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THE
ALIENIST & NEUROLOGIST.
Vol. III,
JANUARY, 1882.
No. 1.
ORIGINAL CONTRIBUTIONS AND PREFERRED TRANSLATIONS
Art. 1.-Moral (Affective) Insanity *
By C. H. HUGHES, M. D., St. Louis, Mo.
N OTABLE instances of the subversion of mind, without
accompaniment of mental perversion, are found in
those cases of gangliopathy which proceed to the extent
of fainting, epilepsia, chorea, etc., in which either volition
or both the will and consciousness are subverted. The
ganglionic (visceral) origin of certain forms of hypochon-
dria, melancholia and hystero-mania has been admitted
since the time of Hippocrates. Morbid states of the
reproductive system have long been deemed sufficient
sources of certain forms of mental derangement, in which
the feelings rather than the reasoning processes are dis-
ordered.
It is conceded that kleptomania, pyromania, dipsomania,
homicidal and suicidal impulses, and the morbid displays
of pregnant women and the mind disorders connected
with the critical periods of woman's life, may have their
starting point in uterine disorder, even with more unan-
imity and certainty than puerperal mania, for the latter is
often as much an insanity of general hæmic and neuric
exhaustion — anæmia and shock — as of reflex irritation.
• Abstract of paper embodying the views presented in the author's precis on
the subject. Presented to the International Congress at London, August, 1881-
Cases omitted. This paper was designed rather to elicit argument than to ex-
haust the subject.
234618


C. H. Hughes.
And, if reflex insanity be conceded, the possibility of
moral insanity must be admitted, for the concession ac-
knowledges the varying shades of mental involvement,
depending upon the degree and source of the reflected
irritation, from the insane longings and freaks of preg-
nancy to the infanticidal and other morbid impulses of post-
partum cerebrasthenia. To concede the possibility of a
homicidal or other morbid impulse not founded in delusion
(and psychiatry furnishes abundant proofs of such impulses),
is to admit the basis fact of moral insanity as it is clinically
observable, namely, insanity not the result of reason per-
verted by disease.*
When ganglionic disease is great, and the morbid
consequences profound enough to involve the intellectual
faculties in marked disorder, those who deny the pos-
sibility of insanity existing without appreciable lesion
of the intellect, now willingly admit the existence of
mental disease, and unwittingly, in those minor degrees of
eccentric irritation connected with the period of utero-ges-
tation and manifested in peevishness and insatiable longings
and changes of temper, they charitably concede that the
patient is to be excused for not putting as complete a
rein upon the display of eccentric feeling and action as
would be considered the proper thing in one not enceinte.
The intellect may appear intact or coëxistent with a minor
degree of moral or emotional perversion, and the perverted
moral feeling excused or extenuated, if indulged; yet, if
we pass a few steps further and venture to say that a
seemingly resistless impulse to which the will yields while
the intellect disapproves is insanity, then their theoretical
1
Tilt saw a case where pressure upon an inflamed ovary excited epileptic fits.
I have seen a vaginal injection cause a maniacal paroxysm, some of the injected fluid
having passed up into the uterine cavity. Sir Benjamin Brodie brought on a fit of
chorea by gentle pressure over the stomach, and the effect of a smart blow in pro-
ducing faintness is so well known to the prize ring that it is considered foul to hit
below the belt. Even death has resulted from violence done to the semilunar
ganglia. But these effects are not more singular than the irritation of dentition or
worms, or indigested substances in the alimentary canal, causing infantile convul-
sions, the effect of a fistula in causing melancholia with impulse to suicide, passing
away after a successful operation, the many eccentric sources of epilepsia, tetanus,
cerebral irritation, hyperæmia, etc.
Tait excises an ovary and cures an epilepsy; Charcot compresees one, and Kuss-
maul a testicle, causing reflex histero-epilepsy and the temporary subversion of
mind from wound of testicle was well known before Charcot, Kussmaul, Tait.
Brodie or Tilt were known to fame.
ca.


Moral (Effective) Insanity.
conception of the unity of mind-it being impossible for
them to understand how emotion, volition and thought
can be separate_leads to the rejection of one of the
most demonstrable facts in practical psychiatry, as well
as one of the most demonstrable facts in our every-day
intercourse with minds that are not insane. Persons in
the best of health are constantly acting from impuise,
prejudice or passion, conforming to society's usages and
the dictates of fashion or feeling without sufficient thought.
The emotions and the intellect are not twin born,
though they mutually influence each other. They do not
always go hand in hand or dwell harmoniously, though
tenanted together in the brain. In good cerebral organ-
izations, they are often at war with each other. The
things which even sane men ought not to do, they often
do; and those they ought to do, they sometimes do not.
(The Apostle Paul confesses this of himself. If a
Saint can concede this much of a healthy mind, a sinner
can do no less for the victim of disease. Paul was a
good psychologist, and discerned, though unconscious of
their physiological foundation, the ganglionic source of
certain encephalic states. He was “constantly at war with
his members.” When he “would do good, evil was
present with him."
I commend St. Paul as a psychologist to certain
of our confrères. May the convincing light of truth
shine upon them as it did upon the persecutor of the
proto-martyr on his way to Damascus, and by way of
contrition for the wrong they have done and may yet do
that least commiscerated of all the mentally afflicted-
the emotional, the impulsive and the morally insane-
may they speedily make amends by renouncing their
heresies and, embracing the true faith, become fol-
lowers of the faithful Rush, Pinel, Prichard, Maudsley,
Bucknill, Tuke and Ray.
Stephen had been stoned, it is true, but there still
remained others to be saved. Many an honest Saul in our
ranks consenting to this wrong remains to be converted. If


C. H. Hughes.
there be any who, in perfect health has not yielded to the
dominion of impulse, emotion or passion, let him cast
the first stone at the victim of mental disease, whose
intellect, while it does not restrain, yet seems not touched
by the morbid process which has deranged the affections,
the emotions and the will.)
Insanity of the emotions, propensities and passions in
which the intellect, if at all disordered, is not appreciably
so, or only momentarily so by being in abeyance or unable
through some want of connection of the will or controlling
power of the latter over the impulses and passions, is a
fact however it may clash with theories of the so-called
unity of mind. It is a fact as much so as ecstasy or hypno-
tism, somnambulism or dreaming which are not completely
harmonious and united actions of all the mental powers.
As much a fact as prejudiced or biased or unconscious
cerebration in the healthy working state of mind. As
much a fact as the many varieties of aphasia without intel-
lectual impairment, which the great Trosseau rejected
because he was biased in judgment by the dominant theory
of Condillac and Wharburton that the mind could only
think in speech. As much a fact as certain illusions or hal-
lucinations in which the intellect does not concur, though
during the formation stage of these mental spectra the
reason may be in momentary abeyance. We should recog-
nize the fact, though in so doing we may have to mend our
theories or even abandon them. We should never whittle
down facts to preconceived metaphysical notions.
All observation of the varying degrees of emotional,
impulsive and intellectual life in different persons and in
the same person at different ages of life attest the possi-
bility of disorder of the emotions, propensities or passions
without more appreciable intellectual lesion than we see
in persons who are regarded as right-minded.
Though insanity is marked generally by change of
character, that change is seldom manifested in augment-
ing the power of the intellect and the will over the
emotions or passions. On the contrary, the latter often
en


Moral (Åffective) Insanity.
5
A
subvert the former. Usually the disease, beginning with
moral or emotional perversion gradually involves or under-
mines the reason and judgment. It is thus that in the
early stages moral, emotional and impulsive disorder is
mainly divorced from the intellect (if the two are ever
then truly wedded) and what begins with an insanity of the
feelings, propensities or passions usually goes on (if not
arrested by timely medical interference) to the graver
forms of more general mental involvement. These cases
may even pass, if not cured, into the stages of delusion
and dementia; a fact which has led some writers to
doubt their existence, unless associated with intellectual
involvement, but which really proves the kinship of these
contested varieties of mental derangement, even where
neither delusion or other intellectual lesion appears, with
universally recognized forms of insanity, just as the insane
heredity of moral mania often establishes in our mind the
fact of insanity as contra-distinguished from uncomplicated
vice when we are in doubt.
Men in their sanest states are often more influenced by
their feelings, prejudices and passions than by their judgments.
Insanity generally expresses itself more in action than in
speech. The restlessness and constant muscular activity
of many lunatics is not always the expression of disor-
dered intellection, so much as it is an accompaniment
simply of morbid feeling, or irritation of psycho-motor
centers, and sometimes the acts of the insane, if their
after confessions in seemingly lucid intervals may be taken
as even approximately true, are not infrequently inde-
pendent of both conscious thought and feeling. They
appear often as blind freaks of disease or mental caprice,
in which the highest intellectual centers seem only uncon-
sciously involved.
That vigorous thinker, John Locke, who was not a
mere surface observer, though he looked at insanity
rather too superficially for a practical alienist, was led
to the conclusion not strictly true, but not altogether
erroneous, that the insane did not so much " appear


C. H. Hughes.
to have lost the faculty of reasoning, but having joined
together some ideas very wrongly, they mistake them
for truths and they err as men do who argue right
from wrong principles; for by the violence of their
imaginations—having taken their fancies for realties—they
make right deductions froin them. Thus you shall find a
distracted man fancying himself a king, with a right infer-
ence requiring suitable attendance, respect and obedience;
others who have thought themselves made of glass have
used the caution necessary to preserve such brittle bodies.
Hence it comes to pass that a man who is very sober,
and of a right understanding in all other things, may in
one particular be as frantic as any in Bedlam; if either
by any sudden, very strong impression, or long fixing his
fancy upon one sort of thoughts, incoherent ideas have
been cemented so powerfully as to remain united.”
Locke here has reference to the deluded or delusional
insane, and is only in part correct, for the insane do often
both reason illogically and incoherently, and establish
wrong premises from which their reasoning proceeds.
Doubtless the correct reasoning manifested sometimes in
the affective insanities contributed to the formation of his
only partly correct opinion, for in the next sentence he
says, “there are degrees of madness as there are of
folly, the disorderly jumbling of ideas together is in some
more, some less," and in some (he might have concluded,
had he been as familar with the insane as they should
be, who aspired to correct notions respecting them) there
seems to be no appreciable lesion of the reasoning facul-
ties.
Locke's idea of insanity was that it must always be
intellectual aberration, and yet his observation taught
him, despite his philosophical bias, a bias in which many
mental philosophers of the purely psychical school still
share, that many lunatics reasoned well. It never occurred
to him to deny the existence of insanity in such, but to
assume that they joined some ideas wrongly together.
With reference to another observation of Locke's, viz.:


Moral (Hffective) Insanity.
7
A
“that reverence gives beauty and prejudice deformity to
our opinions,” it may assuredly be said with equal truth
that intellectual processes in both the sane and the insane
are incited to action and influenced by moral or other
emotions, excited either by example of others or by dis-
ease.
Those who deny the existence of moral insanity
insist that there always exists a certain degree of in-
tellectual acquiescence that entitles it to be termed in-
tellectual insanity, though that intellectual perversion
may be, and often is no greater than that which is found
in the naturally immoral and depraved; but, if one con-
cede this, there yet remain' cases of moral and emotional
disease where the intellect not only does not acquiesce in,
but actually discountenances and seeks to be restrained
from, the morbid impulse or to subvert the morbid feeling.
Momentary impulses and suggestions of a morbid kind*
obtrude themselves upon many healthy minds like the
vague feelings of unreasonable unrest and depression
which obtrude unbidden into the neural chambers of the
cerebral cortex.
Facts like these, and a hundred others needless to
enumerate, show the capability of the mental faculties
to become partially involved in aberrant action without
notable derangement of the reason.
Men are not considered insane because they do not act
wisely, why should it be insisted upon that the intellect
should show disorder before insanity is recognized in those
whose impulsions are undoubtedly of morbid source, and
why should the intellectual implication, when it is found,
though it be no greater than that of some men moved
by passion, be insisted upon as the essential feature of
the disease ?
How, then, can we doubt the possibility of forms of
emotional and impulsive insanity, in which the moral
The great Máré relates of himself how he withdrew from a bridge he was
about to cross, lest he should yield to the impulse which came upon him to precip.
itate himself into the Seine low many persons have confessed to feeling &
disposition to precipitate themselves into the water when looking over a steep
precipice, or the sides or stern of a steamer.


C. H. Hughes.
faculties are so involved by disease as to cause the
individual to appear depraved? The converse, too, is true,
There may be moral exaltation from disease as well as from
intellectual conviction, even from sexual excitation (excessive
or suppressed gratification) religious exhaltation may result
as Dr. Workman and others have shown, and that, too,
without extatic visions or special delusions. Dr. Benj. Rush*
noted long ago that a morbid state of the sexual appetite
“becomes a disease both of the body and mind." This
pioneer in American psychiatry and close observer of the
insane, readily discerned that the will might be deranged even
"in many instances of persons of sound understandings and
some of uncommon talents, the will becoming the involuntary
vehicle of vicious actions through the instrumentality of
the passions,”? under which head he included what he
termed the lying disease, which “ differs from exculpative,
fraudulent and malicious lying, in being influenced by
none of the motives of any of them.” “ Persons thus
diseased,” he says, “cannot speak the truth upon any
subject, nor tell the same story twice in the same way,
nor described anything as it has appeared to other
people. Their falsehoods are seldom calculated to injure
anybody but themselves, being, for the most part, of an
hyperbolical or boasting nature.” He inferred it to be
“a corporeal disease, from its sometimes appearing in
mad people, who are remarkable for veracity in healthy
states of their minds," several instances of which he saw
in the Pennsylvania Hospital. He recognized certain
stages of intemperance as a disease of the will, and was
the first to propose a hospital for inebriates, or "sober
house," as he termed it, comparing the weakened will of
a drunkard to a paralyzed limb. Rush also believed in
a derangement of the principle of faith, or the believing
faculty caused by disease, also in derangement of mem-
ory, under which head he includes some instances of
aphasia, without the accompaniment of intellectual aber-
• New Obs. & Enquirers, 1812,p. 347.
2 Op. cit., p. 264.
3 Op. cit., p. 265.


