not included in this. There are psy¬
chiatric cliniques attached to the Universities of Berlin
(1832), Greifswald (1834), Jena (1848), Wurzburg (1848),
Erlangen (1850), Munich (1861), Gottingen (1866), Strass-
burg (1872), Marburg (1877), Breslau (1877), Heidelberg
(1878), Halle (1879—85 in Nietleben), Konigsberg (1879),
Bonn (1882), Leipzig (1882), Freiburg (1887). In Giessen a
clinique is being built, and one is being prepared in Rostock.
The institutions for the care of idiots are not sufficient.
They are mostly supported by charitable contributions. As
education is compulsory, it is to be hoped that public institu¬
tions like those in the kingdom of Saxony, Mecklenburg-
Schwerin, and Berlin will be followed by others.
In the German Empire there are thirteen unions designed
to help discharged lunatics. There are six periodicals
especially devoted to psychology and psychiatry.
Casuistische Beitrage zur forensischen Psychiatrie. Yon Dr. E.
Siemerling, o. 6. Professor, Director der psychiatrischen
Klinik in Tubingen. Berlin, 1897. 8vo, pp. 172.
In this volume the learned author gives us a report of four
persons accused of crimes, who were examined by him with a
view to ascertain whether they suffered from mental derange¬
ment. These were all pronounced to be sane and responsible;
eight other persons, whose cases are described at length, were
held to be affected with chronic insanity, and not responsible
at law. The descriptions are carefully given, and show much
acuteness and a ripe knowledge of insanity. Next to actual
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experience, such reports are instructive and useful as guides
to medical men likely to be consulted about cases of insanity,
real or simulated. It would, however, serve no purpose to
try to present to our readers a condensed form of these de¬
scriptions.
Les Ftats neurastheniques (The Forms of Neurasthenia). By
Gilles de la Tourette. Paris: J. B. Bailli&re et Fils,
1898. Pp. 100. Price 1 fr. 50.
This little book contains an admirable epitome of the
clinical forms, diagnosis, and treatment of neurasthenia.
There was a real danger that the confusion of views of various
writers and the extension of the term “ neurasthenia ” to
cover obscure maladies with which it has no connection would
ultimately lead to the general discredit of the condition, or
rather the group of conditions differentiated under that name.
The author of this book has cleared up many of the legendary
misapprehensions which have grown as accretions round the
literature of the subject, and he has to a considerable extent
limited and defined those states which may justly be included
in the meaning of the term.
Following Charcot, he divides neurasthenia into two kinds :
1, the true neurasthenia, an acquired condition brought on
by overwork, exhausting diseases, malnutrition, or worry;
and 2, hereditary or constitutional neurasthenia. The predi¬
cate “ hereditary” used in this sense denotes a special or
more intense nervous heredity, and by no means implies that
underlying true neurasthenia there is no heredity to the
neuroses. In other words, the word hereditary is used in the
same sense as when applied to insanity, to indicate a special
hereditary tendency.
The true neurasthenia is distinguished by occurring after
the action of an evident cause, by the absence of vesanic
complications, such as fixed ideas, fixed hypochondriacal
delusions, and chronic mental enfeeblement; by its curability
under suitable treatment, and by the intensity of the physical
symptoms. The constitutional form, on the other hand, is
chronic; the symptoms may arise in early life in the absence
of definite determining causes; may continue constantly or
occur periodically, with a gradual tendency to become worse,
until ultimately many of the subjects spend their time passing
from hospital to hospital, and from one physician to another.
The mental condition gradually becomes involved, hypo-
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chondriacal delusions develop, and without actually becoming
insane the patients touch the border-land of many of the well-
known forms of mental aberration, such as melancholia,
general paralysis, systematised insanity, &c. Into the differ¬
ential diagnosis between chronic neurasthenia and these forms
the author enters at considerable length. A division of the
book is assigned to the description of the association of
neurasthenia with hysteria—a condition which, judging from
the author's description, is by no means common in this
country, unless it corresponds to the British form of railway
spine, for we are told that it is frequently caused by shock,
especially in railway accidents.
The chapter on treatment is particularly minute, and con¬
sidering the space into which it is compressed, appears to be
very comprehensive. Great stress is laid upon the efficacy of
hydrotherapeutics, especially the cold douche. Static elec¬
tricity, applied at intervals of two days, is said to be an
infallible cure for the distressing headache. Bromide of
potassium in small doses (30 to 40 grs.) is given once a day
(in the evening) for sleeplessness. Very little reliance is
placed upon medicinal treatment. The dietetic regimen may
be summed up in one sentence: the most nourishing and
most easily digestible foods are to be administered, frequently
and in small quantities at a time; and alcoholic stimulants
are to be avoided. On the whole the prognosis is not encou¬
raging, except in the true form; and even then, unless the
patient has plenty of money, or abundant leisure and an easy
life, the chances are that he will sink into a hospital chronic,
or end in moral and physical degradation, or become insane.
Nevroses. Par Arvedb Barine. Paris: Hachette, 1898.
Pp. 391. Price 3 fr. 50.
This volume is an interesting and carefully documented
series of studies of certain highly neurotic, and in some cases
insane, men of genius—Hoffmann, Poe, De Quincey, Gerard
de Nerval. The studies are all well written and instructive.
It is sufficient, however, to refer here to the essay on Gerard
de Nerval, and that for various reasons: this writer is little
known, his importance has only recently been recognised,
and owing to the kindness of the successor of Dr. Blanche,
in whose private establishment Gerard de Nerval was fre¬
quently placed, M. Barine has been able to throw new light
on the lire of his subject.
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Gerard de Nerval's real name was Labrunie, and be be¬
longed to Picardy. He adopted the name by which he is now
generally known from a field belonging to his family, and in
later years, when he gave his fantastic conceptions free course,
he traced his ancestry back to the Emperor Nerva. His
father was an army surgeon, from whom the son inherited a
certain vein of eccentricity which developed throughout life.
His life may be said to have been a perpetual waking dream:
he was never able to distinguish very clearly between the
real and the ideal; his work in prose and verse was the out¬
come of this confusion, and bears constant witness to it.
Throughout the greater part of his life his visions and ideas
appear to have been fundamentally insane, though they were
so brilliant and expressed with such eloquence that they
seemed to his friends not so much the utterances of delirium
as “ the cosmogonic dreams of a god drunken with nectar.”
At last, however, in 1841, insanity began to appear, not only
in his ideas, but in his conduct: he was found in the Palais
Royal leading a lobster at the end of a blue ribbon, and his
friends put him in the hands of Dr. Blanche, much to his
indignation, though a man of sweet and equable temper.
“ Why,” he asked, “ is a lobster more ridiculous than a dog
or a cat ? I like lobsters, they are quiet and serious, they
know the secrets of the sea, and they never bark.” In eight
months he was dismissed as cured, having, as he wrote to
Mme. Dumas, “ recovered what is commonly called reason;
but do not believe it, I am the same as I have always been; ”
and he added that he had passed through a very pleasant
dream which he regretted. After this, however, he endea¬
voured so far as possible to conceal “ whatever might shock
the materialism of alienists and the public.” When he felt a
crisis coming on he would disappear for weeks or months
until he felt that he had regained calm. On one of these
flights, into Germany, he noted with much satisfaction that
what was regarded as insane in France was not so regarded
in Germany. With the idea of proving his sanity, he under¬
took a journey to the East, and at Lebanon met a beautiful
Druse girl, the daughter of a sheik whom he persuaded with
great difficulty to give his daughter to him in marriage. At
the last moment, however, a sudden gleam of sanity induced
Gerard to break off the engagement, and he returned to
Europe with his mystical dreams still further fortified and
developed. His manner of life favoured this development; he
was incapable of the most elementary precautions in financial
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matters, though always in a position to procure money; his
meals seldom cost more than a few pence; he only possessed
two shirts, and by preference he spent most of his nights in
the open air. At the same time he maintained a strain of
intellectual sanity, and his letters deal rationally with the
most varied topics. In the spring of 1853, however, a serious
crisis arose. His pleasant and fantastic illusions gave place
to oppressive hallucinations which made work impossible.
One Sunday evening it seemed to him that the stars were
being extinguished, and in place of the heavenly bodies he
saw a blood-red sun, and then a number of moons.* Only one
clear idea remained. He had undertaken a French trans¬
lation of Heine's works, for which Heine had paid him in
advance, and Gerard felt—whether on account of his own
illness or of the approaching end of the world remains un¬
certain—that he must return this money. He went to Heine's
house and talked so incoherently that Mme. Heine sent him
in a cab to Dr. Blanche's. A month later he wrote Sylvie ,
his masterpiece in prose. A few days after the publication of
'Sylvie in the Revue des Deux Mondes Gerard behaved so
strangely in the street, that a threatening crowd surrounded
him; he was taken to the Charite, where it was considered
necessary to apply the camisole de force , and in the morning
he was again transferred to Dr. Blanche. At this time he
believed that he was charged with the direction of the
moon's movements, and everything around him seemed full
of mystical significance. At the same time he possessed the
power of minutely observing and analysing his own mental
states, and he was amassing the material which a few months
later he was to use to such excellent purpose in Le Reve et la
Vie. In this book, it has been said, “ Insanity dictates its
memoirs to Reason." It is doubtless, as M. Barine terms it,
“ a physiological and psychological document of the first
order, only to be compared, in the whole of literature, to
De Quincey's Confessions of an Opium Eater” G6rard left Dr.
Blanche's apparently cured, and spent a month quietly in
Germany, sufficiently able to dissimulate the extravagances
of what he called his “ mystic brother;" but on returning to
Paris the first intellectual effort caused a recurrence of the
old conditions even more severe in character; he now had
ideas of persecution, and instead of regarding Dr. Blanche with
affection, he considered him his gaoler. He was unfortunately
* This may be an instance of a vivid visual hallucination producing after*
images.
XLIV. 57
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liberated, owing to outside pressure which he was able to
bring to bear, and a few months afterwards, on an extremely
cold night in January, 1855, he was found dead, hanging to
a window bar by the cord of a cook's apron in one of the
lowest and filthiest streets in Paris. It was shown that he
had committed suicide, and had long carried the cord about
with him, regarding it at first as Mme. de Maintenon's girdle,
and afterwards as the Queen of Sheba's garter. In his pocket
were found the last fragments of Le Reve et la Vie .
It is now generally recognised by competent critics that
Gerard de Nerval's work is not only of permanent interest and
value, but that he was the forerunner, both in prose and verse,
of the latest school of French literature, the so-called Symbol¬
ists, whose reputation and influence are now European.
G6rard de Nerval, as M. Barine points out, differs from Poe,
De Quincey, and Hoffmann in this important respect, that they
may be said to have killed their genius by alcohol or opium,
and their morbid mental states may be said also in some
measure to be the result of their marvellous gifts. Gerard, on
the contrary, lived a simple and blameless life, though bearing
within him the congenital seeds of insanity. He was one of
those very rare writers whose genius has been favoured and
not impeded by the development of insanity. It is that which
makes him so interesting a study for the alienist, and it is to
be regretted that M. Barine has not presented us with more
detailed facts regarding the course of his disease. The
author of this interesting volume has, however, at least suc¬
ceeded in showing that Gerard “ was only really a poet in
those hours when he was not altogether sane, and when he
wrote under the dictation of his ‘ mystic brother.' He raises in
a more disconcerting and irritating shape than ever that great
question, so often asked and never answered, concerning the
relationship of genius to insanity."
Ueber die Sexuellen Ursachen der Neurasthenie und Angstneu-
rose. Yon Dr. Felix Gattel. Berlin: Hirschwald,
1898. Pp. 68. Price 1 mk. 60.
The remarkable investigations of Breuer and Freud, of
Yienna, into the nature of hysteria—recorded especially in
their Btudien iiber Hysterie , published about three years ago—
are probably less known in this country than they deserve to
be. Starting as a pupil of Charcot, Freud (who has perhaps
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chiefly developed this study) was gradually led to depart from
his master’s views in many essential points, and he was espe¬
cially led to the conclusion, which was beginning to be regarded
as antiquated, that a sexual element is almost an essential
factor of hysteria and allied neurotic conditions, such as the
liability to causeless fright (Angstneurose). Apparently
possessing boundless sympathy, patience, and clinical enthu¬
siasm (sometimes making use of a slight degree of hypnosis to
obtain details of the early life of their cases), Breuer and
Freud obtained a series of histories which have at once the
interest of novels and the skill of acute and elaborate psycho¬
logical analyses. These histories have served to show that in
a considerable proportion, at all events, of cases of hysteria
and allied conditions the morbid state may be traced back to
a lesion of the psychic sexual region, a mental shock of sexual
character, sometimes dating from childhood and no longer
actually present to consciousness, sometimes instinctively
thrust into the background of consciousness; and in many
cases the mere open recognition and confession of this sexual
origin has been sufficient to remove the resulting morbid con¬
ditions.
Dr. Gattel is a Berlin physician who has been much im¬
pressed by Breuer’s and Freud’s results, and during a six
months’ visit to Vienna he was stimulated to carry out an
inquiry on somewhat allied lines, though quite distinct in
character. In the out-patient department of the psychiatric
clinic (Krafft-Ebing’s) of the General Hospital he made notes
of one hundred successive cases of functional disturbance,
excluding obvious hysteria, with special reference to the sexual
history. These patients belonged, of course, to the working
classes, and therefore would not present themselves for treat¬
ment unless feeling really ill; though, on the other hand, there
was the disadvantage that patients of this class are not skilled
in self-observation. In nearly every case, however, the sexual
history seems to have been fairly well ascertained. The results
of the examination of the patients (158 men and 42 women)
are arranged in a tabular form. The nervous disorders
found were (in order of prevalence) Angstneurose , neuras¬
thenia, and hysteria, or some combination of these, the cases
of hysteria being, for the reason above mentioned, in a small
minority.
The author reaches the conclusion that neurasthenia in the
thirty cases in which it occurred was in every instance led up
to by long-prolonged masturbation. The occasional attacks
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of terror, on the other hand, were always found in persons
living in a state of sexual repression. A neurotic heredity
was only found in 12 per cent, of the cases; this is a result,
however, on, which we cannot lay much stress. Nor can we
attach very great importance to the fact (on which the author
insists) that not one of his cases presented what may be called
a normal sexual life: we cannot at present speak very posi¬
tively about abnormal sexuality until we know more than we
yet know regarding the facts of normal sexual life.
The author thus takes what we cannot at present but regard
as a very extreme position concerning the importance of
sexual irregularities and sexual repression in causing nervous
disorders. He has, however, carried out his inquiry in a
commendable manner, and we may hope that his results will
lead to further investigations in this difficult but important
field.
The Subconscious Self and its Relation to Education and
Health . By Louis Waldstein, M.D. London: Grant
Richards, 1897. Pp. 171, small 8vo.
This book (the English edition of a work printed in
America) is a literary essay rather than a scientific study.
Though many authors are named or quoted, there is not a
single definite reference to literature throughout. There are
no foot-notes, table of contents, or index; and while interesting
original experiments are briefly described, they are never
detailed with the precision demanded by a scientific reader.
It is evident, however, that the author possesses a com¬
petent scientific knowledge of his subject, and he conveys his
information and ideas to the reader in a pleasant and skilful
literary style, a well-bred style that is content to touch on
every subject in the slightest and sketchiest way, never
staying to drive home an argument with precision and energy.
Among the subjects thus lightly touched on are genius, the
artistic impulse, dreams, hallucinations, coloured hearing,
suggestion, hysteria, hypnotism, &c. The general tendency
of the essay is to minimise the influence of heredity in
explaining peculiarities and defects of nervous organisation,
and to dwell on the influence of early impressions as of para¬
mount importance; while the author further points out that this
view enables us more easily to treat and to prevent such
conditions. Dr. Waldstein is clearly on safe ground, though
he apparently fails to recognise that the factor of heredity
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must still be taken into consideration, and pushes his
argument too far,—as when he remarks that so great is the
force of early impressions that modem inventions like the
telephone and the phonograph as yet play no part in the
hallucinations of the insane.
L’Annee Sociologique. Publiee sous la Direction d’Emile
Durkheim. Paris: Alcan, 1898. Pp. 563. Price 10 fr.
With this volume Prof. Durkheim of Bordeaux, whose
important study of suicide we recently noticed, has inaugu¬
rated a series in which it is proposed to do for sociological
studies what L’Annee Psycholog ique is doing for psycho¬
logical studies. As sociology in the modern sense is concerned
with many matters which are of interest to psychologists, and
as Prof. Durkheim is one of the few sociologists whose
methods are truly scientific, it seems worth while to call
attention here to this new and valuable undertaking.
Like M. BinePs year-book, which it resembles in appearance,
the volume consists of memoirs and analyses, although at
present there is no full bibliography. The memoirs are wisely
limited to two, but one of these at least—Prof. Durkheim's
study of the origins of the prohibition of incest—is of great
interest and value. The author here traces the prohibition of
incest back to totemism, to the primitive custom of exogamy
and the condemnation of marriage within the clan. He shows
how this custom led to a profound antagonism between sexual
passion and the duties of kinship, which antagonism has
survived long after the decay of exogamy. Incidentally also
he shows how totemism led to blood being regarded as a
sacred thing, and hence, in consequence of the phenomena of
menstruation, to the view of women as possessing magic
virtues of good or bad influence. Thus the almost instinctive
separation of the sexes that prevails to-day, and the reverence
of women enshrined in our literature and art, may be traced
back, link by link, to the primitive phenomena of social
organisation and the conception of taboo.
The analyses of current literature are arranged in sections
which include a very thorough account of recent work
regarding various aspects of religion (primitive beliefs,
domestic cults, beliefs regarding the dead, folk-lore, ritual,
myths, monachism, &c.), the family, marriage, law and morals,
punishment, social organisation, demography, &c. A large
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section is devoted to criminal anthropology and allied aspects
of criminality.
Memory and its Cultivation. By F. W. Edridge Green, M.D.,
F.R.C.S. London : Kegan Paul, Trench, Triibner, and Co.
(International Scientific Series), pp. 310. Price 5s.
The greater part of this book is occupied by a psycho¬
logical description and explanation of memory. Less than
sixty pages are devoted to the subject of the cultivation of
memory. The book must, therefore, be judged almost en¬
tirely from a psychological standpoint; and on that ground
it must be admitted that it falls lamentably short of modem
standards. So far as the author is concerned, physiological
psychology might never have existed; not only so, but he
proclaims, without any apology, his adhesion to the phreno¬
logical classification, which he declares to be “the best
system extant, so far as the discovery and definition of the
ultimate mental faculties is concerned.” The usual well-
known list of phrenological mental qualities follows, and they
are seriously, though briefly, discussed seriatim. No definition
of the term “ mental quality ” is attempted; but we are in¬
formed that “there is not sufficient evidence at present to
admit of the various faculties of the mind being localised in
definite portions of the cerebrum ” (p. 246); although in
another part of the book the probability of such a localisa¬
tion is, on the analogy of Fenner's motor areas of the cortex,
not regarded as utopian. Nor is there any explanation given
of the relation which the author conceives to exist between
the so-called mental qualities and the process of memory.
We are only informed that there is a motor and a sensory
memory; that the former has its seat in the corpora striata,
and the latter in the optic thalami; and that when any of the
mental qualities are specially developed the corresponding
memory is increased in a similar degree. The theory bears a
fantastic resemblance to Wundt's apperception theory, but is
entirely unsupported by any argument or evidence beyond
the author's assertion.
The peculiar psychology of the book may be illustrated by
the following quotations, taken at random from among many
others that might be selected .*—“ The difference in function ”
(between the ultimate faculties of the mind) “ is so great that
we should as soon think of the liver taking on the function of
the stomach as the portion of the brain devoted to the senti-
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ment of love perceiving a tune ” (p. 45). . . . “ In the insane
it is rare to find all the faculties equally disordered, and it is
very common for a single faculty to be specially affected, as
in many varieties of monomania ” (p. 45). “ Nervous
force is a product of the cerebral cells in the same way that
bile is a product of the liver cells ” (p. 52). . . . “ A child,
when born, is in possession of the higher faculties, and these
have the same functions then as in after life.Sucking
is a very simple movement, and one which, the sense of taste
being in the tongue and palate, consists in getting those
parts as close as possible to the object desired. . . . Having
found that sucking its hand is unsatisfactory, it will suck
some other object applied to its lips, as the nipple or the teat
of a bottle. The successful result of sucking these objects
is remembered ;” &c. &c.
While a description of the operation of sucking is, in itself,
interesting and perfectly permissible, an attempt to found,
upon a teleological unconscious instinct, any explanation of
conscious thought phenomena is palpably absurd.
The short portion of the book devoted to the subject of the
cultivation of memory will be found by those interested in it
to contain many useful and curious suggestions.
Crime and Criminals. By J. S. Christison, M.D. Chicago:
The W. T. Keener Company, 1897. Pp. 117.
This book is not a scientific work, but of the order of “ pot¬
boilers.” It is conceived in execrable American-English, and
teems with slang terms redolent of the Bowery.
Dr. Christison founds his generalisations on a study of
twenty-three criminals, the description of each being, as we
are assured on page 9, the product of an examination of two
or more hours’ length. At this rate he must have wasted at
least forty-six hours in compiling this unnecessary work.
He finds that “ with prison inmates the forms of head and
the expressions of face, in the great majority of cases, will be
seen to differ in some respects from the normal type”—the
normal type being represented in the frontispiece by the
head of that intellectual giant, Ian Maclaren. The foregoing
discovery is not phenomenally new, but it is at least true, ana
is well shown in the photographs given of the author’s cases,
all of which exhibit the ill-developed occiput characteristic of
low-type skulls according to Crochley Clapham.
Two other discoveries Dr. Christison is responsible for: (1)
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that “ crimes are now nearly five times as numerous as forty
years ago ”—which we venture to doubt; and (2) “ that New
York has grown wickeder in the last ten years ”—which we
are inclined to consider probable if possible.
Dr. Christison wanders off occasionally into what he would
call Psychologies, during which he formulates the proposition
that “ mind molds (sic) matter, while matter conditions mind
by its inherent limitations .” Notwithstanding the above
lamentable restrictions, he considers that “ it is in every-day
evidence that a fortunate education will produce the best
character in spite of the physical deformities we call de¬
generate stygmata (sic). External features do not indicate
the moral character, though they must always represent
energies which, if not well directed, will run wild. It thus
would seem that environment explains heredity, and that,
strictly speaking, nothing is inherited but specie character¬
istics.” “ Specie ” is good, and no doubt some reference is
intended to the “ stygmata ” observed amongst the gatherers
of the almighty dollar.
Another interesting observation of our author’s is, “ Ac¬
cording to statistics, as woman encroaches upon man’s sphere
she becomes more and more liable to become insane or to
commit crimes.” This is rather rough on the New Woman.
We really cannot follow our author further through his
tangle of “ repeaters,” “ hard cases,” “ safe blowers,” &c. &c.
He winds up with a chapter on the degenerate ear, conclud¬
ing as follows:—“ But the ear is very sensitive to emotion,
as it is but little influenced by the will, and thus it may
betray emotion when no other part of the body does.” It
is just possible that the author’s ears may “ betray emotion ”
should he come across this review.
PART III.—PSYCHOLOGICAL RETROSPECT.
SOME ASYLUM REPORTS, 1897-8.
English County and Borough Asylums .
Berkshire .—This report, the first one which we take in hand, raises
the cry of want of room, either immediate or in the near future—a
cry which is met with in almost every other report received by us.
The accommodation is in process of being raised from 630 to 800
beds, but before this addition is ready it is feared that the authori-
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ties will be in sore straits. Dr. Murdoch is of opinion that several
cases, sent from workhouses, did not require asylum care.
Bristol .—A chauge of the city boundaries.in 1897 added no less
than 139 patients to the number for which the city was already
responsible. This and similar additions have led to the further
erection of blocks, and the 1000 beds, for which the administrative
centres were provided, will soon be in existence.
Chester {Upton ).—The electric light has superseded gas, and
has demonstrated its practical and financial superiority. The
weekly maintenance rate is Is.
Derby {Borough ).—Of the 82 admissions, more than one quarter
were readmissions. These included cases sent to workhouses,
every one of which was returned as unsuitable. In speaking of
the number of cases sent in, for the reception of which the asylum
was not intended, Dr. Macphail says:
Another unsatisfactory feature about the admissions must be mentioned—the fact
that 5 children under 16 years of age were sent here for treatment. Although in
each case they were certified as violent and dangerous, and requiring asylum treatment,
we found them only troublesome in the sense that their habits were not clean.
Dorset .—This report contains several excellent photographs of
wards, &c. We think this is desirable, as giving an opportunity'
to the outside public of seeing what asylum wards are really like.
The accommodation for private patients is evidently excellent.
£2500 profit was made on out-county and private patients. We
hear that already steps are being taken to add to the accommoda¬
tion. Ninety per cent, of the admissions were “ first ” cases. This
is an undoubtedly high proportion, and seems to justify Dr. Mac¬
donald’s opinion that, in Dorset at least, “ occurring ” insanity is
on the increase. In 80 per cent, of cases coining from Portland
heredity was found.
Glamorgan. —Dr. Pringle is not only right, but he is wise in
preaching to his local authorities their duty in sanitary matters.
Now whilst many of these causes are avoidable, others are wholly beyond the
control of the individual, and must be dealt with by the community, whose duty it
is to provide healthy surroundings, so as to enable everyone who wishes to lead a
wholesome life. When one sees, even in the hemes of the wealthy, no provision for
letting either fresh air in or impure air out, it need not be a matter of surprise that
in the homes of the working classes the only ventilation is by doors or windows,
which practically means that during the winter months the same air is breathed
over and over again, a lower vitality results, and, too frequently, a craving for
alcoholics, owing to the sense of temporary comfort and well-being that they
give.
The following statement may well bo added to our vaccination
facts.
A female patient was found to be suffering from smallpox shortly after the visit of
her friends, who, 1 believe, infected her. She was isolated as well as we could in
our overcrowded condition, and she made a good recovery, and no other cases
occurred; but we took the precaution of vaccinating all the inmates, sane and insane,
who had not been recently protected.
858 Asylum Reports . [Oct.,
Gloucester .—This report invites criticism, in the first place as to
the unsatisfactory statistical information supplied. As we have
frequently pointed out, this is one of the very few institutions in
which the Tables of the Association are seriously departed from.
But it also is, in places, unnecessarily aggressive. Because Mr.
Craddock has much dementia to complain of (how much cannot be
discovered in his tables) he, in despair, writes:
When I read reports of a recovery rate of 50 per cent, on admissions, I can only
admire and envy, though sometimes sorely tempted to wonder with the old gillie,
whether “ higher up stream there are bigger fish or bigger leears ! ”
There is a tertigim quid , which no doubt the gillie hid from his
master—big fish require much art in catching. Anyhow, it is not
for one medical superintendent to suggest to the public that any of
his more fortunate colleagues may be fraudulent in his returns.
The Committee in 1896 ordered that “ no references should be given
to those leaving to undertake similar work in other asylums,” with
a view to “ checking the restless spirit and love of change.” This
has had a marvellously good (?) effect. We take leave to question
the morality and wisdom of such a procedure. How can it be
expected that good and suitable candidates will apply in the face
of an unusual aud harsh condition? The right way to check
restlessness is to give good wages and a fair pension. This might
well have been tried at Gloucester in the first instance. We
wonder whether the same provision is attached to the junior
medical staff.
Kestevm .—We have to congratulate Dr. Ewan on his appoint¬
ment to the asylum of this newly separated area. The patients, to
the number of 102, have been temporarily lodged in the old
Grantham Workhouse, which has been adapted to requirements.
Land has been purchased for a new asylum at Quarrington, near
Sleaford, and plans are being prepared.
Middlesex .—The Annexe for Idiots has been opened. The
Commissioners at their visit recorded their opinion thus: “ We can
hardly adequately express our satisfaction at this arrangement;
and the neatness of these children in person and dress, together
with their contented looks, show clear indication of the care and
kindness bestowed upon them.” A similar opinion was formed by
those members of the S.E Division of the Association who
attended the meeting at Wandsworth in March of this year, on
the hospitable invitation of Dr. Gardiner Hill. Notwithstanding
this substantial addition, a committee has been appointed for the
purpose of providing a new asylum, where it is proposed to have
accommodation for private patients.
Monmouth .—The County Borough of Newport is leaving this
asylum, and must remove its patients before the end of 1906. The
union between Monmouth, Brecon, and Radnor has been dissolved
also, the latter two counties having to provide accommodation for
1898.] Asylum Reports. 859
themselves. Thus there will be much building activity in these
parts. The committee gave each of the seventeen attendants who
obtained the Association's certificate a silver medal, a gratuity of
£2, and a substantial addition to his or her wages.
Nottingham (City Asylum). —Dr. Powell suggests to the com¬
mittee the provision of accommodation for private patients of
slender means, since it is difficult to find such accommodation
anywhere in the Midlauds. 14*3 per ceut. of the admitted cases
were general paralytics, and 20 per cent, were due to intem¬
perance.
Salop and Montgomery .—The admissions showed the unusually
high proportion of 60 per cent, of acute cases, no less than 16
cases out of 202 being acute dementia. We could wish that Dr.
Strange would adopt the Association's Table of Causes. A
considerable addition to the accommodation is called for by the
crowded state of the wards.
Stafford ( Burntwood ).—We are glad to see that arrangements
are being made for erecting on the male side an infirmary block
on the same lines as the admirable accommodation recently pro¬
vided for the females.
The farm has, as hitherto, been invaluable in providing an outlet for the energy of
many of our troublesome cases—especially of our turbulent epileptics, of whom we
have a very large number ; and as a restorer to health of those recovering from
various mental disorders its usefulness cannot be exaggerated. The psst year has, in
addition, enabled us to show a good balance at the right side of the profit and loss
account, and the professional valuers in their report write that they “ found the
farm in a very good statej in fact we have seldom, if ever, seen a better lot of stock
or in better form. ,,
Sunderland (Borough Asylum). —Dr. Elkins has had but a short
tenure of office here, having been promoted to the Leavesden
Asylum in place of Mr. Case, whose death shortly after his
retirement we greatly regret. Dr. Middlemass has succeeded him.
The drainage has continued to give trouble, but it is hoped that
this will now cease. The admissions have increased by leaps and
bounds. The number of cases becoming chargeable and sent to
the asylum (Durham County till 1895) have been in the last eight
years respectively—59, 48, 72, 63, 73, 71, 103, 102. On turning
to Table XI to see whether the large increase in 1897 has been due
to the filling up of vacant accommodation with troublesome work-
house wrecks, we find no case of chronic mania or chronic melan¬
cholia, and only one of secondary dementia, among the admissions.
We are forced to the conclusion that there is in Sunderland a
substantial increase in “ occurring ” insanity. Heredity was proved
in 41 per cent., general paralysis accounted for nearly 10 per cent.,
and intemperance was assigned in 22 per cent, as a cause.
> We are pleased to see that in addition to table x, Dr. Elkins
(who makes the report) gives another, in which the forms of
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860 . Asylum Reports . [Oct.,
insanity on admission are arranged according to Skae’s classifi¬
cation.
Smsex (East). —Dr. Saunders, as usual, gives a valuable little
table in the body of his report showing bis prognosis of cases on
admission. Of the 248 admissions 65 had good, 52 fair, and 125
bad or hopeless prospects, the latter being in striking contrast with
the analogous proportion at Sunderland. More than a quarter of
the admissions were actively suicidal.
A large number of senile cases are sent here—let us hope it adds to their
euthanasia —but sometimes the thought springs to mind that, for a mere senile
breakdown, a person might be spared the association of a lunatic asylum with their
life's history. In this connection it may be mentioned that the combined ages of
four out of nine females admitted in the month of February amounted to no less
than 302 years.
This report always contains a table (which might well appear in
all other reports) showing the exact disposition of every pauper
lunatic of the county, whether in the asylum, workhouse, with
friends, &c. On comparing this year with last year we are struck
with a great diminution in workhouse patients. A foot-note
accounts for this as follows ;
Some re-classification of the infirm in mind has been made in the Brighton
Workhouse, and these figures show a decrease of 94 persons now certified as com¬
pared with last year’sreturn.
It is cheering to hear of another way of reducing the total
amount of insanity in the country.
Worcester. —The present report of the superintendent is made by
Dr. Braine-Hartnell, who has succeeded to the office vacated by
Dr. Cooke on his appointment to a cotmnissionership in lunacy.
The latter event is recorded by the Visiting Committee in terms of
congratulation, regret, and warm appreciation of the work which
Dr. Cooke has done for the county.
GERMAN RETROSPECT.
By William W. Ireland , M.D.
The Significance of Deficiency of the Corpus Callosum. — It
might appear that it would be easy to find out the function
of the corpus callosum (trabs cerebri), of which the situation is so
suggestive and the anatomical relations so clear and definite, yet
neither dissections nor vivisections nor the study of degeneration
nor development have solved the BaUcenfrage. Dr. H. Zingerle
has a long paper on this subject in the Archiv fur Psychiatric ,
Band xxx, Heft 2. He describes the case of a little boy three and a
half years old in whose brain only the genu of the trabs was
remaining; there was hydrocephalus internus sufficient to mask
any possible symptoms following the destruction of the corpus
callosum. Dr. Zingerle has made a diligent study not only of his
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German Retrospect.
861
own case, but of the recent literature of the subject. The reader
may be grateful for the following notes. He confirms the ob¬
servations of Onufrowicz, who described a band of fibres under the
corpus callosum connectiug the occipital and frontal lesions, the
fronto-occipital association bundle or tapetum. It appears from
the observations of Flechsig that we have no want of association
bundles connecting parts of the same hemisphere together, and
Dr. Zingerle traces the bundles of fibres connecting the basal
portions of the cerebral lobes which come into prominence in the
absence of the trabs. What we should like to know is how the
trabs work in connecting the two hemispheres, and bow or why
deficiency or section of this structure is not attended with any
apparent derangement of mental function. Dr. Zingerle starts the
interesting question whether in such cases there is not at least a
partial substitution of functional connection of both hemispheres;
but he fails to follow out this obscure indication. The develop¬
ment of the corpus callosum begins at the fourth month of foetal
. life, a little after both the trausverse fibres and those of the
tapetum get their axis-band. He remarks that a knowledge of the
. course of the fibres in the anterior part of the corpus callosum is
still too much a matter of conjecture. Rossi, however, assumes
that the fibres of the corpus callosum are connected with the
pyramidal cells of the cortex. Kolliker was able to trace the fibres
in part into the great pyramidal cells, and partly to the polymorphic
cells. The fibres of the trabs are also believed to take part in the
formation of the superficial nerve-fibres of the cortex. Through
the normal trabs the fibres of the occipital lobe are connected
with the temporal lobes of the other hemisphere. Dr. Zingerle
gives us the result of his anatomical examinations in the following
terms :
1. Through the failure of the trabs fibres there comes into
prominence a long connecting system between the frontal, parietal,
and occipital lobes (fronto-occipital association-bundle of Onu¬
frowicz, F. 8ubcallosus of Muratoff) and between the temporal and
parietal lobes.