Moral (4.ffective) Insanity.
9A/
ration. He was an unequivocal believer in derangement
of the moral faculty, conscience and the “sense of Diety,"
and notes especially the case of a boy of thirteen years, in
Bethlehem Hospital, described by Haslam, “who was
perfectly sensible of his depravity, and often asked why
God had not made him like other men.” In the course
of his life, Dr. Rush was consulted in many of “those cases of
total perversion of the moral faculties.” “One of them
was addicted to every kind of mischief. Her wickedness
had no intervals while awake, except when she was kept
busy in some study or difficult employment.”
This great observer concluded that in these cases “there
is probably an original defective organization in those parts
of the body which are occupied by the moral faculties of
the mind," though he could not determine where to draw
the line which divides free agency from necessity, and vice
from disease. He discourses further as follows:
"In whatever manner this question may be settled, it
will readily be admitted that such persons are, in a
preëminent degree, objects of compassion, and that it is
the business of medicine to aid both religion and law in
preventing and curing their moral alienation of mind.”6
Thus did one of the fathers of American medicine
contribute in the beginning of the present century
to the overthrow of that approbrious doctrine of diabol-
ical possession, or moral depravity, which has led many a
hapless lunatic to the stake and gallows, and to give us in its
stead the conception of moral mania, a form of insanity just
as real as the demonomania which overtook unfortunate old
women past the menstrual climacteric in Cotton Mather's
day, and resulted in their being drowned for witchcraft,
and which, notwithstanding the reality of disease for its
cause, finds even now in some quarters neither commis-
eration or extenuation, being regarded as the mani-
festation of a wicked and devilish spirit, entitling its
possessor to the punishment of the gallows or the peni-
6 Op. cit., p. 360.
6 Op. cit., p. 300.


IO
C. H. Hughes.
tentiary, rather than the restraint and treatment of the
asylum for the insane. The existence of the knowledge
of right and wrong with the judge, the absence of appre-
ciable intellectual disorder with the physician, are regarded
as incompatible with their ideal conception, not of what
insanity is, but of what it to them ought to be, and the
penalty for this theoretical misconception of the real
nature of mind is visited on the unfortunate victim of
disease, whose bad luck it is to be afflicted in a manner
theoretically proscribed. Theoretical views and metaphysi-
cal conceptions of mind have too long stood in the way of
true progress in psychological knowledge. To this has been
due the fact that physical disease, as the basis of all forms of
mania, now a generally accepted truth, was so long
controverted. To this stumbling block are we indebted
for the inhuman treatment the insane received in the
time of Galen, and up to that comparatively recent
period when Pinel immortalized himself and lifted
humanity to a higher pedestal by striking the shackles
from the madmen in the dungeons of Bicêtre.
There is a somatic as well as a psychic element in
mind as we are permitted to see it, to be taken account
of in all study of psychical display, whether in health or
disease, though what mind is we do not know, and per-
haps we may never completely comprehend, save in its
manifestations. All that we can see of mind is displayed in
the operations of the intellect, the emotions, feelings and the
will. There is a time in life when we see but little of
the former, and a time when we see more of it than of
the two latter attributes of the accompaniments of mind.
The emotions and the will are part of the mind, as it
manifests itself to us; and whatever may be our preconcep-
tion of the impossibility of their being separated, if we
see them practically severed by disease, it is only just to
acknowledge the fact.
To assert that the doctrine of moral insanity is a
dangerous one, from which society may suffer, as Mayo
and his followers have done, is to render science subsery-


Moral (ffective) Insanity.
TT
ient to social polity, illogical, cowardly and, of course,
unscientific, whereas social polity should be ever subserv-
ient to scientific truth, whatever that may be revealed
to be. Let us, always speak according to our convic-
tions. If we trim and prune truth so that we may adapt
it to social expediency, we become false lights—we degrade
science, the sceptre of influence falls from us, and judicial
wrongs, even murder perpetrated by strong handed Law
upon the weak and miserable, will continue to be com-
mitted in our name, and be the lasting monument of our
disgraceful surrender of truth.
There is moral perversion and degeneration resulting
from disease, with but little, if any, appreciable intel-
lectual lesion, less intellectual lesion oftentimes than we
find in those whose lives have been given up to vice,
through self-will or parental coersion or evil communication.
Then let us, when occasion demands, tell the courts so,
and not say we cannot conceive it possible for moral
derangement to exist without concommitant intellectual
aberration while observable facts confute such theories,
and let us turn our attention to searching out, for the aid
of jurists, instead of ignoring the line of demarkation
between responsible and irresponsible vice; the charac-
teristics of disease on the one hand, and on the other,
voluntary moral depravity coupled with a body sound
and a mind free to choose.
Moral insanity constitutes an observed and observable
fact of psychology ; let us not seek to theorize it out
of existence.
The metaphysical conception of mind, the abstraction
made into an entity, as Maudsley justly observes, “has
overridden discerning observation ” in some quarters,
and eminent and observing men have thus suffered their
judgments to become biased by the idea that the faculties
of the mind cannot act separately—that to derange one
must necessarily and appreciably disorder others.
On this reasoning, many eminent men believe
the existence of moral insanity impossible, while others,


12
C. H. Hughes.
among them the lamented Ray, not so biased, follow-
ing in the foot-steps of Prichard, who first promul-
gated the doctrine, see no more difficulty in recognizing
insanity of the moral feelings and of other impulses, propen-
sities and passions without necessary involvement of the
higher faculties of reasoning in appreciable disorder, than
the great Pinel did long before them in discerning what,
up to his time, was regarded as equally inexplicable,
namely, mania without the delirium of madness.
Dr. Mayo,' who made the first and strongest assault on
the doctrine of Prichard has unwittingly admitted, as
indeed all close observers of insanity know “that the
earliest indications of approaching insanity are moral,"
and he makes the further fatal admission “that at
every period of the actual presence” of insanity “the
powers of self-control are interfered with, the affections
suppressed or altered, the passions excited or perverted.”
All practical observers concede a frequent gradual
change of feeling and conduct in prodromal insanity
preceding the culmination of intellectual aberration, and
some who deny the possibility of moral insanity make a
classification of moral imbecility, concessions which logically
debar all opposition to moral insanity.
Whatever the stage at which we view mental disease,
whether initial or terminal, insanity exists, as much so,
as fever at any stage of typhoid or typhus is fever.
If a change of moral conduct have disease for its cause,
it is as much entitled to be called insanity as the mor-
bid aversions, antipathies, fears, or acts not brought about
by delusion, are to be classed among the recognized
evidences of mental derangement.
Blandford's searching analysis of Prichard's cases,
while it divests many of them of the vestments of uncom-
plicated moral insanity, leaves a number that can not be
elsewhere placed, “good examples of what may be called
moral insanity if the term is to be used at all," as Bland-
1 Elements of the Pathology of the Human Mind, Medical Testimony and
Evidences in Cases of Lanacy. By Thos. Mayo, M D., F, R S., London; p. 64.


Moral (Effective) Insanity.
13 A
ford himself confesses, one of which he concedes de-
serves to be called morally insane.'
Those who engage in the study of morbid mental
phenomena with the preconception that the intellect
must be always synchronously deranged in all morbid
mental expression must consistently regard every act or
feeling of the insane person “as plainly the outcome of
some idea present for the moment, but present, possibly,
but for the moment, and then so obliterated that the
individual has lost all trace of it,'” in certain morbid
impulsions or feelings. Those who think “the intellect-
ual and emotional functions of the mind can not be
divorced, that the ideational portion of the mind is so
intimately joined in operation to the emotional—the stored
ideas of the brain are so influenced by the feelings of
the moment, whether these arise from within or without
—that the two must be sound or unsound together," will
be reluctant to concede the demonstrable fact that the
affective life may be greatly changed by disease, while
the intellectual processes remain intact, so far as may
be discernable by any known methods of testing the
integrity of the reasoning powers; slow to recognize those
cases in which the will and not the reason is weakened or
perverted. Yet the morbid impulsions arising in neuro-
pathic organisms often reasoned against and sometimes
resisted, but finally surrendered to stand out in practical
refutation of the impossible conception of the invariable
unity of mind disturbed by disease.
The dipsomaniacs, the kleptomaiacs and sometimes
even pyromaniacs, yielding to impulses against their
reason are examples no less destructive to this hypoth-
esis than the auto-amnestic acts and impulses of hypno-
tism, somnambulism and certain epileptoid states. To
gauge insanity by the integrity or non-integrity of the
reasoning processes alone would make the automatism
of certain manifestations of alcoholism, epilepsia and mes-
1 Cases 4 and 5, p. 317. Insanity and Its Treatment, 1871.
? Ibid, p. 319


14
C. H. Hughes.
merism normal mental states. The reasoning faculties
in moral insanity often appear to act as correctly as in the
most perfect cerebral automatism. If there is a leison short
of intellectual disease and beyond that of pure derange-
ment of the moral faculties, and there usually is in
this as there is in all insanity, a degree of auto-amnesia
by which the affected individual does not discern the
change that has taken place in himself—it is simply an
impaired or lost appreciation of the transformation in his
character—which has been brought about by disease, but
many sane persons also fail to discern their descent into
viscious ways. However, if this degree of involvement of
the comparing faculties be deemed sufficient to ally it to
insanity in general (and it does on the basis of a part of
Conolly's definition), and thus to rescue a real mental disease
from the theoretical assaults made upon it, we cheerfully con-
cede it, for it is a fact that the morally insane, like most
other insane persons, usually do not see themselves as
others see them. But there are cases where the search
must be exceedingly close to reveal any greater lesion.
Normal mind is the sum of the aggregate display of the
cerebro-psychic functions constituting the natural “ego,"
abnormal mind consists of such disorder of one or more
of the cerebro-psychic functions as causes so marked
a change in the psychical characterestics of the indi-
vidual, whether principally involving the emotions, the
reasoning powers or the will, as to make an inconsistency
and inharmony in the person's character explicable only
by disease.
Moral insanity is as clearly comprehended in this defini-
tion as other forms of mental derangement, and as much en-
titled to be recognized as a distinctive appellation and form
of disease as the many other mental affections that are named
on account of their prominent symptomatic feature or features.
Not to recognize it in the present state of cerebro-
mental pathology would in certain instances prove disas-
trous to the rights of the insane before the courts, and
to their welfare elsewhere.


Art. II.-Animal Magnetism.
RECENT STUDIES COLLECTED BY DR. G. SEPPILLI,
OF REGGIO-EMELIA, ITALY.
Translated by JOSEPH WORKMAN, M. D., Toronto, Canada.
[CONTINUED.]
PHENOMENA OF THE SENSES.—That which any
1 person is obliged to observe concerning hypnotism
is, the analgesia may be so intense that, even when
practicing deep punctures in any part of the skin, the
person magnetized does not give any sign of pain ; the insen-
sibility is provoked by the hypnotism of the suffering person.
Braid tried to profit in operations through magnetism as
an “anästhetic,” like that which is used in chloro-
forming. In fact, he amputated persons' limbs whom he
had hypnotized, and his experiences were repeated in
France, by Broca, Vermeil and others, with like good
results. Dr. Esdale, of Calcutta, produced, with somnam-
bulism, anæsthesia in over two hundred and sixty persons
before the operations. But the trial of applying hypnot-
ism is now totally abandoned, either because the hypnotic
sleep was not obtained in every person, or because
new and more sure producers of anæsthesia were discov-
ered in chloroform, ether and protoxide of nitrogen.
When the hypnotism is of a light grade, as is to be
found in the state which we shall speak of it, hallucina-
tions constitute the dominant phenomena, and it is difficult
to meet with complete analgesia. In general, in such
conditions, the patients complain of punctures received,
and sometimes they react more than normally. In a
friend of Richet, the magnetic passes produced a singular
cutaneous hyperästhesia. He could never be put to
sleep, and he had memory and consciousness intact;
but the sensibility was so excited that the lightest contact
on the skin produced true pain.


16
Seppilli-Workman.
At such times, although analgesia may exist, tactile
sensibility remains conserved, by which the contact of
bodies is perceived. In proportion to the withdrawal of
the hypnotic state, and the return of sensibility, the
punctures, which at first were not felt, become painful.
Heidenhain and Grützner have found the capacity of
distinguishing between heat and cold abolished in the limbs
put into the cataleptic state by unilateral manipulations.
Two persons could not distinguish the contact of a
pitcher filled with cold water from another with warm
water, while in the cataleptic state; but they recognized them
perfectly on the other side, which was in the normal state.
Apropos to the state of general sensibility in hypnot-
ism, we believe that it will be important to search in
the future whether the hypothesis recently offered by
Herzen (that the stimuli of heat and of pain are trans-
mitted to the centers by one and the same order of
fibres, which, however, are different from those by which
the stimuli of cold and of touch pass) may find appli-
cation or not. It would be necessary to endeavor to see
whether, in the first degrees of hypnotism, when as yet
the patient can give account of his sensations, there is,
at the same time, a modification of the dolorific sensi-
bility, and of that of heat, and not of tactile sensibility
and of cold, or vice versa ; or if, instead, this coincidence
is not verified.
Besides the modifications of general sensibility, those
of the special senses are also observed, among which the
most interesting, and the most easy of recognition, relate
to the visual apparatus. In the initial stage of hypnosis,
when consciousness is yet intact, one of the character-
istic phenomena is cramp of the accommodation of the
eye. The consequence of this is the diminution of
vision at distance. In fact, far off objects are no longer
perceived ; writing, which at first was read at consider-
able distance, does not become distinct unless when
brought near to the eye. Heidenhain and Grützner, who
have called attention to this phenomenon, explain it as
vision at disturing which at hrst
distinct unless


Animal Magnetism.
being a contracture of the ciliary muscle. It is, in brief,
a condition very analogous to that which gives place to
myopia. Throughout the hypnotism, the pupils are seen
to be dilated, the eye is rendered immobile, and is
frequently slightly protrudent.
The alteration in the perception of colors, with which
H. Colm, Professor in the University of Breslau, has been
specially occupied, are very interesting. In the majority
of the cases, the singular phenomenon of color blindness
was observed. This is brought out under two aspects.
Sometimes the color blindness is complete, all objects
appear gray, contrast of colors is feebly perceived, the
white, the black and the various gradations of gray are,
however, quite distinct. At other times, the disturba.ice
in the perception of colors consists in this, that, on pre-
senting to the person magnetized a colored paper on a
white ground, she does not see its true color, but ordin-
arily its complementary color, as green instead of red,
yellow, instead of blue, or vice versa; often, again, she
sees, at the same time, the color of the object and its
complementary, or first the one, and then the other. It
is to be noted that the impression of a given color per-
ceived by a person in hypnotism does not continue the
same, but, in the course of the observation, it is subject
to changes. Thus, some persons at first see an indistinct
gray, which afterwards becomes transformed into another;
others again have, in the beginning, the sensation of a
color, though it may be false, but afterwards it loses its
intensity, or becomes substituted by a gray.
Color blindness may be produced in only one eye
by making passes on the opposite region of the head ;
this enters into the phenomena of unilateral hypnotism.
In those persons, in whom the unilateral passes on the
head act on the members of both sides, disorder of the
sense of colors is provoked in both eyes. Color blind-
ness being obtained in the method indicated, in a single
eye, it disappears on making passes on the corresponding
half of the head.


18
Seppilli— Workman.
The gustatory and the olfactory sensibilities, in states
of profound hypnotism, are usually abolished. The
strongest stimulants of the organ of taste (vinegar, pepper,
quinine), and of smell (ammonia, sulphuric acid) provoke
no reaction. Hearing on the contrary, is usually
preserved intact, and in some cases it presents a true
hyperästhesia to such a point that certain excitations,
which, from being too weak do not become perceived
in the normal state, are so, on the contrary, in the mag-
netic sleep. Berti relates the following fact, of which he
was witness: “A boy of fourteen years, sound and intel-
ligent, was immersed in magnetic sleep for about half an
hour. His ear, open to the voice of the magnetizer,
seemed perfectly closed to every other sound; then, after
several experiments, he was told to walk. Wait,' he
responded, “till 8 has ceased sounding. Silence being
enjoined on those present, we heard a distant clock slowly
striking, but with so feeble a sound that it hardly reached
our ears, though we were silent and attentive.”
In a memoir on animal magnetism, of which notice is
found in the Revue Scientifique, p 20, 1877. Bennet
relates that a young woman, who was magnetized by
him, replied to him immediately, even when he spoke to
her in a voice so low that no other person could under-
stand it. He has also noted that a hypnotized subject
could hear conversations held by him at a great distance,
and could perceive the slightest sounds. In these
phenomena of general and specific modified sensi-
bility of the hypnotized, we have a new and very evident
proof of the analogy before mentioned by us, between
provoked somnambulism and hysteria. In the latter, we
very often have occasion to observe cutaneous anæsthesia,
now general, again unilateral, and on the left (hemi-anæs-
thesia), from which the patients are totally incapable of
perceiving deep punctures and the hottest bodies applied
to the skin. It has likewise been established that some
hysterical patients no longer distinguish colors, or that
they perceive them very difficultly with one or with both


Animal Magnetism.
19
eyes (acromatopsia and discromatopsia hysterica), and
that they have the other special senses more or less
abolished.
It is worthy of record, that in women affected with
hysteria major, during the state of catalepsy or of provoked
lethargy, as Charcot has observed, a total anæsthesia has
been met with, even if at first hemi-anästhesia existed,
but that the excitation of the so-called hysterogenous
zones, as by firm compression over the ovaries, is capable
of developing a convulsive crisis. Richet found in some
hysteriques, in whom he had provoked a species of sleep,
which he calls the last phase of hysteric lethargy, loss
of muscular excitability, with complete relaxation of the
muscles, and absence of any reaction whatever to excite-
ment of the hystero-epileptogenous points.
Lastly, we shall speak of some special reflex phen-
omena which have been observed during hypnotism. It is
known, from the researches of Goltz, that the medulla
spinalis in dogs being cut through at the twelfth dorsal
vertebra, after the complete healing of the wound there
is produced in the posterior trunk of the animals a series
of reflex movements, dependent on the lumbar medulla,
and that by scratching the dorsal skin in the vicinity of
the lumbar vertebræ, a reflex movement takes place in
the corresponding limb.
These two reflexes are likewise obtained, as Berger
and Heidenhain have observed, in the hypnotised. Thus,
by running the hand on one side over the last lumbar verte-
bræ, the leg corresponding is move backwards, by which,
making this movement alternately on the two sides, the
individual is caused to walk for a certain time backwards
like a crabfish. By stroking over the spinous processes of
the superior dorsal vertebræ, we obtain elevation of the
arms. Excitement of the skin over the medium dorsal
vertabræ determines movements of the arms backward ;
on the last dorsal and the first lumbar vertebræ, tonic
contraction of the extensors of the vertebral column is
obtained.


20
Seppilli— Workman.
Charcot and Richet, in one of the latest meetings of
the Society of Biology (March 2, 1881), communicated
several of their researches on hysteriques in hypnotism.
One series of these appertains to the tendon reflexes.
They have seen in some cases, that reflexes are
exaggerated, as in provoked hysteric lethargy and this
is manifested either by means of extension and diffusion
of reflex action, or by modification of the muscular con-
traction, which is more quick or slow in its transforma-
tion into contracture. Not only a blow on the tendon,
but even a light pressure over it, provokes contracture of
the corresponding muscle. In other cases, as in provoked
hysteric catalepsy, the contrary is observed—that is, abol-
ition of the tendon reflex.
PsychiCAL PHENOMENA.—When the hypnotic state is of
a very light degree, the intellect suffers no sensible modi-
fications, with exception of a species of torpor more or
less profound, but consciousness is perfectly conserved,
memory is intact and external impressions are accurately
perceived. It is not so in hypnosis of a more strong
degree; the subjects fall into a sort of sleep called
magnetic, in which they have the capacity of feeling cer-
tain impressions and of responding to questions addressed
to them, a fact which has permitted the accomplishment
of accurate examination of them, so as to ascertain
clearly their intellectual state.
The magnetic sleep presents phenomena of much
interest in the domain of psychology. One of these con-
sists in the great facility of provoking hallucination. The
individual is put to sleep, but the experimenter by
addressing him has the power of awaking in his mind a
given order of ideas, sensorial images, which in certain cases
reach such a degree of exactitude, vivacity and precision
as not to be actually distinguished from realities. Richet
said to a hypnotised friend, "see my watch is in my
hand,” and he saw it and distinguished the quarter and
the circles. Again he said to him, “Behold this lion,”
and his friend was agitated; showed in his aspect active


Animal Magnetism.
21
terror, and said, “look, he is coming, he is near; let us
get away quickly.” In the meantime he moved on his
seat and his fear almost culminated in a true nervous
crisis.
From this facility of provoking and diverting ideas and
images in a hypnotised subject, some magnetizers have
endeavored to establish the belief that those magnetized
by them have acquired the power of seeing places which
they have never visited, and of being present at far
distant occurrences. In fact, the subject who has fallen
into the hypnotic state, when directed by an able experi-
menter, will, for example, give a vivid description of a
country which he does not know farther than as it cor-
responds to the image that has been created in his mind,
that is to say, to the locality as he figures it, and not as
it really exists; and herein exactly stands the error in
the belief that whatever the magnetized says always per-
fectly corresponds to the reality of things.
This is especially applicable to the so-called clairvoy-
ance of somnambulists, through which it is held that they
see distinctly the organs of those patients who come to
see them, that they are able to tell precisely the locality
affected, and even the nature of the morbid process.
Well, now, in such instances, the subject who is really in
the state of somnambulism, manifests merely what his
imagination suggests to him, and if, perchance, this comes
near to the reality, it is so much the more readily believed
by persons of good faith.
Several facts observed with scientific rigor, demonstrate
precisely that the descriptions of objects, places and per-
sons given by the magnetized, are for the most part
creations of the imagination, the phantasy, since they do
no more than relate what they have heard said, have
read in books, or have seen in pictures and designs.
These visions approach the closer to realities, the more
exact may be the idea entertained by the magnetized of
that which is presented to his mind. A somnambulist who
was questioned by Maury, who knew the place very well


22
Seppilli— Workman.
about the City of Algiers, gave a description of it, in
which it was easy to see that he was not relating real
visual impressions, but his rather vague recollection of
what he had been able to learn about the place. Richet
carried off, in thought, a female patient of Beaujon, into
a distant place which she did not know—Lake Comore.g.
or into the icy regions of the North, and she gave way
to her imagination in conceits, interesting from their appa-
rent precision.
To another, a friend of his, put to sleep, he said,
“Come with me, let us get into a balloon; let us mount
* * * We are for the moon,” and whilst he was
speaking, his friend was viewing the precipices of the
fantastic voyage, and all at once he burst into laughter,
saying, “ Behold down there now, that great bright ball !”
It was the earth which his imagination represented to him.
We might say with Spenser, that the hypnotized manifest
symbolic conceptions or fancies more or less bordering
on reality, like those we form, when we make out the
representation of a monument, a country, or a scene,
according to the description given of it.
The property is singular, which the hypnotized have
of reproducing the sensations related to an idea aroused
by the words of the magetizer. Thus, they show a sense
of disgust or nausea, if on presenting to them a bottle of
water to smell, they are told that it contains ammonia.
They will, on the contrary, remain indifferent on making
them smell ammonia, if told that it is water. In some it
is easy to provoke vomiting by simpiy saying, “smell this
nasty odor, or to make their gustatory sensations pleasing
by making them swallow disgusting substances, and telling
them they are exquisitely delicious. The celebrated
English physiologist, Carpenter, relates that a person
whose arms had been raised, believed, on being told that
he was made to support a heavy weight, that he was
really doing so, and he felt a sense of fatigue. Rochet
announced to a woman in hypnotism that he would draw
one of her teeth ; she cried out with pain, as if the operation


Animal Magnetism.
23
had actually been performed. Another, whom he persuaded
that she was ascending a tower, showed herself tired.
By saying to a hypnotic, "you cannot open your mouth,
and repeating the words in a loud voice so as to impress
him strongly, the sensation is aroused which we really
experence when we cannot open the mouth. A hypno-
tized person was made to believe that his body was
covered with bees. He then acted precisely as a person
stung, giving every sign of pain; shaking his hair, and
slapping his face with his hands in a frantic manner;
finally he stripped off his clothes in order to free himself
from his imaginary foes. This fact has been recorded by
Taine in his great work on the intellect. (Paris, 1878,
Vol. 2, 21).
Hitherto, we have spoken of general and specific ideas
and sensations which the magnetizer is able to provoke
at pleasure, in hypnotized subjects, by his words. The
same result is obtained by other means. Braid first made
known the fact, that an attitude being given to the
members of a subject, corresponding to an emotional
state, or any passion whatever, this mental condition is
awakened, and even the physiognomy will express it
immediatedly. Braid called this phenomenon suggestion.
Again, Carpenter and many other observers have been
convinced of its verity. Thus, e. g., if the hands of a
magnetized person be put as if in the act of praying, her
physiognomy will assume an air of supplication, and she
will kneel as one who would implore something. If, on
the other hand, the fist be shut and the arm extended,
the person will then take the bearing of one in anger
and making threats. Bend the head forward and the
trunk gently, and he will exhibit a sentiment of profound
humility. “Not, alone, simple emotions," says Carpenter,
“but further precise ideas may be educed. Thus : elevate
the hands of the patient above the head, and flex the fingers
on the palm, and immediately the idea of climbing is provoked
-of preserving equilibrium, or pulling on a cord. If, on
the contrary, the fingers be bended and the arm left hanging


24
Seppilli— Workman.
by the side, the idea is awakened that he is raising a
weight; and if the fingers be fexed whilst the arm is.
being carried forward in the position of striking a blow,
the idea arises of giving fight.” Richet says these phe-
nomena of suggestion are very readily observed in hyste
riques in somnambulism, and he states that the suggestion
may be localized on one side of the body, so that by
putting the left fist in the attitude of threatening, and the
right hand in the act of throwing a kiss, on the left the
traits of anger are seen, and on the right those of amore
ous tendency.
Suggestions may be provoked not only by commu-
nicated attitudes, but also by appropriate gestures,
executed before the subject under experiment. The fact
related by Richet is, under this point of view, remarkable.
In one of the patients of Charcot, when she was put to
sleep by certain very simple gestures, a whole series of
hallucinations was produced. If, e. g., the gesture was
made of scattering things on the ground, she imagined
she had flowers before her, and she stooped to
gather them up, one by one. If her index finger was
elevated, placing it horizontally at the height of the eye, she
imagined a bird had come to perch on it, and she caressed
it, and acted as if kissed by it. Thus, merely by appro-
priate gestures, a somnambulist may be made to imagine
the presence of an animal, as a lion, a serpent, etc. The
gesture, for example, of chasing a bird may be made, and
it is seen that the hypnotized acts as if really seeing it.
As is seen in these phenomena of suggestion, the
idea is awakened by means of exterior excitation, whether
this be a movement communicated to the muscles, or
by a sensorial impression. An idea being provoked, it, in its
turn, excites other ideas in relation with it, and thus the
somnambulist remains absorbed in the sphere of the
numerous vivid mental impressions which have been
aroused, manifesting by his attitude of body and the
expression of his physiognomy, the corresponding emo-
tional state.