2. The fibres along the walls of the middle ventricle have axis-
cylinders in spite of the deficiency of the trabs. The posterior horn is
mainly formed by the prolongation of the fronto-occipital bundle.
3. The cingulum gives some of its fibres to the middle wall of
the posterior cornu.
4. The long association bundles go to constitute a middle asso¬
ciation layer, which also comprises the cingulum.
5. The shorter association systems form an outer association
tract, the layers of which can only be artificially separated from
one another.
6. A layer of the basal frontal bundle runs through the anterior
> limb of the internal capsule to the ganglia of the middle brain.
Flechsig observes that the projection and association fibres
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862 German Retro&pect. [Oct.,
mostly end in defined regions of the brain, and serve to keep up
the association of the different sensory spheres. He distinguishes
different brain areas in which only association centres are repre¬
sented ; especially he describes a frontal, a middle, a parietal, occi¬
pital, or posterior association centre. There are thus no long
conducting paths by which the different lobes of the brain are
connected, and the sphere of bodily sensation in the middle of the
cortex appears to connect the frontal and occipital parts of the
cortex. Dr. Zingerle puts the question how far the results of these
minute dissections agree with those of Flechsig. It cannot, he
thinks, be denied that there are projection centres in the brain
which throw ofE a large number of fibres, and that these portions
are richer in such fibres. Clinical and experimental observations
also combine in showing that lesions in certain portions of the
cortex are followed by no recognisable symptoms in the sensory
or motor functions, that there are dumb portions of the brain
which when injured only entail defects that may be brought out
by a fiue psychological investigation. Dr. Zingerle did not succeed
in tracing the fibres of the corona radiata into the areas of the
association centres. In the cortex the nerve-fibres lose themselves
in a maze, through which the histologist can trace neither their
beginnings nor their endings. Our author observes that Flechsig
has brought no convincing proof of his assumption that the
different sensory areas are separated by neutral areas of cortical
substance. If Flechsig, for example, assigns the basal long
bundle of fibres of the association system to the corona radiata,
this has not been confirmed by clinical studies. Our case, Zingerle
observes, does not chime in with Flechsig’s views. We saw in the
first place a long connection between the frontal and parietal
lobes on the one side and the occipital on the other, through
which it could be ascertained that some of the fibres had become
atrophied along with the deficiency in the visual sphere.
It appears that the sensory spheres indicated by Flechsig con¬
tain richer association fibres, and not only short ones which are
the means of a direct connection with the adjacent parts of the
cortex, but also some fibres which run through the areas of the
presumed association centres without interrupting their course.
Anatomical observations have shown that there is also a direct
connection of the different sensory spheres through the trabs,—for
example, the visual sphere of one hemisphere is connected with the
auditory sphere of the opposite one. In the relations of the two
hemispheres we do not find the principle carried out that the
utilisation of sensory impressions does take place in separate
association centres.
Not only does the fronto-occipital association bundle serve to
maintain a connection with the frontal and occipital lobes, but
also with the parietal, as Muratoff has already pointed out. By
this path there is an opening for the direct transmission of iin-
pressions from the visual sphere to the motor centres of the
parietal and frontal lobes ; perhaps this has something to do with
the co-ordinated action of the muscles of the eyes. Wernicke
regards the lower portion of the parietal lobe as the optic motor
field. Flechsig, on the other hand, describes a cortifugal path to
the visual sphere, the fibres of which path do not get their axis-
cylinders at the same time as the fibres of the visual sphere.
This path allows excitations to reach the nuclei of the nerves of
the muscles of the eye. Dr. Zingerle concludes his long paper
with the following observations :
In order to understand the functions of the fronto-temporal
bundle we must wait for further researches. Flechsig observes
that in the first month the nerve-fibres of the path from the third
frontal have been found to have axis-cylinders. This tract goes
backwards to the outer capsule and thence to the anterior sub¬
stantia perforata. At the same time there is a band of fibres also
with axis-cylinders which goes from first parietal gyrus to the
lenticular ganglion, and loses itself in the substantia innominata,
where the first-mentioned tract from the third frontal seems to
end. Flechsig does not say whether these two systems of nerve-
fibres communicate with one another. This may turn out to be
the case.
Innervation of the Vessels of the Brain. —Obersteiner describes a
preparation in his museum (“ Arbeiten aus dem Institut fur Ana-
tomie und Physiologie des Centralnerveusystems,” herausgegeben
von Prof. Obersteiner, Heft v, 1897, quoted in Centralblatt fur
Nervenheilkunde, November, 1897) which shows a net of very fine
branching nerves clinging to a small artery of the pia. The
nerves had been coloured with chloride of gold. The iutra-cranial
arteries have a distinct muscular coat, of which the contractions
and dilatations are no doubt regulated by these nerve twigs. The
distinguished pathologist believes that the variations observed in
the calibre of the minute arteries of the brain are dependent upon
irregular innervation of the walls of the vessels.
Amusia. —Knauer describes this disorder in a patient with
exophthalmic goitre ( Deutsche med. Wochenschrift , No. 46, 1897,
reported in Neurologisches Centralblatt , No. 5, 1898). She took a
great interest in music, for which she had a high capacity, and had
received good training. She suddenly lost in one night her ear
for tones and musical sounds, although she had practised her
music as usual the day before. At the same time the patient was
troubled with noises in the ears, giddiness, sense of choking, head¬
ache, attacks of unconsciousness without any previous aura, dul-
ness of hearing, and sleeplessness. There were also ringing sounds
in the ear, generally excited by the hearing of melodies. If one
person alone spoke to her she could understand, but when several
spoke she only heard a confused noise. It was found by carefu
examination that she had lost the perception of tones, the under-
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864 German Retrospect [Oct.,
standing of musical notation, the power of singing after another
person, the capacity of writing musical notes after hearing them,
and of singing from notes, but she still retained the power of
copying music and of spontaneous singing Knauer treats this as
a pure case of sensory amusia, or tone deafness, analogous to cases
of aphasia, in which the power of using words or writing are more
or less lost. He holds that there are analogous centres and
conducting paths for the musical functions as for those of speech.
The injury to hearing resembles those attending Menifere’s disease.
He regards the affection as the result of intoxication on the brain
following upon deranged function of the thymus gland.
Retrograde Amnesia after Hanging. —In the Hospital Tidende of
Copenhagen (reported by Berger in the Neurologisches GentralblaM ,
No. 2, 1898) Dr. Knud Pontoppidan describes the following
case. A man aged sixty-five, with a neuropathic heredity, bad,
under the pressure of care and sadness, long entertained thoughts
of suicide. One morning he got up early and tied a thin cord
round his neck; between the noose and the skin he put some
pieces of cloth, and suspended himself by bending his knees. He
hung for about two minutes before he was cut down. Carried to
the hospital, he lay for twenty-four hours without consciousness.
During this time the head was livid above the ring in the neck.
This was succeeded by restlessness and agitation, which lasted two
hours, after which the patieut fell asleep. He awoke with full
consciousness, but his recollection only reached back to the evening
before the attempt at suicide. He remembered going to bed,
but after that till he awoke in the hospital his memory was a
blank. This remained the case a year after the event. With this
patient there were all the marks of great hypereetnia, brought on by
the asphyxia and the compression of the carotids. There was also
a partial paralysis of the nervus accessorius, and of the branches
of the cervical plexus, as a result of the pressure of the noose.
Dr. Pontoppidan mentions another patient who had also retro¬
grade amnesia following fracture of the skull, and recalls other
instances of the same derangement after epileptic attacks, poison¬
ings, infectious diseases, and hysteria.
Tattooing .—Dr. Buschan has sent in a reprint of a short paper
on this custom communicated to the Handworterbuch der Zoologie ,
Band vii, and there is another paper on the subject in the
Centralblatt fur Nervenheilkunde for April, 1898, by Dr. Otto
Snell. Tattooing is practised over the whole world, and has ap¬
parently been practised in primeval times. In the palaeolithic
deposits of France and Germany there have been found pins of
bone with lumps of oxide of iron and Tuts of pottery similar to
the utensils still employed for tattooing amongst savage tribes.
The historians of antiquity have recorded many peoples addicted
to this practice, the Assyrians, Phoenicians, the Hebrews, the
Geloni, the Britons, and the Piets. To-day we find tattooing not
merman Metrospect.
805
only amongst wild tribes, but amongst persons in the meet
civilised countries. Buschan tells us that ttm m ? 8t
sailors, soldiers, shepherds and labourer I knowT^ ^
fishermen in Scotland are tattooed, sometimes Lder The WeaThat
f “T* to , get . their ^dies identified should they be drowned
Lme memCs o n f ‘tL"^ “ S8 ^ g tbat in GreatWJnTvt
some members of the aristocracy are tattooed. This holds es
pecially with naval officers. Lombroso found it very freauent
with criminals, and treated this as a convincing proof of atavism
d“Lnd A? regard 11 a8 the remai “ 8 a custom wWch has
W^H d d fr °* m anci ® nt t™ 68 rather than a sudden revival of a
Asfb.m !=> Da f udhen ’ amongst 501 insane persons in the
Asylum of Ville Evrad, found 62 tattooed. Snell tells U s it is
rr^ W w the l0W6r Ckss of Prostitutes, especially in sea!
e^° Ut ten i, Per CeDt were found tattooed in Copenhagen
T^tooing is much commoner with men than with women It is
fhm?M h° understttnd wb J thi8 method of disfiguring the skin
should be so common with human beings. As pilctised bv
soldiers, sailors, and fishermen, the tattooedfigures are often ver^
simple and mart,at,c,-arms, swords, guns, anchors, names*ThSt
often^uccJdedT W fn a common d evice, or initials of sweethearts,
often succeeded by others, are the most frequent. We have also
seen figures beautifully executed in various colours. There are
artists in Japan who are skilful in tattooing. The sites most
frequently chosen for tattooing are the arms and breast.
,0 7 7 7 . Diel ^ ba - nce ™th Dwarfish and Giant Growth— Uhthoff
, N f>- 29, 1897, reported in CmtralMatt
fur Nervenheillcnnde, Apnl, 1898) describes a case of stunted
ouita snnn-I K 11 ^ 17 *1 ^ sig , ht - This was a child who remained
quite sound both in body and mind till the ninth year. Prom
this time, apparently after inflammation of the lungs, her bodily
growth ceased. The girl is now fourteen, but presents the appear¬
ance of a child of about nine years of age. The thvroid gland has
almost disappeared, the skin has a peculiar unhealthy appearance,
Th? lV h,nner tban USI i al ’ 811(1 not ba ggy aa in myxedema.
atT‘^ g n enCe 6e ? mS uaa f ected - The injury to sight consists in
* ^“P 0 ™ 1 hemiopia with descending atrophy of the optic nerve
™® m i!£ piC P up I 1 r 5 ac , tion ' The cause of the disease must lie in
* be °f ghbo ur£ood of the chiasma. It probably consists in some
°, f . the Ptuitary body. Uhthoff also describes two cases
Sut W . b ! cb were accompanied by loss of sight, anomalies
of the field of vis,on, and disturbance of the muscles of the eye.
treated in Traugott describes a patient who was
Polyclimque for norrous disorders at Breslau (Allge-
X™ ^ Ucl r ft l B J an J d 1,v > iterator Heft). She was a woman 75
^ e8r8 ° ld '7 h ° bad dimness of the lens in both eyes. She also
ears** A giddiness, sleeplessness, and sounds in the
' ngular symptom was hallucinations of sight. They
xxiv. 5g
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866 German Retrospect. [Oct.,
began with an appearance like a brightened cloud, which was suc¬
ceeded by a procession of lively coloured images across the field of
vision, generally from left to right, such as a ship and a company
of men, which passed along and then disappeared. The woman
fully recognised that these apparitions were the result of disease.
Artificial Production of Illusions in Delirium Tremens .— Pro¬
fessor Bechterew (Centralblatt fur Nervenheilkunde , October, 1897)
calls attention to Liepmann’s experiments showing that in some
cases of delirium following upon drinking, pressure upon the eyeball
was sufficient to induce spectra of various kinds (see our German
Retrospect for April, 1896). The apparitions were seldom those of
beasts, rats, or mice, as is common in delirium tremens, but rather
of inanimate objects or of men, and they were rarely of a threaten¬
ing character. Professor Bechterew recalls the old observations of
Jolly, who found that he could induce illusions of hearing by
excitation of the ear through the continued current, as well as
those of Koppe, who found that he could arouse illusions of hearing
by the use of the ear speculum and similar manipulations; and
Nacke found that visual illusions could be produced by irritations
applied to the eyeball, causing flashes of light, which in the diseased
brain were transmuted into apparitions. Alzeimer showed that by
pressure upon the eyeball illusions might also be induced in para¬
noiacs, hysterical patients, epileptics, and paralytics, so that this
was not a symptom peculiar to alcoholic delirium. Bechterew goes
on to say, “In my old observations of the alcoholic form of mental de¬
rangement I have for many years given much attention to the
artificial production of illusions of the senses, though not with the
same methods. To produce illusions of hearing I made use of the
monotones of a hammer of the induction apparatus, to which •the
patient’s attention was directed. To produce optic illusions the
patient was made to gaze at a glittering object held near the eye,
as is practised in hypnotising. In this and similar ways I found
that I could easily induce illusions of the senses, not only during
the period of delusional delirium, but also for some time after it
had quieted down. I have had patients in whom no symptom of
the delirium was left, and nevertheless it was enough for the
patient to hear the sound of the induction apparatus when he
heard a voice which uttered words. In the same manner were
produced visions of objects and faces. In some cases these illu¬
sions could be brought back months after the subsidence of the
delirium. A striking example of a similar condition was afforded
by a patient who had an attack of acute alcoholic insanity, with
hallucinations of hearing almost confined to the left ear. Years
after the subsidence of this attack, on fixing his gaze upon a
glittering object there appeared to him first the vision of a double
watch, a little after that of a man gesticulating, then of a man
with children. In this patient, heariug the sound of an induced
1898.]
German Retrospect,
867
Z r l n L ba l tery r^ teS iU " 8i0118 of heari "g- These deceptions of
the senses have little unpleasant or threatening
Bechterew observes that it is not a sufficient explanation to
assign these illusions to the heightened excitability of the sensory
ptCi th ™ are “ U ° h “ oreow “g to the suggestions of strained
* rhese atl “ uh only succeed when the patients direct
a i te S tl0n u P° n t ^ m -. When this is not the case they are
followed by no such illusions. There is no doubt that whatever
significance we may assign to peripheral irritation as a cause of
illusions the great excitability of the psychical centres plays
an important part. Bechterew observes in conclusion that such
illusions are common in alcoholic insanity, although they may
appear in other forms of mental derangement. J
In a succeeding paper, - On the Suggestive Influence of Halluci¬
nations of Hearing,” Bechterew comments upon the mixture of
acuteness m argument and unreason in a patient who heard a
male voice in the left ear. Though the impressions of all his
other senses were correct, this hallucination commanded his com-
plete faith. There are cases, observes the Professor, in which the
hallucinations of the senses are so lively that they seem more
convincing than the representations of another person. In this
case, however, the voice was confined to one ear, which was gener¬
ally the seat of a subjective noise, and the hallucination was
accompanied by an abnormal sensation in the outer ear and the
parts around the ear muscles. Under these circumstances the
Professor feels much surprise that the patient would not admit
the force of his arguments as to the falsity of the hallucination,
and defended his own belief by fanciful remarks and ingenious
questions.
The Influence of Alcohol on Muscular Activity. —Professor Destr^e
of Brussels has made some experiments on this question ( Monats -
schrift fur Psychiatrie und Neurologie , Band iii. Heft 1). There
are two views of the action of alcohol; one that it is exciting, the
other that it is paralysing to muscular action. Using Mosso's
ergograph, Prey reached the conclusion that alcohol has an
injurious action upon an unwearied muscle, and a favourable
action upon a wearied muscle. Dostree finds that alcohol has a
favourable influence both on an exhausted and upon afresh muscle,
but that this influence passes so quickly away that if one waits above
ntteen minutes this stimulus has disappeared, to be replaced bv
the paralysing effects of alcohol.
Prom his experiments with the kilogrammeter Destr^e con¬
cludes that the favourable influence of alcohol follows almost
immediately after its enjoyment, but is only of momentary dura¬
tion. After this the paralysing effect of alcohol comes into play.
1 he muscular capacity sinks about half an hour after the use of
alcohol to a minimum, and it is difficult again to raise it by new
doses. The paralysing influence of alcohol much surpasses the short
Digitized by
868
German Retrospect . [Oct.,
exciting effect, so that the total muscular capacity is actually
lessened by its use. Such depressing effects are not observed
after the use of tea, coffee, and kola.
Cardiac Deficiency as a Cause of Insanity. —Dr. Jacob Fischer
has a paper in the Allgemeine Zeitschrift fur Psychiatrie , Band
liv, Heft 6, upon the “ Influence of Heart diseases in producing
Insanity.” After quoting the views of a number of authors on
this question, amongst whom are Dr. Mickle and Dr. Farquharson,
and describing some cases which he himself has observed, Dr.
Fischer states the following conclusions:
1. Diseases of the heart may become the exciting cause of
insanity in predisposed persons. The different symptoms which
accompany such disorders, such as pain in the precordial region,
palpitation, exaggerated heart-sounds, feelings of constriction,
difficulty of breathing, headache, and giddiness, may all, by
causing derangements of sensation and illusions of the senses,
become the starting-points of insanity. k
2. Deficiencies of the heart’s action may lead to mental affec¬
tions in persons not predisposed, partly by deranging the circula¬
tion of blood in the brain, and partly by altering the chemical
action of the blood. The mental disorders thus caused generally
take the form of mania haliucinatoria, confusional insanity with
hallucinations. The hallucinations take their colour from the
abnormal organic feelings.
3. If the heart disease goes on without alleviation or betterment,
the hallucinatory derangement may pass into dementia.
The Etiology of General Paralysis .—Dr. Heiberg of Copenhagen
observes that almost all the cases of general paralysis in that city
find their way into St. Hans Hospital. It is therefore interesting
to compare what is known of the prevalence of syphilis with the
deaths from dementia paralytica. The mean time from luetic
infection to the outbreak of general paralysis is estimated at
twelve years ; the mean duration of the latter disease at three
years. In fact, there was observed a maximum of syphilitic cases
in the year 1869, and a maximum of deaths from this and paraly¬
tics in the year 1884. There was another rise in the frequency
of syphilis in Copenhagen in the year 1886, and so we may expect
a corresponding rise in the mortality from general paralysis at
the beginning of the next century.
In this connection it may be mentioned that Dr. Muller, in a
contribution to the statistics of general paralysis in the Allgemeine
Zeitschrift fur Psychiatrie , Band liv, Heft 6, 1898, informs us
that out of 96 cases of general paralysis (65 male and 31 female)
which he examined in the Asylum of Gabersee, in Upper Bavaria,
he only found lues in 14*6 per cent., t. e. in 17*7 per cent, of the men
and 6*4 per cent, of the women. This, Dr. Muller observes, agrees
with statistics obtained from the asylums at Munich and Deggen-
dorf. Kundt found for the latter place syphilis certain in 8*4 per
1898.] German Retrospect. 869
cent, for the men and 7 per cent, for the women. Heilbronner
for Munich, found it certain in 16 26 per cent, of the men and in
6‘3-per cent, of the women, and that it was very probable in 9-4 of
all cases, in 62 per cent, of the men and 161 per cent, of the
women.
Dr. Muller is somewhat apologetic at not making out such a
large percentage as is done in circles of the better and more
intelligent class of society, which amount to 50 and more per cent.
He treats his own lower percentage as owing to the difficulty of
gaining information of the past history of his patients.
The Differential Diagnosis between Lues Cerebri and Demerdia
Paralytica.—Dr. Wickel has given the results of his studies in the
Psychiatric Clinique of Professor Tuczek of Marburg in the Archiv
fur Psychiatre , Band xxx, Heft 2. The paper occupies 78 pages,
and is illustrated with a wide lithographic plate and twelve wood-
cuts of handwritings. Dr. Wickel begins by stating that there
are two ways in which syphilis acts injuriously upon the nervous
system, by well-known anatomical changes of a specific character,
and through a chemical poison engendered by the luetic process*
causing post-syphilitic degeneration. To the last of these lesions
belong tabes dorsalis and general paralysis. This assumed poison
acts first upon the nerve-fibres, and then causes infiltration of the
nerve-cells much in the same way as diseased maize, ergot of rye,
alcohol, lead, opium, bromide of potassium, and atropine, all which
intoxicants may be the cause of a pseudo-paralysis resembling
dementia paralytica. Dr. Wickel cites some statistics to show that
syphilis holds the first place as a cause of general paralysis. It is
known that there are cases of insanity following on syphilitic
infection which bear a close resemblance to general paralysis.
There is a like alteration in the reaction of the pupils, mental
weakness, excitement, depression, and finally an apathetic state—
symptoms common to both. The difference is that in dementia
paralytica the mental degeneration is more progressive ; in pseudo¬
paralysis syphilitica the disturbances of the muscular apparatus of
the eyes are of a shifting character, there are fleeting and chronic
aphasic symptoms, passing pauses, and mental weakness not ad¬
vancing. The decisive test is recovery under treatment with
iodide of potassium and the repeated inunction of mercury. Dr.
Wickel describes six cases at great length. In all the evidence of
luetic infection was decisive. Four of these patients recovered
through antisyphilitic treatment. One of them died, a man
forty-two years old, who had lues thirteen years before. The
insanity lasted about three years. Attempts at treatment were of
no avail; the disease seemed to take on more and more the typical
character of general paralysis. The post-mortem appearances are
described at great length. There were endarteritis and arterial
changes, and meningitis visible to the naked eye, and thickening of
the membranes, discoloration of the arachnoid, with adhesions of
Digitized by
870 German Retrospect. [Oct.,
the pia mater. It might be advanced that when the cause is
identical and the symptoms are so much alike, it is a mere matter
of literary arrangement to call the one false and the other true
general paralysis, because in the latter case the malady is so
virulent that it will yield to no treatment. It seems, however,
certain that there are instances of general paralysis which do not
arise from syphilis either hereditary or acquired, and that in
ordinary cases antisyphilitic treatment is of no avail.
The Mental Derangements of Old Age.—Die Geistesstdrungen des
Greisenalters, von Dr. Hermann Schmidt, of Dalldorf. Sonder-
Abdruck aus Deutsche Medizinal-Zeitung , 1898, Nos. 9—15.
Neuere Arheiten uber die Dementia Senilis und die Atheromattiser
Gefasserkrankung basierenden Gehimkrankheiten. —Referiert von
A. Alzheimer, Monatsschrift fur Psychiatrie und Neurologie, Band
iii, Heft 1.
TJeber Miliare Skierose der Himrinde bei seniler Atrophie. Yon
Dr. Emil Redlich, Jahrbiicher fur Psychiatrie und Neurologie ,
Band xvii, Hefte 1 and 2.
Of late years there have been several studies of senile dementia,
some of which have opened new points of view, while others have
deepened our knowledge of the symptoms and histology of this
form of alienation. It is not to be wondered that senile insanity
should have some well-marked features. It is difficult to under¬
stand how the periods of pubesceuce or adolescence should have
any causal connection with mental derangement, as these are
times of healthful growth ; but old age as a period of decline
seems liable to loss of and perversion of function. Such studies
are somewhat dismal. A man is not bound to have epilepsy or
general paralvsis; but all men not prematurely cut off become
old, and in describing the degenerative changes of that period
pathologists can hardly forget that they are recording their own
future. It is some consolation to bear in mind that in the natural
progress of life the blunting of the faculties is gradual and almost
insensible, and that some old men retain their intellectual power,
their acquired knowledge, and acquired skill almost to the last.
Indeed, old age may have certain advantages and compensations,
as shown by Cicero in his treatise De Senecute. Passing over the
examples of Fabius, Cato the Censor, Masinissa, and other heroes
of antiquity, we have proofs in our own day of what old men can
do in von Moltke, Radetzky, and Lord Clyde. It is needless to
mention their powers in deliberative assemblies and in writing
history, which seem the most natural occupations for men who
have led long lives distinguished by action and ripe studies.
The following observations are less cheerful, giving the patho¬
logical side of natural decline. It is not easy to fix an average
time when old age may be said to commence. In some men,
indeed, it begins twenty years after others, nor does it equally
affect every function of the body. As the two powers of assimila-
1898*] German Retrospect . 871
tion and absorption slacken, the vital processes are less active on
the surface of the body than in the central organs, and thus the
nervous system retains its capacity for some years longer.
Iji old age there has been noted a diminution in the volume and
weight of the brain. It has been found, Dr. Schmidt tells us,
quoting Demange, that at the thirtieth year a man reaches the
weight of 587 grammes for each hemisphere, after which there is a
diminution of about 10 grammes for every five years. It is
remarkable that the brain should keep about the same weight
from the fiftieth to the seventieth year. After that age the weight
rapidly diminishes, so at the age of eighty-five the total brain loss
is about 207, of which the larger half, 106 grammes, is borne by
tbe physiologically higher left hemisphere.
In women the brain attains its highest weight about the twenty-
fifth year. From this time till thirty-five there is a loss of weight.
From sixty to eighty-five the diminution is about 90 grammes.
Such a loss can only be accounted for by a decrease in the mass of
the brain. Alzheimer observes that we are indebted to Noetzli
for a fresh statement of brain weights in senile dementia taken
with exactness, and after a method free from objection. Of
especial interest are the forty cases of senile dementia without
any inflammatory deposits. The mean brain weight was for men
1195, for women 1099 grammes. The brain weight of a healthy
man is taken as 1400 grammes, of a healthy woman as 1300
grammes. Thus in senile dementia there was noted a decrease of
about 200 grammes. The atrophy of the cortex was found to be
greater thau that in the cerebellum and pons and medulla. Dr.
Alfred W. Campbell has observed that in senile insanity there is
almost invariably a decrease in the diameter of the spinal cord,
and a diminution in its weight. It may be here noticed that both
Schmidt and Alzheimer frequently quote from Dr. CampbelPs
valuable paper upon “The Morbid Changes of the Aged Insane,”
which was published in the Journal of Mental Science for October,
1894. It is not my business to reproduce the information given
by Dr. Campbell, which is generally confirmed by the German
pathologists.
All observers are agreed that the most noteworthy degeneration
of old age is in the arterial system. Demange states that in 500
examinations of the bodies of old men there was not a single case
in which there was no atheroma. Alterations visible to the naked
eye are found in the aorta, the coronary arteries of the heart, and
the basilar arteries of the brain. The occurrence of atheromatous
degeneration in the larger vessels is an indication that such
changes are also to be found in the smaller ones, but their absence
in the aorta or radial artery is no proof that the brain of a senile
dement is exempt from them.
The degeneration of the larger vessels seems to begin with
diminution or closure of the calibre of the vasa privata. These
Digitized by
872
German Retrospect.
, . C°et.,
body? espemlly^he'Sdneys^and^iver^^ i t nterna | °FS ans of th e
attention to the lesions observed in ti ’ ^ 7® 8 ^ a 1 confine our
which are of the same character TToaf C °j d and the brain,
tion of twelve brains of old nersor,^i° S f JUrln f ? und ln bis examina-
eight a strong deposit of tw een s lxt y-five and eighty-
young the cefls are f ree f£>m pignS,? 6 In“two°of't? 8 ’ 7 hi '- 8t in tbe
was observed a decrease in tifo V»r, u 0 ^ ^ese brains there
Of the vessels, atheromatou! de~7° f ^ ™™-**«*. Xerosis
careous deposits a slight r tl0n ° f their walls, with cal-
great increase of the neuroglia thicken^ 1116 "* tbe adventitia > a
of the cortex, and a gSr or 1 »ht °l the neur °gba layer
the same situation These bodies UU1 ^, ei of corpora amylacea in
cord espeahUlj T° the ,„“rto- fiL"' spihal
ot the a.aiagli, i, * h f ,'1«"».
ganglion-cells of the spinal nord d„ ma ™ ed ; The nuclei in the
They are affected by Kes more liL^ C0l< T 7 ith 08mic ^id.
nucleus of the aged fs EeUed i„ ™ PV oto P lasm - The cell
of the wearied cell is also shrivelled ^ Wa ^ ’ tbe nucleus
Alzheimer confirms the observations C °i° Ur . s more rea <%-
as to the increased number of spider cells'?* 1 tifTf and ® an, pbell
They a,e e ^ny m nVmeaZ
■dcrotisof'thJbSn r^^hTtb! i,i d ‘" lbt the arterial
of the brain in senile demSt.t It Z! T™ ° f ^^neration
atrophy of the nerveSus TheJe » 7 £ P ™ eded b 7 primaiy
which (he atheroma!^ t,™ 8 °- f disea8e *
degenerative orocesR Tr» <? + 1 ®^ n< ^ 8 ln the middle of the
thf ,e.altT. P 2c"thi JS”SSr*S. dh rf th « lid °“»
attacked at once or whether this is th* G W u° * P^ renc byma is
processes. la th, Mae/ „S*«llTasX Jlf?" ?° tbid
another, but in the brain owintr to tho !r the same function as
different anatomical elements th^ord dlve 7" fied Action of its
the different tissues or^Ut^^n^/T !9ui ^. in " b . ich
must produce different clinical symptoms In lit m ° rbld a ^ 10n
f tbe e g r g n iio e LS
■he cSa^ * Dr - , 0ampbe ' 1 >**»«
insanity, and the increase^of^ *n P a,al J rtic aa d alcoholic
Alzheimer thus goes on •_“ The firs?? CG ^ ,® ende dementia,
generally diminished in dTpth An LtT" ° f C f* ° f the cortex “
ganglion-cells is always ofeerved On^ fi d® de ,? enera 1 tion of the
d.c*r. Th. ^ JSsaraj
1898-3 German Retrospect . 873
affects cells of all sizes. One notices cells whose protoplasm is
wholly replaced by pigment. There is an increase of pericellular
nuclei and of the nuclei of the neuroglia. The blood-vessels of the
cortex are in some places not easy to distinguish. The perivascular
spaces are mostly dilated and contain pigment, some leucocytes,
and detritus. The tissues around are full of fibres, and contain
spider-cells. The basal ganglia show still more marked changes in
the vessels and their vicinity. The perivascular spaces, through
the destruction of the surrounding tissues, widen into irregular
cysts, which contain remains of fibres and cells, blood-globules and
detritus. One ofteu finds a squeezed blood-vessel on the wall of
such hollows. The tissue which surrounds the cyst appears brown,
infiltrated with crystals of hsematoidin, and there are also heaps of
spider-cells. Some sections show the evolution of these cysts from
small extravasations of blood produced by the decay of the sur¬
rounding tissues.” The description of the changes in the spinal
cord are taken from Campbell's paper. Well-marked and im¬
portant changes are also observed in the peripheral nerves in senile
dementia; also acute parenchymatous degeneration of single fibres,
a notable diminution in the number of the large nerve-fibres, which
are replaced by connective tissue. There are also bundles of fine
nerve-fibres, which have only a thin sheath thickening of the peri-
and epineurium, which are infiltrated with fatty cells, and great
thickening of the vessels with proliferation of the intima. Nissl
has pointed out the dividing of the nuclei of the neuroglia of the
cortex in senile dementia.
Alzheimer observes that in some cases the peri-vascular sclerotic
process is confined to some parts of the cortex. To this form he
gives the name of perivascular gliosis of the cortex cerebri, on
account of the remarkable degeneration of the neuroglia with
which it is associated. He has met with perivascular sclerosis of
the cortex in persons from fifty to seventy years old. In such
cases the clinical symptoms vary with the site of the lesion. There
may be aphasia, paralysis, word-deafness, or word-blindness. The
decline in senile dementia is often not general, but there are break¬
downs at some weak points in the organism.
Dr. Redlich describes at length a case of advanced, senile
dementia in which there was much atrophy of the whole brain,
especially marked in the frontal and parietal lobes. Redlich’s
microscopical observations coincide with those of Campbell and
others, that the alterations in the ganglion-cells and nerve-fibres,
and the appearance of pigmented spider-cells, are characteristic of
senile atrophy.
Peculiar to the case described by Redlich was the appearance
of very small patches of miliary sclerosis. They were rare in the
molecular layer, and most diffused in the pyramidal layer, to become
again scarcer in the deeper parts of the cortex. This microscopist
is uncertain whether the miliary patches, which he carefully
Digitized by {jOOQle
874 German Retrospect . [Oct.,
describes and figures, are the result of the degeneration of glia cells
and fibres. The fibres in the patches are sometimes observed to
pass into glia fibres; but they do not take on dyes in the same way,
and the miliary degeneration is most frequent in the localities of
the ganglion nerve-cells.
Dr. Schmidt calls attention to senium prsecox , or dementia senilis
prsecox , which sometimes attacks adolescents after infection of
malaria, intoxications and long illnesses. Charpentier describes
this form as sometimes resulting from purely mental causes, such
as a change in the surroundings of the patient. The most usual
symptoms are sleeplessness, want of appetite, listlessness, melan¬
choly, and loss of memory. Alzheimer thus describes dementia
apoplectica:—“ It is sometimes observed that eveu in young persons
apoplexies, which need not be in the cortex or hemispheres, are
followed by a slowly progressing dementia which closely resembles
that of old age.”
Alzheimer found that the anatomical substratum of this declining
mental power consisted in alterations in the cortex, even in the
hemispheres unaffected by the haemorrhage, changes which bore a
close resemblance to those of dementia senilis . Beyer has lately
described the mental condition in dementia apoplectica. He finds
it characterised by listlessness and apathy, indifference to what is
going on in the outer world, dislike of moving about, tendency to
tell stories, weakness of the memory for recent occurrences, with a
good recollection for events long passed. The speech is often slow,
drawling, and varying in tone. Often there are tremors and
difference in the facial muscles and contraction of the pupils on
one side. The reflexes are normal or increased.
We have not space for the clinical descriptions of the symptoms
of senile dementia, which are of a diversified character. Indeed,
those who make a special study of the affections of senility some¬
times trace their lines too exclusively. Old people generally die of
the same diseases as adolescents. The difference is that their vital
powers of resistance are lower. Dr. Clouston has lately shown that
diseases of the nervous system become more frequent in advanced
life; and no wonder, since most people who have lived long in this
age have their nervous system most severely tried.
1898.J
875
PART IV.—NOTES AND NEWS.
MEDICO-PSYCHOLOGICAL ASSOCIATION OF GREAT BRITAIN
AND IRELAND.
ANNUAL MEETING.
The fifty-seventh annual meeting of the Medico-Psychological Association of
Great Britain and Ireland was begun in the hall of the Royal College of Physicians,
Edinburgh, on Thursday, July 21st, Dr. McDowall (Morpeth) presiding. The
following members were present:—Dr. T. W. MacDowall (President), Drs. A. R.
Urquhart (President elect), J. B. Spence, J. Rutherford, H. Hayes Newington
(Treasurer), J. G. MacDowall, T. Seymour Tuke, H. Rayner, T. S. Clouston,
G. J. Swanston, W. Rooke Ley, A. H. Stocker, A. Campbell Clark, T. Aldous
Clinch, John G. Havelock, James Rorie, Neish Park Watt, James Chambers,
Fletcher Beach, W. R. Watson, E. Powell, Walter S. Kay, Bedford Pierce, D.