Animal Magnetism.
25
In the magnetic sleep, the intellectual faculties are,
· therefore, not destroyed, but they present the special
fact that their activity is not awakened unless they are
excited by external stimuli, such as verbal sounds,
gestures, or attitudes given to the body. That which
more especially characterizes hypnotism is the excitement
of memory and of the imagination. The magnetized
describe in all their minute details, the places and persons
they have seen, and the occurrences at which they have
been present, because all the ideas which they relate,
after an opportune stimulus from without, are spontane-
ously reproduced in their minds, associated with each
other and incarnated with images; nor do they differ in
intensity from those formed, for the first time, from the
presence of real objects. The hypnotic sleep may induce
the remembrance of things which appeared to have been
completely forgotten, and of notions acquired a long time
ago. A lady, who, fifteen years before, had been one or
two hours in Versailles, and had almost completely
forgotten the journey, when in magnetic sleep they spoke
to her of Versailles, gave a true and precise description
of it. Another who sang a passage from the "Africana” in
her artificial sleep, on awaking remembered nothing of it.
Excitement of the memory is accompanied by that of the
imagination, by reason of which the magnetized are enabled
to reproduce, mentally, real facts, but of which they had
no direct knowledge, and of representing scenes and
objects, from having merely heard them described; or of
investing, under a new form, often strange and absurd
ideas and sensations, once furnished to them by the
senses.
The affective life, like the intellective, may be pre-
sented profoundly modified in the magnetic sleep. Thus,
some persons manifest passions and sentiments different
from those which are natural to them in the waking
state. Berti informs us that he has seen somnam-
bulists moved by pity and fear at the sight and imagin-
ation of persons and things which, in their ordinary life,


Seppilli— Workman.
would have been passed by almost with indifference ;
others laying aside their humility and gentleness, derived ·
from education, showed themselves arrogant and obstinate.
Sometimes an exaggerated moral sensibility, or an excess-
ive impressionability, is observed, by reason of which the
narration of sad and painful things provokes commotion
and weeping. This is to be attributed to the erethism of
the nervous system during provoked sleep.
As regards the phenomena above described, we do
not find anything strange in them, as at first sight might
be believed. In the physiological and pathological
dominion of nervous states, some are found which have
much analogy with what is met with in the hypnotic
sleep, as regards the psychologic conditions.
• A good example is given by dreaming, in which sensa-
tions and ideas accumulated in the waking state are repro-
duced even when they have been forgotten, and the
mode of their association is sometimes so different as to
cause them to appear altogether new. A person who
sleeps, just as one magnetized, believes in the reality of all
that his dream suggests to him, because the will, the
reasoning power and the judgment are debilitated. These
persons on being subjected to real impressions are capable
of exhibiting a given order of sensations and idieas. Maury
has shown that external impressions have a part in dream-
ing, and they are often the point of its departure.
Having fallen asleep, he dreamed of being subjected to
a horrible punishment while a person tickled his lips and the
point of his nose with a feather, and from the striking of a
pair of steel scissors with a small forceps at some distance
from his ear, he dreamed of hearing the sound of a bell.
He was made to inhale from water of cologne, and he
dreamed he was in the shop of a perſumer, and this idea
led him to think of the East. The same internal sensa-
tions are, in certain subjects, the origin of dreams. Regnard
has noted that in some young chlorotics the blowing
sound in the arteries is a determining cause of dreaming.
The city girl, he says, will dream of a ball or a concert;


Animal Magnetism.
27
she in whom religious ideas are most developed will dream
of hearing the chant of angels and the hymns of saints;
the country girl will, in her dream, believe she hears the
sound of the wind coming through the trees, the murmur
of a stream, or the warbling of birds. The senses furnish
the first idea, the imagination is excited, and it follows
the received impulse.
Ether and chloroform also, in the commencement of
their action, determine an incomplete dream, in which
the patient is rendered insensible to pain, but, like the som-
nambulist, he presents sometimes a hyperæsthesia of hear-
ing, images are called up and succeed in him with great
rapidity; they are readily provoked directly from external
impressions. Maury knew a man, who, whilst under the
operation for fistula in ano, after being etherized, heard
the cuttings of the knife without feeling any pain ;
but he was then dreaming of feasting in the Palais.
Royale, and he took the sounds reaching his ear for that
of his fork. An old foreigner had lived in his youth on :
the Polish frontiers and had often spoken Polish. After-
wards he resided in German districts. His children affirmed
that for thirty or forty years he had not heard or pro-
nounced one Polish word. Now, during a state of anæs-
thesia from ether, which was prolonged about two hours,
he spoke, prayed and sang in the Polish language. Des-
pine speaks of a patient, who, during the inhalation of
ether, had a leg amputated; he gave no sign of pain, and
throughout he answered questions correctly; when restored
to himself he said he was not aware of the operation nor
of the words spoken.
In ecstasy the individual continues under the dominion
of ideas and images, which spontaneously succeed in the
mind; he lives in himself and but in incomplete relation
with all his surroundings. Not rarely such a cutaneous
insensibility is present that the person may be subjected
to the most painful stimuli, without in any way manifesting
the least reaction. The same may be said of that form,
lypemania stupida, in which, whilst the functions of relation


28
Seppilli— Workman.
are suspended, the psychical continue more or less active.
A typical case of this nature has been described by my
esteemed colleague, Dr. Riva; it is that of a youth of
fine intellect, who is affected with intermittent stupor, in
which voluntary motility has appeared lost; tactile thermal
and dolorific sensibility almost abolished, whilst his mind
is concentrated in futile and lofty ideas, and sight and
hearing are the seats of various hallucinations.
What is to be said then of the infinite examples pre-
sented by natural somnambulism, in which, while the
senses are more or less closed to the greater part of
external impressions, the intellectual activity is specially
excited by whatever relates to memory, and thus renders
the subject capable of performing a number of compli-
cate and intelligent acts? In natural somnambulism, just
as happens in the provoked form, we may very well
observe the phenomena of suggestion. Regnard reports
the case of a somnambulist studied in the Hospital St.
· Anthony, by Dr. Mesnet, and observed by himself, Dr.
Maury and others. An old zouave had received in battle
an enormous wound on the head, which laid bare the
brain, but which was afterwards healed. Two years after-
wards he returned to common life, and followed the pro-
fession of coffee-house singer. During this period on
certain days he became sad, and afterwards he would
all of a sudden rise, dress himself, and start out to run
through the streets. He walked always right on, as if
he did not see any one, and at the same time he showed
a tendency to thieving; and every bright object, whether
of value or not, became the object of his cupidity. He
was arrested and imprisoned, but was afterwards sent to
Mesnet, who declared him affected with natural somnam-
bulism. Regnard thus recounts the phenomena of sugges-
tion observed in his patient: “Our subject was put asleep,
a curved stick was put into his hand, he turned it over and
then his figure became more animated; he shouldered his
stick and held it as a musket. One idea was awakened in
this addormentated brain, and this called forth a series of


Animal Magnetism.
29
associates. Let the dream be started, memory steps in, and
we witness a curious scene. This old zouave sets out to
walk prudently, he gives ear, moves some steps, then he
listens again and hides behind a bed; he raises his gun, takes
aim, and then rapidly takes an imaginary cartridge, carries
arms, looks about, his eyes become more ferocious and he
cries out, “See them there; there are at least one hundred.
Ah, me! and down he falls, slapping his forehead with his
hand; he lies dead; the dream ends.” The patient on
waking remembers nothing.
In many hysteriques it is easy to observe accessions
of soinnambulism, which either supervene spontaneously,
or are provoked by the hypogenetic process already
mentioned. In both instances, the phenomena are the
same. The patients are subject to vivid hallucinations,
and among these to varied ideas, and they reproduce in
their attitudes, gestures and expressions of physiognomy,
their state of mind. This is especially observed in the
attacks of hysteria major, in the period of passional
attitudes, in which the hysterique is absorbed in a sort
of dream, which then has the singularity of being repro-
duced in a uniform manner, from which the passional
attitudes are always the same, and appear as if stereo-
typed. Suggestion is a phenomenon which is sometimes
observed in the hysterique in somnambulism. Among the
many examples we could adduce, we shall give one case
described by Gauché, that of a woman affected by hys-
teria with somnambulism, placed in the hospital, in the
section of Professor Ball: “She is told she has a serpent
before her eyes, she sees it and trembles. One night
something was put into her arms, which suggested to her
that she was holding a cat; immediately we see her
caress the accredited animal, calling it by the most
tender names, and comporting herself towards the inert
object as she often had done with the cat in her hall.”
The facts we have related as to dreaming, ecstasy,
sleep induced by anæsthetics, and somnambulism, natural
and hysterical, demonstrate very clearly that the psychical


30
Seppilli—Workman.
phenomena presented by these states are of the same
nature as those proper to provoked somnambulism. In
all, we find a common cerebral hyper-activity, with this prin-
cipal difference, however, that whilst in the magnetic sleep,
produced in normal subjects, the images, ideas, sensations
and sentiments require, for their awakening, an external
stimulus that shall reach the brain; in the other cases,
this is not necessary, because the cerebral activity comes
spontaneously into play.
Since, therefore, the hypnotized respond actively to
impressions coming from without, we can understand how
it is in the power of the magnetizer to provoke in them,
up to a certain point, a given group of ideas and sensa-
tions by means of words, gestures, expressions of physi-
ognomy and communicated attitudes. What, however,
is by many denied, is the so-called mental suggestion,
that is to say, the transmission of thought from the
magnetizer to the magnetized, without the need of any
external impression to awaken it. We shall abstain from
discussing this question, because the subject appears to
us a very delicate one, and has only a very few facts in
its favor, as to the exact establishment of which some
doubts may arise ; and, what is still more important, we
have not found, in the works of those who have been
most recently occupied in amimal magnetism, appropriate
observations establishing the possibility of this transmis-
sion of thought, independently of any exterior impression
whatever. It is a phenomenon whose existence cannot
be confirmed or refuted without further study.
A curious fact, relative to memory, sometimes noted
in hypnosis, is the forgetting of certain words. If, for
example, a magnetized subject be asked, “What is the
name of your brother?” he seems to be considering but
does not find the answer. His brother is shown to him,
and immediately he gives the name. So, even asking
him his own name, it is seen that he has forgotten it, but
when he sees it written on paper he promptly recollects
it. In such a case, there is a sort of amnesic aphasia,


Animal Magnetism.
31
which, as is well known, is characterized by loss of verbal
memory, but this may be called back by presenting the
object, the name of which has been forgotten, or, instead,
the name in writing, or by pronouncing it. An acoustive
or visive impression is, therefore, necessary to bring up
the verbal representation of an idea, the cerebral activity
being incapable of reproducing it as in ordinary condi-
tions. But loss of memory in the somnambulistic state
may be not alone spontaneous, as in the cases noticed,
but provoked. Richet has noticed this, and he adds that
by a simple affirmation, a somnambulist may be made to
lose special memory, as that of proper names, or of
localities, and even total memory. He said, for example,
to V— that she was unable to remember her own
name, and she tried to give it for half an hour, but failed.
He then said to her, your name is V— Yes, certainly,
she responded. He adds that such experiments should
be tried with great prudence, and they ought not to be
prolonged, as the patients are struck with terror, and their
intelligence remains disturbed for some time.
In the state of hypnotism, the mind of the individual,
when it has been in any way excited, and is left to itself,
is more especially directed to those objects and events
which most strike it and hold it preoccupied in the
waking state, accidentally predisposing it to previse what
is to happen. Thus, Despine relates of an anæmic neuro-
pathic woman of eighteen years, whose menses had been
absent for six years, that she predicted in somnambulism
her courses would return in two months, and so it happened.
It is related of hysteriques, that in somnambulism they
have announced, with precision, the duration of their nervous
crises.
All this has led to the belief that the magnetized
possess an intuitive prophetic virtue,' whilst they merely
manifest those ideas and presentiments of the waking
state, which very frequently are afterwards not at all
realized. The same may be said as to dreams, in which,
throughout a long time, people wished to find the revelations


32
Seppilli-Workman.
of future things, but ulterior observation has been
able to recognize, as the cause of dreams regarded as
prophetic, an anterior preoccupation by facts, to which
these dreams have been related, and it has been seen that
the presentiment had been founded on some rational or
merely instinctive conjectures.-[Maury.]
In like manner, as the experimenter awakens in mag-
netism ideas and sensations, he is able also to make his
subjects execute, at his pleasure, some movements.
Heidenhain tells us as follows: “Before Signor X., in
the hypnotized state, I shut my fist, and he shut his; I
opened my mouth, and he did the same. When I shut
my fist behind my back or over his head stooping, he
remained motionless. He then shut his jaws so rapidly
that the dental arches, by striking each other, made a
noise, and they repeated the same action. I contorted
my face, without noise, and he remained quiet.”
Sometimes very complex acts, accomplished by the
magnetizer, are repeated with precision, as walking, sketch-
ing or writing. This shows that the hypnotized comports
himself as a true automaton; he imitates the movements
of the experimenter, which are indicated to him by
acoustic and visive impression, and have the appearance
of being voluntary, but in fact are not so. Heidenhain
has given to these movements the designation, reflex by
imitation. But there is still more to be considered. Some
of the hypnotized repeat with the greatest promptitude,
and exactness, the tones, words and phrases which are
pronounced before them, whether belonging to the
language known by them or the contrary. Berger was
the first to make this phenomenon known; and it was
denominated consecutive language or the language of imi-
tation. (Nachsprechen). He had observed that magnet-
ized persons persisting completely passive to his words,
commenced unexpectly to repeat them as soon as pressure
was made on the neck with his warm hand. The same
was obtained by Heidenhain by speaking with a stetho-
scope, in such a way as to concentrate sonorous waves


Animal Magnetism.
33
on a small space, against the neck or against the stomachic
region. The latter is sensible only over a tract very limited,
commencing about two finger breadths below the sternum,
and extending on the median line of the body about two
inches, in both the longitudinal and transverse directions. In
speaking, even in a low voice against this space, the words
become repeated. Thus, by applying there a diapason in
vibration, the subject under experiment forms with his voice
the sound given by the instrument. Also, if spoken to
against the larynx, or better against the posterior wall of
the pharynx, the phenomenon mentioned is obtained. It is
singular that by speaking against the occiput, or into the
ears, no such result is obtained, while some words spoken
in a low voice against the neck are promptly repeated.
Since the mechanical excitement produced by sonorous
waves in the regions mentioned (the stomach, larynx, neck),
gives place in the magnetized to verbal manifestations, it
is necessary to admit that the sensitive nerves of these parts
are in relation more or less immediate, with the phonetic
center. Heidenhain supposes that the stimuli carried along
these nerves serve to withdraw the phonetic center from the
state of functional arrest, by which the arrival to it of acoustic
excitements would be impeded. In a series of persons hyp-
notized, it was observed that by stroking with the fingers
from above downward and at the same time pressing on the
skin of the neck over the region corresponding to the fourth,
to the sixth cervical vertabra, a doleful sighing tone was
produced. This and the other fact before mentioned, as to
the language of imitation, following words pronounced
against the neck, find a perfect parallel in the curious and
well-known experiment of Goltz, who found that a frog
whose cerebral hemispheres were extirpated above the
corpora quadrugemina, croaked every time it was stroked
with the finger over the skin of the back, on the intra scapu-
lar region. In such a case we have a reflex movement, which
has its place in the medulla oblongata, between the nerves of
cutaneous sensibility, and those of motion destined for sounds.
[To be continued in our next Number.]


Art. III.-Care of the Insane.*
By H. Wardner, M. D.,
SUPERINTENDENT OF THE ILLINOIS SOUTHERN HOSPITAL FOR THE INSANE,
THE problem of the best care and treatment of the
1 insane is exciting much active thought in the pro-
fessional and philantrophic mind.
As the result of the following experiment may add
something towards the solution of the problem, I offer
it as a contribution to that end:
On the 19th of April, 1881, the male department of
the Illinois Southern Hospital for the Insane, at Anna,
was destroyed by fire. About half-past one o'clock in
the morning of that day, two hundred and sixty patients
were marched out of the burning building upon the grounds
in front, where they were kept until the flames were
subdued. They were then crowded into the chapel, center
building and fourth story of the female department; the
women in that story being doubled in on the floors below
to give necessary room for the men.
About three men occupied the space that should be
allotted to one only. It was evident that these patients
could not be kept in this crowded condition during the
approaching hot months, pending the reconstruction of
the burnt wing, without great injury to both physical
and mental health. It was decided to construct temporary
quarters for a part of them, and the decision was carried
out as speedily as possible.
Within a distance to make it readily accessible to
the domestic department of the hospital, a temporary
building of one story was erected in the form of a cross,
with very long arms. The head and foot of the cross
corresponding to the usual center building. Each arm,
* Read before the Tri-States Medical Society, October 26th, 1881.


Care of the Insane.
35
or wing, is one hundred and fifty feet long, and twenty-
eight feet wide. At the end of each wing, fartherest
from the center building, are six well-ventilated, single
or seclusive rooms, for such cases as might be required
to be separated from the rest. All the remaining portion
of the wing being used as one long dormitory.
A room used for baths, lavatory and water closet was
built out from the rear side of the angle of junction with
the center building. The center building is twenty-eight
feet wide and one hundred and twenty-two feet long,
and is divided into three apartments: an attendant's
room, a clothing room, which is also a common connect-
ing hall, and a large common dining room.
At the rear side of each wing is a court yard one
hundred and sixty-four feet long by one hundred and
forty feet wide, enclosed by a board fence high enough
to prevent the demented patients from wandering from
the premises. A door from the wing opening into the
court yard is kept open during the day time, and the
patients may pass at will either way. Seventy-five patients
were assigned to each wing under the care of four attend-
ants during the day time. During the night one attendant
watches the building and all the patients in both wings;
the partitions dividing the wings from the center building
being constructed of wooden bars with interspaces to
admit of the free circulation of air, and give better facil-
ities for oversight.
The patients assigned to these quarters were chronic
cases, a considerable portion of them being demented,
epileptic and paralytic.
In noting the results of this forced experiment, we
observed that the change was highly pleasing to these
afflicted people. A poor demented old man who had
been unable to get out of the hospital with the others,
exclaimed, “I thank God my foot is on the ground once
more."
They delighted in the free, open air of the court yards,
which, by the way, were well shaded with forest trees,


36
H. Wardner.
n peculiar way consequently
evoked by
and amply furnished with seats. They lost the sickly
palor usually observed among patients kept within walls.
The ample space left each man free to exercise in his
own peculiar way without infringing upon the privileges of
his neighbors; and consequently the irritation and assaults,
especially among the epileptic, provoked by limited quar-
ters and personal contact, have been reduced to the
minimum.
During the entire season there has been but three or
four occasions to use restraint, and those arose from
epileptic excitement. These patients have been remark-
ably healthy during the season; no case of serious disease
having originated or developed among them. They have
been contented and the number of escapes have not been
more than in previous years."
Sleeping as they have in such large associate dormi-
tories seems to have had the effect to keep them more
quiet, and with the exception of occasional excitement from
epileptic attacks, there has been no more disturbance
than might have occurred, had the same number of sane
people been lodged in the same room. Those who had
previously been noisy and disturbed their neighbors, while
occupying single rooms or small dormitories, out of con-
sideration for others, or in consequence of the restraining
influence of numbers, and the eye of the night attendant,
became quite and acquired the habit of keeping still, if
not of sleeping well. In fact, a general improvement has
been observable both in physical and mental conditions.
It was intended to take down this temporary building
after a part of the burned wing had been reconstructed
and ready for occupancy, and use the material in the re-
building of the remaining part of the hospital; but its
use has proved so satisfactory that it will be retained for
temporary use during hot weather, and at times when it
becomes desirable to renovate portions of the hospital
edifice, if it should not be devoted permanently to the use
of the epileptic and feeble patients.
A similar building, would in my opinion be found of


Care of the Insane.
37
great advantage at every hospital constructed on the
ordinary plan, and its occupancy by selected patients
during the hot months would prove beneficial, and a great
relief from the monotony of the corridor and wards which
give to asylum life so much of its prison-like gloom.
The asylum at St. Joseph, Mo., met with a similar
misfortune in 1876, which forced upon the management
the necessity of providing temporarily for their patients
during the reconstruction of the hospital.
In the biennial report of that institution for 1881, the
superintendent, Dr. Catlett, asserts that his experience in
providing for the insane in cottages and farm dwellings
during the reconstruction of the hospital, a period of
fourteen months, has in his judgment established the
expediency and practicability of providing for all classes
of insane in far less expensive dwellings than the model
asylum edifice. The Doctor notes particularly the bene-
ficial effects of the free out door life upon the irritable,
excitable and enfeebled patient. He concludes his
remarks upon the subject in the following language:
“I extract from the valuable crucible of experience lessons in
therapy and provisions for insane, which tend to convince me that the
model asylum edifice of this era of psychological activity is perhaps
erected both at the too great expense of the humane public, as well as
opposed to the best hygiene and curative interest of the improved and
chronic insane; or, in other words I am almost persuaded to assert my
belief that less expensive segregated cottages, erected on asylum
farms, for the treatment of the improved and chronic insane, suffi-
ciently near the main edifice where all can be under one supervision,
and where exchange of patients may readily be made, when the con-
dition of the patient requires it, would be a very great improvement
in the present mode of provision and treatment of the insane.
These experiments having shown such results become
strong arguments in favor of a cottage plan, combined
with the prevailing system so as to give more freedom
and out-door life, especially to the chronic insane. Such
additional facilities need not cost over twenty per
cent. of what the usual hospital structures cost the
taxpayers of the country, which is on an average about
$1000 per capita. Our building at Anna, which I


38
H. Wardner.
neglected to state is furnished with hot and cold water, a
system of sewerage, and is lighted by gas, cost thirty-
seven dollars per capita, but is intended for summer use.
If such accommodations were added to hospitals already
built and in operation, but constructed to meet the emer-
gencies of the winter season, it would result in materially
diminishing the cost of maintenance, while the sanitary
and hygienic conditions would no doubt be materially
improved.
With us at Anna, the result of our experiment has
been a strong argument in favor of such a plan, and has
largely dispelled the doubts we have entertained as to its
utility.
Art. IV.-Apoplectics.*
THEIR MENTAL STATE, THEIR DEGREE OF RESPONSIBILITY
AND THEIR CIVIL CAPACITY.
Translated by E. M. Nelson, M. D., St. Louis.
I DESIRE, in a word, to serve you as a guide in a
1 clinical and medico-legal excursion, undertaken amid
difficulties, real and often unforeseen, in the practice of
our art. Our first session will be devoted to the study
of the mental state of apoplectics.
[He calls attention to the fact that the so-called
apoplectic habit has no necessary or even frequent
relation to the occurrence of apoplexy. He places in the
list of “apoplectics” all those who have had one or more
strokes of apoplexy. He mentions the characteristic
symptoms of apoplexy, with its sequelæ of more or less
impairment of intelligence, sensibility and motility accord-
ing as the hemorrhage is more or less extensive, or
occupies this or that situation in the brain.)
• Clinical lecture at la Salpêtrière, by M. Legrand du Saulle.


Apoplectics.
39
I should note, in the first place, that the degree of
intelligence in apoplectics varies according as you consider
such or such another patient. In fact, apoplexy does
not necessarily bring on dementia, and it will be a
grievous error to affirm the irresponsibility or civil inca-
pacity of an individual for the single fact that he has
been previously struck with apoplexy. Just as the troubles
of motility and sensation are very different according to
the cases, as their degree is proportioned to the extent
or site of the cerebral lesion, just so, according as that
lesion shall be more or less important, as it shall be
localized in this or that part of the brain, as it shall be
single or multiple, sometimes the intelligence will survive
the attack of apoplexy, almost unimpaired; sometimes,
on the contrary, it will be greatly disturbed, and some-
times completely abolished.
It is necessary also to form a sort of classification
of apoplectics, a little artificial, I well know, as are
all classifications, but which will permit us to study at a
glance, at once, the totality of intellectual troubles in
these patients, and the peculiarities of each group. I had
believed that we should admit three different degrees of
perturbation in the understanding of apoplectics; but I have
since recognized, with J. Falret, that it would be possible
to describe four :
FIRST DEGREE.—There are apoplectics (and they are
more numerous than is generally thought) who, in spite
of a characteristic hemiplegia, present, as it were, no
appreciable alteration of their mental faculties. A chief
of clinic of Prof. Rostau, although struck with a hemor-
rhage has been able, during twenty or twenty-five years,
to remain one of the most distinguished writers of the
medical press. We have seen magistrates, after an attack
of apoplexy, resume their functions and continue them
with regularity, without anything in them betraying, to a
superficial examination at least, any intellectual disorder.
It is not to be said, however, that the understanding
in these patients remained perfectly unaffected. The


40
E. M. Nelson.
illustrious Prof. Lordat, of Montpellier, being affected
with cerebral softening, was able to resume his course,
but he had lost his brilliant faculty of improvisation, and
was reduced to the necessity of reading his lectures.
The character is modified, the will is ordinarily weak-
ened. These apoplectics have become more easy to
govern, to control, to terrify, to influence, although more
irritable. But these modifications of intellect exist in a
degree so little pronounced that a close habit of obser-
vation is necessary in order to detect them. To judge
these differences, it is necessary to compare what these
individuals are with what they were before the attack.
It is necessary, moreover, to live constantly with them.
The public, and even the physician, appreciate with
difficulty those changes of which the persons immediately
about the patient, his friends, his wife alone can give a
good account.
With regard to patients of this group, there is no
measure to adopt. They continue to occupy in society
the same rank as before their attack, and we could not
place in doubt their civil capacity and their moral respon-
sibility.
Second Degree.—The attack was more profound. The
patients are more sensitive, more impressionable, more
emotional; they weep without occasion; pass, with a like
readiness, from the most touching tenderness to the liveliest
irritation. With them the memory is weakened, they
make a veritable “hunt for ideas;” proper names and
nouns escape them; often it occurs to them to replace
the word that fails them with the word “thing,” which
they sometimes find only afte painful efforts. Some
typical examples will fix these facts in your mind. I
knew intimately in my childhood, said Carpenter, a
remarkable savant, aged more than seventy years; he
was still vigorous, but his memory was declining. He
forgot especially recent facts and words little used.
Although he continued to frequent the British Museum,
the Royal Society and the Geological Society, he could


Apoplectics.
41
no more call them by their names; he designated them
by the term public place."*
Winslow has reported the curious fact which follows:
M. von B., ambassador to Madrid, then to St. Petersburg,
found himself when about to make a visit, obliged to de-
clare his name to the servants. The search being in vain,
he addressed himself to his companion: “For the love of
God, tell me who I am.” The question excited laughter.
He insisted and the visit ended there.
In these patients the will yields still more than the
intellect. They lack spontaneity and decision. These men
who seem so irritable, so intractable and are refractory
against those who govern them, and revolt against one
who attempts to control them; they obey and readily
conform themselves to the rôle of passive beings. Their
will offers a breach by which it is easy to penetrate.
This degree of intellectual weakness is frequent and
is compatible with the preservation of a great number
of correct ideas. Certain of these patients go to their
studies or places of employment; they follow their accus-
tomed occupations, and yet their will is so weakened
that interested persons can, in the matter of a will, for
example, push them to this decision or procure from them
such a desired permission. There is here no insanity;
there is again no dementia; but no more is there a
normal state of the intellectual functions.
THIRD DEGREE.—There is here a frequent variety of
cerebral disorder appearing especially among apoplectics
who have had two or more attacks. The patients have
lost the notion of the simplest things of life, of the day,
of the week, of the place where they are. They forget
persons, often those with whom they were formerly most
familiar. Louyer-Villermay has reported the case of an
old man who, being with his wife, imagined himself to
be with a lady to whom he formerly devoted all his
evenings, and constantly repeated to her, “Madam, I can
*Carpenter, Mental Physiology.