Yellowlees, F. Sidney Gramshaw, R. Langdon-Down, L. R. Oswald, A. R. Turn-
bull, E. B. Whitcombe, F. Perceval, John Mills, Harry A. Benham, C. S. Morrison,
C. Merrier, J. Carlyle Johnstone, D. G. Thomson, P. W. MacDonald, W. Ford
Robertson, G. M. Robertson, J. Peeke Richards, John Keay, Conolly Norman,
James Hvslop (Natal), Crochley Clapham, Richard Legge, J. A. Campbell, T. R.
Macphail, and Robert Jones (General Secretary).
Congratulatory telegrams and letters of regret for non-attendance were received
from Drs. Ireland, David Nicolson, Wiglesworth, Briscoe, A. Friis, Benedikt,
Virchow, Jolly, Bianchi, Boeck, Magnan, J. H. Paul, E. Cowles, Kurella, Ludwig
Meyer, Sir William Gairdner, Sir Grainger Stewart, and Oscar Woods.
The Secretary (Dr. Jones) read the minutes of last meeting, held at New¬
castle, and these were confirmed.
Election or Officers and Council.
The following were elected Officers and Council of the Association:
Officers.
President . A. R. Ubquhart.
Treasurer .H. Hayes Newington.
General Secretary .... Robert Jones.
Registrar . LB. Spence.
r Henry Rayner.
J A. R. Urquhart.
Editor * .*S Conolly Norman.
( Edwin Goodall.
f T. Seymour Tuee.
Auditors .| T. Outterson Wood.
Divisional Secretary for South-Eastern 1 g yy Wh IT k.
Division . J
Divisional Secretary for South-Western 1 p w Macdonald.
Division .J
Divisional Secretary for Northern andj w Crochley Clapham.
Midland Division . J
Divisional Secretary for Scotland A. R. Turnbull.
Divisional Secretary for Ireland . A. D. Finegan.
Digitized by
876
Notes and News .
[Oct.,
Other Members of Council .
A. Law Wade, J. Carlyle Johnstone, A. W. Campbell, T. S. Sheldon,
James Chambers, Oscar T. Woods.
Parliamentary and Educational Committers.
It was agreed, on the motion of Dr. Bower, seconded by Dr. Crochley
Clapham, to re-appoint the Educational Committee.
The re-election of the Parliamentary Committee was proposed by Dr. Bower
and seconded by Dr. Clapham; but Dr. Rayner proposed, and Dr.RooKE Ley
seconded, that Dr. G. Thomson and Dr. Gardiner Hill be added to their number,
which was carried.
Election op Members.
The following were elected ordinary members of the Association, Dr. Whit-
combe acting as scrutineer.
Ashton, George, M.B., Ch.B.Vict., M.R.C.S., L.R.C.P.Lond., Assistant Medical
Officer, London County Asylum, Claybury, Essex (proposed by Robert Jones,
T. E. K. Stansfield, H. Hayes Newington); Blair, David, M.A., M.B., C.M.,
Assistant Medical Officer, County Asylum, Lancaster (proposed by D. M. Cassidy,
James P. Gemmell, Prank A. Elkins); Gill, Prank A., M.D., C.M.Aber., Deputy
Medical Officer, H.M. Prison, Manchester (proposed by David Nicholson, W.
Crochley Clapham, Robert Jones).
Election op Honorary Members.
Dr. Powell proposed the election of Mr. George Thomas Hine, architect, as an
honorary member of the Association. He had devoted himself almost exclusively
for the last twenty years to the designing of asylums for the insane, and those of
them who had the management of the asylums which Mr. Hine had erected could
speak very highly of the extremely able manner in which they had been planned.
Mr. Hine stood in the very first rank of asylum architects, and the Commissioners
of Lunacy had appointed him their consulting architect. There was a precedent
for electing a gentleman who was not a medical man. He referred to Sir William
Wvatt, who was chairman of the Colney Hatch Asylum.
Dr. H AYB8 Newington, in seconding the motion, said that the Honorary
Membership of the Association was given to those who were distinguished mem¬
bers of the medical profession, those who were eminent in psychology or those
branches of science connected with the study of insanity, or who had rendered
signal service to humanity. Mr. Hine by his ability had done much to produce a
good machine for the treatment of insanity. He was eminently worthy to be
enrolled among their honorary members.
Dr. Clouston, Edinburgh, proposed the election of Dr. V. Magnan, Paris, as an
honorary member. He was one of the most distinguished neurologists in France,
the head of psychiatry in Paris, and the highest living authority on alcoholism.
Dr. Urquhart seconded the nomination.
Dr. Rayner, in proposing Dr. A. E. Macdonald, New York, for honorary mem¬
bership, said he was a gentleman in every way worthy of that honour. He was general
superintendent of the Manhattan State Asylum, had written on different phases of
insanity, and he had been delegated to represent the American Medico-Psychological
Association in this country for two years in succession.
Dr. Urquhart seconded the nomination.
All these gentlemen were unanimously elected.
Treasurer’s Report.
Dr. Hayes Newington, in presenting the balance-sheet, pointed out that the
disbursements were a little higher this year in consequence of there being more
secretarial work. Under “ Miscellaneous” the sum was higher in consequence of
the Memorandum of Association. They had also this year the Jubilee Address to
Her Majesty and the address to Dr. Beach. On the other side the income from
THE MEDICO-PSYCH OLOGICAL ASSOCIATION. -For the Year 1897 .
REVENUE ACCOUNT—January ist to December 31st, 1897.
Digitized by
878
Notes and News.
[Oct.,
dividends was slightly larger in consequence of their changing their Stock from
Consols into New Zealand Stock. The sale of the Journal was a little lower,
but that was a matter of accounting. The sale of the Handbooks, of course, was
considerably below, because they had been out of print for some time. The fees
came to very much the same, but the subscriptions were considerably higher—
£536 against £511. He should like to point out, further, that the amount of
subscriptions written off list year were £13 2s. 6d. t and this year it would be less.
Last year also there was a great improvement on the year before. Generally he
might add that the Association was flourishing and seemed to be in a perfectly
sound position, the balance of £526 being a good deal in excess of what it was
last year. The cost of the July number had yet to be met, but undoubtedly they
were in a better position this year than last year.
The Auditors’ report, which was read, certified the accounts as correct. They
were glad to be able to report that the financial condition of the Association was
satisfactory. They had carefully examined the present system of bookkeeping, and
strongly advised that no alteration be made in it without the consent of the Council.
The report was signed by Drs. Whitcombe and Seymour Tuke and Mr. Wood-
ington, C.A.
The Treasurer's report was put from the Chair and adopted.
The Treasurer ‘said he had to make a statement of the payments on both
sides in respect of the Gaskell Memorial Fund. Last year the balance was
£4 5t. 7 d. to the credit of the Association. This year they had spent more than
they received. The payments on the one side were £18 5a., and on the other at
the credit of the Gaskell Fund £64 4a. 9 d. The Association at this time held
£51 19a. 9 d. of the Gaskell money. The figures would all appear in the Treasurer’s
report.
Statement of Payments made and received by the Treasurer on account of the
Gaskell Memorial Fund.
Dr.
1897.
Oct. 6.
1898.
£ s. d. £ s. d.
To Mr. Wyon
for 3 gold
medals . 15 15 0
2 silver ditto 2 10 0
-18 6 0
Balance.51 19 9
1897.
July 24. Balance .
Oct. 8. From deposit account
1898.
Jan. 8. Dividends .
July 1. Ditto.
Cr.
£ s. d.
4 5 7
18 5 0
23 7 1
23 7 1
£69 4 9
£69 4 9
Dr. Clouston moved a vote of thanks to the Treasurer for the great trouble he
had taken and for having adopted a very clear mode of stating the accounts so as
to enable them to compare one year with another.
Dr. Rayner seconded the motion, which was cordially agreed to.
Parliamentary Committee’s Report.
Dr. Hayes Newington, as chairman of the Parliamentary Committee, said the
report had been printed. They had held two meetings, one in April, which decided
to send the result of their deliberations to the Lord Chancellor, who was good enough
to acknowledge receipt, and to say that he would give the matter before him
careful consideration. Nothing had resulted of any importance. The other
meeting was held in May. They had not been able to do very much good, but the
Lunacy Bill was not likely to pass this year. No doubt many members would feel
a great amount of regret that the Pension Clauses would drop again. For reasons
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1898.]
he gave he begged to move, with the approval of the Council, that a sum of not
more than twenty-five guineas be allowed the Parliamentary Committee to take the
opinion of counsel on certain points, if this was found on further consideration to
be advisable. There was a strong feeling that great injustice was being done
in different parts of the country to asylum officers, and it was thought that this was
a matter in which the Medico-Psychological Association might well interfere, and
that there were few subjects on which it could expend its available funds to better
purpose. He had suggested also to the President that it might be useful to hold a
conference to-morrow morning of asylum officers who happened to be in Edinburgh
at this time.
Mr. Whitcombs proposed and Dr. Rooks Let seconded tbe adoption of the
report, which was unanimously agreed to.
Dr. Hayes Newington said another question was discussed in the annual
Committee. Five members were appointed to meet five members of the British
Medical Association to form a Joint Committee to study the question of clauses
for the treatment of incipient insanity somewhat on the lines of the Scots clauses.
The Joint Committee had met several tiroes, and had produced a clause to which he
thought nobody could object on account of its application. It simply provided
that in obtaining a certificate from a registered medical practitioner to the effect that
a person was suffering from incipient insanity, and might well be treated in his
house, he should not be exposed to the application of the section which imposed
penalties on those who took into their houses lunatics without proper provision.
The clause was as.follows:—“(1) Where a medical practitioner certifies that a person
is suffering from mental disease, but that the disease is not confirmed, and that it is
expedient, with the view to his recovery, that the patient should be placed under
the care of the person whose name and address are stated in the certificate for the
period also therein stated, not exceeding six months, then during that period the
provisions of Section 315 of the Lunacy Act, 1890, shall not apply. (2) A
medical practitioner who signs such certificate shall within three days after signing
the same send a copy thereof to the Commissioners, and it shall be lawful for any
Commissioner to visit the patient. The person under whose care the patient is
placed shall not be the person who signs the certificate. (3) The person who re¬
ceives a patient under such certificate shall within ten days after the expiration of
the period mentioned in the certificate, or if he ceases to have the care of the
patient under the certificate at an earlier date, then within ten days after such
earlier date send a report to the Commissioners stating whether the patient re¬
covered, and if not, in what manner he was dealt with when the person making
the report ceased to have the care of him under the certificate/'
Dr. Rayner moved that the report be adopted, and that the Parliamentary Com¬
mittee be asked to press still further on the Lord Chancellor the desirability of this
change in the law.
Dr. Mercier opposed the proposal. The clause practically superseded the Lunacy
Acts, seeing that it allowed lunatics to be received and treated in private houses
without any safeguard whatever. He thought it was a most pernicious proposal.
It was said to deal with cases of incipient insanity, but who was to decide on
indpiency ? At the present time among the better class it was exceedingly difficult
for them or their relatives to decide sufficiently early in the interests of patients
whether they were to be placed under control. If this clause ever became law
that difficulty would be greatly aggravated, and they would have lunatics of the
better class at large without control all over the country. It was a thing this
Assodation ought not to sanction, and he protested against it. He proposed as an
amendment that this clause be not proceeded with.
Dr. Whitcombs seconded.
Dr. Urquhart said that a similar clause had been in operation for many years in
Scotland, and they had experienced no such difficulties as Dr. Mercier had conjured
up. He considered it one of the most valuable of their legal instruments.
Patients were not kept out of asylums by reason of that clause, except those who
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Notes and News.
[Oct.,
should not enter asylums. As for its retaining patients under private care without
proper supervision, they knew that England was full of such cases at the present
moment; that it was a disgrace that any person was permitted to keep an insane
patient if he could get one. It was reasonable to deal with cases in the initial
stages of mental disease without the full apparatus of certificates and orders;
and he thought it would be greatly for the benefit of England if such a clause were
adopted. He should like very much to hear if anybody in Scotland who had prac¬
tical experience of the matter had ever had cause to regret that the clause was part
of their law. He did not believe any one would be found to say he had.
Dr. Rayner said that he felt that this clause would help them greatly in the
early treatment of insanity. Those concerned would have no hesitation in putting
their insane friends under such care, where they would not place them under
certificate. It would rather help than hinder the work of the asylums.
Dr. Hayes Newington said, in reply to a question, that the clause was not
exactly the same as the Scottish clause. This distinctly provided for the detention
of the patient because it abrogated the only section of the English Lunacy Act
which punished a man for detaining a person illegally. He did not think that the
power of detention was settled in Scotland.
Dr. Crochlry Clapham said in Scotland under this clause they did not require
to send notice to the Commissioners at all.
Dr. Urciuhart in explanation said the Scottish clause merely exempted a
person who received a lunatic for money from the operation of the law to which he
would otherwise be liable. That was one distinction; the other distinction was
that it was not compulsory in Scotland to send notice to the Commissioners. Most
of them thought that it would be a good thing if that were adopted, but not for
the purpose of entering these patients on the Register of Lunatics. It was tried in
England to make the proposed clause wider so that no question should arise out of
it. In Scotland it had never been decided what the powers of detention were.
Dr. P. W. Macdonald said he felt inclined to agree with a good deal of what
Dr. Mercier had said; he also agreed with a good deal that Dr. Hayes Newington
had said. He was afraid a happy state of things existed in Scotland that they did
not find in England. If he thought that this clause would lead to early treatment
of the insane, of course he should not oppose it, but he was not convinced that it
was going to do so. The effect of it would rather be that insane people would be
sent into private houses and never reach an asylum.
Dr. Yellowlbes (Glasgow) said that in Scotland they had no difficulty in carrying
out the clause. Many patients within the six months 1 limitation recovered who
would otherwise have had the stigma of the asylum placed upon them. The
provision which allowed this class of patients to be received into a private house
for six months seemed to them in Scotland to be a valuable one, and he could not
understand why they in England should not rejoice to obtain similar provision.
Under the Scottish system the Commissioners did not take cognisance of these
cases. One object of the clause was to keep these people off the roll of lunatics,
but whether they might not be visited by the Commissioners was another matter.
Dr. Hayes Newington, in reply to Dr. Macdonald and Dr. Mercier, said he had
been led to favour this clause by a consideration of the treatment of insanity in
private houses in England. They thought that if such procedure as the clause
suggested was recognised people would be bound to adopt it. At present there
were a great many patients kept in private houses without certificates, and the
Commissioners had had little power to come down effectually on these people.
There had been notorious cases of their failure to secure convictions. If there was
a simpler procedure, such as the clause suggested, for dealing with such cases
benches of magistrates and juries would not be so inclined to let off people brought
before them.
On a division seven voted for Dr. Mercier’s amendment; and on the motion being
put, it was declased carried by a large majority.
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1898.]
Notes and News.
881
Educational Committee Report.
Dr. Clouston asked Dr. Mercier to explain the amended regulations for nursing,
for he (Dr. Clouston) had been unable to attend the meetings of this Committee.
Dr. Mercier said he had little to add to what he had said at Newcastle in refer*
ence to this report, which had received a great deal of careful consideration on the
part of the Educational Committee. It embodied certain very important altera*
tions in the nursing regulations. It was therefore thought at Newcastle that
these ought to be before the Association for a year before arriving at a final deci¬
sion. The draft of the proposed regulations had now been before the Association
for about fifteen months, and as this present meeting was a very large and repre¬
sentative one, he should trust that a decision would be come to that day. He
thought it would be convenient if the regulations were read and discussed teriatim .*
On Paragraph 2, Dr. Mercier said there were two debatable points in this
section. The first and most important was whether the period of training, which
hitherto had been two years, should be raised to three years; and further, another
point was whether the training should be in an institution for lunatics.
Dr. Crochley Clapham said the North Division were in favour of two years.
Dr. Turnbull said that Scottish opinion was pretty evenly divided. The
majority, however, was in favour of two years.
Dr. Macd6nald said that at Oxford they were unanimously in favour of two
years.
On a division, twenty voted for three years and twenty-one for two years.
On the point that the training of nurses should be in “ an institution for
lunatics/ 4
Dr. Carlyle Johnstone moved that in the clause the words •*institution for
the treatment of mental diseases ” should be inserted instead of * 4 institution for
lunatics/’ leaving the point regarding the recognition of any such institution to
the judgment of the Council.
After some debate, Clause 2, as thus amended, was then passed by a majority.
On Paragraph 3, Dr. Clouston moved that the word “ one 44 should be substi¬
tuted for “ two ” years in the fifth line.
Dr. Yellow lees moved that two years stand.
On a division eleven voted for one year, while for two years there was a large
majority.
On Paragraph 5, Dr. Carlyle Johnstone moved under Sub-section 44 a 44
“ That practical instruction in nursing and attending on the insane be arranged at
the discretion of the medical superintendent/ 4
Dr. Mercier said it was assumed that all these regulations were done under the
eye of the medical superintendent. If he was not specifically mentioned in these
regulations it was for the sake of brevity. They were keeping up the general
system of education both among the attendants themselves and also among the
petty officers of the institution.
Thirteen voted for the amendment and eighteen against.
On Paragraph 9, Sub-section “ d” Dr. Hayes Newington said it would be
impossible to carry out the proposal unless they increased the fee beyond 2a. fid.
To equalise matters in the various districts, candidates 4 papers examined should be
paid for each at the rate of some definite sum. The reports of divisional meetings
showed them dead against any increase over 2a. 6 d.
Dr. John Mills said that as the Association was making a profit of £80 a
year on these examinations, he did not see any difficulty in appointing paid
examiners.
Dr. Ybllowlee 8 moved that the fee be raised to 5a. Dr. Carlyle Johnstone
seconded.
* Cf. draft of proposed amended regulations sent out as circular by the Educa¬
tional Committee.—E d.
XLIV.
59
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. Notes and News\
[Oct.,
Dr. Macdonald moved that the fee stand at 2s. 6 d. Dr. Bbnham seconded.
On a division. Dr. Yellowlees* motion was carried by a large majority as against
thirteen for Dr. Macdonald's amendment.
Dr. Turnbull moved that two examiners be appointed for each section of the
Association. Dr. Stewart seconded.
Dr. J. A. Campbell suggested that two examiners should be appointed for
Scotland, two for Ireland, and four for England.
Dr. Spence desired that a scheme should be proposed and brought before the
Council showing how this could be carried out. The principle had been accepted,
the money had been provided, and the details should be carefully considered before
taking definite action.
Dr. Spence’s suggestion was agreed to nem. con.
On Sub-teclion "f” Dr. Carlyle Johnstone moved that instead of the
word “superintendent” the words “examiner or examiners appointed by the
Association ” should be inserted. Dr. Campbell seconded.
Dr. Hayes Newington h'oped there would be no alteration of this clause,
which was the result of a careful compromise after a long debate. It had worked
very well, and he hoped it would be continued.
Dr. Ybllowlees said the point was that the superintendent of the asylum, who
had himself trained the nurses, ought not to be the actual examiner. He certainly
ought to be present, but the coadjutor ought to ask most of the questions.
Dr. Clouston said they ought to follow the precedent of the Universities. Where
they had two examiners they could not make one the inferior to the other.
The amendment was not pressed.
On Paragraph 10, Dr. Ybllowlees said they ought to have it stated in the
certificate much more clearly than it was that it was not a certificate of the
moral character of the person holding it, but simply a certificate of proficiency in
mental nursing. The endorsation on the back of the certificate should be on the
front page, but it would please him best if every reference to moral character
were struck out of the certificate.
Mr. Whitcombr did not think they should now change the form of their certificate,
which had been granted to thousands of persons, on account of exceptional cases
which had come under the notice of Dr. Yellowlees.
Dr. Spence said he felt so much in favour of what Dr. Yellowlees had said that
he ventured to suggest that the point should be remitted to the Educational
Committee for their consideration.
Dr. Yellowlees agreed, provided the Committee reported next morning. His
amendment was that the certificate should run “ that A. B. has, after examination
by us, and after two years’ training, shown that he has obtained proficiency in
nursing and attendance on insane persons,” and that all reference to his character
and conduct be deleted.
Dr. Spence’s suggestion was agreed to, and all the other clauses in the report
were unanimously adopted.
Afternoon Meeting.
On resuming after lunch, the retiring President (Dr. McDowall) said the duty
he had now to perform was to introduce the new President, Dr. Urquhart. They
Anew what an excellent officer he had been in this Association ; that for many years
he had done splendid work for . the Journal, and that in other departments his
aervices had been highly appreciated. In leaving the chair he (Dr. McDowall)
had to thank them again for the great honour they did him in electing him
President, and he had to thank the various officers and members of the Council for
their great assistance in carrying on the affairs of the Association.
Dr. Ybllowlees moved that the thanks of the meeting be given to the retiring
President, Dr. McDowall, for the admirable manner in which he had filled the chair,
Jast year. They all remembered the admirable address he gave them at Newcastle,
and his splendid hospitality there; and they knew how assiduously he had attended
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Notes and News .
883
1898.]
their meetings in the course of the year. He had presided over these meetings
with ability and with courtesy, and he was sure it was the feeling of the meeting
that they should express their thanks to him. (Carried by acclamation.)
FRIDAY'S MEETING, July 22nd.
Second Day.
The Association met at eleven o’clock in the Library of the Royal College of
Physicians, Dr. Urquhart, the President, in the chair. He called upon
Dr. Clouston, who said in regard to the form of the nursing certificate, which
was referred t» the Educational Committee for consideration and report, that the
Committee had a full meeting that morning. It was composed of men with great
experience in this matter of granting certificates, together with the Registrar as
their adviser. They all knew how much they owed to him. The Educational
Committee felt that this whs a question that the Association should have time to
carefully consider. The result was not to come into operation till 1900, and they
came unanimously to the following conclusion :—“That Paragraphs 10, 11, 12, 13,
14, and 15 be referred to the Educational Committee for consideration and report
to the next annual meeting.” The Educational Committee pledged itself that it
would so conduct this matter that every member of the Association would have an
opportunity of voting on it. Their report would be circulated by their honorary
secretary in due time to secure that. lie moved the adoption of the resolution of
the Educational Committee.
Dr. Mercier seconded, and on the President putting the motion to the meeting,
it was unanimously adopted.
Dr. Clouston further intimated that the Educational Committee recommended
firstly, that the examiners be nominated to the General Council by the Educa¬
tional Committee; secondly, that the examiners should be three in number; and
thirdly, that tneir fee be the extra half-crown added to the former fee as fixed by
the meeting on Thursday. He moved the adoption of these recommendations.
Dr. Rayner seconded, and the motion was agreed to.
Report op the Handbook Committee.
Dr. Hayes Newington submitted the report of the Handbook Committee,
which stated that the new edition of the handbook would be ready in five or six
weeks. It was now in print, and had been revised, considerably extended, and
improved. It was proposed to issue another 6,000 copies. They had sold 9,000 of
the old edition. The report was adopted.
The Library Report.
Dr. Fletcher Beach submitted the report of the Library Committee, which
stated that a considerable addition had been made to the library by the gift of
books by the late Sir John C. Bucknill.
The report, after a statement by the Treasurer as to the reinvestment of t
funds in New Zealand StQck, which would realise more income, was adopted.
Report of Council.
The present number of members is 574 (including 36 honorary, 12 correspond¬
ing, and 526 ordinary members). At the date of last annual meeting there were
557 members, the increase for the year being 17.
Two members, whose subscriptions were each three guineas in arrear, were
removed from the roll. In 1897 there were 29 new members and 21 names
removed—5 by death. In 1898 to the date of the annual meeting 36 have
joined and 6 removed—3 by death. The chief accession of new members has
been at the General and South-western meetings.
Three general meetings have been held, and each division has held two meet¬
ings during the year.
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884
Notes and News.
[Oct.,
At the May examination for the Nursing Certificate 599 candidates, drawn
from 55 asylums, and 1 private nurse, sent in schedules duly filled up. The
asylum candidates were drawn from 23 English county asylums, 11 borough
asylums, 6 private asylums and hospitals, 8 Scotch asylums, and 7 Irish asylums.
Of the 600 candidates (260 males, 340 females), 471 (198 males, 273 females)
were successful; 102 (49 males, 58 females) failed to satisfy the examiners;
and 27 (13 males, 14 females) withdrew from the examination. Deducting the
number of candidates who withdrew, 82*19 per cent. (80*16 males, 83*74 females)
gained the certificate, and 17*80 per cent. (19*75 males, 16*25 females) failed
to do so.
At the examination for the Certificate in Psychological Medicine 8 candidates
presented themselves—4 in London and 4 in Edinburgh. One man examined in
London failed. There was 1 candidate (male) for the Gaskell Prize. He was not
successful. The Bronze Medal was awarded to Dr. John R. Lord, Hanwell.
The library has been enlarged by a gift of books from the collection of Sir J. C.
Bucknill. Additional bookshelves have been erected at a cost of .£12, and binding
has been done to the amount of £13. It is proposed that the catalogue should be
issued in connection with the Journal, in the same form as the “ Index Medico-
Psvchologicus.” The Committee have been re-appoirited, with the addition of Dr.
Outterson Wood.
The letter of Dr. Beattie Smith, published in the July number of the Journal,
has had the attention of the Council.
Thr Prevention of Insanity.
Dr. E. B. Whitcombe moved:—“ That a small committee be formed to con¬
sider the subject of the prevention of insanity, and to suggest means whereby this
may be accomplished, and report thereon to this Association at a subsequent
meeting." Dr. Raynbr seconded.
Dr. Carlyle Johnstone said that in the year 1890 a committee of this
Association was appointed to formulate proposals as to the care and treatment of
the insane. They had taken up the question of prevention of insanity. After
reading the report of that committee in so far as it dealt with the proposal of Dr.
Whitcombe, he would ask Dr. Whitcombe whether he thought that it was within
reasonable expectations that they would be able to add anything worthy to what
that committee had already formulated. If Dr. Whitcombe felt that he could, then
he (Dr. Johnstone) would suggest that Dr. Whitcombe be appointed the committee,
with powers to add to his number. Dr. Percival seconded.
Dr. Clouston said the difficulty lay in carrying out the suggestions of the
committee of 1890, and he considered it was quite possible that some plan might
be devised to instruct the public on such an important subject.
Dr. Whitcombe, replying to the discussion, said the committee of 1890 was for
care and treatment only, and besides that he hoped that Dr. Johnstone did not hold
that there had been no advance since that time.
The motion was adopted nem. con,, and a committee was appointed, consisting of
Dr. Turnbull, Dr. Drapes, Dr. Mercier, Dr. Spence, Dr. Rayner, and Dr. Whit¬
combe.
Association Prizes.
The President intimated that the Gaskell Prize had not been awarded this
year. The Bronze Medal of the Association had been won by Dr. John R. Lord,
Assistant Medical Officer, Hanwell, whose essay will be found at page 693.
Vacancies in the Council.
The President said that the secretary informed him that Dr. Robert S. Stewart,
Dr. Maury Deas, and Dr. L. W. Rolleston had been removed from the Council, by
rule, in consequence of non-attendance at meetings, and further that the Council
unanimously recommended that Dr. Ewart, Dr. Soutar, and Dr. Hotchkiss should
be elected in their stead. This was agreed to unanimously.
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1898.]
Notes and News.
885
Paper.
Dr. G. R. Wilson, Mavisbank, read a paper on “The Mismanagement of
Drunkards,” which is printed in this number of the Journal (see page 711).
Afternoon Meeting.
At half-past two o’clock, in the Laboratory of the Scottish Asylums, the Presi¬
dent in the chair.
Dr. Hayes Newington moved a hearty vote of thanks to the Royal College of
Physicians for their very kind hospitality and for the use of their Hall, in which
they had met with so much comfort. It could not but add dignity to the proceed¬
ings of the Association to hold its meetings in such a home of learning.
Dr. Norman seconded, and the resolution was carried by acclamation.
Dr. McDowall proposed a vote of thanks to the Scottish Asylums Laboratory
Committee and their worthy director. Dr. Ford Robertson, for permission to meet
there that day. He took that opportunity of warmly congratulating their colleagues
in Scotland on their position there, on the evidence of progressive work, and on
the very good results, which they hoped to see yet augmented.
Dr. Fletcher Beach seconded, and the resolution was also carried by accla¬
mation.
Dr. R. Jones said it was his privilege to propose a vote of thanks to Dr. Turn-
bull, who had been responsible for the arrangements, and who had carried them
through this their fifty-seventh annual meeting. The success of his labours would
be measured by the success of the meetings. He (Dr. Jones), as General Secre¬
tary, was personally indebted to Dr. Turnbull for having managed the meetings of
their Congress and arranged the papers. He ventured to say that all that had been
done reflected great credit upon Dr. Turnbull.
The vote was carried by acclamation.
Papers.
Dr. Findlay then gave a demonstration on the “Choroid Plexus,” with photo¬
graphic lantern slides. These are published in this number of the Journal (see
page 744).
Dr. Aldous Clinch and Dr. Gbddp^s read a paper on “ A Case of Chorea
Gravis,” published in this number of the Journal (see page 811.)
Dr. Aldous Clinch made a preliminary report on “A Case of Porencephaly,”
which, with relative photographs, will appear in a future number of the Journal.
The President said that he was sure of having the entire support of the meeting
in conveying their best thanks to those who had so kindly brought the results of
their investigations before them. The papers read had been of outstanding excel¬
lence, and represented much honest work.
Dr. Hayes Newington spoke in support of the President’s remarks, and con¬
gratulated him on the success of the meeting, which had been as well attended as
any of recent years.
After a brief acknowledgment by the President, the meeting terminated.
EXCURSIONS.
To Larbert and Gartloch Asylums.
Not the least agreeable of the many pleasant arrangements made for the benefit
of those members of the Association who were able to be present at the recent
annual meeting in Edinburgh was the excursion to Larbert aud Gartloch, where
every opportunity was afforded for an inspection of the asylums under the superin¬
tendence of Drs. Macpherson and Oswald. Larbert may be looked upon as an
example of an asylum brought up to date under judicious and experienced super¬
vision, Gartloch as typical of all that is modern in asylum design and construction.
In both institutions the wards for chronic patients call for no special comfiient,
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Notes and News.
[Oct.,
save, perhaps, that a word of commendation may he permitted for the excellent
taste displayed in the decoration and furnishing of the dayrooms and dormitories at
Larbert. The administrative centre at Gartlocb leaves little to be desired,, while the
wards and offices are admirably adapted for their various purposes. Whqt, however,
chiefly attracted the attention of the visitors was the well-equipped detached hospital
blocks with which these asylums are provided, all the arrangements being of such
a nature that a patient suffering from acute mental disorder has every chance of
recovery afforded him, while the treatment of bodily ailments is quite up to the
standard of the best of the large metropolitan general hospitals, with the added
advantage of pure air and the most delightful surroundiugs. Much interest was
manifested in the system of staffing these hospitals throughout with female nurses,
and many practical difficulties connected with the details of management in this
and other particulars were freely discussed and explained, so that the visit,, from
an educational point of view, could not fail to have been suggestive and instructive
to every member present. But what can he said of the all too generous hospi*
tality which awaited the visitors at both Asylums ! Luncheon at Larbert came as
a most agreeable rest by the way, and the votes of thanks to Major Dobbie and
to Dr. Macpherson only very feebly conveyed the gratitude of the guests to their
kind and most hospitable entertainers. At Gartloch, where tea was provided, the
ex-President happily expressed the pleasure of all present at what they had seen*
and especially thanked Mr. G. B. Waddell, a member of the Board of Management,
who, with Dr. Oswald and his colleagues, had made the visit so great a success.
Th« only drawback to the complete enjoyment of the day was the feeling that more
time might usefully have been passed in the inspection of institutions which
reflect so much credit not only upon all immediately concerned in their direc¬
tion and management, but also in no small degree upon those members of our
Association who have by their energy, persistence, and example educated public
opinion to recognise the necessity for, and economical advantage of. such admirably
equipped hospitals for the mentally afflicted.
To Mklrose.
A small party of ladies and members of the Association made a very pleasant
excursion to Melrose and the “ land of Scott.” Under the guidance of Dr. Carlyle
Johnstone they visited Abbotsford House, Melrose Abbey, and Dryburgh Abbey.
Scott’s romantic dwelling-place, with all its hallowed memories, his last quiet
home amid the desired walls and ancient trees of Dryburgh, the windings of the
classic Tweed, Beraersyde Hill and its glorious prospect, Melrose Abbey, most
beautiful in its decay—all these, and the perfect day w'hich illuminated them, will
not soon be forgotten by that little company of Saxons, Scots, and Americans.
AFTERNOON EXCURSIONS.
On each afternoon of the meeting Mr. Marr, acting as deputy for Professor
Patrick Geddes/unabie to attend owing to indisposition, accompanied the members
round old Edinburgh and the vicinity. Mr. Marr was heartily thanked for the
courteous and interesting explanations he gave, and for his trouble in conducting
the psirty to various places of interest. Dr. and Mrs. Clouston also kindly
extended their hospitality towards the members of the Association.
THE ANNUAL DINNER.
The annual dinner was held in the Balmoral Hotel. There was a large company,
the President in the chair, the croupiers being Dr. Jones, Claybury, and Dr. Turn-
bull, Fife. The company included the following:—Sir William Turner, Edinburgh;
Sir Alexander Christison, Dr. Sibbald, Dr. P. A. Young, the Rev. A. Fleming,
Professor Chiene, Mr. Joseph Bell, Sheriff Jameson, Q.C., Dr. Macdonald, New
York, Mr. James Cadenhead, Dr. Norton Manning, &c. Apologies for inability to
be present were received from Sir W. T. Gairdner, Sir Arthur Mitchell, Sir T.
Grainger Stewart, Sir J. Batty Tuke, Sir J. Struthers, Dr. Fraser, Dr. Philip,
Professor Geddes.
Digitized by
1898 ,] Notes and News. 887
The Chairman, after the toast of “ The Queen,” gave the toast of “ The Navy
and the Army.” * Sir A. Christikon replied.
Dr. Sibbald proposed the toast of “The Learned Professions.” He need not
say so much about the clergy, because the medical profession was always glad to
recognise the cordial way in which they were met by the Church. With regard to
the law, the branch of the medical profession they were connected with very often
criticised the legal view of insanity, and he believed that the members of the legal
profession criticised the medical view. He was in the happy position of thinking
that a great deal could be said in favour of the medical view, and that he thought
the lawyers were very often wrong. If, however, there were not those differences
of opinion, the lawyers, he believed, would be the first to complain.
The Rev. Mr. Fleming, in reply, said he did not think that any of the learned
professions could look with more constant interest upon that class of subjects with
which the Medico-Psychological Society was concerned than the profession to which
he had the honour to belong, and which was always standing, he might say from day
to day, in constant contemplation of that mysterious borderland where mind and
body seem to mingle. He thought it was one mark of the disappearance of narrow¬
ness and bigotry of mind that now they would no longer meet with the clerical
bigot who would say that it was a heresy to suppose that mental trouble of any
kind could be accounted for by partly physical causes, and he thought, on the other
hand, the medical bigot had disappeared who would maintain that it was ridiculous
and superstitious to imagine that no cause but a partly physical one could account
for the painful phenomena which came under his notice. He thought more and
more was due to the professions that they might be mutually helpful to each other.
Sheriff Jameson, in reply for the law, spoke of the sense which lunatics had of
right and wrong and the knowledge and fear of punishment, and said he had
always great doubts about letting criminals off on the score of lunacy unless he was
very clear about the matter. The protection of society, he always held, should be
the first consideration in dealing with cases of lunacy,
Professor Chibne, in reply, regretted that the surgeons had not been able to help
psychologists as much as they wished. He knew there was no branch of the pro¬
fession which could raise so much enthusiasm for humanity as the branch to which
they belonged.
Dr. Yellow lees proposed the health of Dr. Sibbald, and paid a tribute to his
services on the Scottish Lunacy Board, from which he was about to retire. Dr.
Sibbald thanked them for the honour they had done him, and having stated
the ideal which he bad set before him when be was appointed commissioner, he said
he felt a great hiatus lay between that ideal of the functions and his own perform¬
ances. If by any ill-considered words or acts he had appeared to have been
unkindly or really giving pain unnecessarily to any one he very deeply regretted it.
He was very much obliged to them for all their kindness in the past.
Dr. A. G. Macdonald gave the toast of the Association. Dr. Urouhart briefly
replied.
Dr. McDowall proposed “ Kindred Associations,” and Dr. Bell replied in a
happy manner.
Dr. Spence proposed the toast of “The Medical Institutions of Scotland,” and
Sir William Turner replied.
Dr. Turnbull proposed the toast of “The Guests,” to which Dr. Young
replied, and the company thereafter separated with the expression, “ Floreat res
medica.”
RECENT MEDICO-LEGAL CASES.
Reported by Dr. Mercier.
[The Editors request that members will oblige by sending full newspaper reports
of all cases of interest as published by the local press at the time of the
assizes.]
Digitized by
888
Notes and News.
[Oct.,
Crichton and Another v. Ferguson and Others .
A complicated probate case, in which the will was opposed on the usual grounds.
The judge charged the jury that they had not to try the question whether the
testatrix was sane or insane; they had to consider the will, and to say whether
the testatrix had mind enough to understand it, and whether she did understand it.
They must not break the will unless they thought either that she had not sufficiency
of mind to make it, or that she was weak and was led into making it by other
people. It will be seen that the terms of the charge are much narrower than is
customary in the English courts. Nothing is said as to the capacity of the testa¬
trix to appreciate the several claims upon her bounty of those whom she excluded
and those whom she included among the beneficiaries under her will. All that is
left to the jury is whether she “ understood ” the will. The jury found for the
pursuers and against the will.—Court of Sessions (the Lord President).— Scotsman,
July 23rd, 1898.
Bristol Royal Infirmary v. Arlett .
The testator was a man admittedly of great eccentricity, but exceedingly shrewd
and competent in business matters. In June, 1887, he went to live with his sister,
and in the following September instructed his solicitor to make a will in her
favour. In May of the following year there was some “tremendous disturbance”
in the home, which ended in the testator being taken to the police station and
charged with attempting to murder his nephew. Shortly afterwards he instructed
his solicitor that he wished to leave all his property to the plaintiffs. In May,
1891, he executed, despite the opposition of his solicitor, a will in this sense, and
took the precaution of depositing the will at Somerset House for safe custody. He
died in Mav, 1897. The jury found against the will.—Probate Division, May 18th,
1898.— Times, May 19th.
Reed and Another v. The Solicitor to the Treasury and Others .
Probate case involving the validity of the will of a person who admittedly
suffered from delusions at the time of execution of the will. The solicitor who took
instructions for the will had been informed of the condition of testatrix, and tested
her sanity as well as he could. The judge charged that it was quite clear that in
this case the delusions had in no way affected the making of the dispositions in
the will, which, moreover, seemed a most sensible and reasonable will, and which
he pronounced for.—Probate Division (the Right Hon. the President).— Times,
July 14th. 1898.
The solicitor who took instructions for the will knew that the testatrix suffered
from delusions, and tested her sanity as well as be could. It does not appear—
and the omission strikes us as lacking in reasonable precaution—that any expert in
lunacy was employed to ascertain the disposing power of the testatrix. Fortu¬
nately, if strangely, no ill result followed.
Barker v. Barker and Dearsley.
The testator had lived with his wife “ in perfect peace and amity ” for thirty-two
years until 1894. In 1870, 1878, and 1894 he executed wills entirely in her
favour. In 1893 he had a fall, and his mind became affected, so that he had to be
detained in Wandsworth Asylum. In November, 1894, he was released at his
wife’s request, and thereafter his mind was greatly affected. He talked about
(t conspiracies ” and of having his revenge, and complained that his wife and other
people were whispering about him; became addicted to the use of foul and dis¬
gusting language towards his wife, and had various delusions that he was wanted by
the police, &c. In June, 1896, he made another will, under which his wife took
only a life interest.
The judge told the jury that a testator must have a proper appreciation of the
property that he possessed, and of the claims of those whom he ought io remember.
With regard to delusions, to be material they must be such as would affect the
Digitized by LjOOQLe
1898.] Notes and News. 889
making of the will. The jury found for the will.—Probate Division, April 25th,
&c., 1898 (Mr. Justice Barnes).— Times, April 28th.
Another illustration of the tenacity with which juries will cling to a will. Hos¬
tility to his wife was a prominent element in the testator’s delusions. The effect
of the will was to prejudice the wife’s interests. Yet the jury upheld the will.
Donald Ross v. William Ross’s Trustees and Others .
A probate case. The pursuer, D. Ross, sought reduction of the will of his
brother, W. Ross, on the grounds that the testator was of unsound mind and
incapable of managing his affairs, and that the will was impetrated from him
when he was weak and facile by the defenders. The evidence was of the usual
contradictory character, and the judge summed up strongly for the will; but the
jury, notwithstanding, found a \erdict upsetting the will, but exonerating the
defenders.—Court of Session (the Lord President), March 14th and 15th, 1898.—
Scotsman , March 15th and 16th.
This case shows that it is very much easier to upset a will in Scotland than in
England. In England the “pursuer” would have been very ill advised to bring
an action, and would certainly have lost it.
Spence v . Spence .
This was a probate action, the will being disputed on the usual grounds. It was
proved that the testator was an habitual drunkard, that he was “ always soaking,”
“ almost always delirious,” and had been repeatedly under treatment for delirium
tremens. By his will he left the whole of his property to his wife, to whom he
had been married a few months, and whom, it was said, he had known ouly for a
month before marriage. The jury found for the will.—Manchester Assizes, March
1st, 1898.— Manchester Guardian , March 2nd.
Browning v. Green.
Plaintiff was a nurse, and in that capacity had the care of defendant, a dangerous
lunatic. Defendant, in an outbreak of violence, struck the plaintiff a blow in the
eye, whereby the sight was permanently destroyed. For the defence the facts were
admitted, but it was pleaded that defendant, a lunatic, was not liable for an assault.
The jury found for the plaintiff, with £78 damages; and upon an intimation from
the judge that he hoped nothing more would be heard of the point of law, the
defence was abandoned.—Birmingham Assizes (the Lord Chief Justice), March
24th, 1698.— Times , March 25th.
Re Charles Clarke.
This was an important appeal, involving the rights of a judgment creditor as
against a receiver subsequently appointed under Section 116 of the Lunacy Act,
1890. The case, however, is of no medical interest.— Times , March 8th, 1898.
In re the Earl of Sefton.
This case in the Court of Appeal decided an important point with respect to
dealing with the property of a lunatic, but is of no medical interest.— Times , June
15th, 1898.
In re Lamond.
An inquiry into the state of mind of Miss Cordelia Warde Lamond. It was
proved that the lady had employed eleven detectives and thirteen solicitors in con¬
nection with her affairs. She had brought two actions against the H6tel M£tro-
pole, two against Sir George Lewis, one against the Hotel Cecil, five against officers
of the Irish Rifles, and one against a naval officer. Most of these actions were for
slander, and all had failed. In her bankruptcy there were thirty claims against her
estate—seventeen by solicitors and five by detectives. The jury found that she
was incapable of managing her affairs, but capable of managing herself, and was not
dangerous to herself or others. — Before Mr. J. Fischer, Q.C.— Times, June 22nd,
1898.
Digitized by {jOOQle
890 Notes and News. [Oct.,
Thus by the sapience of a jury a person with delusions of persecution is let
loose upon the public.
Harvard v. The Guardians of the Hackney Union and Frost.
Plaintiff was taken by Frost, a relieving officer, to the workhouse infirmary as a
lunatic. A magistrate who saw him there discharged him as sane. Action for false
imprisonment.
The wife of the plaintiff applied to the relieving officer for the removal of her
husband as a lunatic, saying that he had threatened to commit suicide and to kill
her and his children. Upon this application the defendant Frost directed the
removal of plaintiff to the workhouse infirmary, which was accordingly done.
Subsequently plaintiff was seen at the infirmary by a justice, who found him sane,
and he was discharged. Frost deposed that he honestly believed that it was for the
public safety or for the welfare of the plaintiff and others that the plaintiff should
be brought to the infirmary and placed under care and control, and that he was
actuated by no other motive except that of doing his duty.
The man who removed plaintiff on defendant’s instructions was asked by the
judge if hesaw an) thing to lend him to think that the plaintiff was a lunatic.
“I cannot say that theie was; hut I am no judge of that matter. 1 never
thought about it, but simply obeyed my orders.”
Dr. J. J. Gordon, one of the medical officers to the infirmary, said that he saw
the plaintiff on admission. Plaintiff was then very excited, considered himself per¬
secuted by his wife and some other relatives, and that he was the victim of a
conspiracy.
The judge directed the jury that if they thought that Frost had honestly satis¬
fied himself that the plaintiff was a lunatic and should he placed under restraint,
then the defendants would be entitled to their verdict. In any case, there was no
case against the guardians.
The jury found for the plaintiff, damages £25, on the ground that Frost did
not exercise reasonable care to satisfy himself that plaintiff was of unsound mind
and dangerous to be at large before arresting him.—Queen’s Bench Division (Mr.
Justice Hawkins), Jan. 19th and 20th, 1898.— Times, Jan. 21st.
On appeal the verdict was set aside, March 22nd.
Reg . v. Irving.
Ellen Irving was indicted under Section 315 of the Lunacy Act, 1890, for
taking charge of a lunatic for payment in an unlicensed house. There were other
counts in the indictment charging that the person mentioned was an alleged lunatic,
“ was received to board and lodge,” and had been “ detained.” It appeared
that in February, 1897, Miss Irving, who kept a convalescent home at Clacton-on-
Sea, received a telegram asking her to receive a lady patient. The following day
she received a letter from the patient herself asking for a cheerful room. The
patient came alone by train, and at this time there was no suspicion that she was
of unsound mind. In about ten days* time, however, she became very troublesome
and violent. Her friends were communicated with, and in March the patient was
removed. The defendant pleaded guilty, but it appeared that she was ignorant of
the provisions of the statute.
For the prosecution it was stated that the Commissioners in Lunacy had no
yvish to press the matter. Their only object was to make it widely known that the
reception of a lunatic under the circumstances was illegal.
The judge emphasised the importance of diffusing this knowledge, at the same
time stating that the prosecution did not in the smallest degree reflect upon the
defendant, whom lie bound over to come up for judgment if called upon.—Chelms¬
ford Assizes (Mr. Justice Hawkins), July 1st, 1898.— Times, July 6th.
It is satisfactory to find that even in one case, and that a very unimportant one,
the Commissioners have been able to prosecute and to secure a conviction under
Section 315 of the Lunacy Act, 1890. It is notorious that this enactment is being
Digitized by L^OOQLe
Notes.and News,
891
1898 .]
daily violated in hundreds of instances throughout the country, but the. difficulties
of obtaining evidence are great, and . the difficulties of obtaining, a convictiou are
muc.h greater. The British public, with its usual logical acumen, looks with
approval upon the detention of lunatics in unlicensed houses, where they are
under no sort of supervision, and are in charge of ignorant lodging-house keepers,
and regards jealously their detention in institutions for lunatics that are legally so
constituted, and in which the welfare of the patients is secured by a myriad of
minute and stringent regulations.
Reg. v. Weaver.
Charles Weaver, 39, butcher, was indicted for the murder of Annie Brownsell.
On indictment counsel for the prosecution asked his lordship whether, iu view of
the report of Dr. Law Wade, a jury should not be empanelled to say whether the
prisoner was fit to plead. This was accordingly directed, and Dr. Wtde proved
that prisoner was suffering from various delusions.
The Judge : Do you think he is capable of understanding the proceedings taking
place with regard to him at the. present time?—Not fully so as to conduct his
defence. Is he able to understand, as a reasonable and intelligent man would, the
nature of the proceedings he is called upon to plead, and to give such instructions
as are necessary for his defence?—1 don’t believe he is. The Judge instructed the
jury to say whether the prisoner was at that moment in a condition to under¬
stand the character of the proceedings and reasonably to instruct counsel for his
defence. The jury found that he was not, and the trial did not proceed.—Somerset
Assizes, June 9th, 1898 (the Lord Chief Justice).— Wettem Gazette , June 10th,
1898.
The report shows the character of the questions that a witness must be prepared
to answer when the ability to plead to the indictment is the issue tried. The case
is of interest from the peculiarly brutal character of toe murder committed by a
lunatic who had been known for months to' be suffering from delusions of persecu¬
tion, but who had never been considered dangerous, and had been allowed to be at
large and to pursue his calling of butcher. It is another illustration of the duty
that lies upon medical men who are cognisant of insanity to spread the knowledge
that a person suffering from delusions of persecution is always a potential
homicide.
Reg. v. English.
Archibald English, 43, cook, was indicted for shooting at Henry Pearce, with
intent, &c. Dr. Scott, medical officer of Holloway, said that in his opinion the
condition of the prisoner’s mind at the time was not such as would enable him to
distinguish between right and wrong, and that he would be incapable of appreciating
that he was doing wrong. “ Guilty, but insane.”
Dr. Scott said that the prisoner was no longer insane. The judge said that he
was bound by statute to make an order for the prisoner to be detained during Her
Majesty’s pleasure, but his friends could present a petition to the Home Secretary
for his discharge.—Central Criminal Court (Mr. Justice Hawkins).— Times, December
16th, 1897.
An unusual instance of the recovery of a prisoner between committal and trial,
illustrative of procedure.
Reg. v. Murphy.
Francis Rowland Murphy, 33, labourer, was indicted for the murder of his two
daughters, attempting to strangle his infant son, and wounding Gertrude Hester,
the woman with whom he lived.. It was proved that the couple lived happily to¬
gether, that the prisoner was an affectionate father, that several of his relatives were
in asylums, that he had had a severe blow on the head necessitating an operation
and the removal of part of the skull, and that he bad suffered in America from sun¬
stroke. At the time of the murder he was suffering from influenza and bronchitis,
and after a very restless night passed in choking and coughing, he said to the
Digitized by
892
Notes and News.
[Oct.,
woman, “ I have got pneumonia. If I have I shall die, and if I am going to die you
must die with me.” Shortly afterwards he committed the acts for which he was
indicted.
Dr. Annger said that when the prisoner was admitted into the Royal Infirmary
(apparently on June 10th, immediately after the crime) he was in a dazed condition,
and did not realise where he was or anything that had happened. In this condition
he remained for the next twenty-four hours.
Dr. Price, of Walton Gaol, said that prisoner had been under his observation since
June 20th. During that time he had been perfectly sane, but confessed to an utter
want of knowledge as to what had passed during the period from 10 p.m. on June
9th to 8.30 on Sunday the 12th.
Dr. Wiglesworth had visited prisoner on July 23rd, and found that he was quite
sane. Witness considered that prisoner was not capable at the time of the tragedy
of understanding the nature and quality of the act he had committed.
His l.ordship told the jury that the prisoner appeared to have been for a time not
a human being at all. No conduct such as was ordinarily associated with humanity
offered a parallel to what occurred on June 10th. It appeared that from the time
he awoke on that morning until he came to consciousness again he acted like a wild
beast rather than a man, and as if he was not in possession of his faculties. If the
jury considered that this was so, it was their duty to find that the prisoner was not
responsible for his actions. Guilty, but insane.—Liverpool Assizes, August 1st,
1898 (Mr. Justice Ridley ).—Liverpool Daily Poet, August 2nd.
A good instance of the complete freedom which a large-minded judge assumes
when the facts are strongly in favour of’the insanity of the accused. It does not
appear from the report that the judge considered himself bound in any way to refer
to the rule of law. He allowed a wide latitude to the medical witnesses, aud charged
the jury in terms which left that rule on one side.
Reg. v . Norris.
Prisoner, a solicitor set. 35, had lived happily with his wife for nine years. On the
early morning of February 13th he shot her with a revolver while she was asleep in
bed. He then cut his throat in four places. Indicted for shooting with intent, &c.
It was proved that prisoner had always been on affectionate terms with his wife, and
that they had never had a quarrel; that he had been much overworked for a long
time, that he had complained lately of sleeping badly, of bad dreams, and that “ he
could not distinguish between his dreams and his thoughts when awake.” He had
always been a strict teetotaler.
The judge told the jury that there was only one verdict that they ought to find,
and that was that owing to overwork and not having sufficient change the defendant’s
mind became unhinged, and that lie did what he did in a fit of temporary insanity,
and did not know what he was doing, and that he was not responsible for his actions
at the time. It was only a passing fit of brain exhaustion, and he hoped that with
change the defendant would soon recover, and that he would go back to his busi¬
ness as good a man as ever. “ Guilty, but insane,”—Central Criminal Court, March
11th, 1898 (Mr. Justice Grantham).— Times , March 12th.
Another instance of the freedom as»umed by a judge who forms a strong opinion
on the depositions.
Reg.v. Woolf ord.
The prisoner, set. 29, of no occupation, was seen kneeling outside the church
door at Heckfield, dressed in a tom shirt only, and praying aloud. Some neighbours
saw him and tried to induce him to come home; but he became very excited and
Violent, and seizing a ladder, tried to hatter down the church door. He fought
and shouted, got away, ran along the Reading road, assaulting a bicyclist in his
way, ran on to a farmhouse, jumped the hedge, and seeing a child in the garden,
knocked her down and knelt on her, beating her about the head and face with his
fists, and so injured her that her life was for some time in danger. It was proved
that the prisoner was subject to epileptic fits, and the medical evidence was that he
Digitized by {jOOQle
Notes and News.
893
1898 .]
was not responsible when suffering from the fits, and was not safe to be at large.
Guilty, but insane.—Winchester Assizes (the Lord Chief Justice), June 28th.—
Times , June 30th.
One of the numerous instances of crime committed by a man who ought not to
have been at large.
ASYLUM NEWS.
The New Edinburgh Asylum. —Competitive plans for the asylum to be
erected by the Edinburgh District Lunacy Board were exhibited to the public
during the week of the British Medical Association meeting. We have already
indicated that the system of construction developed at Alt Scherbitz was adopted,
and the architects who sent in plans have worked in strict accordance with
instructions. Mr. Hippolyte J. Blanc has been successful in securing the first
place in order of merit, and bis designs are to be adopted with certain modifica¬
tions in detail. We hope to give a full account of the completed plans at no
distant date.
QUEBEC MEDICO-PSYCHOLOGICAL SOCIETY.
The physicians attached to the asylum of the province of Quebec have organ¬
ised themselves into an Association for the advancement of the specialty. Dr.
Vall£e has been appointed president, Dr. Burgin vice-president, and Dr. Chagnon
secretary. The first meeting of the society was held at the St. Jean de Dieu
Asylum on July 14th, 1898, and we have been favoured with an account of the
proceedings, which will find place in our next issue.
CORRESPONDENCE.
From Dr. Percy Smith.
In the July Number of the Journal I notice on page 653 a statement reported
as made by the Chairman of the meeting of the Northern and Midland Division,
held at Cheadle on May 25th, to the effect that “ every hospital had pensioned its
superintendent on retirement/’ I think it is right to correct this statement and
say that no superintendent of Bethlem Hospital has ever received a pension. This
has, however, not been the fault of the governing body, but owing to the fact that
the superintendents have gone into other spheres of work, with the exception of
Dr. Helps, who died while still superintendent.
OBITUARY.
Henry Case, M.R.C.S.
We record, with regret, the death of Mr. Henry Case, at Folkestone, on the 15th
of June. He had but recently retired from the office of medical superintendent of
the Leavesden Asylum, which he had held since 1876. Born in 1843, and medically
educated at the Middlesex Hospital, at which he held with credit the post of house
surgeon, he became subsequently house surgeon to the West Herts Infirmary and
to the Hampstead Smallpox Hospital, and assistant medical officer to the Leavesden
Asylum, of which, on Dr. Claye Shaw’s removal to Banstead, he was entrusted with
the chief charge.
For upwards of twenty-one years he held this important appointment, and dis- %
charged with zeal and efficiency its onerous duties, maintaining throughout the best
relations both with his colleagues and patients, and, despite the number of the
latter, having an intimate knowledge of their cases, and himself directing their
medical treatment. For some years, and until increasing work compelled his relin¬
quishment of the office, he was also lecturer on psychological medicine at the
Middlesex Hospital.
Digitized by LjOOQle
894
■ Notes and News.
£Oct.,
• In January of the present year lll-hedUh necessitated his retirement from Leaves-
den, and his colleagues and the staff generally marked this event by a handsome
presentation of plate. The committee, to whom he had rendered service for so large
a portion of hie life, voted him the insignificant pension of £250 a year, and added yet
another proof of the need which exists in the service of our speciality for a fixed and
liberal scale of statutory pensions which shall be assured as the complement of long
and faithful service.
R. Batters by Scholes, M.D.
Dr. Scholes, whose death is recently recorded, was an Australian by birth, but
studied in Edinburgh, where he took the degrees ofM.B. and C.M. in 1874. He
returned to Australia, and at once entered the service of the Government of New
South Wales as assistant medical officer of the Hospital for the Insane at Para¬
matta, from which he was soon promoted to the superintendentship of Callan Park.
In 1878, on the nomination of Dr. Manning, he was appointed superintendent of
Goodna, near Brisbane, Queensland, and later on became Inspector of the Asylums
at Ipswich andTowoomba, and at the Reception Houses at Rockhampton, Towns¬
ville, and elsewhere, which Dr. Scholes himself established on the same basis as
those in New South Wales.
Dr. Scholes soon placed the Lunacy Department of Queensland on a proper
footing, and under his advice and with his assistance the new Lunacy Act was
drafted and submitted to Parliament. By bis genial manners and his kindness of
heart he won the love and respect of the patients and staff, and by his adminis¬
trative ability the confidence of all classes of the community. For twenty years
under his guidance the Lunacy Department of Queensland has worked without
internal friction and without trouble to the .Government, and at the same time with
ever-increasing efficiency. As medical superintendent, an altogether unique ex¬
perience befell Dr. Scholes. During the floods (previously unequalled) which some
seven or eight years ago wrecked the city of Brisbane, destroyed its bridges, devas¬
tated its beautiful botanic gardens, and ruined thousands of the colonists. Dr. Scholes
found hitmelf with upwards of 300 male patients in all stages x>f their malady sur¬
rounded by water and in imminent danger. As the water rapidly rose it was found
necessary to vacate all the lower floors, and before nightfall it was ascertained that
the buildings were in danger and were indeed in parts crumbling away. By means
of a boat, guided by ropes made of torn bedding, it became necessary to remove all
the patients through the windows of the upper stories. Such as resisted or w ere
maniacal or suicidal were rolled in blankets and placed like mummies under the
thwarts of the boat, and by morning Dr. Scholes had the satisfaction of finding all
his patients, with one solitary exception, and all his attendants in safety in the wards
set apart for women, which stood on higher ground. Dr. Scholes himself crossed
the flood in the last trip made by the boat, and then had to house his homeless flock
in buildings already overcrowded with female patients. These buildings, though on
high ground, were surrounded by water, but to them were attached kitchens,
bakeries, and stores, from which the whole Asylum population were supplied until
the flood subsided and communication with the outside world w r as again possible.
The Government of Queensland has since that time taken steps to remove the low-
lying buildings, but before this could be completed Dr. Scholes, on two subsequent
occasions, found it necessary to make every preparation for the timely removal of
the whole of the male patients. To the incessant work incidental to his position, to
the special anxieties attending the danger due to floods, and to the. worry involved
in the re-organisation of the Asylum, may no doubt be attributed Dr. Scholes*
early and unexpected death, which took place from heart disease on July 8th.
The great flood left behind it much misery and destitution in the village of
Goodna, where many of the staff of the Asylum resided. This Dr. Scholes did his
.best to meet, not only by active sympathy, but by such munificent donations from
his private means as has left an abiding sense of gratitude and respect. By Dr.
Scholes’ death the Government of Queensland has lost one of the most trusted, able.
Digitized by
1898.] Notes and News. 895
and talented of its public servants, and the insane of the colony their truest and
best friend. Dr. Scholes leaves a wife and family.
Auguste Voisin.
The death of Dr. Auguste Voisin'has been announced. He was physician to the
Saltpetriere, and was best known by his writings on idiocy, hysteria, hypnotism,
'and allied subjects. Dr. Voisin wes nephew to Dr. F61ix Voisin, formerly physician
to the Bic£tre, and early in life devoted himself to the study of mental diseases.
In 1879 he won an appointment to the Bicetre, which he held until 1884. when
he was transferred to the Saltpetriere as physician to the department of back¬
ward children and epileptics. Dr. Voisin’s paper at the Bournemouth meeting of
the British Medical Association (1891) directed special attention to his opinions
on the relation of hypnotism to crime, for he held that his experiments had indu¬
bitably proved that persons in the hypnotic condition might be caused to commit
crime unconscious of the act. Dr. Voisin’s treatment of insane persons by hyp¬
notism did not command the approval of independent observers, and was not
pursued by his colleagues.
NOTICES BY THE REGISTRAR.
The following gentlemen were successful at the examination for the Certificate in
Psychological Medicine, held on July 7th, 1898:
Examined at Bethlem Hospital , London .—Herbert Barraclough, Frank Herbert
A. Clayton, William Cotton.
Examined at the Royal Asylum , Momingside , Edinburgh. — James Masson,
James Orr, William James Stuart, David Barty King.
The following is a list of questions which appeared on the paper:
1. What indications with regard to a person’s sanity or insanity may be obtained
from observation of his or her dress? 2. To what points would you specially direct
your attention with a view to ascertaining the testamentary capacity of a patient ?
Can a patient in an asylum make a valid will ? 3. What are the principal sym¬
ptoms which distinguish a case of acute dementia or anergic stupor from one of
melancholia attonita ? 4. In what forms do climacteric insanity appear ? Give the
prognosis of each. 5. Describe the different kinds of mental disturbance that
occur in epileptic insanity. State shortly the connection between epilepsy and
crime. 6. Compare the various forms of auditory hallucination with the various
forms of deafness of cerebral origin. Describe psycho-motor hallucinations.
The Bronze Medal has been awarded to John Robert Lord, M.B., C.M., Assistant
Medical Officer, London County Asylum, Hanwell.
The next examination for the Certificate in Psychological Medicine will be held
in December, 1898. Due notice of the date will appear in this Journal and in
the medical papers.
Examination for the Nursing Certificate .—The next examination for the Certifi¬
cate of Proficiency in Nursing will be held on Monday, November 7th, 1898, and
candidates are earnestly requested to send in their schedules, duly filled up, to the
Registrar of the Association not later than Monday, October 3rd, 1898, as that
will be the last day upon which, under the rules, applications for examination can
be received.
Note.
As the names of some of the persons to whom the Nursing Certificate has been
granted by the Association have been removed from the Register, employers are
requested to refer to the Registrar in order to ascertain if a particular name is still
on' the roll of the Association. In all inquiries the number of the Certificate
should be given.
For further particulars respecting the various examinations of the Association,
apply to the Registrar, Dr. Spence, Burntwood Asylum, near Lichfield.
Digitized by {jOOQle
.896
Notes and News.
[Oct.,
NOTICES OF MEETINGS.
Medico-Psychological Association.
South-Eastern Division .—At Springfield House, Bedford, on Monday,
October 10 th.
Northern and Midland Division .—At Derby County Asylum on Wednesday,
October 12th.
South-Western Division .—At the Grand Pump Room Hotel, Bath, on Tuesday,
October 18th. Agenda. —(1) Adjourned discussion on Dr. Blachford’s paper read
at last meeting. (2) Paper by Dr. H. Bristowe, “Lunacy in Private Practice.”
(3) Paper by Dr. Weatherly, “ Lunacy and the Public.”
Scottish Division .—At Edinburgh on the second Thursday of November.
General Meeting .—At London on October 13th.
APPOINTMENTS.
C. Hubert Bond, D.Sc., M.D.Edin., appointed Senior Assistant Medical Officer
to the new asylum for the county of London, Bexley, Kent.
Maurice Craig, M.A., M.D., M.R.C.P., appointed Senior Assistant Physician to
Bethlem Royal Hospital.
Theo. B. Hyslop, M.D., C.M., M.R.C.P.Edin., appointed Resident Physician to
Bethlem Royal Hospital, vice R. Percy Smith, M.D., F.R.C.P., resigned.
T. E. K. Stansfield, M.B., C.M.Edin., appointed Medical Superintendent to the
new London County Asylum, Kent.
OMISSIONS.
We regret to omit “ Report of British Medical Association Meeting,” “ Parlia¬
mentary News ” and other matters of importance owing to the pressure on the space
in this number of the Jofbnal.
Digitized by
INDEX TO YOL. XLIV.
Pabt I.—GENERAL INDEX.
Acroparaesthesia, 157
Acute mania in a boy, 320
Adams, Mr. R., retirement of, 221
After-care Association, Annual Meeting, 328, 448
„ „ reminiscences of, 299
„ of the insane in America, 409, 616
Aim of modern education, 171
Alcohol, influence on muscular activity, 867
Alcoholic insanity simulating epilepsy, 492
„ intoxication in children, 463
Alcoholism and insanity, 597
„ and suicidal impulses, 259
,, effects on nervous system, 341
„ mismanagement of, 711
American psychiatry, 406
» retrospect, 169, 386, 616
Amnesia after hanging, 864
„ and mind-blindness, 170
Amusements and recreation, question of, 197
Amusia, 863
Analgen, 185
Analysis of 131 criminal lunatics, 64
„ of causes of insanity in 1000 patients, 500
Anisine, 389
Anthropological data in asylums, 235
Anthropology, 802
Anthropometric data of the ear in the insane, 241
Aphasia, 581
Appointments, 230, 458, 672, 896
Asylum abuses, 424
„ attendants, aspirations of, 197
„ „ badges for, 196
„ life, risks of, 450
„ news, 445, 893
„ reports, 192, 856
„ versus hospital, 836
„ Workers' Association, 661
Asylums and the Government, 332
Ataxy, 370
Atkins, Dr. R., death of, 453, 676
Atypical and unusual brain forms, 17
Auditory disturbances in nervous diseases, 598
Auto-infection in the insane, 627
Bacteriological researches in acute delirium, 626
Baltimore asylum, 339
Bannister, Dr., progress of psychiatry in America, 406
Belgian asylums and the Belgian Government, 416
„ retrospect, 412
XLIV.
60
Digitized by
898
Index .
Bianchi, Prof., Italian retrospect, 417
Biology, cellular, 778
Blood in insanity, 801
Blushing, obsession of, 402
Boarding out of harmless lunatics, 657
Bond, Dr. C. H., American retrospect, 169, 886
Bones, fragility of, in insane, 450, 672, 296
„ spontaneous fractures in locomotor ataxy, 404
Brain cell degeneration, 887
„ „ structure, new Nissl method, 698
„ concussion of, simulating delirium tremens, 95
„ deficiency of corpus callosum, 860
„ innervation of the vessels of, 863
„ localisation of mental processes in, 1
„ pathological histology of the choroid plexuses, 744
„ sarcoma of, removal, 179
„ specific gravity of, in insane, 700
„ surface morphology, 17
Bresler, Dr., German retrospect, 422
British Association at Toronto, 215
,, Medical Association and its Council, 328; meeting at Montreal, 210;
mental evolution, 210; pelvic disease in women and insanity—after effects of
surgical procedure—reflexes in psychiatry, 211; heredity and insanity—acute
melancholia—physical and mental disease—inebriety—insanity and the State,
212; degeneration of nerve-cells—the subconscious mind—active treatment of
general paralysis, 213; the nose and sexual apparatus, 214
Annual Meeting at Edinburgh, 825
Bucknill, Sir John C. v 104
Cairo asylum, 660
Calomel, sedative effects of, 177
Cane, Sir E. du, on criminal treatment, 655
Cardiac deficiency as a cause of insanity, 868
Care and education of weak-minded and imbecile children, 474
Carlyle, his wife and critics, 76
Case, Mr. H., death of, 898
Cerebellum, anatomy of, 678
Cerebral cortex, structure of, 677
„ diplegia, 386
„ lobes, intellectual value of, 290
Child, an extraordinary, 398
Children, abnormal, and their education, 414
„ defective, and imbeciles, 667, 668, 665
„ insanity in, 459
„ weak-minded and imbecile, care and education of, 474
Chlorhydrins, action of, 186
Chorea gravis, 811
Cigarette, a brief for, 628
H description of, 401
Colitis, 626
Commissioners in Lunacy, reports of, for England, 118
„ „ „ for Scotland, 126
Complimentary presentations to Dr. R. Adams and Dr. Nathan Raw, 221
„ Prof. Ludwig Meyer, Dr. G. Marriott Cooke, Sir J. Batty
Tuke,461
Concussion of brain simulating delirium tremens, 95
Confidentiality, medical, 825
Digitized by
Index.
899
Confusion, primitive mental, 159,167
Corpus callosum, significance of deficiency of, 860
Correlation of sciences in psychiatric and neurological research, 764, 826
Correspondence—
Prom Dr. Reid, on electric lighting, 219
„ Mr. Townsend, on electric lighting, 220
„ Dr. Percy Smith, 898
„ Dr. W. B. Smith, Victoria, N.S.W., 663
Cortez cerebri, changes in, 424
, t of a criminal paranoiac, 420
Cortical nerve-cells, histology and pathology of, 729
Cowan, Dr. P. M., Dutch retrospect, 424
Crime and criminals, 866
„ and hypnotism, 626
„ and insanity, 846
Criminal anthropology, 607
„ Evidence bill, 567, 827
„ law reform, 324
„ lunatics, 64
„ responsibility, 614
,, treatment, 665
Criminality in Russia, 610
Criminals, insanity among, 612
„ physical development of, 611
,, stigmata of degeneracy among, 607
Criticism, evil of irresponsible. 111
Danish asylums for feeble-minded, 46
„ retrospect, 426
Darenth scandal and scapegoat, 322, 670
Deaf and dumb institution in Holland, 54
Defective children and imbeciles, 667, 656
Ddlire g6n£ralis£, 416
Delirium tremens, artificial production of illusions, 866
>, concussion simulating, 96
„ paraldehydicum, 178
Differential diagnosis between lues cerebri and dementia paralytica, 869
Disinfectant, formalin as, 206, 330
Disinfection of dwelling-rooms, Ac., 393
Divining rod for water, 362
Dodswell, Rev. H. J., case of, 460
Drunkards, mismanagement of, 711
Dutch retrospect, 424
Ear in the neurotic, insane and criminal, 241
Early treatment clause, 558
Edinburgh district lunacy board, 218
Education, aim of modern, 171
„ of the central nervous system, 868
Effect of poisons on nerve-cells, 173
Egyptian asylum, Cairo, 199
Electric lighting, 219
Ellis, Dr. Havelock, retrospect of criminal anthropology, 607
«. » » of physiological psychology, 372
Elmira reformatory, 613
Emotions, psychology of, 147
English retrospect, 624
Enteric fever in asylums, 829
Digitized by
900
Index.