42
E. M. Nelson.
not remain any longer; it is necessary that I return at
once to my wife and my children."
Judgment in these patients has lost its correctness.
. There is here veritable insanity or rather a true dementia.
Sometimes delirious conceptions arise; the apoplectics
have apprehensions, sudden fears; some one wishes to do
them an injury; some one has taken everything from
them; some one plunders them; some one persecutes them;
they are really unhappy. Sometimes hallucinations appear;
terrifying nocturnal visions; a whole phantasmagoric pano-
rama of terrible or bizarre objects passes before the eyes
of the patients.
Formerly they were generous, even prodigal. They
are to-day parcimonious to a degree which approaches
avarice. You see them walking in the streets, generally
accompanied by a servant and presenting some signs of
semi-maniac excitement; at other times, on the contrary,
full of an anxious melancholy, suspicious, distrustful,
whining; they complain in a loud voice, repeating in the
same tone the same griefs and the same complaints.
These are the insane, the demented insane. That is why
they are most often placed by their families in the
asylums or retreats; a useless measure, for these patients
are difficult to watch over and need special care.
Fourth DEGREE.—We have to do with complete demen-
tia. The decrepitude is complete, intellectual and physical
failure absolute; there is degradation and brutishness to
its extreme degree. Pass through certain wards of this
hospital [la Salpêtrière), and you will see brought together
there, I could almost say accumulated, many of these
worn out apoplectics of old date, whose autopsy will soon
show the destruction over a large extent (by centers of
softening) of the cortical layers of the brain. There
remains scarcely anything human to these unfortunates
except the external form of the body; the heart still
beats, the lungs yet breathe, but all cerebral activity is
extinct. Approach these patients, question them; you
will have much trouble most frequently, I will not say to


Apoplectics.
43
obtain a reply, but even to fix the attention. Sometimes
you will be received with a vacant smile, an uncertain
look, at unintelligible grunt. The functions of organic
life continue to be exercised, those of the life of relation
are almost wholly abolished. An apoplectic singularly
resembles a general paralytic arrived at the last phase
of his affection. You might be deceived here if you
were not enlightened by information derived from the
past of this patient. You will be definitely informed by
the examination of the lesions which you will find here-
after in the amphitheater, and which you know differ
entirely from those which we meet in diffuse meningo-
encephalitis. In closing that which relates to intelligence
in apoplectics, I ought to call your attention to one inter-
esting peculiarity, which has been brought out by one of
my pupils, Dr. De Finance, in an excellent work upon
the mental state of aphasic patients. Whatever may be
the intellectual weakening in patients who are the subjects
of hemorrhage or of softening, there is one aptitude which
most frequently is preserved: it is the aptitude for play.
These patients, even when memory exists no more, and
when intellect is impaired, can follow a game of cards,
of dominoes, of chequers, understand the plays, even, to
a certain extent, combine and discuss them. Nothing is
more curious than the frequent preservation of this
faculty in the midst of the general wreck of their under-
standing.–Gazette des Hôpitaux, June 14, 1881.
Let us pass in review first the immoral or criminal
acts coinmitted by apoplectics, we shall find out what
may be, perhaps, the civil capacity of these patients.
1. IMMORAL AND CRIMINAL Acts.—I have read, in the
course of my life, an immense number of proceedings
drawn up by police commissioners of the city of Paris or
its suburbs against apoplectics. It is always the same
set of facts which are related : such an apoplectic is lost
in the street, was unable to regain his residence, sat
down upon a bench and slept there ; such another has
publicly held out his hat to those passing by, and asked


44
E. M. Nelson.
alms; this one has urinated on the public way, has
exposed his genital organs, or has forgotten to button his
pantaloons; that one has raised the skirts of a little girl
in open day before the whole world, upon the slope of
the fortifications; another, in the Jardin des plantes, has
made obscene proposals to a nurse, and offered her two
cents to suckle the child in his presence; another has
squatted down and evacuated his bowels in a public
square; another has made attempts to take obscene
liberties with little boys; another has taken three prunes
from the stand of a grocer; another has stolen a little
saber in a store; another has eaten and drunk in a
creamery without having money to pay; another has
entered a carriage and had himself driven around for
several hours, and he was able neither to remunerate the
driver, nor make known his identity; another, having
slept two hours in a café, could not indicate his address;
another readily followed a woman of pleasure and installed
himself at her house, and, believing himself at his own
residence, would not go away; another alights from a
wagon, has lost his ticket, refuses to pay a second time
for his seat, becomes insolent and is arrested; finally,
another is completely undressed in a public place.
The supposed criminality of an apoplectic is sometimes,
moreover, very serious. I remember a very curious case
which occurred some years ago. A farm servant, aged thirty-
seven years, affected with hemiplegia from a cerebral
lesion, who was neither hysterical nor epileptic, became
pregnant. She was confined in the night, and the next
morning her infant was found dead. She was taken into
a court of assizes on charge of infanticide. Acquittal
took place because it was easy to demonstrate that, in
fact, they were concerned not with a voluntary infanticide
but with an infanticide by omission, the servant not being
in a state to take care of her infant.
You will see, after the facts which precede, how impor-
tant it is to be able to appreciate correctly the degree
of responsibility of apoplectics. In the presence of such


Apoplectics.
45
persons accused, the mission of the judges is not always
easy. Magistrates are liable to be too indulgent or too
severe. It is upon the physician that devolves the
unquestionable duty of casting light upon the question.
Now it is evident that your estimate should differ accord-
ing as you find yourself in the presence of such or such
another apoplectic. Refer in your mind to the details into
which I entered at the beginning of this lesson. If you
have to do with one of those patients whom we have
classed in our first, and even in our second group, so
that an attentive examination demonstrates to you that the
apoplectic possesses a degree of will and reason sufficient
so that the act charged was free and conscious, you
ought necessarily to admit the responsibility. If it is
proved to you, on the contrary, that the intelligence is
distinctly diminished, that the will has failed much, but
that there still remain, nevertheless, quite precise notions
as to good and bad, the just and the unjust, it will be
necessary for you to make prevalent the idea of a pro-
portional, that is to say, a modified responsibility. Among
these last, in fact, liberty is so limited that we cannot
without injustice make them bear the whole responsibility
of their faults; it is sufficient that they have to answer
in a certain measure for the morality of their acts.
If, finally, the attack was more profound, if uncon-
sciousness was proven, if dementia is positive, you should
claim for the apoplectic the benefits of Article 64 of the
penal code which is thus expressed: “There is neither
crime nor misdemeanor when the prisoner was in a state
of dementia at the time of the act.
2. Civil Acts. If it is important to be able to judge
clearly of the mental state of apoplectics in the point of
view of the responsibilities which these patients sometimes
incur, and the criminal acts or misdemeanors for which
they have to answer before the court of assizes or simply
before the tribunals of correction, it is no less necessary
to know how to appreciate the degree of their capacity
in the matter of civil acts. There is a question here which


46
E. M. Nelson.
presents itself every day. Let a question arise as to an
agreement, to a financial transaction, a guarantee, a
marriage, a prohibition, a judicial opinion, a will, you may
be asked as to the value of a consent given by an apo-
plectic, of a signature which he may have affixed, of a
contract which he may have concluded.
It is not rare, in fact, that an apoplectic consents to
a burdensome agreement. Being well, he had a store, a
shop, a manufactory; he carried it on himself, or was
assisted by associates or employés. Then the disease
came; the attack of apoplexy was produced; then it was
that the faculties became weaker and the intelligence
diminished. The people who surround him, interested in
his affairs, very quickly perceive this failing and hasten
too often to experiment upon the situation to the injury
of the patient. His associates, for their greater profit,
engage in venturesome operations, in which he alone incurs
the risks, while they arrange matters in such a way as
to share the benefits of the enterprise or of the specu-
lation if it shall be profitable. The physician cannot, to
be sure, interfere of himself in cases of this sort; he has
not the right, you understand, to set himself as governor
or manager of families. But let the patient's wife come
to consult him, and this circumstance is not very rare,
concerning such an operation or such an agreement which
her husband is about to conclude, and it will then be neces-
sary for him to declare his opinion conscientiously.
You ought, in a case of this nature, to have recourse,
in order to discharge your whole duty, not only to
the attentive examination of the objective symptoms
presented by the patient, but also to the elements of
information, which I will call, if you wish, extra-medical.
Is he concerned in a partnership without sufficient guar-
antees, in an ill-advised loan, in an unjustifiable removal
of capital? It is very probable that your apoplectic, in
a state of health and before his attack, would not have
complied with these manœuvres, unhandsome, imprudent
and, perhaps, disastrous.


Apoplectics.
47
There may present, in practice, questions still more
difficult. The patient is alone, without children; he
occupies a mansion which came to him from his father;
those about him know that it is much easier to appro-
priate a sum of coin or a bundle of bank bills than to
take possession of a piece of real estate. They over-
reach the proprietor, who opposes too little resistance to
the interested counsels which they give him; they
persuade him that he ought to sell and make use of
good opportunities which offer. In such cases, you will
sometimes be called upon to unmask the manœuvre, at
least to display the wicked projects in giving strong advice.
Secure the preservation of the status in quo.
About the apoplectic are exercised the worst inclina-
tions, the most criminal plots are woven. It is easy to
lead this man, alone, isolated, alarmed as to the future,
sometimes abandoned, who sees himself making each day
a step towards the grave, to an inappropriate alliance.
Shameless speculation is not wanting. It is a mistress,
a domestic, who may have had for the patient the slightest
but best calculated affection, and will easily succeed in
making him marry her, with a contract in good and due
form. Here is a fact which recently occurred: An
apoplectic was placed in a retreat, with the consent of
his family, by a regular process and upon my certificate.
Soon an old mistress sent an order from the court
which set the patient at liberty. He was immediately
taken to a little house, almost inaccessible, situated not
far from the fortifications whence he only went out to
the church. On the very threshold he was stricken with
a new attack, and died in a few months. In vain did
we intervene, five or six physicians and myself, to prevent
this marriage; one would not have believed it. At the
autopsy, M. Laségue, G. Bugeron and myself found old,
quite characteristic lesions. So it was that by a criminal
stratagem a family has been defrauded of a part of the
fortune which should of right come to them.
In the presence of such facts, what ought to be the


48
E. M. Nelson.
attitude of the physician? He should not forget the
reticence which professional discretion imposes upon him.
In no case, is it proper for him to become an informant
of his own accord. But I claim that it is sometimes dis-
graceful that he cannot take certain straight-forward, honest
and helpful initiative steps. * * * * * *
SHOULD APOPLECTICS BE “INTERDICTED"?—To this most
grave question, as it is necessary to place the patient
under supervision and to suppress his capacity as to civil
acts, one could not answer by a simple yes or no. The
application, in fact, should be different according to the
case.
Do not forget, moreover, that "interdiction” is a meas-
ure which it is necessary to use with the greatest reserve,
an extreme measure to which it is allowed to have
recourse only when the most serious interests of the
patient of the no less legitimate ones of his family,
are set in peril. So the physician ought to pronounce
in favor of "interdiction” only in the case of demon-
strated dementia, when the memory is affected without
hope of return, and the will is annihilated.
If intelligence is only diminished, if certain faculties
persist while others are tottering, if the will is weakened
without being destroyed, it would be preferable to have
recourse to the giving of a “judicial council” (un conseil
judiciaire). The “judicial council" is a sort of middle
state between the free exercise of all the rights and
“interdiction.” The individual who is so provided
preserves the enjoyment of his effects, the disposal of
his revenue, but he is not allowed to alienate his real
estate, to invest or withdraw funds, or to contract important
engagements without the consent of his “judicial council.”
He can marry; he can even make a will.
If the apoplectic is placed in a retreat, it will be
well to have him name a provisional administrator.
Finally, there are cases where intelligence, in spite of
the cerebral lesions, is well preserved, where the faculties
are so clear that one can, without inconvenience to the


Apoplectics.
49
patient, without prejudice to those about him, leave him
the free administration of his fortune. It is upon you,
you see, upon the estimate that you form, upon the
judgment which you formulate, that will depend the
taking of such or such measures which I have just indi-
cated with regard to these patients.
I ought, before ending this lesson, to take up one
last question: Can an apoplectic make a valid will ?
Article 901 of the civil code says, “ to make a gift during
life, or to make a will, it is necessary to be sound in mind.”
Now, from the details upon which we have heretofore
entered, it follows that certain of our patients have surely
preserved a sufficient degree of reason to be able to
make a will validly; that others, on the contrary, are
evidently unfit to do so. Here again is concerned a
question of degrees, even of shades, of which you will be
the sovereign judges. * * * * * *
Having reached the end of this lesson, which I have
shortened at more than one point in order not to over-
step the limits which I have assigned myself, I should be
happy to have convinced you of the practical interest
which exists in knowing well, under its multiple aspects,
the intellectual state of the patients whom I have desig-
nated “apoplectics.” May I have been able to introduce
into your minds the thoughts which seem to me indis-
pensable from the standpoint of professional practice each
day! These thoughts, no one should ignore to-day,
especially, when cerebral pathology has entered upon a
new and fruitful way, thanks to important works, many
of which have been inspired by the observation of
patients placed under treatment in this scientifically
celebrated hospital.—Gazette des Hôpitaux, June 21, 1881.


Art. V.-A Case of Disseminated Sclero-
sis. *
By ARCH. Dixon, M. D., Henderson, Kentucky.
THE history of the following case of spinal trouble, I
1 desire to lay before you, at the earnest request of
the sufferer, in the sincere hope that some new light may
be shed upon the subject, especially as regards prognosis
and treatment :
Dr. J. B. C., aged fifty-nine years, had been a prac-
titioner of medicine in a highly malarious portion of
Alabama for sixteen years previous to his removal to
Henderson, Kentucky, in 1857. During that time he had
been the subject of frequent attacks of malarial fever,
accompanied by dyspepsia, constipation, vertigo, headache,
etc. Arriving in Kentucky, in a broken down condition,
he did not attempt to practice his profession, but devoted
himself to the recuperation of his general health. The
following year he resumed practice, and continued in
fair health, with the exception of occasional constipation,
till the fall of 1868, when he had an attack of so-called
typho-malarial fever, from which he was slow to recover,
since which time his general health has not been good,
having suffered more or less with constipation and poor
digestion. In 1878, an eczema appeared first upon his hands,
and gradually spread over the whole surface of the body.
The eruption failed to respond to treatment, and his
health became still more impaired. In the fall of the
year (1879), he made a trip to the mountains of Alabama,
where he remained three weeks. Under the influence
of pure air and active out-door exercise (hunting every
day), his health notably improved, his strength increased,
his appetite was good, he gained about six pounds in
• Read before the Tri-States Society, St Louis, Oct. 26th, 1881.