Epiblast, congenital aberration* of, in insane, 819
Epidemic in Warwick a*ylum^446
Epilepsy, hot-bair baths in, 190
„ nature of, 427 . . 1AQ
sclerosis of cornu Ammonia in, 169
l, stigmata of, in insane criminals, 421
lt surgical treatment of, 180
Epileptic and alcoholic insanity, 492
„ insanity, case of, 892
„ jaundice, 895
Epileptics, home for, 51 . „
„ statistical data concerning, 427
Erotomania in early life, 467
Evil of irresponsible criticism, 111
„ of unrestricted zeal, 112 ^
Evolution of general ideas, 148
Exaltation and depression, physiology of, 881
Fatigue in schools, 449
Fishes, memory of, 231 _ t oi k
Flechsig on localisation of mental processes, 1, 215
Fleming, Dr., English retrospect, 624
Food, refusal of, in the insane, 62
Formalin, use of, 206, 330
Fractures of bones in insane, 101
Fragility of bones in insane, 450, o72, 20b
French retrospect, 395, 410
Friendly societies and insanity, 217
Friis, Dr., Danish retrospect, 426
General paralysis, active treatment of, 2i3
w ” apoplectiform and epileptiform attacks, 397
” ” diagnosis of, 410
” M eye troubles in, 157
prodromal period, 166
” „ reflexes in, 417
Genius, insanity in men of, 847
German asylums, guide to, 844
German retrospect, 422, 860 KrV7
Giant-cells of the motor cortex in the insane, 507
Government and lunatic asylums, 382
Graves* disease, treatment of, 291
Greene, Dr. R., resignation of, 447
Habitual Inebriates bill, 666
Hackney union case, 659,890
Hmmatoporphyrinuria, case of, 305
Hallucinations, 165,619
and illusions, 358
” isolated, 865
Handbook for attendants, 671
Harward v. the Hackney Guardians, Ac., 827
Haughton, Prof., death of, 222
Hawkhead asylum, sewage disposal, 707
Headache with visual hallucinations, 619
Headaches, localisation of, 583
Hearing in nervous diseases, 698
Digitized by LjOOQLe
Index .
901
Heidenheim, Dr. Rudolf, death of, 228
Hemicrania, its connection with epilepsy and hysteria, 842
Hereditary predisposition, 196
Heredity and insanity, 212
„ in insanity of children, 460
„ in relation to mental disease, 638
„ normal and pathologic, 693
Higgins, Dr. W. H., death or, 222
Holmboe, Dr., Norwegian retrospect, 428
Hot-air baths in epilepsy, 190
Howden, Dr. J. C., death of, 223
Hydrocephalus in adult life, 887
Hyperamnesia, 166
Hypnotic suggestion, 400
Hypnotism and crime, 626
,, and will-making, 831
„ in court, 569
„ practical application of, in medicine, 608, 833
Hypochondriasis, 156
Hysteria in children, 470
„ post-epileptic, 818
„ treatment of, 188
Hysterical attacks, loss of consciousness in, 403
Illegal reception of lunatic, 890
Illusions, artificial production in delirium tremens, 866
Imbecile children, care and education of, 474, 567
Imbeciles, industrial training of, 531
„ training schools for, 46
Immunity, acquired, 694
Imperative ideas and related phenomena, 866
Impulses, 592
Incest, 853
Incipient insanity, temporary treatment of, 108
Incontinence of urine in insanity, 344
Increase of insanity, alleged, 113,195, 826
Inebriates bill, 826, 566, 828
Inebriety, 212
Influence of alcohol on muscular activity, 867
Influenza and isolation, 449
,, and melancholia, 198 •
Inhibition, phenomena of, 172
Innervation of vessels of the brain, 863
Insane ear, 241
„ nursing of, 415
„ osseous system in, 295
„ poor in private dwellings, 439
„ provision for, in Belgium, 415
„ psychological examination of, 412
„ refusal of food by, 62
Insanity among criminals, 612
„ and acquired syphilis, 277
„ and pelvic disease, 211
„ and penal servitude, 271
„ and the State, 212
„ caused by cardiac deficiency, 868
„ „ marital indifference, 198
„ chirurgico-gynaecological treatment of, 188
Digitized by
902
Index.
Insanity, delusional, 155
,, hereditary predisposition to, 196 (see also Heredity)
„ in children, 459
„ increase of, 113,195, 326
„ in 1000 patients, analysis of, 500
„ scientific investigation of, 764
,, similarity between epileptic and alcoholic, 492
Insomnia, treatment of, 393
,, wet pack in, 395
Intemperance a sign of insanity, 196
International Medical Congress at Moscow, 214
Ireland, Dr., German retrospect, 173, 860
,, report of inspectors of lunatics, 134
Irish Local Government bill, 334, 659, 664
,, lunatics, chargeability, 331
„ ,, pauper, 106
Italian retrospect, 188, 417, 626
Jaundice, epileptic, 395
Jaws among degenerate classes, 609
Joint troubles in locomotor ataxy, 404
Katatonia, 389
Kryofin, a new antipyretic, 390
Laboratories, pathological, 406
Laboratory of the Scottish asylums, 450
Lactophenin, poisoning by, 391
Laughter, psychology of, 382
Lavage in refusal of food, 62
Law of settlement, 829
Lead poisoning, 833
Lenticular nucleus, function of, 399
Lindell, Dr., Swedish retrospect, 430
Lues cerebri, 869
Lunacy bill, 665, 640, 646, 829
„ certificates, 830
Lunatics at large and public press, 110
„ wandering, 449
Luys, Dr. J. B., death of, 227
Macevoy, Dr., French retrospect, 395
Male nurses, temperance co-operation, 661
Mania, acute, in a boy, 320
„ in children, 469
Manning, Dr. Norton, retirement, 664
Marshall, Dr. W. G., death of, 224
Masturbation in children, 463
Medical confidentiality, 325
„ responsibility, 699
Medico-legal cases—
Reg. v. Marriotini, 216
Commission v. Shaw, 216
Friendly societies and insanity, 217
Law and insane murderers, 218 |
Howard v. Hackney Guardians, 327
Reg. v. Prince, 438
„ v. Cross, 439
Digitized by
Google
Index.
903
Medico-legal cases— continued.
Barnett v. Blagg, Ac., 489
Hypnotism in court, 569
Crichton v. Ferguson, 888
Bristol Boyal Infirmary v. Artett, 888
fteed, Ac., v. Solicitor to the Treasury, 888
Barker v. Barker and Dearsley, 888
Donald Ross v. W. Ross’s trustees, Ac., 889
Spence v. Spence, 889
Browning v. Green, 889
Be Charles Clarke, 889
„ Earl of Sefton, 889
„ Lamond, 889
Harward v. Hackney Guardians, 890
Reg. v. Irving, 890
„ v. Weaver, 891
„ v. English, 891
„ v. Murphy, 891
„ v. Norris, 892
„ v. Woolford, 892
Medico-Psychological Association—
General meeting in London, November, 1897, 200
South-Eastern division at Northampton, October, 200
Northern and Midland division, York, October, 202
South-Western division, October, 202
Proposed special pathologist, 203
Compulsory pensions, 203
Scottish division, November 1st, 204
The use of formalin, 205
Cortical nerve-cells in insanity, 206
Adjourned meeting, November 27th, 209
Suggestions of Education Committee, 209
General meeting at Sheffield, February, 1898, 432
Vote of condolence on death of Dr. Wallis, 432
South-Western division, 433
Discussion on Dr. Goodall’s paper, 433
Scottish division, March, 1898, 434
Expenses of secretaries, 435
Fatal Accidents Inquiry Act, 436
Amended regulations for nursing certificates, 437
General meeting in London, May, 1898, 632
South-Western division, April, 633
Nursing certificates, 634
Compulsory pensions, 637
South-Eastern division at Wandsworth, April, 638
Regulations for nursing certificates, 639
Lunacy bill, 641
Northern and Midland division at Manchester in May, 643
Regulation for nursing certificates, 643
Lunacy bill, 646
Irish division, April, 1898, 654
Local Government bill, 654
Presidential address, 673
Annual Meeting at Edinburgh, July, 1898, 821, 875
Treasurer’s report, 876
Election of officers, 876
Parliamentary Committee’s report, 878
Digitized by LjOOQle
904
Index .
Medico-Psychological Association—
Annual Meeting at Edinburgh—
Educational Committee's report, 881
Prevention of insanity, 884
Excursions, 885
Annual dinner, 886
Melancholia, acute, 212
» an analysis of 3,000 cases, 621
>> caused by influenza, 198
„ certain physical signs in, 247
tt delusions in, 168
» in children, 468
Memory and its cultivation, 854
» of fishes, 231
Mental derangements of old age, 870
„ diseases, Belgian official classification, 414
»> evolution, 210
» hygiene, 365
Mescal, effects of, 449
>» intoxication, phenomena of, 183
Metopismus, 584
Micro-photography, 174
Mismanagement of drunkards, 711
215 in ““ e ^ in pri7ate dweUiagS * 489
Morrison, 363
f l ° n , e st 5? di “K onred b y bromide poisoning, 187
mobcow, international medical congress at, 214 6
Nerve-cells, cortical, in insanity, 206
» degeneration of, 213
»» effect of poison on, 173
,9 specific functions of and histo-pathology of, 424
N«*S. .*1SSliU£5u“'’"**•'**
.iS«k , 181
>* system, changes produced by want of sleep, 630
antS. •$’*“* 683
wet in the insomnia of, 395
Neurology, comparative, 773
Neurotic men of genius, 847
New Italian journal, 629
Nissl method, a new, 693, 816
Normal histology and pathology of the cortical nerve-cells, 729
tt. '• of the nervous system, 786
Norwegian retrospect, 428
Nose and sexual apparatus, 214
Ur8ing ®? 1 ! t l j fi ? lte8 » examination for, 228, 634, 639, 643
99 of the insane, 415
Obituary—Atkins, Dr. Ringrose, 453, 675
Case, Mr. Henry, 893
Hart, Mr. Ernest, 456
Haugbteim, Prof., 222
Heidenbeim, Prof. Rudolf, 228
Higgins, Dr. W. H., 222
Digitized by ^ ooqLc
Index.
905
Obituary—Howden, Dr. J. C., 228
Lays, Dr. J. B., 227
Marshall, Mr. W. G., 224
Scholes, Dr. R. B., 894
Sheppard, Dr. E., 225
Smith, Mr. R. G. v 227
Voisin, Dr. Auguste, 895
Wallis, Dr. J. A., 452, 666, 676
Obsession, 162, 166
„ and imperative ideas, 411
Old age, mental derangement of, 870
Optic thalami, physiology of, 421
Origin of number forms, 388
Osseous system in the insane, 295
Overwork causing insanity, 892
Paraldehydricum, delirium tremens from, 178
Parathyroid glands, 628
Pathological institute for investigation of insanity, 765
,, laboratory of Scottish asylums, 105
Pathology, bacteriology, and physiological chemistry, 783
„ experimental, 792
„ in the London County Asylum, 104
„ of the nerve-cells, 173,206, 213, 424, 507
Pellotin as an hypnotic, 184
Pelvic disease in women and insanity, 211
Penal servitude and insanity, 271
Pensions, compulsory, 203,637
Pbenacetin poisoning, 185
Phesin and cosaprin, new drugs, 891
Physical and mental disease, 212
Physiological psychology, retrospect of, 372
Physiology of exaltation and depression, 381
Porencephaly, 625
Premature discharges and increase of lunacy, 326
Press on lunatics at large, 110
Priest and physician, 834
Prison reform, 828
Private patients, provision for poor, 108,181,144
„ ,, success of, in asylum, 194
Pseudo-bulbar paralysis, 157
Psychological methods for the examination of the insane, 412
Psychology and psycho-pathology, 756
,, of laughter, 382
,, of religion, 372
„ scientific, 151
„ the new, 585
Puberty in relation to anthropology, psychiatry, education, and sociology, 850
Puerperal psychoses, 156
Quebec Medico-Psychological Society, 893
Questions likely to be put to medical witnesses, 891
Rainhill Asylum, enlargement of, 218
Raw, Dr. N., presentation to, 221
Reception-houses for insane, 568
Reflexes in psychiatry, 211
Relieving officers and alleged lunatics, 659
Digitized by
906
Index .
Religion, psychology of, 372
Report of Commission in Lnnacy, England, 113
„ „ „ Scotland, 126
„ of Inspector of Lunatics, Ireland, 134
Researches on reaction time, 384
„ upon school children, 377
Resignations of Dr. Greene, Dr. T. A. E. Strahan, and Mr. Mitchell, 448
Responsibility, the idea of, 614
Retirement of Dr. Norton Manning, 664
Retrospect of physiological psychology, 372
Rigor mortis, statistics relating to disappearance of, 74
Robertson, Dr. W. F., Italian retrospect, 188, 626
Sainsbury, Dr. H., therapeutic retrospect, 177
Sanitary appliances, 451
Sarcoma of brain, successful removal, 179
School children, researches upon, 377
Sciences, correlation of, in psychiatric and neurological research, 754
Sclerosis of the cornu Ammonis in epilepsy, 169
Scopolamine as a calmative in insanity, 394
Scotland, growth of insauity in, 218
„ report of commission for, 126
Scottish asylums, laboratory of, 105
Seclusion, treatment of insane without, 423
Sedative effect of calomel in large doses, 177
Self-accusing persecution, 411
Semelaigne, Dr. R., French retrospect, 410
Senile psychoses, 419, 870
Serum in nervous and mental diseases, 412
Sewage disposal at Hawkhead Asylum, 707
Sexual impulse, 347
„ inversion, 162
Shakespeare, study of insane characters, &c., in, 838
Sheppard Asylum, Baltimore, 339
„ Dr. E., death of, 225
Sleep after dinner, 176
„ its physiology, pathology, hygiene, and psychology, 605
„ want of, effect on nervous system, 630
Smith, Dr. R. G., death of, 227
Speech, functional interdependence of the cortical centres, 581
Sperm in, 389
Spinal cord, extension of, in tabes, 182
Spleen extract, therapeutic value of, 624
Statistics relating to the disappearance of rigor mortis, 74
Straits Settlements asylum, 109
Study, excess of, active cause of insanity in children, 462
Subconscious mind, 213
Subconsciousness, 586, 852
Suggestion and auto-suggestion, therapeutics of, 401
Suicidal impulses and alcoholism, 259
Suicide in early life, 468
„ sociologically, 588
Surgical operations, after effects of, 181, 211
Swedish retrospect, 430
Syphilis and insanity, 277
„ of the nervous centres, 342
Tabes, 369
Digitized by
Index .
907
Tabes, true extension of spinal cord in, 182
Tactile amnesia and mind-blindness, 170
Tattooing, 864
Temporary treatment of incipient insanity, 108, 659
Therapeutic retrospect, 177, 389
„ value of spleen extract, 624
Thyroid body, innervation of, 602
„ extract, treatment of insanity by, 158,193
,, gland, action of, on growth and obesity, 399
Time, unconscious estimation of, 175
Tuberculin, 392
Tumour of the frontal lohes, 420
Ulcer, perforating, treatment of, 183
Unfortunate middle classes, 661
Uric acid as a cause of disease, 590
Urine, estimation of toxicity, 191
„ hsematoporphyrin in, 305
„ incontinence of, 344
Urquhart, Ur. A. R., Presidential Address, 673
Vascular reflexes in limbs and brain, 421
Visits to Danish asylums, Ac., 45
Visual disturbances with dwarfish and giant growth, 865
Wallis, Dr., death of, 452, 665, 675
Wandering lunatics, 449
Warfare, suggestion in, 396
Water-finding by divining rod, 352
Weak-minded children, care and education of, 474
Weak-mindedness, 635
Wet pack in insomnia, 395
Will-making and hypnotism, 831
Wills, making of, by certified patients, 96
„ „ by insane, 888,889
Xerostomia, or dry mouth, 622
Yew poisoning, 313
Part II.—ORIGINAL ARTICLES.
Ambler, Dr. J. R., a case of concussion of the brain simulating delirium
tremens, 95
Beacb, Dr. Fletcher, insanity in children, 459
Blachford, Dr. J. V., statistics relating to the disappearance of rigor mortis, 74
,, „ - analysis of insanity in one thousand cases, 500
Briscoe, Mr. J. F., notes on a case of fracture of the fibula in a melancholic
patient, with remarks on treatment in fractures generally,
101
„ „ the osseous system in the insane, 295
Campbell, Dr. K., a case of hsematoporphyrinuria, 305
„ Dr. Alfred, colitis, 526
Carswell, Dr. J., the care and education of weak-minded and imbecile children
in relation to pauper lunacy, 474
Clapham, Dr. C., a note on the comparative intellectual value of the anterior and
posterior cerebral lobes, 290
Clinch, Dr. T. A., a case of chorea gravis, 811
Digitized by
908
Index .
Crichton-Browne, Sir J., Carlyle, his wife and critics, 76
Crooksbank, Dr. F. G., clinical cases, 818
Dawson, Dr. W. R., the relation of acquired syphilis to insanity: a critical
digest, 277
Douglas, Dr. A. R., penal servitude and insanity, 271
„ „ remarks upon the term weak-mindedness, with observations
upon the need of definite nomenclature for cases of congenital mental defect
which are not certifiable as imbecile or insane, 585
Farquharson, Dr. W. F., heredity in relation to mental disease, 638
Findlay, Dr. J. W., observations on the normal and pathological histology of the
choroid plexuses of the lateral ventricles of the brain, 744
Geddes, Dr. J. W., a case of chorea gravis, 811
Giesen, Dr. 1. Van, the correlation of sciences in psychiatric and neurological
research, 754,826
Goodall, Dr. E., the systematic collection of anthropological data in asylums, 235
Greenwood, Mr. H. H., lavage in refusal of food by the insane, 62
Hawkins, Rev. H., reminiscences of "After-care ” Association, 1879—1898, 299
Hearder, Dr. F. P., an analysis of 181 male criminal lunatics admitted to the
West Riding Asylum, &c., 64.
Ireland, Dr. W. W., Flechsig on the localisation of mental processes in the brain, 1
„ „ visit to Danish asylums for the feeble-minded and other insti¬
tutions, 45
Lord, Dr. J. R., the collecting and recording of descriptive and anthropometric
data of the ear in the neurotic, insane, and criminal: a new
method, 241
„ „ a new Nissl method: normal cell-structure and the cytolo-
gical changes terminating in fatty degeneration, &c., 693
McIntosh, Dr. W. C., note on the memory of fishes, 231
Mickle, Dr. W. J., atypical and unusual brain-forms, especially in relation to
mental status : a study on brain-surface morphology, 17
Morton, Dr. W. B., notes of a case introducing a discussion on the making of
wills by certified patients, and the duties of medical men in regard to this, 96
Noott, Dr. R. H., points of similarity between epileptic and alcoholic insanity, 492
Orr, Dr. D., histology and pathology of the cortical nerve-cells, 729
Pierce, Dr. B., notes on a case of yew poisoning, 313
Ray, Dr. M. B., case of acute mania occurring in a boy, 320
Robertson, Dr. W. F., and Dr. D. Orr, the normal history and pathology of the
cortical nerve-cells (especially in relation to insanity), 729
Shuttleworth, Dr. G. E, the industrial training of imbeciles, 531
Simpson, Dr. F. O., the specific gravity of the insane brain, 700
Stoddart, W. H. B., certain physical signs in melancholia, 247
Sullivan, Dr. W. C., alcoholism and suicidal impulses, 259
Turner, Dr. J., remarks on the giant-cells of the motor cortex in the insane
examined in a fresh state without hardening : a contribution to the pathology
of the nerve-cell, 507
Urquhart, Dr. A. R., the Presidential Address delivered at the fifty-seventh
Annual Meeting of the Medico-Psychological Association, held at the Royal
College of Physicians, Edinburgh, on the 21st July, 1898, 673
Watson, Dr. W. R., sewage disposal at Hawkhesd Asylum, 707
Wilson, Dr. G. R., the mismanagement of drunkards, 711
Digitized by
Index.
909
Pabt III.—REVIEWS.
Annie psychologique, 146
Annie sociologique, 863
Allison, Dr. H. E., Methods of securing health for insane convicts, 606
Ballet, Dr. G., Leqons de clinique mldicale—psychoses et affections nerveuses,
154
Barine, Dr. Arvdde, Nlvroses, 847
Barrett, Professor W. F. t On the so-called divining rod or virgula divina, 852
Bibby, Mr. G. H., The planning of lunatic asylums. The housing of pauper
lunatics, 607
Benedikt, M., Quelques considerations sur la propagation des excitations dans
le systdme nerveux, 592
Brian, Dr. Eugene, I/innervation du corps thyroide, 602
Brouardel, Dr. P., La responsabilitl medicale: secret medical declaration de
naissance; inhumations; expertises; mldico-llgales, 699
Buschau, Dr. G., Metopismus, 584
Charbaneix, Dr. P., Le subconscient chez les artistes, les savants, et les lerivains,
586
Chaslain, Dr. Pb., La confusion mentale primitive, stupidity, dlmence aigue,
stupor primitive, 159
Ohristison, Dr. J. S., Crime and criminals, 855
Clark, Dr. A. Campbell, Manual of mental diseases, 356
Collet, Dr. F. J., Les troubles auditifs dans les maladies nerveux, 698
Cornelius, Vons Hans, Psychologic als Erfahrungswissenschaft, 151
Cross, Dr. R., Results of thyroid feeding in insanity, 158
Dana, Dr. C. L., Text-book of nervous diseases, being a compendium for the use
of Students and practitioners, 583
Darin, Dr. H., Rapports de l’alcoolisme et de la folie, 597
Debierre, Professor Ch., L’hlrlditl normale et pathologique, 598
Flrl, Dr. Ch., La descendance d'un inverti: contribution & Fhygi&ne de Pin ver¬
sion sexuelle, 162
Gadelius, Dr. B., Om trangstankar och dermed beslagtade fenomen, 366
Gattel, Dr. F., Ueber die sexuelles Ursachen der Xeurasthenie und angstneurose,
860
Gilles de la Tourette, Les Itats neurastheniques, 846
Giufforda-Ruggeri, Dr. V., Sulla dignitk morphologies dei segni detti degenera¬
tive, 596
Green, Dr. F. W. E., Memory and its cultivation, 854
Haeckel, Prof. E., Le monisme, lieu entre la religion et la science: profession de
foi d'un naturaliste, 863
Haig, Dr. Alex., Uric acid as a factor in the causation of disease, 590
Halleck, Dr. R. P., The education of the central nervous system, 368
Hallervorden, Dr. E., Abhandlungen zur Gesundheitslehre der Seele und Nerven.
I. Arbeit und Wille, ein Kapitel-kliniscber Psychologic zur Grundlegung der
Psychohygiene (treatises on the hygiene of the mind and nervous system),
365
Hewetson, Mr. H. B., The localisation of headaches and sick headaches, 583
Holmes, Mr. T. V., On the evidence for the efficacy of the diviner and his rod in
the search for water, 852
Krafft-Ebing, Dr., Arbeiten aus dem Gesammtgebiet der Psychiatric und Neuro-
pathologie, 841
Digitized by
910 Index .
Laehr, Dr. Hans, Die Darstellang krankhaften Geistzustande in Shakespeare’s
dramen, 888
„ „ Henr., Die Heil- and Pflegeanstalten fur psychiatschkranke dm
deutschen Sprachgebietes, 844
Lamy, Dr. Henri, La syphilis des centres nerveux, 342
Lewis, Dr. W. Be van, The structure of the first or outermost layer of the cerebral
cortex, 577
Magnan, Dr., Rechercbes sur les centres nerveux—alcoolisme, folie des h 6 r£ditaires
d£g 6 ner 6 s, paralysis g 6 n£rale, m^decine 15gale, 341
Manec4ine, Marie de. Sleep, its physiology, pathology, hygiene, and psychology,
606
Manheimer, Dr. M., Le gatisme au cours des 6 tats psychopat hiques, 344
Marie, Dr. P., Lemons de clinique m6dicale,152
Marro, Dr. Antonio, La puberta, 350
MObiuB, Dr. P. S., Ueber die Tabes, eine abbandlung fur praktische aerate, 368
Moll, Dr. A., Untersuchungen ueber die libido sexualis, 347
Parrish, Dr. E., Hallucinations and illusions, 358
Raman y Oayal, A contribution to the study of the medulla oblongata, the cere¬
bellum, and the origin of the cranial nerves, 362
Reid, Dr. Archdall, Acquired immunity, 595
Report of the State Commissioners in Lunacy of the State of New York, 571
Ribot, Professor Th., L ’6 volution des id£es g 6 n£rales, 148
Sano, Dr. Fitz, De l’interdependance functfonelle des centres corticaux du
laugage, 681 I
„ „ ,, Lea localisations motrices dais la moelle lumbo-sacrfe, 582
Scripture, Dr. E. W., The new psychology. 685
Seglas, Dr. J., L 090 ns cliniques sur les maladies mentales et nerveuses, 166
Siemerling, Dr. E., Casuistische Beitrfige: zur forensischen psychiatrie, 846
Thomas, Dr. Andr£, Le cervelet 6 tude anatomique, clinique, et physiologique, 578
Waldstein, Dr. Lories, The subconscious self and its relation to education and
health, 852
Wetterstrand, Dr. Otto G., Hypnotism and its application to practical medicine,
603
Ziehen, Dr. Th., Leitfaden der physiologischen Psychologic, 589
ILLUSTRATIONS.
Photogravure of Sir J. Bucknill, 1
Five figures illustrating Professor Flechsig’s work, 16,17
Photograph of Dr. Ringrose Atkins, 231
Five figures to illustrate Dr. Lord's article, 242
Chart for recording anthropometric and descriptive data of the ear, 246
Charts to illustrate Dr. Blachford’s paper, 606
Coloured lithographs of brain-cells to illustrate Dr. Turner's paper, 626
Five figures illustrating Dr. Lord's paper, 700
Eleven figures illustrating Dr. Ford Robertson and Dr. Ora's paper, 738, 740, 742
Six figures illustrating Dr. Findlay's paper, 746, 748, 750
Digitized by LjOOQle
INDEX MEDICO-PSYCHOLOGICUS,
Address in mental disorders. F. X. Dercum. Tr. M. Soc. Penn., Phi la.,
1895, xxvi., 115-124.
Agoraphobia. A propos d’un cas d’agoraphobie. J. Sottas. Med. mod.,
Paris, 1895, vi., 357-359.
--A case of agoraphobia. N. Taylor. N. York M. J., 1895, bri., 397.
Alcoholism. Der Alcohol als &tiologisches Moment bei chronischen
Psychosen. P. Nacke. lrrenfreund, Heilbr., 1895-6, xxvii., 33-46.
-Alcoholic insanity due to secret drinking, affecting two sisters. P.
Jenner. Am. J. Insan., Chicago, 1894-5, li., 472-474.
- Ueber die Delirien der Alkoholisten und iiber kunstlich bei ihnen
heworgernfeue Visionen. H. Liefman. Arch. f. Physiat., Berlin, 1895,
xxvii., 172-232.
-Notizie statistiche sull’ alcoolismo in Italia e in alcuni altri stati.
Bull, del’ Inst, internat. statist., Rome, 1894, vii., 307-321.
-The effects of alcohol on our military and civil population at home
and abroad. F. £. McFarland. Dub. J. M. S., 1894, xcviii., 473-489.
-La cure des buveurs. Marandon de Montyel. Ann. med. psych.,
Paris, 1894, 7 s., xx., 411-441.
-Transitorischea Irresein eines Alkoholikers. Rtith. Freidriech's Bl. f.
gerichtl. Med. Niirnb., 1894, xlv., 401-406.
- Contribution au traitement du delirium tremens; traitement au moyen
du chloralose. L. Haskovcc. Compt. rend. Soc. de biol., Paris, 1894,
10 s., i., 810
-L’alcool et l’alcoolisme. Joffrov. M4d. mod., Paris, 1894, v., 1621.
-Inebriety and its treatment. E. J. Kempf. Am. Pract. and News,
Louisville, 1894, xviii., 489-498.
- Sulle psicosi alcooliche larvate ricorrenti esaminate de punto di vista
psychiatrico e medico-legale. A. Reid. Riv. internaz. cl ig., Napoli,
1894, v., 321; Nos. 7 and 8, 277, 373.
-Hallucinations psychomotrices dans l’alcoolisme. C. Vallon. Am.
m4d.-psych., Paris, 1895, 8 s., 91-98.
-Alcoolisme aigu chez les animaux domestiques. R. Bissange. Rec.
de med. vet., Paris, 1895, 8 s., ii., 5-14.
-Des asiles sp4ciaux pour les alcoolis4s. Christian. Ann. m&d. -psych.,
Paris, 1395, 8 s., i., 68-76.
-The disease of inebriety; its study from the standpoint of the experi¬
ence of American physicians of eminence who have worked in this field
of research. E. C. Mann. J. Am. M. Ass., Chicago, 1894, xxiii., 821;
850 ; 907; 1895, xxiv., 19; 55.
-Du regime int4rieur des aisles de buveurs. E. Marandon de Montyel.
Rev. d’hyg., Paris, 1894, xvi., 1059-1088.
-Inebriety and imbecility. T. D. Crothers. J. Am. M. Ass., Chicago,
1895, 262-265.
-Les stigmales de l’alcoolisme. W. Monnier. Gaz. med. de Nantes,
1894-5, xiii., 137; 1895-6, xiv., 4-10.
- L alcoolisme chez les enfants. P. Moreau. Ann. m6d.-psychol., Paris,
1895, i., 8 s., 337-372.
-Sulle nevriti latenti degli alcoolisti. C. Negro. Atti d. xi. Cong.
med. internaz., 1894, Roma, 1895, iv., psychiat. (etc.), 67-70.
-Alcohol en alcoholisme. Niermeyer. Geneesk. Courant, Tiel, 1895,
xlix., No. 31.
-Three hundred and twenty-five cases of inebriety. R. M. Phelps.
Med. Fortnightly, St. Louis, 1895, viii., 576-578.
Digitized by {jOoqi e
2
Index Medico-Pqchologicua.
Alcoholism. Delirium tremens. K. Pontoppidan. Bibliot. f. Laeger, KjBbenh.,
1896, 7 R, yi., 369-386.
-Inebriety and alcoholism among children. M. de Tours. Quart. J.
Inebr., Hartford, 1896, xvii., 222-231.
-Ueber die Delirien des AJkoholisten. H. K. Liepmann. Berl., 1896,
L. Schumacher. 32 p., 8o.
-Lesions produced by the action of ethyl alcohol on the cortical nerve
cell; an experimental study. H. J. Berkley. Am. J. Insan., Chicago,
1896-6, Hi., 10-12.
-Epileptiform inebriety. T. D. Crothers. Med. and Surg. Reporter,
N. Y., 1896, lxxiii., 363-367.
-Some facts concerning dipsomania. T. D. Crothers. Med. Rec.,
N. Y„ 1896, xlvii, 622.
- — The ophthalmoscopic appearance of the fundus oculi in delirium
tremeis. A. E. D&yis. Post-Graduate, N. Y.. 1895, x., 379-386.
-Dipsomania and hypnotism. J. G. Dill. Proc. 8oc. Psych. Re¬
search, Lond., 1895-6, xi., 18-22.
-Alcool et alcoolisme. Joffroy. Gas d’hopit., Paris, 1895, lxviii.,
237-246.
-Hysteria and alcoholism : their influences upon the child. J. H. McKee,
Philo. Polyclin., 1896, iv., 161.
-La dipsomanie dans la yille de Mexico. R. Macouzet. Atti d. xi.
Cong, med. internaz., 1894, Roma, 1895, iv., psichiat. (etc.), 95-98.
Amok. Ueber die Amok—KrankHeit der Malayan. C. Reach. Neurol.
Central., Leipz., 1895, xiv., 856-859.
Arterial system. On the degenerative lesions of the arterial system in the
insane, with remarks upon the nature of granular ependyma. C. F.
Beadles. J. Ment. Sc., 1895, xli., 32-50. 1 pi.
Asylums. Behandlung des Ineseins im allgemeinen. Emminghaus, Handb.
d. spec. Therap. inner. Krankh., Jena, 1895, v., 3. Teil. 3-81.
-Anstalt fOr Irre und Epileptische; Bericht liber die Zeit vom 1 April,
1893, bis 3 Marz, 1894. Sioli. Jahresb. u. d. Verwalt. d. Med. Wes d.
Kiankenhanst ...d Stadt Frankf., 1894, xxxvii., 91-100.
-Impressions of a flying visit to a Dutch asylum. M. D. Mucleod.
J. Ment. Sc., Lond., 1895, xli., 218-222.
-Irrenanstalten des Orients. A. Moll. Deutsche med. Wchnschr.,
Leipz. u. Berlin, 1895, xxi., 133, 162.
-The ideal hospital for the insane. R. M. Phelps. Northwest Lancet,
St. Paul, 1895, xv., 281-285.
-The future of asylum service. A. C. Clark. Internet. Cong. Char.
(etc.), Balt, and Lond., 1894, 58-65.
-Ueber zwei neue Basen im Ham von Irrenkranken. M. Krliger.
Arch. f. Physiol., Leipz, 1894, 553-555.
-Verfflgung des Ministeriums des Innera betreffend die Abanderung des
Status fflr die Staatsirrenanstalten vom 21 Januar, 1875. Med. Cor.-Bl.
d. wttrrtemb. firztl. Ver. Stuttg., 1894, lxiv., 269-271.
-Die disciplin&ren Maassrcseln in den Irrenanstalten. Kreuser. Med.
Cor.-Bl. d. wfirrtemb. ftrztl. Ver. Stuttg, 1894, lxiv., 265-269.
-Ought private asylums to be abolishad. J. F. S. Pieterson. West¬
minster Rev., 1894, cxliii., 688-694.
-Some Irish asylums. C. E. Riggs. Northwest Lancet, St. Paul, 1894,
xiv., 476-478.
-La direction de manicomios. M. Beca. Rev. med. de Chile, Sant, de
Chile, 1894, xxii., 368-388.