A Case of Disseminated Sclerosis.
51
weight, and the eczema had almost entirely disappeared.
Returning to Kentucky, feeling well and much encour-
aged, he plunged at once into a heavy and laborious
practice This soon began to tell upon him, and, early
in the winter of 1879-'80, he became aware that his
sexual desire was impaired, and by February, 1880, he
was entirely impotent. He complained of being tired
almost constantly, and there was perceptible loss of
power in the left leg; there were tingling sensations
about the toes, with a dull aching along the back, there
was, also, pain of a dull character referred to the left
knee, which he ascribed to rheumatism. This condition
continued until March, 1881, when he was compelled to
take his bed, having almost entirely lost the use of his
left leg.
I had diagnosed his case as one of “Spinal Hyperæmia,"
but there was a difference of opinion among his physicians,
and he was treated for rheumatism. He was confined to his
bed about five weeks. At this time there seemed to be a
remission in the course of his disease, and there was grad-
ual, though distinct improvement, so that by the last of
April he was able to hobble about with a cane, but there
was marked paresis of the left lower extremity, accompa-
nied by muscular contractions and some tremor. In a short
time he began to have difficulty in controlling his bladder,
and there was constipation almost amounting to impaction.
In the early part of June he was again compelled to take
his bed. There was slight, if any alteration in tempera-
ture; the pulse, however, was quickened, running up at
times to 130 (his normal pulse being about 70). There was
hyperästhesia over almost the entire left side, and the sen-
sitiveness on right side was also slightly increased. Muscu-
lar contractions were marked with exaggerated tendo-reflex.
Pain in the left knee was still present, and he complained
much of headache. Tremor still existed, and manifested
itself upon change of position, as sitting up. It was also
present when an attempt was made to carry anything to the
mouth. Vertigo, of a gyratory character, added much to


52
Arch. Dixon.
the discomfort of our patient. There was slight inequality
of the pupils and some nystagmus. The diagnosis of “Dis-
seminated Sclerosis” was now made, and the opinion con-
curred in by the other attending physicians. The condition
of Dr. C. rapidly grew worse, and by the first of July he
had lost all control over the sphincters, his bowels and blad-
der were emptied involuntarily; the paresis had involved the
right leg; he complained of girdling pains and a constrict-
ing band. Cerebral symptoms became manifest, his
consciousness impaired and there was a condition of
partial stupor for about two weeks. He spoke in a slow
drawling manner, with difficulty in enunciation. There was
no stammering. His thoughts were collected slowly and
with evident effort, and his memory was faulty. He was
exceedingly emotional and gave way to fits of crying
without cause. There was slight fever, temperature rarely
going above 102° (F). This condition gradually changed
for the better, the temperature declined to normal, the
mind recovered, in a large measure, its power, revealing
to my friend that he was totally paralyzed from the
region of the sixth dorsal vertebra, downward, with an
utter absence of sensibility. Muscular contractions,
though not permanent in character, had markedly
increased. Ankle clonus was sometimes present, and
tendo-reflex much exaggerated. The following Septem-
ber Dr. C. went to Hot Springs, Ark., in the hope that its
thermal waters would benefit him. There his trouble was
diagnosed as being specific in character, and he was put
upon specific treatment, mainly Potass-Iodide, which was
increased daily, until he was taking about 5 iv. in the
twenty-four hours. I should here state that Dr. C. had
no syphilitic history. There was, it is true, a sore upon
his prepuce-eczematous in character-and accompanied
by glandular enlargment, but there was no characteristic
induration, nor were there any constitutional develop-
ments. The opinion that Dr. C.'s trouble was of specific
origin was at first not concurred in by my friend Dr. J.
M. Keller, who, however, in a letter, subsequently stated


A Case of Disseminated Sclerosis.
53
that he perfectly agreed with me in regard to the case.
In December, 1880, Dr. C. returned to Kentucky. There had
been some improvement in his general health. His appe-
tite was better as was also his digestion, and he was
notably encouraged as to the final issue of his case. He
was still taking the iodide, but very soon found it nec-
essary to discontinue the amount taken daily and in a
short time had to give it up entirely, so small a quantity
as two grains producing trouble about his throat. In June,
Dr. C. W. Stevens, of St. Louis, paid him a professional
visit. After careful examination the opinion of the Doctor
concurred with that of his attending physicians, and Dr.
C. was informed in a gentle, though positive way, that
there was very little to hope for from treatment. He
was, however, put upon the syrup of the hypophosphites
with nux vomica, which he continued to take for some
time, without perceptible benefit. During the past month
or two he has taken nothing beyond an occasional purg-
ative with the application of mild currents of electricity
in connection with baths and about the one-sixth of a
grain of morphia at night. His condition upon examina-
tion to-day, October 18th, is as follows: General appear-
ance good, appetite good, digestion good, muscular atro-
phy very slight, tendo-reflex slightly exaggerated, muscles
respond to electrical irritation, contractions frequent, none
permanent, urine normal but somewhat increased in quan-
tity. Suffers pains of a dull character almost constantly,
on left side, on a line extending from a point about two
and a-half inches to the left of the zephoid carti-
lage backward to the seventh dorsal vertebra. There is
total anasthesia from the middle of the dorsal region,
down. Paresis also complete. There is slight loss of
memory and a condition of irritability, with frequent fits
of crying. There is no tremor. During the last few
weeks he has, now and then, had pain (neuralgia) about
the left scapular region. He has never been troubled
with bed sores, with the exception of a small sachral
eschæ, produced during his trip to and from Hot Springs.


54
Arch. Dixon.
This yielded to treatment and is now entirely well.
Temperature normal, pulse 76, full and strong. Has
pleasant dreams, sometimes erotic in character. Has
erections, and thinks he could complete the sexual act,
but I am afraid this is altogether imaginary. This, then
gentlemen, is the history of a case which, to me has
been of exceeding interest, both on account of the misfor-
tune of my friend Dr. C. and from a clinical standpoint,
During the last quarter of a century, such an impetus
has been given to the study of nervous diseases by the
researches of neurologists, both abroad and at home, that
the general practitioner who fails to look into the subject
finds himself drifting behind and unable to keep abreast
of the times. I, therefore, consider it useless to occupy
your time by a description of the pathological anatomy
of disseminated sclerosis, but shall confine myself to some
general remarks, more especially as regards the symp-
tomatology of the disease. Disseminated sclerosis, accord-
ing to Charcot, is not an exclusively spinal affection, but
may invade the cerebrum, cerebellum, pons Varolii, the
bulbus rachidicus, as well as the spinal cord. He speaks
of the alteration as being comparatively a coarse one, and
expresses surprise that it should have escaped observation
so long, but accounts for it on the ground that it is an
eminent polymorphic affection. The patches of sclerosis
sometimes occupying the spinal cord exclusively, in the
other cases they predominate in the cerebral hemispheres.
and medulla oblongata, and, finally, there are cases in
which they are dispersed throughout all the departments
of the nervous centers. In consequence of those varieties
of position, three forms of the disease have been recog-
nized: 1st, the cephalic form; 2d, the spinal form; and
3d, the mixed or cerebro-spinal form. Of these three,
the cerebro-spinal is of most frequent occurrence, and,
therefore, of most interest, and I cannot but regard the
case which I have endeavored to lay before you, as
being of that character, notwithstanding the marked
intermission and improvement which have taken place


A Case of Disseminated Sclerosis.
55
in reference to cerebral symptoms. The tremor of
the upper extremities, rythmical in character, and absent
when the muscles were in repose; the peculiar enuncia-
tion, nystagmus and vertigo, with the impairment of mind,
pointed unmistakably to cerebral involvement, sclerotic in
character. The tremor was not that of paralysis agitans,
neither was there present the incoördinate gesticticula-
tions of different degrees of disorder and abruptness seen
in ataxy. The tremor of paralysis agitans exists as well
when the members are in a state of repose as when they
are set in motion by the will. In this case, the tremor
only manifested itself when some intentional movements
were made, and ceased when the limbs were at rest. The
difficulty in enunciation was present for a number of
weeks, accompanied by slight trouble in deglutition, and
resembled a corresponding condition seen in progressive
bulbar paralysis. The vertigo was marked, and of that
gyratory character which is mentioned by Charcot as
being present in about three-fourths of the cases of
multiple sclerosis, and which mark its invasion. Nystag-
mus, which is also met with in about one-half the num-
ber of cases, was also one of the phenomena noticed.
All of these symptoms were preceded by a more or less
decided decline in the motor power of the left lower
extremity; there was a feeling of weariness, with dull
pain referred to the left knee. There was no notable
disturbance of sensibility until after the second attack,
when there was complete anæsthesia, from a point above
the umbilicus, about two and a-half inches downward.
Loss, or marked disturbance, of sensibility is not usually
found in “sclerose en plaque,” but Rosenthal, in his excel-
lent work on “Diseases of the Nervous system,” p. 91,
vol. 1., has this to say in reference to that point:
" Disorders of sensibility are not regarded as frequent symytoms of
diffuse sclerosis of the nerve centers, but the absence of sensory disturbance
is not, as authors still think, a characteristic sign. We can, with difficulty
comprehend bow sensibility should remain intact in the presence of such
frequent changes in the parenchyma of the cord. * * * If the lesions
of the posterior portions of the cord and the gray matter are slight, sensi-


56
Arch. Dixon.
bility is only moderately affected; on the other hand, if the posterior
columns are seriously involved as well as the adjacent parts (as in the
sclerose en plaques and ribbon-shaped sclerosis of Bourneville and Guérard)
there is considerable diminution, and even complete abolition of sensi.
bility."
The posterior columns must, in this case, be seriously
affected, and, in fact, from the beginning there was an
intermixture of symptoms which properly belong to ataxia.
There were slight girdling pains, but none of those ful-
gurant crises which play such a prominent part in the
early stages of progressive locomotor ataxia. There was
partial throwing forward of the foot, as in ataxic patients,
but there was an absence of that loss of the sense of
position of parts, which also belongs to that disease.
Charcot, p. 164, “ Nervous System,” says:
“ It is common enough for the sclerosced patcbes, which, as a rule,
principally occupy the antero-lateral columns, to cross the posterior-
lateral fissures and encroach on the posterior columns. Occasionally I
have seen them, when they were confluent, involve a large portion of the
substance of these columns throughout the whole extent of one of the
regions of the cord—the lumbar region for instance.”
Bourneville says:
“Cases of disseminated Sclerosis, in which the posterior columns
were involved so as to occasion some of the symptoms of locomotor-ataxy,
are numerous enougb."
Another unusual feature in this case was the loss of
power over the sphincters which supervened, shortly
after the second attack, and which rarely shows itself
until the disease is far advanced. Again, spasmodic mus-
cular contractions were present at an early stage, a
symptom not commonly seen till two, four or even six
years after the appearance of the first accidents of multi-
locular sclerosis. There has, however, been no disorder
of nutrition, the muscles of the lower extremities exhibit-
ing but little, if any, atrophy. Finally, the age of the
patient might cast some doubt upon the correctness of
the diagnosis, as diffuse selorosis rarely attacks those who
have passed the age of forty years.
I am aware, gentlemen, of the transient and unsatis-
factory impressions which are made upon the minds of


A Case of Disseminated Sclerosis.
57
hearers, by symptoms detailed at a distance from the
bedside of a patient, but, for the sake of my friend, and
in the earnest hope that some suggestion may be made
by those who have made nervous diseases a study, that
will be of benefit to my patient, I have ventured to give
a condensed history of his case. Again, it may be pos-
sible that I am mistaken in the diagnosis, for I am aware
that there are symptoms which point towards other dis-
eases, and others which are common to multilocular
sclerosis, not present. But, in reviewing the whole case,
I think I am justified in calling it one of disseminated
sclerosis.
Art. VI.-Current Delusions Relating to
Hypnotism (Artificial Trance).
By GEORGE M. BEARD, A. M., M. D., New York.
I INDER this head, I will endeavor to indicate briefly,
and, if possible, clearly, some of the errors in regard
to the artificial form of trance popularly known as hyp-
notism, that just now prevail among scientific students of
this subject, both in Europe and America.
The popular delusions on this subject, of which mag-
netism and animal magnetism are the most familiar, are
now passing away–have, indeed, already become historic
-but there remain, even with some of the best of the
special workers in this line, a number of other and almost
as serious delusions, which must be dissipated before
trance, in all its phenomena and numerous scientific and
practical relations, becomes appreciated and understood.
For the sake of clearness—to know just where we
stand-a few definitions may be repeated here.
First-Trance is the concentration of nervous force
in some one direction, with corresponding suspension of


58
George M. Beard.
nervous force in other directions. It is subdivided into
natural and artificial forms.
Second— Natural trance, that which comes on through
natural causes, is, like insanity, variously subdivided into
cataleptic trance, somnambulistic trance, alcoholic trance,
intellectual trance, emotional trance, etc.
Third-Artificial trance, popularly called “hypnotism."
One law governs all these varieties of trance, natural
and artificial. One theory, the concentration theory,
explains and unifies them all. He who has experienced
or witnessed an ordinary attack of absent-mindedness and
understands it thoroughly in all that it suggests, under-
stands the philosophy of trance natural and artificial, and
in all varieties and sub-varieties.
The delusions now prevailing on this subject among
specialists in this line of study are as follows:
First—That the artificial variety of trance, so-called
hypnotism, is something distinct from the natural varie-
ties, such as somnambulistic, ecstatic, intellectual, epilep-
tic, cataleptic trance, etc. Although it is seven years since
it was demonstrated in my work on “Trance” that all the
varieties of this condition, whether produced naturally or
artificially, were simply sub-divisions of a general state
analogous to the sub-divisions of epilepsy, hysteria, or
insanity, yet this fact seems to be only beginning to be
understood; and only by a few of the most advanced
and liberal investigators. Writers speak of the artificial
variety as something different from the general state, just
as they would speak of the different varieties of insanity
as something distinct from general insanity. Insanity
may be artificially produced in various ways, just as
trance can be produced artificially. If we make a man
drunk with alcohol, we produce a case of artificial insan-
ity the symptoms of which resemble many cases of
natural insanity; if we put a man out of his head by
fright, we may also in some cases produce a case of arti-
ficial insanity, and it is the same in principle as the natural
varieties of insanity. An attack of drunkenness, then, is


Current Delusions Relating to Hypnotism. 59
to insanity what an attack of hypnotism is to trance.
Artificial trance may be produced in ways innumerable.
In this country we are mostly familiar with artificial
trance caused by exciting the emotion of expectation ;
and it is incomparably the best way for a scientific study
of this subject; but the method of Braid, now used in
Europe, the method of Mesmer, used before Braid, or
the method of Von Helmont, and scores of others used
before Mesmer's time, produced the same phenomena,
though in quality and variety far less satisfactory for
scientific purposes.
Secondly.—That it is necessary for the operator to do
anything, or cause the subject to do anything, in order
to produce this artificial trance, so-called hypnotism.
Nothing astonished the European experts in the case
I exhibited so much as the fact that he entered the
trance state and came out of it without anything being
done, either by himself or by anybody else. A method
I often used was to have the subject sit down before a
clock or watch, and tell him at such a time he was to
enter into the trance state, and at such a time to come
out of it; meanwhile I might not be in the room or
near it; it would make no difference with the results if
we were thousands of miles apart.
It is beginning to be comprehended by a few of the
best European investigators that this can be done with
trained subjects, that is, those trained through the emo-
tion of expectation; but it seems not to be compre-
hended that this is the best of all ways to train cases for
the purposes of scientific study. It may in some instances
take a longer time than some other of the myriad meth-
ods that have been used, but the results are infinitely
more varied and satisfactory, and it makes it possible to
devise experiments in such variety and quantity as
assure ourselves that the subject is not deceiving us,
either intentially or unintentionally.*
• It is this very phenomena that causes those who are unfamiliar with
trance to suspect that the subject is not genuine. Such an inference is natural.
indeed almost inevitable, to those who have not thoronghly and experimentally
investigated this department of science.