-Ein Gutachten fiber die Anlage und bauUche Einrichtung einer
modemen Irrenanstalt mit Berftcksichtigung der Bauanlage de nieder
6stermchischen Landesirrenanstalt m Kierting-Gugging. J. Krazatsch.
Jahrb. f. Psvchiak Leipz., u. Wien., 1894-6, adii., 303-338.
-SotaM drfects in the man&gemeiit of institutions for the insane in
Digitized by L^OOQLe
Index Medico-Psycho logicus. 3
Virginia. E. T. Brady. Virginia M. Month., Richmond, 1894-5, xxi.,
912-922.
Asylums. Die Privat-Irreuanstalt Christophsbad in Coppingen; vierter Bericht
iiber deren Bestand und Wirksamkeit in den Jahren 1888-1893. Med.
Cor.-Bl. d. wilrttemb. arztl. Ver., Stuttg., 1896, lxv., 14.
--New Craig House, Royal Edinburgh Asylum. T. S. Clouston. Edinb.
Hosp. Rep., 1895, iii., 1-6.
-Progress in the care and treatment of. the insane during the half-
century. E. Cowles. Am. J. Insan., Chicago. 1894-5, li., 10-22.
-(On the condition of the care of mentally diseased in St. Petersburg.)
V. G. Dekhtereff. Tmdi. Obsh. mask. vrach v. S. Petersb., 1894-5,
lxi., 247-254.
-11 nostro asilo dei cronici degli asili dei pazzi cronici e loro importanza.
P. Funaioli. Siena, 1895, C. Nava, 26 p., 12o.
-Vortrage iiber Irrenpflege Fiir Pfleger und Pflegerinnen sowie fui
Gebildete jedes Standes. F. Seholz. 2 Aufl., Bremen, 1895 M. Heinsiut,
140 d„ 8o.
-Hospitals for the insane and their treatment. C. Bell. Med.-Leg. J.,
N. Y., 1894-5, xii., 309-340.
-Jets over naakte verpleging. C. Bijl. Psychiat. Bl., Amst., 1895,
xiii., 221-226.
-The development of the insane asylum. Helen W. Bisscll. North¬
west lancet, St. Paul, 1895, xv., 268-271.
-Die Centralanstalt Fagerniis fiir Geisteskranke in Finnland. A. Hardh.
Allg. Ztschr. f Psychiat., etc., Berlin, 1895, lii., 385-392.
- Hospitals for the insane; their scope and design. E. J. Wells. J.
Am. M. Ass., Chicago, 1895, xxiv., 37, 84..
Automatism. Post-epileptic automatism, with reports of two cases. A. D.
Heath. Binningh. M. Rev., 1894 xxxvi., 296-299.
- Contribution a 1’etude de l’autom&tisme ambulatoire; de la dromo-
maine dcs degen4r6s. V. C. Dubourdieu. Bordeaux, 1894, 90 p., 4o,
No. 66.
Blood. The blood in the insane. J. Burton. Am. J. Insan., Chicago,
1894-5, li., 496-502.
-Les globules blancs chez les alienes. L. Roncoroni. Atti d. xi. Cong.
med. interna/.., 1894, Roma, 1895, iv., psichiat (etc.), 148.
Bones. (On pathological anatomical change in the bones of insane.) N. V.
DmitrevsKi. S. Petersb., 1895, M. Stasyulevich. 78 p., 8o.
Care. The care of the insane in Canada. C. K. Clarke. Internat. Cong.
Char (etc.). Balt, and Lond.. 1894, 134-138.
- State care of the feeble-minded. A. C. Rogers. Internat. Cong.
Char, (etc.), Balt, and Lond., 1894, 8-13.
-Care and training of the feeble-minded, being a report of 8 section
of the International Congress of Charities, etc., Chicago, June, 1893.
Edited by G. H. Knight. Balt., 1894, Johns Hopkins Press, 22p., 8o.
-Modern ideas with reference to the care of the insane. G. L. Sinclair.
Maritime M. News, Halifax, 1895, vii., 117-121.
-Erziehung und unurricht der Schwachsinnigen. E. Glaser. Med.-
p&dogog Monatschr., Ber., 1894, 321, 358.
Catalepsy. A case of catalepsy, with prolonged silence, alternating with
verbigeration. T. Waroock. J. Ment. Sc., 1895, xli., 82-86.
Chloroform. Chloroform as an hypnotic in the insane. J. P. Wade. Am. J.
Insan., Chicago, 1894-5, li., 492-494.
Colonies. (Family colonizing in the government of Yekaterinoalav.)
A. Govseyeff. Arch, psichiat. (etc.), Varshava, 1895, xxv., No. 1, 88-117.
Digitized by LjOOQle
4
Index Medico-Psychologicus.
Degenerates. Lee d6gen6r6s (6tat mental et syndromes 6pisodiques). Magnan
et Legrain. Paris, 1896, Rueff etCie., 235 p., 16o.
Delirium. Om Delirium scutum, scerligt med Hensyn til AEtiologien. H. S.
Christensen. Hosp.-Tid., Kjdbenh., 1896, 4 R., iii., 117, 166.
Delusions. Les persecutes pers6cuteurs. C. Vallon. Rev. de med.-16g.,
Paris, 1896, 1-9.
-The nature of a delusion. • J. S. Christison. J. Am. M. Ass., Chicago,
1895, xxv., 864.
Dietary. Sulla alimentazione degli alienati sitofobi. G. Antonini. Gazz.
med. di Torino, 1894, xlv., 881-884.
-■ The dietary of the N. York State Hospitals for the Insane. A. Flint.
N. York. M. J., 1894, lx., 798.
-The diatary of the New York State Hospitals. C. W. Pilgrims. Am.
J. Insan., Chicago, 1895-6, 111., 228-233.
- Notes on hospital dietaries. Ellen H. Richards. Am. J. Insan.,
Chicago, 1895 6, lii., 214-217.
-Asylum dietetics. J. D. Munson. Am. J. Insan.,Chicago, 1896-6,
lii., 58-66.
Duestrow. The mental condition of Arthur Duestrow; a report submitted
to his attorneys. C. Chaddock. J. Am. M. Ass., Chicago, 1896, 232-236.
Dual brain action, Notes on a case of. L. C. Bruce. Brain, 1896, xviii.,
p. 64.
Epilepsy. Two cases of epilepsy; headache. D. R. Brower. Internat. Clin.,
Phila., 1896, 4 s., iv., *62-166.
- Tran:natic epilepsy; operation; improvement. J. A. Hodges. North
Car. M. J., Wilmington, 1895, xxxv., 33.
-— Trephining in three cases of epilepsy ; two of the Jacksonian variety;
one due to old meningeal haemorrhage; improvement. J. T. Eskridge.
Tr. Colorado M. Soc., Denver, 1894, 343-358.
- Psychical epilepsy. S. J. Fort. Virginia M. Month., Richmond,
1894-95, xxi., 824-830.
- The nature and treatment of epilepsy, with a case of Jacksonian
epilepsy. D. Inglis. Internat. Clin., Phila., 1894, 4 s., iii., 141-147.
-A case of cardiac epilepsy. W. B. Pritchard. N. York Polyclin.,
1894, iv., 175-178.
-De Tepilepsie avec conscience. E. Hennocq. Lille, 1894, 32 p., 4o.
4 8., No. 46.
- Trephining in epilepsy. J. T. Boutelle. Virginia M. Month., Rich¬
mond, 1894-95, xxi., 813-824.
- Discussion des rapports de M. Masoin sur l’hospitalisation des
epileptiques. Bull. Acad. roy. de med. de Belg., Brux., 1894, 4 s.,
viii., 86, 154, 203, 282, 448, 654.
- Trattato clinico dell’ epilessia con speciale riguardo alle psicosi
epilettiche. L. Roncoroni. Milano, 1894, F. Vallardi, 636 p., 1 tab.,
11 pi., 12o.
-Contribute alio studio dell’ epilessia traumatica. N. Zarra. Salerno,
1895, 24 p., 8o.
-Colony for epileptics. J. Craig. Bull. Am. Acad. M., Easton, Pa.,
1895, 705.
-Contribute alio studio della epilessia tardiva. C. Rossi. Riforma
med. Napoli, 1895, xi., pt. 1, 242-245.
-On the care of epileptics. F. Peterson. Internat. Congress Char.
(etc.), Balt, and Lond., 1894, 139-148.
-On the relation of urea to epilepsy. J. N. Teeter. Am. J. Insan.,
Chicago, 1894-5, li., 330-335.
-Ueber die transitorischen Bewisstseinstdruhgen der Epileptiker in
forensischer Beziehung. E. Siemerling. Berl. klin. Wchnschr., 1895,
xxxii., 909-958.
Index Medico-Psychologies.
5
Epilepsy. Casuistiche Beitrage zur Tjehre von den epileptoiden Zustanden. F.
Straussminn. Vrtjschr. f gerichtl. Med.. Berl., 1895, 3 F., x., 80-98.
- Ein Beitrag zur Lehre von der Seelenstdrung mit Epilepsie in
gerichtl ich-medizinischer Hinsicht. Tiele. Preuss. Med.-Bearaten-ver.
off. Ber , Berl., 1895, xii., 109-119.
-Ueber die Blutcirculation im Grosshirn wahrend der Anfalle experi-
mentaller Epilepsie; nach den Beobachtungen von Dr. A. Todorski.
W. v. Bechtei ew. Neurol. CentraJbl., Leipz., 1894, xiii., 834-838.
-Ueber die Bedeutung des gleichzeitigen Gebrauchs der Bromide und
der Adonis vernalis bei Epilepsie. W. v. Bechterew. Neurol. Centralbl.,
Leipz., 1894, xiii., 838-843.
- La conscience dans les crises epileptiques. M. Bombarda. Rev.
neurol., Paris. 1894, ii., 673-677.
-Case of epilepsy due to genital irritation and cured by circumcision.
J. H. Burchard. Arch. Pediat., N. Y., 1895, xii., 35.
-Clinical lecture on epilepsv. A. J. Hall. Med. Press and Circular,
1894, n.s., lviii., 663-665.
- Traumatic epilepsy illustrated by two operative cases. J. A. Hodges.
Virginia M. Month., Richmond, 1894-5, xxi., 942-947.
- Fiirsorge fur Epiloptiker. R. Krafft. Freidreich’s Bl. f. gerichtl.
Med., Niirnb., 1894, xfv., 407-442.
- Successful treatment of the status epilepticus by bleeding. Pearson.
Lancet, 1894, ii., 1489.
-A case of right hemiplegia with epilepsy treated by trephining. T. O.
Wood and E. Cotterell. Brit. M. Jour., 1895, i., 10.
- Epilepsy and its relation to insanity and crime. A. Clurn. Cleveland
M. Gaz., 1894-5, x.. 515-526.
- Epileptiform inebriety. T. D. Crothers. Cincin. Lancet-Clinic, 1895,
n.s., xxxv., 251-256.
- A case of remarkable morbid sensory phenomena of an explosive or
epileptiform character, the result of old injuries to the head. Drapes.
f. Ment. Sc., 1895, xli., 290-295.
-Die Geistesstorungen der Epileptiker. Feige. Vrtljschr. f. gerichtl.
Med.. Berlin, 1895. 3 F.. ix., 309-325; x., 51-79.
— - Sur un cas de pliobie chez un 6pileptique neurasthenique. Isnel.
Dauplune med., Grenoble, 1895, xix., 37-42.
-Perturbamento morale di origine epilettica con emiplegia ed
emianestesia. Mandalari. Atti. d. xi., Cong med. internaz., 1894, Roma,
1895, v., med.-leg., 81-86.
- Epilettico o simulatore e delinquente? Perizia freniatrica. G. Motti.
Morgagni, Milano, 1895, xxxvii., 486-500.
-De la spontaneity impulsive des 6pileptiques. V. Parent. Arch m4d.
de Toulouse, 1895, 181-193.
- Des impulsions irresistibles des dpileptiques. [Rap.] V. Parant.
Ann de m4d. scient. etprat., Paris, 1895, v., 258-261.
-Fits following touching the head; a case published by Dr. Dunsmore
(1874). F. H. Jackson. Lancet, 1895, i., 274.
-Provision for epileptics. W. P. Letchworth. Buffalo M. and 3. J.,
1894-5, xxxiv., 18-29.
_Considerations cliniques sur I’etiologie et la nature de 1’epilepsie
tardive chez l’homme. L. Maupate. Ann. med.-psychoL, Paris, 1896,
8 s., ii., 33-84.
- Sulla torsicitA delle urine nella frenosi epilettica. G. Mirto. Atti. d.
r. Acad. d. sc. med in P^ermo (1894), 1896, 9-32.
_Some wards of the state; a study of the care of epileptics. C. E.
Riggs. Northwest Lancet, St. Paul, 1896, xv., 181-183.
— -The pupil in health and in epilepsy. W. Reber. Med. News, Phila.,
1896, xlvii., 207-210.
Digitized by
Index Medico-Psychologicus.
Epilepsy. Crise epileptoide; pouls lent transitoire. Riolacci Loire med., St.
Etienne, 1896, xiv., 167.
Arch, de
— Un cas interessant d’epilepsie. Roskam. Scalpel, Liege, 1895-6,
xlviii., 123.
— La gliosi cerebrale negli epileticci. A. Tedeschi. Rio. sper. di
freniat., Reggio-Emilia, 1894, xx., pt. 2. 332-340, 1 pi.
— De {’intoxication dans l’epilepsie. J. Voisin and R. Petit. Arch, de
neurol., Paris, 1895, xxix., 257, 359. 436; 1895. xxx., 14, 120.
— Untersnchungen uber die Geneee der epileptischen Anfalle. W. von
Bechterew. Neurol. Centralb. Leipz., 1895, xiv., 394-397.
— Dei Oliosebei Epilepsie. E. Beuler. Mfinchen med. Wchnschr., 1895,
xlii., 769.
— Un cas d’automat isme ambulatoire comitial. E. Cabacle. Arch. clin.
de Bordeaux, 1895, iv., 145-163.
-Epilessia tardiva Legli alienati di mente. A. Christiani. Arch, di
psycniat., etc., Torino, 1895, xvi., 90-99.
— Zur Pflege dor Epileptischen. 0. Dornblfith. Ztschr. f. Krankenpfl.,
Berl., 1895, xvii., 333-337.
- Some remarks on epilepsy; and the care of epileptics on the colony
plan. W. F. Drewry. Virginia M. Month., Richmond, 1894-6, xxi.,
477-492.
-State provision for epileptics. W. F. Drewry. J. Am. M. Ass.,
Chicago, 1895, xxv., 765-769.
-The public care cf epileptics by colonisation. W. M. Edwards. Tr.
Mich. M. Soc., Grand Rapids, 1805. xix., 446-456.
-La pelade post-epileptique. C. Fere. N. iconog. de la Salpetriere
Paris, 1895, viii., 214-217, 1 pi.
-Note sur un cas d’6pilepsie dont les acces debutent par des inouve-
ments professionals. C. F6re. Compt. rend., Soc. de biol., Paris, 1895,
10 s., ii., 395.
-Notes of a case of epilepsy with aphasia. F. Hay. J. Ment. Sc.,
1895, xli.. 307-319.
-Sera6iologie des impulsions irrtaistibles dee epileptiques. V. Parant.
(Abstr.) Arch. clin. ae Bordeaux, 1895, iv.. 213-237.
-Pollutions nocturnes et epilepsie; crises dEpilepsie de nature £rotique
et caract6ris£es par des pollutions. Zucarelli. Bull. soc. de m£d. ment.
de Belg., Gaud, et Leipz.. 1895, 76-78.
-Notes on epilepsy. W. F. Wilson. Northwest Lancet, St. Paul,
1895, xv., 349-353.
W. F. Drewry. J. Am. M. Ass.,
— The public care cf ei
Mich. M. Soc., Grand I
Frontal lobes. The functions of the frontal lobes. L. Bianchi. Brain, 1895,
xviii., 497.
General paralysis. The spastic and tabetic types of general paraylsis. R. S.
Stewart. J. Ment. Sc., 1895, xli.. 222-228, 1 pi.
- Case of general paralysis of the insane in a child. J. Thomson and
W. R. Dawson. Lancet, 1895, i., 397-399.
- Zur Aeticlogie und Therapie der progreKsiven Paralyse der Irren.
W. IschUch. Atti d. xi. Cong. med. internaz., 1894, Roma, 1895, iv.,
psichiat (etc.), 140-143.
-Contribution k l’6tude de Furine dans le paralysie generale. Klippel
et Serveaux. Arch, de neurol., Paris, 1894, xxviii., 365-379.
-Die Abgreuzung der allgemeiuen progressiven Paralyse. O. Bins-
wanger. Berl. klin. Wchnschr., 1894, xxxi., 1103, 1137, 1180.
- Demenza paralitica d’ origins puerperale. A. Christiani. Riforina
med., Napoli, 1894, x.. pt. 3, 772-775.
-On the pathology of dementia paralytica. H. J. Berklev. Am. J.
Insan., Chicago, 1894-5, li., 289-301.
Digitized by {joovle
7
Index Medico-Psychologicus.
General paralysis. The eye symptoms of early paresis. N. 8. Hepburn.
Am. J. Insan., Chicago. 1894-5, li., 302-309.
-Considerations on the findings in the spinal cord of three general para¬
lytics. A. Meyer. Am. J. Insan., Chicago, 1894-5, li., 374-379.
-r- Epiecrcbral hemorrhages in paresis. L. P. Clark. Med. Rec., *
N. Y., 1895, xlvii., 79.
-Syphilis et paralysie generale en Islande. E. Ehlers. Ann. de dermat.
et sypn., Paris, 1894, 3 s., v., 1336-1341.
-- Sur la pathog6)iie des attaques 6pileptiformes dans la paralysie
generale (hypertoxicite du sang). Legrain. Ann. med.-psych., Paris.
1896, 8 s., i., 98-112.
-Ueber Lahraung im Gebiete des Nerous peroneus bei progressive Para¬
lyse. Moeli. Neurol. Centralbl., Leipz., 1895, xiv., 98-104.
-Ein Fall von progressiver Paralyse complicirt durch chronische pro
gressive Ophthalmoplegie. Siemerlung. Aim. f. Psyohiat., Berl., 1§94,
xxvi., 889.
-Sulphates in the vrinc of general paralytics^ with special reference to
the seizures in this disease. J. Turner. J. Ment Sc., 1895, xli., 14-31.
-Contribution & 1’etude des rapports de la syphilis et de la paralysie
generale (paralysie generale juvenile, paralysie conjugale). Leon C.
Henri. Bordeaux, 1894, 78 p., 4o, No. 98.
- - Des fugues dans la paralysie g£n£rale. C. Berger. Arch. Clin, de
Bordeaux, 1895, iv., 25-34.
-De la paralysie g6n6rale k forme tab^tique. A. Joffroy. N. iconog.
de la Salpetriere, Paris, 1895, viii., 30-40,1 pi.
-Ueber die Zunahrne der progressiven Paralyse, im Hinblick auf die
sociologischen Factoren. R. von Krafft-Ebing. Jahrb. f. Psychiat.,
Leipz u. Wien, 1894-6, xiii., 127-143.
-De la d4menc3 paralytique dans la race ndgre. A. Cullerre. Ann
m&L-psychol., Paris, 1895, 8 s., i., 220-225.
-Ricecercbo istologiche sui gangli spinali nella paralisi progressiva degli
alienati. G. Piccolomini. Incurabli, Napoli, 1895, x., 465-476.
-Deux cas de paralysie generale juvenile avec syphilis h£r6ditaire; con¬
tribution a l’^tude des rapports de la paralysie g6n£rale et de la syphilis.
E. R4gis. J. de med. de feordeauXj 1895, xxv., 246-249.
-Syphilis et paralysie generale ; deux nouveaux cas de paralysie s6n4-
rale infantile avec syphilis hereditaire. E. Regis. Mercredi mod., Paris,
1895, vi., 241.
-Fall von Muskelatropie bei progressiver Paralyse. Riebeth. Mun-
chen med. Wchnschr., 1895, xlii, 859-863.
-Sobre urn caso de paralysia geral. F. da Rocha. Brazil, med., Rio
de Jan., 1895, 225.
-La terapia delle alterazioni del linguaggio e della scittura nella paralisi
generale. L. Roncoroni. Gior. d. v. Acad, di med. di Torino, 1895, 3 s.,
xliii., 300-308, 1 pi.
-General paralysis of the insane. (A patient’s letter.) G. Savage.
Clin, sketches, Lond., 1895, i.,'71.
-Recheichee sur les urines a la deuxieme periode de la paralysie g£n6-
rale. H. Rieder. Paris, 1895, G. Steinheil, 86 p., 8o.
-Die Friihfonn der allgemeinen progressiven Paralyse. Alzheimer.
Allg. ztschr. f. Psychiat. (etc.), Berlin, 1895, lii., 533-694.
-La delimitation de la paralysie g6n6rale. Binswanger. Arch, de
neurol., Paris, 1895, xxx., 258-262.
-Hie velationship between general paralysis and chronic renal disease.
H. C. Bristowe. J. Ment. Sc., 1895, xli., 245, 422.
-Des attaques ^pileptiformes et apoplectiformes dans la paralysie gene¬
rale. Christian. Ann, med.-psych., Paris, 1895, 8 s., i., 271-278.
-Case of general paralysis occurring in a girl aged nine-and-three-quarter
years. E. L. Dunn. J. Ment. Sc., 1895, xli., 482-486.
Digitized by {jOOQle
8
Index Medico-Psycholog icus.
General paralysis. (On hallucinations in progressive paralysis.) M. Falk.
Arch, psichi.it. (etc.), Varshav^. 1896, xxv., No. 2, 93-129.
-On the clinical and pathological relations of general paralysis of the
insane. R. Farrar. J. Ment. Sc., 1896, xli., 460-482.
-Sur un memoiie de M. le Dr. Regis concemant la paralysie generate
juvenile d’origine h4r6do-syphilitique. [Rap.] A. Fournier. Bull.
Acad, de m6d., Paris, 1896, 3 s., xxxiii., 486-494.
-Syphilis et paralysie generale. A. Fournier. Semaine med., Paris,
1894, xiv., 490.
— Les pseudo-hallucinations de la paralysie generale. Haunion. Union
m6d. du nord-est, Reims, 1896, xix., 189-1%.
-*— Tabes et paralysie g4n£rale. Hannion. Gaz. liebd. de med., Paris,
1895, xlii., 281, 293.
-Beitrag zu der Symptomatologie der progressiven Paralyse und
Epilepsie. Hillenberg. Neurol. Centralbl.. Leipz., 1896, xiv., 364, 403.
-Beitr&ge zur kenntniss der progressiven Paralyse im jugendlichen Altei
und im Senium. J. A. Hirschl. Wien. klin. Rundschau, 1896, ix., 481,
499.
-Stallstiache zusammenstellung der makroskopischen Yeranderung der
Centraluervensystems am der Leiche bei allgememer Paralyse. T. Kaes.
Allg. Ztschr. f. Psychiat., etc., Berlin, 1894-5, li., 884-938.
- Rectification historique de l’dude des rapports entre la syphilis et la
paralysie generale progressive. P. Kovalevsky. Rev. neurol., Paris,
1896, iii., 167.
-Ueber Dementia paralytica. Von Krafft-Ebing. Allg. Wien. med.
Ztg., 1895, xl., 395, 406, 415, 426.
- Progressive Paralyse im Jugendlichen Alter und progressive Paralyse
(Tabes) bei Ehelenten. F. LQhrmann. Neurol. Centralbl., Leipz., 1895,
xiv., 632-634.
.-Contribution & l’etude du r^flexe cr£mast£rien etudie chez les memes
malades aux trois p^riodes de la paralysie generale. E. Marandon de
Montyel. Arch, de physiol, norm, et path., Paris, 1896, 5 s., vii., 571
684.
- Effeti li prolungate o abbondanti suppurazioni nelli paralisi progres¬
siva con applicazione terapeutische. A. Marro e A. Ruata. Ann. di
freniat. (etc.), Torino, 1895, v., 181-187.
- L’ influenza di copiose suppurazioni per la cura della paralisi progres¬
siva. A. Marro e A. Ruata. Atti. di xi. Cong. med. internaz., 1894,
Roma, 1896, iv., psichiat. (etc.) 202.
- La diminution de poids du cerveau dans la paralysie generate;
graphiques destines 4 faire ressortir cette diminution sur le cerveau et
ses parties constitutives. A. Mercier. Mitth. a Klin. u. med. Inst. d.
Schweiz., Basel u. Leipz., 1895, 2 R., 443-487, 5 diag.
— - De la forme infantile de la paralysie generale. A. Moussons. Mitth.
a Klin. u. med. Inst. d. Schweiz, Basel u. Leipz., 1894, iii., pediat., 62-64.
-Etude sur un cas de tabes uniradiculaire chez un paralytique general.
J. Nageotte. Rev. neurol., Paris, 1896, iii., 337, 369, 401.
-Note sur un plaque de mydite si^geant dans le faisceau ant4ro-lateral
chez un tab6tique paralytique g£n6ral. Nageotte et Lenoble. Bull. Soc.
anat. de Paris, 1895, lxx., 574-577.
-Troubles oculaires dans la paralysie generale. Panas. Rev. g6n. de
clin. et de la therap., Paris, 1896, ix., pt. 2, 146.
-Notes oh a case of general paresis, with special reference to the study
of the relations between the temperature, pulse-rate, and respiration.
R. W Parsons. J. Nerv. and Ment. Dis., N. Y., 1895, xxii., 409-419.
-Gli studi recenti sulla demenza paralitica. G. Selvatico-Estense. Riv.
sper. di freniat., Reggio-Emilia, 1894, xx., pt. 2. 578-617.
— Rapport sur la these de M. Guerin, sur le r61e de Fan to-intoxication
dans la g6nese des attaques apoplectiformes et epileptiformes dans la para-
Digitized by
Index Medico-Psycholog icus. 9
lysie generate. P. S6rieux. Ann. med.'psychol , Paris, 1895, 8 s., ii.,
102-106.
Gererai paralysis. Ueber den Zusammen hang zwischen Syphilis und pro-
gressiver Paralysie. E. Sokolowski. St. Petersb. med. Wchnscnr.,
1895, n.F., xii., 155-157.
- Considerazioni medico-legili supra la paralisi generale progressiva.
O. Perrando. Atti d. xi. Cong. nied. internaz., 1894, Roma, 1896, v.,
med.-leg., 68.
- Ein Fall von circularer Form der progressiven Paralyse. Fr&nkel.
Neurol. Centralbl., Leipz., 1895, xiv., 1110-1114.
Hallucinations. Hlusioni e allucinazioni. A. Cugini. Clin, mod., Firenze,
1895, i., 326-330.
-Un degen&re persecute-persecuteur. Febvre.- Ann. med.-psych.,
Paris, 1895, 8 s., i., 287-295.
-Zwangsvorstellungen und Phobien; ihr psychischer Mechanismus und
ihre Aetilogie. S. Freud. Wien, klin., Rundschau, 1895, ix., 262, 276.
-The Bowman lecture on subjective visual sensations. W. R. Gowers.
Lancet, 1895, i., 1564, 1625.
- (Contributions to theory and pathogenesis of sensory illusions.) H.
Higier. Gaz. lek., Warszawa, 1895. 2 s., xv.. 224, 251, 282.
- (On psychical hallucinations.) V. S. Ivanova-Yakovenko. Vestnik
kliu. i sudeb. psichiat i nevropatol., St. Petersb., 1895, xi., pt. i., 203-222.
-Zur Genese de Hallucinationem. L. Kramer. Prag. med. Wchnschr.,
1895. xx., 168-170.
-Vetements et appariels protecteurs Stranges jportes de jour et de nuit
par un deg^n^re persecute*. Le Filliatre et P. Garnier. Ann. m4d.-
psych., Paris,'1895, 8 s., i., 261-271.
-Ueber eine querulirende Familie. Liebmann. Allg. Ztschr. f.
Psvchiat., etc.. Berlin, 1894-5, li., 950-953.
-Ueber den QuaruUntewahnsinn, seine nosologische Stellung und seine
forensische Bedeutung. E. Hitzig. Leip., 1895, F. C. W. Vogel,
152 p., 8o.
- La d61ire des negations: semeiologic et diagnostic. J. Scglas. Paris,
1894, G. Masson, 2o4 p., 12o.
-A psychological mystery. Bertha W. Antrobus. Med. Age, Detroit,
1895, xiii., 420-424.
- Delire systematise des grandeurs sans affaiblissement intellectual
notable chez un vieillard de uuatre-vingts ans passes. G. Ballet et F.-L.
Amand. Ann. med.-psych., Paris, 1895, 8 s., i., 161-173.
-Zur Pathologie dev acuten haJlucinatorischen Verworrenheit. E.
Beyer. Arch. f. Psychiat., Berlin, 1895, xxvii., 233-267.
—r—Paranoia qu«vrulans. P. K. Bolshesolski. Protok. i trudi Obsh.,
Archangel vrach (1894), 1895, ii.. 19. 24.
- Coexistence d’hallucinations verbales anditives (sensorielles) et d’hallu-
cinations verbales psycho-motrices; dialogue entre les voix exterieures
et interieures. P. Garnier et Le Filliatre. Ann. m4d.-psvch., Paris,
1895, 8 s., i., 79-91.
-Genese physiologique de la folie hallucinatoire. T. Luys. Ann. de
psychiat. et d’hypnol., Paris. 1895, n.s.. v., 314-318.
-Das Delirium halhicinatorium. E. Mendel. Veroffentl. d. Hufeland,
Gesellsch in Berlin Vortr. (1894), 1895, 20-31.
- Ueber die Beziehungen zwischen Zwangsvorstellungen und Hallu-
cinationem. A. Pick. Prag. med. Wchnschr., 1895, xx., 451-453.
-Genesi di alcune allucinazioni. E. Rossi. Ann. di nevrol., Napoli,
1895. xiii., 66-115.
-Ueber geometrisch qptische Tauschungen. A. Thiery. Phil. Stud.,
Leipz.. 1805, xi.. 307-370.
_Klinische Beit rage zur Lehre von deu Zwangsvorstellungen und ver-
Digitized by
10 Index Medico-Psyckologicits.
wandten psych ischen Zustanden. Thomsen. Arch. f. Psychiat., Berlin,
1896, xxvii., 319-385.
Hallucinations The haunted swing illusion. R. W. Wood. Psychol, Rev.,
Lond. and N. Y., 1895, ii., 277.
Head. Leg deformites osseuses de la tete et la deg£nerescence. A Cullerre.
Ann. m6d.-r>sych., Paris, 1895, 8 s., i., 52-61.
Heredity. De llieredit^ dans les maladies ment&les. E. Toulouse. Oaz. d.
hop., Paris, 1895, lxviii., 163-170.
-The problem of heredity in reference to inebriety. T. Morton. Quart.
J. Inebr., Hartford, 1896, xvii., 1-14.
-Morbid heredity. C. F6r6. Pop. Sc. Month., N. Y., 1895, xlvii.,
388-399.
Hypnotism. Relation of matter and mind in hypnotism. J. F. Hibberd.
J. Am. M. Ass., Chicago, 1895, xxv., 87-90.
-Ueber Schlaf, Hypnose und Sonnambulismus. M. Hirsch. Deutsche
med. Wchnschr., Leipz. u. Berl., 1895, xxi., 595.
-De quelques conditions favorisant I’hypnotisme chez les grenouilles.
E. Gley. Corapt. rend. Soc. de Biol., Paris, 1895, 10 s., ii., 518-521.
- Suggestion und reflex. Eine Kritisch-experimentelle Studie fiber die
Reflexpnaenomene des Hypnotismus. K. Schaffer. Jena, 18%, G. Fisher,
116 p., 6 pi., 8o.
-Hypnotism; how it is done; its uses and dangers. J. R. Cocke.
Bost., 1894, 378 p., 12o.
-Etude sur un cas du phenomena dit de transmission de la pensee
(expos© d’un m&thode de recherches). Laupts. Rev. de l’hypnot. et
psychol. physiol., Paris, 1894-5, ix.. 321-330.
- Hypnotic insanity. E. D. Moffett. J. Am. M. Ass., Chicago, 1895,
xxv., 814-816.
-Hypnotism at Nancy. H. T. Patrick. Chicago M. Recorder. 1895,
viii., 107-116.
-Hypnotism. C. Prentice. Med. Rec., N. Y., 1895, xlvii., 558-560.
- Du r6le social et hygienique des suggestions religieuses chez les
Hindous. P. Valentin. Rev. le l’hypnot. et psychol. phvsiol., Paris,
1895-6, x., 149-152.
-(On hypnotism and hypnotic treatment based on personal observation.)
A. Wizel. Medycyna, Warszawa, 1895, xxiii., 417-435.
Hysteria. Studies fiber Hysteria. J. Brener und S. Freud. Leipz. and
Wien, 1895, F. Deuticke, 269 p., 8o.
-Traite clinique et th4rapeutiquc de l’hyst£rie d’apr&s l’cnseignement
de la Salpetriere. Gilles de la Tourette. Preface de J. M. Charcot.
Part 2, vols 1 and 2, Paris, 1895, E. Plon, Nourrit etCie., 556; 607p.,8o.
-Sulle mamfest&zioni auricolari dell’ isterismo. G. Gradenigo. Torino,
1895, 265 p., 8o.
-Ueber Hysteria im Rindaalter. Bruns. Allg. Ztschr. f. Psychiat.
(etc.), Berlin, 1895, lii., 658-661.
-The relation of hysteria to structural changes in the uterus and its
adnexa. A. P. Clarke. Am. Gynac. and Pseaiat., Phila., 1894-5, viii.,
55-67. •
-Ueber Hysterie. S. Freud. Wien med Bl., 1895, xviii., 684.
-Hystero-epilepsy. A. M. Gossage. Westininst. Hosp. Rep., 1895, ix.,
60-62.
-D’une forme hyst^rique de la maladie de Raynaud et de l’erythro-
m61algie. L. Levi. Arch, de neurol., Paris, 1895, xxix., 1, 102, 166.
-The combination of hysteria and organic disease. H. T. Patrick.
Medicine, Detroit, 1895, i., 334-340.
-Un truffatore isterico. S. Personali. Arch di psichiat., etc., Torino,
1894, xv., 560-564.
-Hysterical syncope, hemianesthesia, rapid respiration. C. W. Burr.
Univ: M. Mag/, Phila., 1894-5, vii., 334-338. -
Digitized by ^ooQle
Index Medico * Ps ycholoyicus. ll
Hysteria. Ueber die Hemianasthesie Hysterischer. Von Krafft-Ebing. Allg.
Wien. med. Ztg., 1896, xl., 25, 38, 51.
- Des eructations hysterioues. A. Pitres. Progres med., Paris, 1895,
3 s., 17-21.
-Toss© isterica epidemica. Bozzolo. Riforma med., Napoli, 1894, x.,
pt. 4, 735-737.
-Some etiological types of hysteria. W. Browning. Brooklyn M. J.,
1895, ix., 155-161.
- Is hysteria a disease of females onlv? B. Edson. Ain. J. Obst.,
N. Y., 1895, xxxi., 170-175.
-Ueber die Selbstbeschadigung der Hysterischen. Kreeke. Miinchen
med. Wchnschr., 1896, xlii., 69-73.
-Considerations climques et therapeutiques sur Thysterie. Verrier.
France med., Paris, 1895. xlii., 115-117.
- Contribution a 1’etude du role des idees fixes dans la pathogenie de la
polyurie hysterique. A. Souques. Arch, de neurol., Paris, 1894, xxviii.
-So hock" nerveux; hysteri© monosymptomatique ; asta&ie-abasie ;
guerison. Vilcoq. Union med. du nord-est, Reims, 1894, xviii., 302-310.
-Contributo clinico alio studio dell’ isterismo traumatico. E. Arcoleo.
Gazz. med. lomb., Milan, 1894, liii., 413-416.
-D&ire de maim'eur chez une hysterique. E. Brissaud et A. Souques.
N. iconog. de la Salpetriere, Paris, 1894, vii., 327-337.
- Fievre intermittente d’origine hysterique. Coquet. Mein, et bull.
Soc. de med. et chir. de Bordeaux, 1894, 469-471.
-Tremblement hysterique. Delmas. Ibid., 426-462.
- A proposito di due isteriche. S. De Sanctis. Bull. d. Soc. Lancisiana
d. osp. di Roma, 1894, xiii., fasc. 2, 110-133.
- Hysterical stutter. B. S. Greidenberg. Vrach, St. Petcrsb., 1894,
xv., 1093-1096.
-L’hysterie consecutive aux maladies infectieuses. R. Grenier. Presse
med., Paris, 1894, 382.
-Hysteria, its simulation and combination with sexual spasms. H.
Himer. Gaz. lek.. Warszawa, 1894, 2 s., xiv., 1284, 1315, L549.
-Ueber die gegenwartige Auffassung der Hysteric. P. J. Mobius.
Monatsohr. f. Geburtsh. u. Gynaek., Berlin, 1895, i., 12-21.
- Des borborvgmes hysteriques. A. Pitres. Progres med., Paris, 1894,
2 s., xx., 493-496.
-Histerie cu abulii generalisate, mutism, lipmanie, melancholic. A.
Popescu. Spitalul, Bucuresci, 1894, xiv., 724-728.
-Isteriva (hvsteria). G. Selenski. Akuscherka, Odessa, 1894, v.,
160-166. ‘
—-Hystero-Epilepsie. 1 Fall. Jahresb. ii. d. chir. Abt. d. Spit, zu
Basel (1894), 1895, 12.
-Hvsteria. Text-book Nerv. Dis. Am. Authors. J. H. Llovd, Phila.,
1895/ 87-134.
- A study of hysteria and hvpochondriasis. C. E. Lockwood. Med.
Rec , N. Y., 1895. xlviii., 733-736.
-Un mode special de provocation de l’hvsterie. Martin-Durr. Gaz.
1. hop., Paris, 1895, lxviii., 1181, 1183.
-Hysteria. E. E. Montgomery. Internal. Clin., Phila., 1895, 5 s.,
iii., 2B7.
- Witchcraft v. hysteria. G. Pernet. Med. Mag., London, iv., 271-279.
'-Faits nouveaux relatif A la nature de 1’hysterie. P. Sollier. Atti d.
xi. Cong. med. intemaz., 1894, Roma. 1895, iv., peichiat. (etc.). 41-49.
-Un cas de isterie la un barbat. D. Tatusescu. Spitalul, Bucuresci,
1895, xv., 306.
- (Epidemic of hysterics in the county of Podolsk, 'government of
Moscow.) V. Yakoveniko. Vestnik obsh, big.* sudeb. i. pfakt. med., St.
Petersb., 1895, xxv., 4 Sect., 103-109.
Digitized by
t2
Index Medico-Psyckolog icus.
Hysteria. Hysterical amblyopia and amaurosis; report of five cases treated by
hypnotism. J. A. Booth. Med. Rec., N. Y., 1895, xlviii., 256-260.
—■— Abmagerungs wakn bei einer Hysterischen. Brissaud und Souques.
Internat. med.-phot. Monatschr., Leipz., 1895, ii., 70-77.
-Contributo alia eura dell’ istero-epilessia colla castrazione. C. Caliari.
Clin, chir., Milano, 1895, iii., 120-125.
- De Torigine gastro-intestinale des hystero-nevroses. Clozier. Gaz.
d. hop., Paris, 1895, lxviii., 1118-1120.
- Organopathies et hysterie; (irritation spinale d’origine hysterique;)
guensonj>ar la suggestion. P. Desplats. J. d. sc. mol. de Lille, 1895,
-(The manifold varieties of hysteria.) G. Donath. Orvosi hetil., Buda¬
pest, 1835, xxxix., 503-506.
- Mutismo isterico guarito con 1* eterizzazione. F. Fazio e C. Gioffredi.
Atti d. xi. Cong. raed. internaz., Roma, 1894, iii., farmacol., 107.
- Clinical lecture on hysteria and cardiac affections. Giraudeau. Med.
Week., Paris, 1895, iii., 339-341.
-Death from hysteria; report of a case. L. C. Allen. Med. Rev.,
St. Louis, 1895, xxxi., 284.
- (Death in bvsteria.) Fournier and Sollier. Jour, de m£d., Aug. 25,
1896.
- (Rare cases of hysteria in man : i. hysteria from lightning stroke, ii.
hysteria resembling disease of cerebellum.) M. B. Bliimenau. Vrach. St.
Petersb., 1895, xvi., 496-527.
- Hysteria in the male. N. P. Dandridge. Am. J. Obst., N. Y., 1895,
xxxii., 29-33.
-A case of male hysteria characterised by recurrent attacks of motor
aphasia and lethargy; apparent cure by hypnotism and suggestion. T.
Diller. Internat. Med. Mag., Phila., 1894-5, iii., 182-186.
- Zur Frage von der Hysterie bei Soldaten. W. Greidenberg. Centralbl.
f. Nervenh., u. Psvchiat., Coblenz u. Leipz., 1895, n.F.. vi., 398-402.
-A case of complete hysterical anaesthesia in the male. G. J. Preston.
J. Nerv. and Ment. Dis.^ N. Y., 1895, xxii., 475-480.
-- Some notes on hysteria, with Special reference to hysteria in the male,
and its connexion with specific organic disease of the nervous system.
A. S. Walker. Edinb. M. J., 1894-5. xl., 312-322.
-- Zwei Falle von vollsttindiger Erblindung in Folge von mannlicher
Hysteric; Heilung. A. Barkau. Festschr. z. Jubil. d. Yer. deutsch.
Aerzte zu San Fran., Calif., 1894, 10-13.
- Des rapports de 1’hysterie et de la folie. Ann. de psychiat. et
d’hypnol., Paris, 1894, n.s., iv., 260,308.
-Hysterie; confusion mentale et amnesie continue; anesthesie gene
ralisee; experience de Strumpell. J. Seglas et Bonnus. Arch, de neurol.,
Paris, 1894, xxviii., 353-365.
-Hysteria grave; cura pela psyehotherapia suggestiva. A. Barretto
Praguer. Gaz. med. da Bahia, 1894-5, 4 s., v., 97-105.
-A case of hysteria in which the breathing is almost entirely
diaphragmatic. J. Calvert. Tr. Clin. Soc., 1893-4, xxvii., 270.
-The gravity of hysteria. G. Eliot. Proc. Connect. M. Soc., Bridge¬
port, 1 m, 181-185.
-Sur une forme hysterique de la maladie de Raynaud et de l’erythro-
m41algie. S. Levi. Compt. rend. Soc. de biol., Paris., 1894, 10 s., i.,
647.
-Hysteria in the male. C. E. Lockwood. N. York M. J., 1894, lx.,
746-748.
-Hysterical pyrexia. G. J. Preston. Maryland M. J., Baltimore,
1894-6, xxxii., 133-136.
-De quelques cas d’anesth&ie gen6ralis6e dans l’hysterie. P. E. Colin.
Paris, 1894, 53 p , 4o, No. 189.
Digitized by
Index Medico-Psychologicutt.
13
Hysteria. Contribution a l’£tude de l’hysterie toxiqne (intoxication sulfo-
carbonoe). C. Martel. Paris, 1894, 58 p., 4o, No. 254.
—-Ueber hysterischo Schlafsucht. L. Ltiwenfeld. Centralbl. f. Nerrenh.
u. Psychiat., Coblenz u. Leipz., 1895, n.F., vi., 225*231.
-Sopra un caso di ipertermia isterica, con straordinaire elevazioni di
temperatiira. O. Lumbroso. Atti. d. xi. Cong. med. internaz., Roma,
1894, iii., med. int., 236-245.
- Intorno a duo interessanti casi de istcrismo e di ipnotismo; nevralgia
del 5° paio in isterica; parestesie della lingua con vomito in isterica.
C. Luraschi. Atti. d. As*, med. lomb., 1894, Milano, 1895, 340-357.
-Sopra un caso di edema bleu isterica gaurito colla suggestione ipnotica.
S. Marzocchi. Gazz. med. di Torino, 1895, xlvi., 37, 57.
-Hysterical contra?tures. S. W. Mitchell. Med. News, Phila., 1895,
lxvii., 197-232.
-Ueber die gegenw&rtige Auffassung der Hysterie. P. J. Mdbius.
Med.-chir. Centralbl., Wien, 1895, xxx., 213-216.
- Forme rare d’hystero-traumatisme. Moty. Bull. m&i. du nord.
Lille, 1895, xxxiv., 337-343.
- De la gangrene chez les hysteriques. A. Narath. Ann. de dermat. et
syph., Paris, 1895, 3 s., vi., 231.
-Cases of infection by the seeing of the eye. W. O’Neill. Med. Press
and Circ., London. 1895, n.s., lix., 643.
-Hysteria and hysterical tetanus. K. C. S. Pillai. Indian M. Rec.,
Calcutta, 1895, ix., 47.
- Hysterical or functional disease. W. B. Ransom. Brit. M. J., 1895,
1., 9J7z.
- Hysteria; cerebral manifestations. A. B. Richardson. Am. J. Obst.,
N. Y., 1895. xxxi.. 635-642.
- Hysteria and neurasthenia. A. B. Richardson. Columbus M. J.,
1894-5, xiii., 131-137.
- Ein schwerer Fall von Hysteroepilepsie. »S. H. Scheiber. Pest med.-
chir. Presse, Budapest, 1895, xxxi., o96-399.
- (lie) hvsterique. Sein. J. d. m£d. et chir. prat., Paris, 1895, lxvi.,
573,
- (Case of hysteria combined with akinesia algera). A. Shpanbok.
Arch, psichiat. (etc.). Varshava. 1895, xxv.. No. 1, 118-124. Translated
in Neurol. Centralbl., Leipz.. 1895, xiv., 530-534.
-Tympanisme hysterique chez un enfant de douze ans. P. Taitout.
J. de clin. et de therap. inf., Paris, 1895, iii., 441-443.
- Deux cas de folie hysterique d’origine infectieuse. T. Taty. Ann.
med.-psychol., Paris, 1895, 8 s., ii., 376-390.
- Un cas de gangi^ne cutanee d’origine hysterique. Veuillot. N. iconog.
de la Salpetriere, Paris, 1895, viii., 288-290, 1 pi.
Idiocy. The diagnosis and treatment of feeble-minded children, with remarks
on prognosis. F. Beach. Practitioner, London, 1895, lv., 39-46.
- De l’assistance des d£gen&res et des idiots. Bourneville. -Assistance.
Paris, 1895, v.. 97, 122, 129, 148.
—-- Traitement et education de la parole chez les enfants idiots et arricies.
Bourneville et J. Boyer. Arch, de neurol , Paris, 1895. xxx., 108-120.
- Idiotie complete congenitale aver parapl£gie compliquee de contracture
et de deformations des pieds. Bourneville et Noir. Progrcs med., Paris
1895, 3 s.. i.. 166-171.
-Sull’ imbecillismo L. Cognetti de Martiis. Puglia med., Bari, 1895,
111., 226-229.
-,— Congenital imbecility and its /-.luxation. E. French. Atlantic M.
Weeklv, Providence, 1895, iv., 33-36.
-Reisebericht ilber den Besuch einiger deutscher Idiotenaustalten. J.
Krayatsch. Jahrb. f. Psychiat-., Leipz. u. Mien, 1895. xiv., 1-80.
Digitized by ^ooQle
14
Index Medico-Psychologicus.
Idiocy. The operative treatment of idiocy. E. Lanphear. J. Am. M. A as.,
Chicago, 1895, xxiv.. 743, 783.
-Body weight and mental improvement. A. R. Moulton. Am. J.
Insan., Chicago, 1894-5, li.. 209-m
- De la necessity de creer une educa* on sptkiale et des maisons de refuge
pour les enfants degeneres, faibles d’esprit, Imbecile*, idiots ou cretins.
Kosseau Saint Phillipe et K. R6gis. J. de med. de Bordeaux, 1895, xxy.,
437.
- Assistance, traitement et education des enfants idiots et degeneres;
rapport fait au Congres national d*Assistance publique (session de Lyon,
jum 18J4). Boumeville. Paris. 1895, F. Alcan, 244 p., 8o.
-Studien fiber Klinik und Pathologic der Idiotie nebst Untersuchungei
iiber die normals Anatomie des Hirnrmde. Nach dem Tode des Verfassers
aus dem Schwedischen ubersetzt von Walter Berger und hrsg. von S. E.
Henschen. C. Hammarberg. Upsala, 1895, E. Berling, 126 p., 7 pi., 4o.
-Mentally deficient children ; their treatment and training. G. E.
Shuttle ^orth. London, 1895, H. K. Lewis. 154 p., 12o.
-The influence of heredity on idioev. M. W. Barr. J. Nerv. and
Ment. Dis., N Y., 1896, xx., 344-353; 3 tab.
-Notes on the microcephalic or idiot skull and on the macrocephalic
or hydrocephalic skull. Sir G. Humphrv. J. Anat. and Phvsiol., Lond.,
1894-5, xxix., 304-323.
Imbecility. Mental deficicncv in children. G. Mogridge. Omaha Clinic,
1894-5, vii., 450-453.
-Massenhafte motiolose Brandstiftungen, moglicherweise in praemen-
strualer manischer Exaltation von einer Imbecillcn begangen. Von Krafft-
Ebing. Freidriech's Bl. f. gerichtl. med., Niimb.. lf§4, xlv.. 453-462.
-A plea for a home for tne care and training of feeble-minded youth.
B. Jones. Tr. M. Ass. Missouri, St. Louis. 1894, 137-144.
-The colony plan for all grades of the feeble-minded. G. H. Knight.
Intdrnat. Cong. Char, (etc.), Balt, and Lond., 1894. 5-8.
Imperative ideas. On. Brain, 1895, xviii., p. 318.
Incendiarism. Les incendiaires en Savoie au point de vuc medico-legal; etude
sur la d£mence legale. J. Dumas. Ann. m6d.-psych., Paris, 1894, 7 s.,
xx., 370-400.
- Incendiario pazzo; (perizia medico-legale). Lombroso e Carrara. Arch.
di psichiat., etc., Torino, 1895, xvi., 108-112.
Insanity. A case of insanity cured by removal of a fibroid tumour of the ovary.
E. * Lanphear. South. M. Rec., Atalanta, 1895, xxv., 355-357.
-Manuele di semejotica delle malattie mentuii. Guida alia diagnosi
della pazzia per i medici i medici-legisti egli student! ? E. Morselli. Vol.
ii., Esame psicologico degli alienati. Milano, 1894, F. Vallardi. 870 p.,
10 pi., l2o.
- I riflessi superficiale e profondi quale mezzo d’ ainto diagnostics nelle
malattie mentale. C. Agostini. Riv. sper. di freniat., Reggio-Emilia,
1894, xx., pt. 2, 481-500.
-A case illustrating the importance of an accurate diagnosis in mental
diseases. D. H. Arthur. Med.-Leg. J., N. Y.. 1894-5, xii.. 486-491.
-Communicated insanity and negro witchcraft. J. W. Babcock. Am.
J. Insan., Chicago, 1894-5, li., 518-523.
— -— Consanguinity of parents in relation to idioev. M. W. Barr. Phila
Polyclin., 1895, iv.. 124.
A theory of the causation of permanent dementia. H. J. Berkley.
Med. News, Phila., 1895. lxvii., 505-506.
— Notes on a case of ataxic insanity. J. V. Blaohford. J. Ment. Sc.,
1895, xli., 486-489. _
— The gelation of diabetes to insanity. C. H. Bond. Brit M. J., 1895>
ii., 777.
Digitized by
15
Index Medieo-Psychblogicus.
Inmnity. Mental symptoms occurring in bodily disease. E. S. Reynolds.
Brit M. J., 1895, ii., 766-768.
-The recognition of incipient insanity A. B. Richardson. Tr. Ohio
M. Soc., Toledo, 1895,1., 294-304.
-The significance of motor disturbance in insanity. A. B. Richardson.
Am J. Insan., Chicago, 1895-6, lii., 153-160.
-A brief study of the physiological epochs that predispose to insanity,
with observations on the management of each. W. P. Spratling. Med.
Rec., N. V., 1895, xlviii.. 549-551.
-The difficulties of rrognosis in insanity. H. Sutherland. Lancet,
1895, i., 277-280.
-De la predisposition et des causes dites occasionnelles dans les malades
mentales. E. Tculouse. Gaz. d. hop.. Paris, 1895, lxviii., 701-707.
- (On reform in the management of insanity.) C. Geill. Ugeskr. f.
Lceger, KjObenh., 1895, 5 R., ii., 73-86.
-The influence of jccidental maladies upon the course of insanity. F.
St J. Bullen. Am. J. Insan., Chicago, 1894-5, li., 503-509.
- Intomo al decorso dell’ azione delr atropina sulla frequenza del polzo
nelle vane psicapatie. U. Stefani e L. Scabia. Riv. sper. di freniat.,
Regie Emilia, 1895, xxi., 28-38, 1 ch.
-Psychiatrische Heilbestrebungen. W. von Tauregg. Wien. klin.
Wchnschr., 1895, viii., 155-159.
- Frequent disorder of pneumogastric functions in insanity. T. H.
Kellogg. Am. J. Insan., Chicago, 1894-5, li., 196-204.
-Ueber Peptonurie bei Geisteskranken. H. Meyer und H. Meine.
Arch. f. Psychiat., Berlin. 1895, xxvii., 614-630.
-Ueber Analgesie des Ulnar is- Stammes bei Geisteskranken. 0. Snell.
Berl. klin. Wchnschr., 1895, xxxii., 914.
-Die Behandlung der Geisteskranken in den Krankenhausern. 0.
Dornbliith. Beitr. z. wissench. Med. Festschr. . . Theodor Thierfelder. . .
Leipz., 1895, 17-32.
-Ueber Geisteskrankheiten im Kindesalter. H. Comads. Arch. f.
Kinderh., Stuttg., 1895, xix., 175-216.
-Mental development and insanity of children. W. B. Fletcher.
Internat. Clin., Phila., 1895, 5 s., i., 138-147.
-Ueber angeborene moralische Degeneration odor Perversitftt des
charakters. T. Tiling. Allg. Ztschr. f. Psvchiat., etc., Berlin, 1895, lii.,
258-313
- Clinical study of the individual insane. H. A. Tomlinson. North¬
west Lancet, St* Paul, 1895, xv., 285-288.
-II deliro sensoriale cronico. D. Ventra. Atti. d. xi. Cong. med. inter-
naz., 1894, Roma, 1895, iv., psichiat. (etc.), 191-193.
-Om Amentia. J. Wideroe. Norsk. Mag. f. Lccgevidensk., Kristiania,
1895, 4 R., x., 89-114.
-An expiscation of acute delirium. H. C. Wood. Am. J. M. Sc.,
Phila., 1895, n.s., cix., 361-379.
- Confusional insanity. W. L. Worcester. Am. J. Insan., Chicago,
1894-5, li., 71-77.
-Der Gesichts aus druck des Zorns und des Unmuts bei Geisteskranken.
T. Ziehen. Internat. med.-phot. Monatschr., Leipz., 1895, ii., 225-232,
1 pi.
-Sur la n£ces8it6 de creer des institutions sp.4ciales pour les individua
inaptes 4 jouir de la liberty. J. Morel. Atti. d. xi. Cong. med. irter-
naz., 1894, Roma, 1895, iv.. psichiat. (etc.), 165-169.
- La pazzia confusionale o disnoia (confusione mentale). E. Morselli.
Gazz. a. osp , Milano, 1895, xvi., 500-502.
-— La valeur des aignes de d6g6n6r£scence dans l’etude des maladies
mentales. P. Nfccke. Atti. d. xi. Cong. med. internaz., 1894, Roma*
1895, iv., psiehiat. (etc.), 49-55.
Digitized by {jOOQle
16 Index Medico-Psychologicus.
Insanity. Locura circular. Oto y V. Esquerdo. Rev. de med. y cirug.
pract., Madrid, 1895, xxvi., 289, 333, 417.
-Le champ visuel chez les d6g£n6r6s. S. Ottolenghi. Attl d. xi.
Cong. mcxl. internaz., 1894, Roma, 1895, iv., psichiat. (etc.), 198*200.
-fi delirio ambiilatorio. Raymond. Gazz. d. osp., Milano, 1895, xvi..
1081*1083.
-La malaitia meutale del Tasso. L. Roncoroni. Arch, di psichiat.
(etc.), Torino, 1895, xvi., 436*446.
-L’ergographie des alien6s. L. Roncoroni e G. Diettrich. Arch. ital.
de biol., Turin, 1895, xxiiL, 172-174.
-I a iigestione gastrica nei sitofobi. A. Runta. Ann. di freniat. (etc.),
Torino, 1895, v., 95-101.
-Psychiatric als Exatnensfach. Sommer. Ztschr. f. socialc Med.,
Leipz., 1895, i., 150-159.
-Su alcuni caratteri dclle forme psicopatische nel mezzogiorno d’ Italia.
F. Del Greco. Ann. di nevrol., Napoli, 1895, xiii., 13-42.
-Acute mania. W. H. DewitR Cincin. Lancet-Clinic, 1895, n.s.,
xxxiv., 719-721.
- Sviluppo storico della psichiatria in Polonia e in Russia. A. Di Rothe,
Atti d. xi. Cong. med. internaz., 1894, Roma, 1895, iv., psichiat. (etc.),
34-40.
*■■■ — Discussion on the lelationship of epilepsy and insanity. Brit. M. J.,
1895, ii., 774-776. t
- Confusional insanity. W. L. Worcester. MarWand M. J.. Balt.,
1894-5, xxxii . 353-357.*
- (On the disorders of consciousness in the insane.) L. V. Blumenau.
Kazcn, 1895, 24 p., 8o.
- On hypochondriasis and nosophobia. J. Althaus. Am. J. M. Sc.,
Phila., 1895, n.s., cx., 1-13.
-Mania. G. H. Rohe. Intemat. Clin., Phil.. 1895, 4 s., iv.. 145-153.
-Johann Wasilewitsch iv., genannt der Grausame; eine psychiatrische
Studie. A. von Rothe. JahTb. f. Psychiat., Leipz. u. Wien, 1894-5,
xiii., 144-207.
-- Over psychiatrische clineken. P. F. Spaink. Nederl. Tydschr. v.
Geneesk., Amst., 1894, 2 R. xxx., pt. 2, 1182*1186.
- Insanity with homicidal tendencies, diseased pelvic organs; complete
recovery. M. B. Ward. Kansas M. J.. Topeka, 1895, vii., 32.
-Pazzia morale, simulazione, mania. L. Cognetti de Martiis. Gior.
med. d. r. esercito, etc.. Roma, 1894, xiii., 1323-1350.
-On the insane. W. J. Corbet. Intemat. Cong. Char, (etc.), Balt.
and Lond., 1894, 29-57.
——— Insanity among the natives of South Africa. T. D. Greenlees. J.
Ment. Sc., 1895, xli., 71-78.
-Observations sur les d£lires associes et les transformations du d4lire.
H. Dagonet. Ann. m^d.-psych.. Paris, 1895, 5-23.
-Krankzinnigenverpleging in Netherlandsch-Indie. T. van Deventer.
Psychiat. Bl., Amst., 1894, xii., 153-165.
-The clinical features of a physician’s certificate of insanity. W. H.
Anderson. Med. Sentinel, Portland, Oreg., 1895, iii., 6-12.
-Due casi de eritromelalgia fparalesi vasomotrice della estremita) in
alienati di mente. A. Christiani. Riforma med., Napoli, 1894. x., pt. 4,
4-8.
-Favourable modification of unfavourable symptoms in the incurable
insane A. B. Richardson. Cincin. Lancet-Clinic, 1895, n.s., xxxiv.,
12, 14.
-Forms of insanity. C. B. Burr. International Clin., Phila., 1894, iii.,
121-123; 1895, 3 s., iv., 154-161.
- - What constitutes insanity? C. H. Sers. Med. Press and Circ., Lond.,
1894, n.s., lviii., 583-585.
Digitized by
Index Medico-Psychologicua.
17
Insanity. Geistesstfirnng und Strafvollzug mit besonderer Beriick sichtigung
des periodiscben Irreseins. H. Szigeti. Friedreich’s Bl. f. gerichtl. Med.,
Niirnb., 1894, xlv, 282-344.
-Le mobilier et les instruments de travail des ali^nes pauvres et curables.
T. Taty. Arch, de neurol.. Par., 1894, xxviii, 355-392.
■■ Pszyczynek do nauki o psychozach peryodyczmych i o pojmow anin
zboczeu zmyslowych. (Contribution to theory of periodic psychoses, and
what is understood by hallucinations.) K. Rychliuski. Medycyna,
Warszawa, 1894, xxii, 951, 978, 991, 1019, 1039.
■ — Proposed change of the legal status of the insane, in accordance with
our present knowledge of the nature of insanity, for the purpose of securing
for them more rational and efficient treatment. S. Smith. Internat. Cong.
Char, (etc.), Balt, and Lond., 1894, 104-123.
’ Reform in the treatment of the insane. D. H. Tuke. Internat. Cong.
Char, (etc.), Balt, and Lond., 1894, 86-68.
■■ Defective humanity unchecked by State interference. W. Bernard.
Atti d. xi Cong. med. internaz., 1894, Roma, 1895, iv, psichiat. (etc.),
164.
• -Le funzione di relazione nella demenza. C. Bernnrdini e A. Perugia.
Riv. sper. di freniat., Reggio-Emilia, 1895, xxi, 120-135.
-- La frenosi sensoriale: sua dignita clinica; sua forma. L. Bianchi.
Atti d. xi Cong. med. internaz., 1894, Roma, 1895, iv, psichiat. (etc.), 149.
-The Lumleian lectures on the diagnosis, prognosis, and prophylaxis
of insanity. G. F. Blaudford. Brit. M. J., 1895, i, 741, 797, 855.
-Circular insanity ; report of three cases. W. F. Drewry. J. Nerv. and
Ment. Dis., N. Y., 1895, xxii, 223-230.
—-Le r61e de la medecine mentale; ce qu’il est, ce qu’il doit 5tre. H.
Francotte. Gaz. Med. de Liege, 1894-5, vii, 25, 37.
* . . Zur Kenntniss und zum Verst&ndniss milder und kurz verlanfender
Wahnformen. M. Friedmann. Neurol. Centralbl., Leipz., 1895, xiv,
448-457.
-Contributo alio studio clinico della mania ricorrente. R. Fronda.
Atti d. xi Cong. med. internaz., 1894, Roma, 1895, iv, psichiat. (etc.), 197.
-Jemima Wilkinson, “ the universal friend.” H. P. Frost. Am. J.
Insan., Chicago, 1895-6, iii, 13-22.
-Le arcate sopraccigliari ed i seni frontali nei pazzi. A. Giannelli. Riv.
sper. di freniat., Reggio-Emilia, 1894, xx, pt. 2, 425*441.
-(On acute forms of insanity.) B. S. Greidenberg. Yestnik klin. i
sudeb. psichiat. i nevropatol., St. Petersb., 1895, xi, 1 pt., 179-202.
-Les id5es fixes de forme hvsterique. P. Janet. Presse med., Paris,
1895, 201-203.
-Ueber acuten Wahnsinn. Von Krafft-Ebing. Allg. Wien. med. Ztg.,
1895, xl, 119-131.
-La pazzia nei tempi antichi e nei moderni. C. Lombroso. Arch, di
psichiat. (etc.), Torino, 1895, xvi, 404-435.
-Del ricambio materials negli alienati. A. Lui. Riv. sper. di freniat.,
Reggio-Emilia, 1895, xxi, 39-55.
— - - Des attractions morbides des nli£nes entre eux nu point de vue du
manage. J. Luys. Ann. de psychiat. et d’hypnol., Paris, 1895, n. s., v,
152-154.
■ — Des d£lires systematises dans les diverses psychoses. Magnan. Arch.
de Neurol., Paris, 1894, xxviii, 273, 433; 1895, xxix, 17-25.
—— Mania transitoria, or temporary insanity. E. C. Mann. Maryland M. J.,
Balt., 1894-5, xxxii, 59-62.
- - ■- Entwarf eines Gesetzes betreffend das Irrenwesen. Medem. Ztschr.
f. sociale. Med., Leipz., 1895, i, 137-149.
-Collective investigation in mental disease. C. Mercier. J. Ment. Sc.,
1895, xli, 449-460.
2
Digitized by {jOOQle
18
Index Medico-Psychologicus.
Insanity. Ueber Errichtung getreunter Anstalten fiir lieilbare nnd unkeilbare
Geisteskranke. Meschedc. Atti d. xi Cong. med. internaz., 1894, Roma,
1895, iv, psichiat. (etc.), 175-180.
-Sullo stato mentale di Lord Byron. G. Mingazzini. Riv. sper. di freniat.,
Reggio-Emilia, 1895, xxi, 89-102.
— Coutributi alia craniologia degli alienati. G. Mirto. Atti d. R. Accad.
d. Sc. Med. in Palermo (1894), 1895, 33-70.
- - The essentials of insanity. J. S. Christison. J. Am. M. Ass., Chicago,
1895, xxv, 666-668.
-Les sentiments et les passions dans leurs rapport avec l’alienation mentale.
H. Dagonet. Ann. mld.-psychol., Paris, 1895, 8, s. ii, 5-32.
-Ecchymosis in insanity. W. R. Dawson. Dublin J. M. Sc., 1895, c.
121-129.
-Een geval van meervondige krankcinnigheid. J. van Deventer. Psycbiat.
Bl., Amst., 1895, xiii, 227-234.
■ 1 Chronic delusional insanity with acute alcoholism. B. D. Eastman. Am.
J. In sail., Chicago, 1895-6, lii, 168-173.
-Ueber geistige Schwachezustande eigenthiimlicher Art (Kraepelin) ala
Ausgangs stadium der Paranoia. Fliigge. Allg. Ztschr. f. Psycbiat. (etc.),
Berlin, 1894-5, li, 962-970.
-Ueber die Beziehungen der patbologischen Walmbildung zu der Ent-
wickelung der Erkenntniss principien, insbesoudere bei Naturvolkern. M.
Friedmann. Allg. Ztschr. f. Psychiat. (etc.), Berl., 1895, lii, 393-432.
-The breaking strain of the ribs of the insane: an analysis of a series of
fifty-eight cases tested with an instrument specially devised by Dr. C. H.
Mercier. A. W. Campbell. J. Ment. Sc., 1895, xli, 254-274.
-A comparison between the breaking strain of the ribs of the sane and the
insane. A. W. Campbell. Brit. M. J., 1895, ii, 776.
-Weitere Untersucliungen iiber das Ulnaris-Symptom bei Geistes kranken.
W. Goebel. Neurol. Centralbl., Leipzig, 1895, xiv, 718-724.
-The effects upon mental disorders of intercurrent bodily disease. E.
Goodall and F. St. J. Bullen. Journ. Ment. Sc., 1895, xli, 232-244, 1 pi.
-The borderland on sanity and insanity, including normal and abuormal
men. T. B. Greenley. Am. Pract. and News, Louisville, xix, 1895,401,460.
-De la maladie democratique; nouvelle esp&ce de folie. Groddeek. Ann.
de phsychiat. et d’hypnol., Paris, 1895, n. s., v, 129, 176, 199, 240.
-An epidemic of religious mania originating from a case of spurious
pregnancy. J. G. Havelock. Edin. Med. Journ., 1894-5, xl, 261-263.
■ ■ Some mental states associated with visceral disease in the sane. H.
Head. Brit. Med. Journ., 1895, ii, 768.
■■ Un caso di demonopatia: considerazione sulla patogenesi e natura di
questa forma mentale. C. Bonfigli. Riv. sper. di freniat., Reggio-Emilia,
1894, xx, pt. 2, 341-360.
-Some current errors respecting insanity. C. B. Burr. Tr. Mich. Med.
Soc., Grand Rapids, 1895, xix, 15-39.
-La folie du Tasse. Cabanas. Cliron. med., Paris, 1895, i, 289-297.
-A case of insanity consecutive to ovaro-salpingectomy. E. Regis. Internat.
Cong. Char, (etc.), Balt, and Lond., 1894, 91-99.
-The boarding-out system in Scotland. C. E. Riggs. Am. Journ. Insan.,
Chicago, 1894-5, li, 319-329.
-Communicated insanity. C. W. Pilgrim. Pop. Sc. Month., New York,
1894-5, xlvi, 828-833.
-Insanity with homicidal tendencies; diseased pelvic organs ; complete
recovery. M. B. Ward. Internat. M. Mag., Phila., 1895-6, iv, 427.
-A review of the influence of reflex and toxic agencies in the causation of
insanity and epilepsy. F. St. J. Bullen. Journ. Ment. Sc., 1895, xli, 187-202.
-Heredity in insanity. R. H. Chase. Maryland Med. Journ., Balt., 1894-5,
xxxii, 430-433.
Digitized by {jOOQle
Index Medico-Psychologicus.
19
Insanity. Symptomatology de la confusion men tale primitive idiopathique.
Cbaslin. Progrfcs mdd., Paris, 1895, 3 s., i, 129-131.
-Traumatischer Blodsinn in Folge einer Kopfverletzung; partielle oder
Totale Erwerbsunfahigkeit. Dietriclj. Ztschr. f. Med.-Beamte, Berlin,
1895, viii, 157-163.
- l)e la folie post-operatoire et de la manie des operations chirurgicales
(mania operativa passive) chez certains n£vropathes. Glorieux. Ann. de la
Policlin. de Paris, 1895, v, 140-151.
-Ancora sui rapporti tra la pazzia ed i traumi. Roscioli. Cron. d.
manic, de Teramo, 1895, iii, 25-27.
-Uterine malposition and disease as a cause of insanity. S. R. Shepherd.
Yale Med. Journ., N. Haven, 1894-5, i, 49-59.
Insanity, jurisprudence of. The irresponsibility of the insane under the laws of
France. V. Parent. Internet. Cong. Char, (etc.), Balt, aud Lond., 1894,
69-80.
-On doubtful responsibility of the insane in court. I. J. NaumofF.
Nervol. Vestrick., Kazan, 1894, ii, pt. 3, 59*84.
-Brief mention of a few cases of nervous and mental malady involving
medico-legal questions. I. C. Rose. Boston M. and S. J., 1895, cxxxii,
173-176.
-La m5decinel6gnle des alien£s en Italie. P. Moreau. Aun. med.-psych.,
Paris, 1895, 8 s., i, 36-51.
-The lunacy administration of Scotland, 1857-92. J. S. Clouston. Internat.
Comr. Char, (etc.), Balt, and Lond., 1894, 1-12.
■■ Gutachten iiber einen reinen Fall von Irresein mit Zwangsvorstellungen
und Zwangshaudlungen. C. Werner. Vrtlzschr. f. gerichtl. Med., Berlin,
1895, 3 F., ix, 326-331.
-The plea of insanity as a defence for crime. B. L. Wyman. Alabama
M. and S. Age, Anniston, 1894-5, vii, 221-228.
--In causa d* omicidio commesso da un paranoico: studio medico-legale.
S. Ziino. Gior. internaz. d. sc. med., Napoli, 1895, n. s., xvii, 12, 51.
-Ueber einen interessanten Crimimilfall. Lougard. Allg. Ztschr. f.
Psychiat. (etc.), Berlin, 1894-5, li, 953-962.
-Homicide and suicide. J. E. McCrag. Kansas, M. J. Topeka, 1895, vii,
589-592.
-iStat mental des d6g6n6r&. Magnan. Progres med., Paris, 1894, 2 8.,
xx, 185, 201, 289; 1895, 3 s., xxi, 65, 81, 97, 257.
-Some points relating to the medical jurisprudence of insanity. E. C.
Mann. Times and Reg., Phila., 1895, xxx, 241-245.
-Simulation von Gedachtnissschwache. A. Mercklin. Vrtljscbr. f. gerichtl,
Med., Berlin, 1895, 3 F., x, Suppl., 79-94.
■■■ - Sullo stato mentale di Pall. Ang. imputato di truffe (recidivo per la
8 a volta) ; contributo alio studio dell* imbecility morale). G. Mingazzini.
Gior. di med. leg., Lanciano, 1895, ii, 5-22.
- — Zur Wiederaufhebung der Entmiindigung. Mittenzweig. Ztschr. f,
Med.-Beamte, Berlin, 1895, viii, 181-192.
■ Degenerazione psichica criminality e mobility da alcoolismo. R. Nardelli.
Atti d. xi Cong. med. internaz., 1894; Roma, 1895, iv, psychiat. (etc.),
132-135.
- Rapport sur l’5tat mental du Sieur A— inculp5 d’ontrages aux moeurs;
perversions sexuelles; exhibitionnisme. Rayneau. Aun. m^d.-psychol.,
Paris, 1895, 8 s., i, 387-393.
-A discussion on insanity in relation to criminal responsibility. Brit.
Med. Journ., 1895, ii, 769-773.
■ Omicidi, pazzi comuni e pazzi omicidi. E. Ferri. Scuola positiva,
Roma, 1894, iv, 948-952.
-Betrachtuncen 'zum Aachener Process (Fell Mellage-Forbes). Fiirer.
Irrenfreund, Heilbr., 1895, xxxvii, 65-73.
Digitized by
20
Index Medico-Psychologicus.
Insanity, jurisprudence of. Evidence of sanity in criminal cases. J. G.
Kiernan. Alienist and Neurol., St. Louis, 1895, xiv, 117-140.
, - (Forensic psychiatry.) P. J. Kovalevski. Arch, psychiat. (etc.), Vorshava,
1895, xxv. No. 1,1-76.
Zweifelhafter Geisteszustand einer jugendlichen mehrfachen Brandstif-
•in. R. von Krafft-Ebing. Friedreich’s Bl. f. gerichtl. Med., Nurnb.,
nir _l_i IKK
les ali4n£s. Larroussinie. Progrfes m&L,
terin
1895, xlvi, 155-170.
— Sur la dissimulation chez
Paris, 1895, 8 s., ii, 177-182.
Des alien^s criminels. C. Lefevre. Chron. m6d., Paris, 1895, i, 827-335.
Sittlichkeitsverhrechen und Geistesstdrung. E. Siemerling. Med. Cor.-
_v st_ii IT-.- 1DQR Ww 9A1
G. B. Yerga
■ 1 111 OJ bVULUAClWD f W w* vvmv- ^ -O' -
Bl. d. Wiirttemb. firztl. Ver., Stuttg., 1895, lxv, 241-246.
_In causa di mancato omicidio; perizia medico-psichiatrica.
e F. Mari. Anomalo, Napoli, 1894-5, vi, 24-34.
_The insane and the law (etc.). E. Pitt-Louis, R. Percy Smith, and F. A.
Hawke. London, 1895, J. and A. Churchill, 450 pp., 8vo.
_Mental inhibition, or self-control; and its relation to legal responsibility.
C. Stover. Amstd., New York, 1895, 11 pp., 8vo.
—— Insanity among criminals. H. E. Allison. Am. Journ. Insan., Chicago,
1894-5, li, 54-63. . __ . . . . A . .. . ,. . , . x
_Due gozzuti cretinosi cnminali. G. Antonim. Arch, di psichiat. (etc.),
Torino, 1895, xvi, 554-569.
■ La simulazione di pazzia in rapporto alia medicina legale.
__j j: lftOK
Gazz. med. di Torino, 1895, xlvi, 617, 637, 667.
• In causa di omicidio volontario premeditato,
• _ ■« p n io m oi on
M. Carrara.
Di&rio d. San Benedetto in
Pesaro, 1895, xxiv, 1, 5, 9, 13, 17, 21, 25. . _
_ X new departure in medical jurisprudence. J. B. Chapin. Am. Journ.
Insan., Chicago, 1894-5, li, 145-150. ,
_Imputirte Geisteskrankheit. Chlumsky. Yrtljschr. f. genchtl. Med.,
Berlin, 1895, 3 F., x, suppl., 95-102.
_The legal responsibility of the physician upon whose certificate a sane
person is committed to an insane asylum. M. V. B. Clark. Omaha Clinic,
1894-5, vii, 311-313.
-Evidence of sanity in criminal cases.
Neurol., St. Louis, 1895, xvi, 1-21.
J. G. Kiernan. Alienist and
Katatonia. A well-marked case of Kahlbaum’s so-called katatonia. L. W.
Dodson. Med. Rec., N. Y., 1895, xlviii, 25.
Laboratory. Laboratory of the McLean Hospital, Somerville, Mass. G. S.
Hall. Am. J. Insan., Chicago, 1894-5, li, 358-364, 2 pi.
Lunacy. Er en Reform paa vort Sindssygevceseus Omraade nodvendig? C.
Geill. (Is a reform necessary in everything connected with lunacy in our
country P) Ugesk. f. Loeger, Kjbenb., 1894-5. R., i, 1006, 1036, 1053.
, Lunacy administration in Berlin and in Scotland, with special reference
to the care of the insane in private dwellings. J. Sibbald. J. Ment. Sc.,
1895, xli, i, 202. wi _ _ . c . , , T
Lunatics Einige Mittlieilungen uber den heutigen Stand des Irrenwesens in
England und Schottland. W. Koenig. Allg. Ztsclir. f. psychiat. (etc.), Berlin,
1895, lii, 229-257. . J . .. ,. r .
Lungs. A study of the degenerative and destructive diseases of the lungs
among the insane. H. A. Tomlinson. Internat. M. Mag., Phila., 1895-6,
iv, 101-109.
Medical. Medical work in wards of hospitals for the insane. P. M. Wise. Am.
Journ. Insan., Chicago, 1895-6, lii, 1-9. .
Medico-psychological. A half-century of American medico-psychological
literature. G. A. Blumer. Am. J. Insan., Chicago, 1894-6, li, 40-50.
Digitized by {jOOQle
Index Medico-Psychologicus.
21
Melancholia. Three cases of recovery from melancholia after unusually long
periods. J. Neil. J. Ment. Sc., 1895, xli, 86-89.
-- Ein Fall von Melancholie; drei F&lle von Paranoia. F. Scholz. Inter¬
nal ined.-phot. Monatsschr., Leipz., 1894, 1, 293-297.
-Melancholia; synonyms, psychalgia and lypemania. F. A. Todd.
Toledo M. and S. Reporter, 1895, viii, 22-36.
— Report of a case of melancholia atonita. T. E. Bamford. J. Nerv. and
Ment. Dis., N. Y., 1895, xxii, 357.
— -The Cavendish lecture on dreamy mental states. Sir J. C. Browne.
Lancet, 1895, ii, i, 73.
—La melancholie. A. de Jong. Atti d. xi Cong. med. intemaz., 1894;
Roma, 1895, psichiat. (etc.), 55-60.
-A discussion on the treatment of melancholia. Brit. M. J., 1896, ii,
760-766.
■ Simple melancholia. H. Elliott. Med. Rec., N. Y., 1895, xlviii, 477-
480.
«— -Melancholia, with special reference to its characteristics in Cumberland
and Westmorland. W. F. Farquharson. Lancet, 1895, ii, 722-725.
— -Four typical cases of melancholia : melancholia with imperative suicidal
impulses; melancholia attonita; melancholia agitata; melancholia with
stupor. C. F. Kieffer, Med. News, Phila., 1895, lxvi, 659-662.
— Ueber Melancholie. Von Krafft-Ebing. Allg. Wien. med. Ztg., 1895, xl,
247, 257, 269, 281.
— Ueber die Beziehungen zwischen Melancholie und Verriicktheit. H.
Schloss. Jahrb. f. Psychiat., Leipz. u. Wien, 1895, xiv, 114-131.
— Melancholia; with report of cases. F. H. Stephenson. N. York M. J.,
1895, Ixii, 104-107.
Mental medicine. A practical mannal of mental medicine. 2nd ed. E. Regis.
Transl. by H. M. Bannister. Phila., 1895, P. Blakiston, Son, and Co., 708
pp., 12mo.
Mental state. The mental state as conducive to organic disease. G. S. Brown.
Med. News, Phila., 1895, lxvii, 91-95.
Mental stupor. Mental stupor as a pathological entity. J. R. Whitwell.
Brain, 1895, xviii, p. 66.
Methods. Laboratory methods. R. G. Cook. Am. J. Insan., Chicago, 1894-5,
li, 459-471, 4 pi.
Obsessions. Obsessions et phobies; leur mecanisme psychique et leur Itiologie. S.
Frend. Rev. neurol., Paris, 1895, iii, 33-38.
Pain. A study of the origin and nature of pain. H. G. Matzinger. Buffalo
M. J., 1895-6, xxxv, 137-144.
Paranoia. A paranoiac conspiracy. W. C. Krauss. Am. J. Insan., Chicago,
1894-5, li. 351-357.
--Paranoia in some of its clinical aspects. J. Collins. Yale M. J., N.
Haven, 1894-5, i, 143-154.
-Paranoia as a term of the old alienists. J. G. Kiernan. Rev. Insan. and
Nerv. Dis., Milwaukee, 1894-5, v. No. 1,1-3.
-Ein Beitrag zur Lehre von Querulantenwahn. G. Aschaffenburg.
Centralbl. f. Nervenh. u. Psychiat., Coblenz and Leipzig, 1895, n. F., vi,
57-63.
— A case of paranoia, with a study of the cerebral convolutions. H. J.
Berkley. J. Hopkins Hosp. Bull., Balt., 1894, v. 130-133.
-Ueber einen Fall von gerinngrndiger chronischer Compression der Medulla
oblongata und des obersten Halsmarks durch den Proc. odontoid bei einem
Paranoiker; zugleich ein Beitrag zur Entstehung der Wahnideen durch
Allegorisirung kdrperlicher emptindungen. Vorster. Allg. Ztschr. f.
Psychiat. (etc.), Berlin, 1895, lii, 314-336.
Digitized by {jOOQle
22
Index Medico-Paychologicus.
Paranoia. Anatomische Untersuchungen des Centralnervensystems bei chroniseher
Paranoia. B. Feist. Arch. f. path. Anat. (etc.), Berlin, 1894, cxxxviii,
443-481, 1 pi.
-A case of moral insanity. E. Gorton. Am. J. Insan., Chicago, 1895-6*
Hi, 199-206.
-Paranoia impotentia hypochondriaca. C. H. Hughes. Alienist and
Neurol., St. Louis, 1895, xvi, 284.
-Les delires plus ou moins coh£rents d£sign6s sous le nom de paranoia.
P. Keraval. Arch, de neurol., Paris, 1894, xxviii, 475; 1895, xxix, 25, 90,
187, 274.
-Zur Psychopathologie der chronischen Paranoia. R. Sandberg. Allg.
Ztschr. f. Psychiat. (etc.), Berlin, 1895, lii, 619-654.
-Paranoia secondaria. W. Steele. N. York Polyclin., 1895, vi, 261-264.
-Moral paranoia. M. W. Barr. Alienist and Neur., St. Louis, 1895,
xvi, 272-284.
-Ueber die schriftstellerische Thatigkeit iin Verlaufe der Paranoia. A.
Bebr. Samml. klin. Yortg., n. F., Leipz., 1895, No. 134 (Innere Med., No.
40, 369-392, 2 L.).
-Nuove riclierche nuove considerazione snl campo visivo dei pazzi morali.
S. de Sanctis. Riv. sper. di freniat., Iieggio-Einilia, 1894, xx, pt. 2, 397-
424, 1 pi.
-Querulantenwahn; Paranoia und Geistesschwache. F. Gerlach. Allg.
Ztschr. f. Psychiat. (etc.), Berlin, 1895, lii, 433-453.
Pathological anatomy. The condition of the gcmmules or lateral buds of the
cortical neurodendron in some forms of insanity. H. J. Berkley. Johns
Hopkins Hosp. Bull., 1895, vi, 68.
-(Microscopical changes in the brain of an insane woman.) L. V.
Blumenau. Protok. zasaid. Obsli. psychiat. v. St. Petersb. (1893), 1895,
28-35.
-Sull* anatomia pathologica degli element! nervosi in diversi frenosi e
specialmente nella frenosi epilettica, V. Irelli. Ann. de freniat. (etc.),
Torino, 1895, v, 156-166.
-Sur les fines alterations de l’dcorce cdr^brale dans quelque maladies
mentales. R. Colella. Atti d. xi Cong. med. internaz., 1894; Roma, 1895,
iv, psichiat. (etc.), 105-107.
-(Certain abnormalities of convolution and structure in the brains of the
insane.) W. L. Andriezen. Lancet, 1895, i, 1058.
-Pathological conditions accompanying mental defects in children.
A. W. Wilmartli. Internat. Cong. Char, (etc.), Balt, and Lond., 1894,
14-22.
Pathology. The pathology of the acute insanities. A. B. Richardson. Cincin,
Lancet Clinic, 1895, n. s., xxxiv, 355-361.
-Pathology of the nervous system in relation to mental disease. J.
Middlemass and W. F R.obertson. Edin. M. J„ 1894-5, xl, 509-518.
-Przyczynek do patologie padaczki polowicznej. Contribution a la patho¬
logic de rh6mi-6pilepsie. W. S. Zawadzi. Medycyna, Warszawa, 1894-5,
xxiii, 21*24.
-The pathology of mind. H. Maudsley. 2nd ed., 1895, Macmillan and
Co., 582 pp., 8vo.
-On some of the newer aspects of the pathology of insanity. W. L.
Andriezen. Brain, Lond., 1894, xvii, 548-692.
-(Pathology of shock, pain, and fear.) J. Sikorski. Irudi. Obsh. Eievsk
vrach., Kiev., 1895, i, 1-14.
Phthisis. Insanity and phthisis, their transmutation, concurrence, and co¬
existence. H. A. Tomlinson. J. Nerv. and Ment. Dis., N. Y., 1895, xxii,
643-661.
Physiognomy. fitude de la pliysionomie cliez les nli£n£s. L. Mongeri. Internat.
med.-phot. Monatsschr., Leiz., 1894, i, 353-360.
Digitized by
Google
Index Medico-Psychologicus.
23
Psychiatry. Ueber den Entwickelungsgang der Psychiatrie und iiber die
Bedeutung des psychiatrischen Untersuchts fur die wissenscliaftliche und
praktisclie Ausbildung der Aerzte. F. Meschede. Deutsche raed. Wchnschr.
Leipz. u. Berl., 1895, xxi, 37, 60.
-Role and importance of psychiatry in contemporary science and life.
N. M. Popoff. Kazan, 1894, B. Bashmakoff, 22 pp., 8vo.
-De jongste phase in den strijd om bet bestaan van bet psychiatrisch
onderwijs in Nederland. C. Winkler. Nederl. Tijdschr. v. Geneesk., Amst.,
1894, 2 R., xxx, pt. 2, 666-680.
-Kompendium der Psychiatrie fur Studirende und Aerzte. Otto Dom-
bliith. Leipzig, 1894, Veit & Co., 176 pp., 2 pis., 16tno.
-Modern medico-psychology and psychiatry. T. S. Clous ton. Hospital,
Lond., 1895, xviii, 337.
Psychic paralysis. S. McClelland. Med.-leg. Journ., New York, 1894*5, xii,
300-308.
-Psychic paralysis. S. McClelland. Bull. Psychol. Sect. Med.-leg. Soc.,
New York, 1894, ii, 81-89.
Psychology. Note de psychologic morbide comparoe: l’immobilitd du cheval.
C. Fer5. Rev. neurol., Paris, 1895, iii, 38-40.
Pulse. The pulse in insanity. T. H. Kellogg. Geneva, 1895, W. F. Humphrey,
13 pp., 8vo.
Relations. The relations of mental and physical disease. J. M. Mosherl
Med. Rec. New York, 1895, xlvii, 390-396.
Self-mutilation. Deux cas typiques d’automutilation. Derome. Union m&L
du Canada, Montreal, 1895, n. s., ix, 459.
Sexual perversions. Die Entwickelung der Homosexualitat. Autorisirte ueber
Zetzung aus dem Franzosischen. M. A. Raffalovicb. Berlin, 1895, Fischer,
39 pp., 8vo.
-(Secret vices.) Tainuii porok [pt. 2]. Moskva, 1895, I. D. Sin tin,
54 pp., 8vo.
-Sexual perversion in the female. A. J. Bloch. Proc. Orleans Parish
M. Soc., 1894, N. Orl., 1895, ii, 70-76.
-Anomalie del sentimento sessuale in un degenerato. L. Borri. Ann. di
freniat. (etc.), Reggio-Emilia, 1895, xxi, 82-88.
—--Sexual inversion in women. H. Ellis. Alienist and Neurol., St. Louis,
1895, xvi, 141-158.
-L’ivresse erotique. C. F5r& Rev. de m6d., Paris, 1895, xv, 553-558.
-How to diagnosticate sexual deraugements in the male. E. Fuller. Ann.
Med.-Surg. Bull., New York, 1895, viii, 1156-1159.
-Pervertis et invertis sexuels; les fetichistes ; observations m&lico-16gales.
P. Gamier. Ann. d*Hyg., Paris, 1895, 3 s., xxxiii, 349, 385.
--Neuer Beitrag zurTheorie des Homosexualismus. A. litis. Aerztl. Centr.-
Anz., Wien, 1895, vii, 338.
-Tentatives de viol; folie impulsive Erotique et paralysie g^nerale alld-
guees ; responsibility du prevenu; condamnation. S. Gamier. J. de m5d. de
Paris, 1895, 2 s., vii, 522-525.
-Beitriige zur Kenntniss des Masochismus. R. von Krafft-Ebing. Cent
tralbl. f. d. Krankh. d. Hern u. Sex.-Org., Leipzig, 1895, vi, 353-360.
-Enqu£te sur les fonctions cer^brales normales ou devices. Laupto.
Arch, d’anthrop. crim., Lyons and Paris, 1894, ix, 101, 209, 365, 728 * 1895,
x, 128, 228, 320.
-Une perversion de Pinstinct, Pnmour morbide; sa nature et son traite-
ment. Laupto. Ann. m^d.-psych., Paris, 1895, 8 s., i, 174-182.
-Des anomalies de Pinstinct sexuel et en particular des inversions du sens
genital. Legrain. Ann. de la Policlin. de Paris, 1895, v, 289*314.
Digitized by {jOOQle
24
Index Medico-Psychologicus.
Sexual perversions. Observation de sexualitd pathologique feminine. [Transl.]
A. MacDonald. Arcli. d’anthrop. crim., Lyons and Paris, 1895, x, 293-
303.
•-Etudes de psychopathic sexuelle. Minime. Rev. de m&l.-leg., Paris,
1895, ii, 250-252.
--Sexual abuse in the male. J. P. Nolan. Med. Tribune, N. Y., 1896, ix,
399, 635.
-- Rapport m6dico-legal sur un cas de perversion du sens genital. Pacotte
et Raynaud. Arch, d’anthrop. crim., Lyons and Paris, 1895, x, 435-
444.
— ■ (Jranism, congenital sexual inversion; observations and recommenda¬
tions. M. A. Raffalovich. J. Comp. Neurol., Granville, O., 1895, v, 33-65.
1 ■ Sur un cas de p6d6rastie. L. Schoofs. Rev. de m5d.-l£g., Paris, 1895,
ii, 101-104.
-Ein Beitragzur Aetiologie der contraren Sexualempflndung. Yon Schrenck-
Notzing. Klin. Zeit.- u. Streitfragen, Wien, 1895, ix, 1-36.
--Masturbation in the adult. E. J. Spratling. Med. Rec., N. Y., 1895,
xlviii, 442.
-Etudes de psychopathic sexuelle; le coit chez les enfants. [Transl.]
W. Stekel. Rev. de med.-l^g., Paris, 1895, ii, 189-194.
— -Fetichiste honteux ; rapport medico-legal. C. Vallon. Ann. d’liyg.,
Paris, 1895, 3 s., xxxiv, 547-554.
— -Offesa publica al pudore. P. Viazzi. Arch, di psichiat. (etc.), Torino,
1895, xvi, 36-56.
— -P&ruafetischismus egy esete [a case of pillow fetichism]. M. Wohl.
Gydgyaszat, Budapest, 1895, xxxv, 388.
— -Le modiflcazioni dell’ istinto sessuale. Zero. Unione med., Catanzaro,
1894, 65-68.
--L’affaire Oscar Wilde. M. A. Raffalovich. Arch, d’anthrop. crim.,
Paris, 1895, x, 445 477.
Statistics of Insanity. Increase of mental unsoundness; a view of Dr. Wallace’s
paper. A. N. Denton. Texas M. J., Austin, 1894-5, x, 646-656.
— --Sulla durata della pazzia; dati stntistici e considerszioni sul movimento
del Manicomio di S. Niecold in Siena del lo Gennaio 1864 al 31 Decembre
1894. A. Lachi. Cron. d. manic, di Siena, 1895, xxi, 79, 95, 115.
— --Statistics concerning insanity. E. B. Lane. Boston M. and S. J.,
1895, cxxxiii, 161-163, (discussion) 167-169.
-Statistique de la consultation des maladies mentales a la Clinique de la
Faculty de M6decine, janvier—juillet 1895. A. Remond. Arch. med. de
Toulouse, 1895, 16-26.
--The increase of insanity and some of its causes. S. E. Smith. Pop.
Health Mag., Wash, and Balt., 1895-6, iii, 428-431.
— -in relation to the increase of insanity. H. P. Stearns. Yale M. J.,
N. Haven, 1894-5, vii, 15-23.
" Reflections upon the increase of mental unsoundness. D. R. Wallace.
Texas M. J., Austin, 1894-5, x, 569-585.
— -Statistics of insanity in New South Wales considered with reference to
the census of 1891. C. Ross. Internat. Cong. Char, (etc.), Balt, and
Lond., 1894, 81-90.
Alleged increasing prevalence of insanity in Scotland. Suppl. to 36th
annual report Gen. Board Commiss. in Lunacy, Edinb., 1895, Neill and
Co., 108 pp., 8vo.
■ Beitrag zur Erblichkeitsstatistik der Geisterkranken im Canton Zurich.
Vergleichung derselben mit der erblichen Belastung gesunder Menschen
durch Geistes stdrungen u. dgl. [Zurich], Berlin, 1895, Arch. f. Psychiat.,
xxvii, 268-294.
— Geschichte der Psychiatric in Russland. A. von Rothe. Leipz. and
Wien, 1895, F. Denticke, 104 pp., 8vo.
Digitized by
Index Medico-Psychologicus.
25
Statistics of insanity. The increase of insanity in Virginia, and practical
suggestions for the care and maintenance of insane people by the State.
J. S. Appcrsou. Virginia M. Month., Richmond, 1894-5, xxi, 301-318.
-A review of the last twenty years at the Worcester County and City
Lnnatic Asylum, with some conclusions derived therefrom. £. M. Cooke.
J. Ment. S.. 1895, xli, 387-408.
Stupor. Contribution k l’etude clinique de la stupeur. Capitan et Kortz. M£d.
mod., Paris, 1895, vi, 632.
Suggestion. Mental suggestion as an aid in the treatment of morphinomania.
S. H. Green. Virginia Med. Monthly, Richmond, 1895-6, xxii, 393-397.
Suicide. Validity contestata del testamento di un suicida; perizia psichiatrica.
L. Bianchi. Gior. med.-leg., Lanciano, 1895, ii, 145-163.
-Note sur l’amnesie retrograde apres les tentatives de suicide par
pendaison. E. Regis. Arch. clin. de Bordeaux, 1894, iii, 515-523.
-II sucidio negli alienati. G. Antonini. Boll. d. Soc. med. prov. di
Bergamo, 1895, vi, 49-54.
-Opium suicides. J. A. Greig. China M. Miss. J., Shanghai, 1894, viii,
175.
Syphilis. Folie secondaire cliez une d4g6ndree syphilitique presen tan t de l’art^rio-
sclerose, une affection cardiaque et de ralbuminuric; diagnostic avec la
paralysie gdnerale. Joffroy. Bull, med., Paris, 1894, viii, 1019-1021.
Thyroid feeding. Observations on the effect of thyroid feeding in some forms
of insanity. L. C. Bruce. J. Ment. Sc., 1895, xli, 50-71.
-Observations of the effect of thyroid feeding in some forms of insanity.
L. C. Bruce. Edinb. Hosp. Report, 1895, iii, 484-494.
-Thyroid feeding in some forms of mental trouble. C. R. Clarke. Am.
J. Insan., Chicago, 1895-6, Iii, 218*227.
-A case of chronic insanity which recovered uuder thyroid treatment.
C. C. Easterbrook. Brit. M. J., 1895, i, 698.
Treatment. What improvements have been wrought in the care of the insane
by means of training schools? C. B. Burr. Commitment . . . insane,
Internat. Cong. Char, (etc.), Balt, and Lond., 1894, 124-133.
-Revue de Th^rapeutique appliquee au traitement des maladies mentales.
A. Lailler. Ann. med.-psycliol., Paris, 1895, 8 s., ii, 227, 391.
-Higiene general de la locura. G. Lopez. Crdn. med.-quir. de la Habana,
1895, xxi, 591, 619.
-Routine medication in asylum practice. W. A. McClain. Med. Rec.,
N. Y., 1895, xlviii, 516-518.
-The care of the insane and the treatment and prognosis of insauity.
P. L. Murphy. North Car. M. J., Wilmington, 1895, xxxvi, 68-80.
-Des ressources de la th^rapeutique et de Thygidne en pathologic mentale.
Moreau. France mdd., Paris, 1895, xlii, 257-260.
-(The influence of feverish symptoms artificially brought on in the cure
of insanity.) B. Nagy. Orvosi Netil., Budapest, xxxix, 100.
-Zur Behandlung der Unreinlichen. G. Nache. Allg. Ztschr. f. Psychiat.
(etc.), Berlin, 1895, Iii, 373-384.
-Mechanical restraint in the treatment of the insane. J. F. G. Pie terse n.
Med. Mag., London, 1895, iv, 442-453.
---Des injections de liquide testiculaire et de phosphate de sonde dans le
traitement des maladies mentales. Legrain et Bourdin. Ann. de la Policlin
de Par., 1894, iv, 9-44.
-— The management of convalescence and the after-care of the insane.
H. R. Stedman. J. Nerv. and Ment. Dis., N. Y., 1894, xxi, 786-814.
-Commitment, detention, care, and treatment of the insane. International
Congress of Charities (etc.), Chicago, June, 1893. Edited by G. Alden
Blumer and A. B. Richardson. Balt., 1894. J. Hopkins Press, 193 pp., 8vo.
3
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26 Index Medico-Psychologicus.
Treatment. Spot specialism; a plea for the treatment of the entire patient.
C. H. Hughes. Alienist and Neurol., St. Louis, 1895/16, 260-271.
-A delusion of stiffened extremities treated by suspension. E. J.
Spratling. Med. Rec., N. Y., 1895, xlviii, 173.
-The favourable modification of undesirable symptoms in the incurable
insane. A. B. Richardson. Am. J. Insan., Chicago, 1894-5, li, 449-458.
-The early treatment of mental cases in private practice. J. Shaw,
Liverpool Med.-Chir. J., 1895, xv, 337*342.
-Caro of the insane in Finland. E. Hougberg. Intemat. Cong. Char.
(etc.), Balt, and Lond., 1894, 100-103.
-Hospital for the insane and their treatment. C. Bell. Med.-leg. J.,
N. Y., 1894*5, xii, 309-340.
-Surgical treatment of insanity. J. Macpherson. Edinb. Hosp. Rep.,.
1895, iii, 495-532.
-Some limitations to curative work in State hospitals for the insane; a
criticism of present methods, and a plea for a better system of treatment
of the acute curable insane. C. B. Mayberg. Ann. Med.-Surg. Bull., N. Y.,
1895, viii, 1093-1099.
Trophic affections. Trophic intestinal affections in the insane. T. P. Cowen.
Lancet, 1895, i, 669-672.
- On so-called trophic intestinal affections in the insane. F. W. Eurich.
Lancet, i, 1243-1245.
Tuberculosis. Tubercular disease and its treatment in Irish asylums. Finegan.
J. Ment. Sc., 1895, xli, 228*231.
-Tuberculosis in hospitals for the insane. Med. News, Phila., 1896, lxvi,
357-359.
-The prevention of tuberculosis in hospitals for the insane. J. W. Bab¬
cock. Am. J. Insan., Chicago, 1894-5, li, 182-195.
-Brief studies in tuberculosis among the insane. E. D. Bondurant.
N. Y., 1895, D. Appleton & Co., 10 pp., 12mo.
Urine. Sul peso specifico dell' urina nelle malattie mentali. U. Stefani. Atti
d. xi Cong. med. internaz., 1894; Roma, 1895, iv, psichiat (etc.), 190.
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THE JOURNAL
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MENTAL SCIENCE
(Published by Authority of the Medico-Psychological Association
of Great Britain and Ireland V
Edited by
H. RAYNER, M.D. A. R. URQUHART, M.D.
CONOLLY NORMAN, F.R.C.P.I. EDWIN GOODALL, M.D.
“ Nos vero intellectual longius a rebus non abstrahimus quam ut rerum imagines et
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Francis Bacon, Proleg. Initaurat. ifag.
OCTOBER, 1898.
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Enniscorthy,* Kilkenny, Killarney, Letterkeuny, Limerick,* Londonderry,* Mary¬
borough, Monaghan, Mullingar,* Omagh, Dublin,* Sligo, Waterford.*
The following Asylum Reports have also come to hand:—Pennsylvania, New
York, Taunton, Massacliusets, Ontario, Craig Colony, Toledo, Egypt.
Authors of Original Papers receive 25 reprints of their articles. Should they
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JOURNAL OF MENTAL SCIENCE.
CONTENTS FOR OCTOBER, 1898.
PART l.-ORIGINAL ARTICLES.
A. R. Urquhart, M.D.—Presidential Address . . ,
J. R. Lord, M.B.—A New Nissl Method ......
Francis 0. Simpson, L.R.C.P.—The Specific Gravity of the Insane Brain
W. R. Watson, L.R.C.S.—Sewage Disposal at Hawkhead Asylum
George R. Wilson, M.D.—The Mismanagement of Drunkards .
W. Ford Robertson. M.D., and D. Orr, M.B.—The Normal Histology and Patho¬
logy of the Cortical Nerve-cells ......
John Wainman Findlay, M.D.—Observations on the Normal and Pathological
Histology of the Choroid Plexuses of the Lateral Ventricles of the Brain
Ira Van Giesen, M.D.—The Correlation of Sciences in Psychiatric and Neuro¬
logical Research ........
673
693
700
707
Clinical Notes and Cases.—A Case of Chorea Gravis; by J. W. Gbddes, M.B.,
and T. Aldous Clinch, M.D.—Clinical Cases. 1. Post-epileptic Hys¬
teria. 2. Congenital Aberrations of the Epiblast in an Insane Man ; by
F. Graham Cbookshank, M.D. . . . 811—820
Occasional Notes of the Quarter.—The Annual Meeting of the Medico-Psycho-
logicaal Association.—The British Medical Association.—The Correlation
of Sciences in the Investigation of Nervous and Mental Diseases.—
Criminal Evidence.—Prison Reform.—Inebriates Act.—The Lunacy
Bill.—The Law of Settlement (Plymouth v. Axminster Guardians).—
Lunacy Certificates.—Hypnotism and Will-making.—Lead Poisoning.—
Hypnotism.—Priest and Physician.—Asylum v. Hospital . 821—838
*’ ' ; ■ * ’ : /v ;
PART ll.~REVIEWS.
Die Darstellung Krankhaftar Geist/.qstande in Shakespeare’s Dramen ; von Dr.
Hans Laehr. —Arbeiten aus dem Gesammtgebiet der Psychiatrie und
Neuropathologie; von R. v. Krafft-Ebing. —Die Heil- uud Pflegean-
stalten fur Psychischkrauke des dcutschen Sprachgebietea; von Dr.
Heinb. Laehr. —Casuistische Beitrage zur forensischen Psychiatrie;
von Dr. E. Siemebling. —Les ^tats neurastheniques; by Gillks de la
Tourette. —Ndvroses ; par Arv^de Barine. —Ueber die Sexuellen
Ursnchen der Neurasthenie und Angstneoro&e; von Dr. Felix Gattel. —
The Subconscious Self and its Relation to Education and Health;, by
Louis Waldstein, M.D.—L’Annee Sociologique ; Publieesous la Direc¬
tion d’fimile Durkheim.—Memory and its Cultivation; by F. W. Edridge
Green, M.D.—Crime and Criminals; by J. S. Chbistison, M.D. . 838—866
PART 111.—PSYCHOLOGICAL RETROSPECT.
Some Asylum Reports, 1897*8: English County and Borough Asylums.—
German Retrospect ; by William W. Ireland, M.D. . . 856—874
PART IV.*—NOTES AND NEWS.
Medico-Psychological Association of Great Britain and Ireland.—Recent Medico¬
legal Cases reported by Dr. Mercier.—Asylum News.—Quebec Medico-
Psychological Society.—Correspondence.—Obituary.—Notices by the
Registrar.—Notices of Meetings.—Appointments.—Omissions . 875—896
————--— — " ~ , . . . .
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