60
George M. Beard.
Thirdly.-In assuming that persons who are entranced
artificially are necessarily liable to the natural varieties of
trance, and also that they are liable to be injured thereby
in mind or body.
There is common belief that good subjects for these
experiments are those who are, or have been, epileptic,
anæmic, hysterical or insane. This belief, which is mostly
an erroneous one, prevails all over Europe and in this coun-
try also, except among those who have given much time
and thought to investigation of this subject. Prof. Preyer,
of Jena, who is working faithfully ;and successively in this
department, on witnessing the experiments, repeatedly
urged me to desist or to be more moderate lest the
subject should be injured. Trance produced by acting
on the emotion of expectation is a purely psycho-
logical, not a physical state, and has not necessarily
any relation to physical health, whether good or bad.
The Jumpers of Maine are strong and long-lived. I
have experimented with persons of different ages, of both
sexes, white and black, old and young, and the majority,
though not all of the very best subjects for the average
of experiments and for the most interesting experiments,
are of firm or medium health, and it is on this class that
for scientific purposes, I prefer to experiment. Nervous,
feeble, hysterical women, who are made subjects of these
experiments, and become frightened or alarmed in regard
to them, may become temporarily and, possibly, in rare
cases permanently injured thereby. The possibility of
this, on theoretical grounds, I will allow, but I must say,
that in my own personal experience extending over many
years, in which I have made many thousands of exper-
iments on hundreds of different individuals, I have never
known of one being permanently injured thereby ; a few
temporary disturbances, lasting over a few hours or days,
have been the only unpleasant results I have witnessed,
and these due almost always to the inexperience of the
experimenter. This is the position which the psychologi-
cal science of the future is to take on this subject.


Current Delusions Relating to Hypnotism.
61
I have watched persons who have been in the habit
of entering this state, off and on, for years, and if any
one of these cases should at any time become insane, it
would take very much evidence to convince me that
such experiments had been the cause of their insanity.
Even traveling performers, who, as a rule, know
nothing of psychology, however expert they may be in
their practical performances, rarely do any harm to the
cases on whom they may experiment; and they usually,
if not always, have a certain proportion of delicate women
among their subjects. On the contrary, I have seen
many who have been benefited in various ways by these
experiments, and all the claims made by Mr. Braid on
this subject are verified and more than verified.
I dwell on this question with special earnestness, for
it has been stated that in Germany experiments have been
stopped by the Government, and there is a probability
that scientific investigators may be crippled in their study
of this subject, as they have already been in the study of
animals. The popular oppositions to vivisection, to dis-
section and to vaccination are far more scientific, more
wise, and have a better foundation in reason than the
opposition to the experimental study of trance in human
beings.
Fourth.—That there is no way of proving the genuine-
ness of the phenomena of artificial trance, but that we
must take it entirely on our faith in the truthfulness of
the person operated upon.
In a recent paper, Richet has said that the only way
to convince ourselves of the genuineness of this state is to
go into it ourselves. Is it impossible for any one to
know that there is such a disease as insanity unless he
himself becomes insane? Must then every expert in
insanity be himself a lunatic? Must every psychologist
who testifies in regard to questions in lunacy before a
court of justice be dismissed as an incompetent witness
unless he can prove that he has been a patient in an
asylum?


62
George M. Beard.
Not only do we have as much proof of the genuine-
ness of the phenomena of artificial trance as we have of
any of those of insanity, but we have far better and more
convincing proofs than can be acquired of insanity
where we suspect simulation. To develop these tests
has been, indeed, the labor of years, and they will be
described in detail in my work on trance. They can
be mastered by any psychologist who will give as
much time to this subject as is necessary to become
familiar with lunacy or with nervous diseases in general.
In some cases, a long series of experiments of different
kinds, repeated over and over again, under different con-
ditions, not in the presence of audiences but alone, or
with a few earnest coöperators, as in all branches of
science, are needed to assure ourselves absolutely and
beyond all question that we are dealing with a genuine,
not a pretended case. No person, however skillful in this
department, or however large his experience may be, can
tell from witnessing a number of experiments whether they
are genuine or not. The genuineness of the case which
I had in London had been proved here through months
of labor by myself and others. In London I used him
merely to illustrate certain new discoveries that had been
made during the year; although, familar experiments were
repeated.
When, two years ago, Charcot showed me one of his
interesting cases of artificial trance, I asked him whether
he had convinced himself that the case was genuine,
he replied that he had, that he had spent much time in
investigating; and I had, and have no doubt that he was
quite right; but although I was myself allowed to make
experiments with the same subject, I did not regard all
the phenomena as demonstrative. So when Prof. Preyer,
of Jena, called to see my subject, and asked if I had
convinced myself of the reality of the phenomena, I re-
plied that I had, and he then witnessed the experiments
with Mr. Braid and Mr. Romaines.
This is the true position of science on this subject,


Current Delusions Relating to Hypnotism. 63
ary
and it cannot be insisted on too frequently, or with too
much emphasis.
Fifth.--That the failures in any subject are evidences
or suggestions of deception.
Years ago I was myself a victim to this delusion, at
least to a degree, and was only emancipated by inde-
pendent reasoning and study.
Failures are rather a sign of sincerity, while uniform
successes at all times and under all circumstances might
give reason for a suspicion that there is shamming, unless
there is positive evidence to the contrary.
I have had opportunity in my life to study a large
number of cases of sham trance, and the rule is that
they succeed in what they attempt; if there is a doubt
about their not being able to succeed, they are not likely
to make the attempt. Genuine cases, like those that
have been used by me in Europe and America before
scientific men, are very likely to fail or to act unevenly.
We cannot always depend upon them, even in those
phenomena that can be readily simulated without any
training whatever. There are atmospheric reasons for
this, as there are climatic reasons for the fact that arti-
ficial trance is more easily produced in this country than
in Europe, and that the opportunities for studying it are
better here, probably, than in any other part of the world.
The nearest approach to the cases I have lately studied
and exhibited in America and Europe in the rapidity and
suddenness of going into trance and out of it, are some
of those on whom Charcot performs his experiments
in Salpétrière. But in Charcot's trained cases some pro-
cedure, as holding up a pencil, or staring or looking at a
light or bright object, are employed. In my cases nothing
is done. Simply the emotion of expectation is acted upon,
and the subjects are not hysterical or nervous, but, as a
rule, strong, healthy and active.
Sixth.–Neglecting to make a distinction between the
positive and negative symptoms of artificial trance.
This distinction is fundamental to the philosophic


64
George M. Beard.
study of this side of science. By negative symptoms I
mean those that appear negatively, spontaneously, as an
incidental result of the hypnotic condition, however pro-
duced, and without any suggestion from any source
whatever, or any expectation on the part of the subject.
These negative symptoms, such as sleep in its various
grades, modifications of the special senses, either exalta-
tion or depression, are the chief features in Mr. Braid's
researches; and the best analysis of these negative phe-
nomena of trance is to be found in the latest edition of
Prof. Preyer's work on the “History of Hypnotism,” which
contains a résumé of what Mr. Braid did, including some
manuscript not before published, which has been given
me by a relative of Mr. Braid's family, and which I
placed in Prof. Preyer's hands.
The positive phenomena of trance, those which take
place by direct suggestion, and take place simply because
the subject expects them to do so and which are infinite,
in a well-trained subject, including abolition, exaltation,
and manifestation of the senses, special or general, have
not been extensively studied in Europe, and are rarely
referred to, even by the most recent writers.
These positive symptoms are the most important phe-
nomena of artificial trance.
Seventh.—That the will of the operator is an essential
factor in these phenomena.
The vitality of this delusion is very great indeed,
although it was apparently destroyed a long time since.
I find it as active in Europe among those who had not
studied the subject thoroughly as in America. I found
it necessary to do there as I do here, go out of the
room for a short time and leave others to carry on the
experiments, simply by way of proof that I had nothing
whatever to do with the matter, and to show them that
all that was done could be done without my presence,
and that any person or thing in whom the subject has
confidence, so that the emotion of expectation can be
influenced, serves the purpose of an operator.


Current Delusions Relating to Hypnotism.
65
“The world does move,” but the people that dwell
upon it tremble as it moves, fearing lest its centrifugal
force may hurry it to destruction. Our present theme,
the interaction of mind and body, has been the terror
of not a few amiable and timid non-experts in both hem-
ispheres; and solemn editorials in able journals are
praying scientific investigators to stop where they are lest
we learn too much of the secrets of the nervous system ;
and are exhorting young men to stand fast by the old
truths that our dear fathers and mothers of the middle
ages found so useful and loved so well. But all this
terror comes too late ; the work has been done; the dis-
coveries have been made; both the peril and the investi-
gation are nearly over; what we now hear is not the rising
but the retiring storm ; henceforth, for our time and for
all time, this branch of science shall quietly take its
place in the ranks of psychology, side by side with hys-
teria, epilepsy and insanity, all of which diseases gained
their admission only after long years of doubt, denial
and delay.


Art. VII.-Inebriate Criminals.*
By T. D. CROTHERS, M. D.,
SUPERINTENDENT WALNUT LODGE, HARTFORD, CONN.
THIS class of inebriates are quite numerous in all the
1 large cities and manufacturing towns, and are also
prominent in seaports, and on the frontier of civiliza-
tions, and yet as a class they have never been studied.
They form a conspicuous element of the great under-
stratum of the dangerous classes, and permeate all ranks
of society from the hovel to the palace.
They occupy an uncertain and anomalous position in
the estimation of the public, and are either regarded as
debased criminals and paupers, requiring severe punish-
ment, or as insane and totally irresponsible.
A careful study of the literature of inebriety reveals the
startling fact, that most of the theories and deductions of
inebriety are based on the superficial observations of crim-
inal drunkards.
To illustrate : The superintendent of an insane asylum,
who has had a number of this class under treatment, find-
ing the alcoholic symptoms disappearing and the crim-
inality prominent, denies the disease theory of inebriety.
In the same way the penitentiary and alms-house phy-
sician, finding only vicious symptoms in the inebriates
under his care, reaches the same conclusion.
The judge on the bench, and the officer in court, and
the daily press, each form a theory of inebriety which
they put forth with confidence, and thus the general pub-
lic have the most complex and erroneous views.
Up to this time no general study of inebriety has been
made which includes all classes, hence this confusion of
both theory and treatment.
* Read before the Ninth Annual Meeting of the American Association for the Cure
of Inebriates. Boston, September, 1881.


Inebriate Criminals.
67
In much the same way the student of any phase of
insanity, who saw many cases of melancholy, mania, or
dementia, and who should build up a theory of cause,
pathology and treatment, based on these cases, announc-
ing authoritatively that it comprehended them all would
be in error. In this way much of the literature of inebri-
ety is based on the imperfect studies of particular classes,
and especially the classes we are to consider in this
paper. What we need is a comprehensive study of the
whole subject from a higher stand-point. The great un-
derlying laws and principles governing the entire subject
are yet to be discovered.
In a study of this class two divisions naturally present
themselves with distinctive causes, which, although they
run parallel, yet are quite different in many respects.
The first class are the inebriate criminals, which be-
come so by conditions of surrounding and accidents, and
from special external predisposing causes. Sometimes an
inherited neurosis is present.
The second class always begins with physical degener-
ation of the brain and nerve-centers—either arrested de-
velopment, or general perversion of function and structure.
They are born criminals or inebriates. In the latter
class the criminal and insane diatheses are always present;
in the former the neurosis is not marked, but is fre-
quently masked for a long time, then breaks out suddenly.
Before we enter upon a special study of these classes
it will help us to note some of the general symptoms
which appear to the ordinary observer.
As a class, they are the “fast men,” such as gamblers,
speculators, traveling men, showmen, patent right, swind-
lers, dealers in alcohols and tobacco, etc. Lower down,
they are bar-room loafers, hack drivers, low workmen,
street tramps and beggars, etc.
As criminals, they commit crimes against property,
and rarely against persons; always acting under a dis-
eased impulse, which ignores everything but the selfish
gratification of the body.


68
.
T. D. Crothers.
As inebriates they drink impulsively without any
special exciting cause, or remain sober an indefinite time
without special reason or purpose. Frequently they have
strong mental and physical capacities, coupled with great
defects, and with more or less power of concealment.
Hence, they often take advantage of all those who come
in contact with them.
As a rule, they are treacherous, cowardly and sensi-
tive, full of impulsive delusions, and governed by no
motives except those of the lowest, and those of the
present moment. Audacity is another common symptom,
cupidity and strong dislike for work, and general disgust
for regular living. Improvidence is also prominent in
nearly all conditions.
As patients coming to inebriate asylums, they are
almost always very much reduced in both mind and
body, either having delirium or profound exhaustion of
all the organism. At first, they are extremely penitent,
and give much promise of permanent recovery. But in a
few weeks all is changed; they lapse, becoming low
intriguers, exhibiting a wilful cunning, and disregard for
the rights of others that is deplorable. They abuse all priv-
ileges, drink, and procure opiates for others, and respect
nothing but force, and are most difficult and troublesome
patients. Such are some of the general facts of the
symptomatology.
If, now, we inquire more particularly into the history
and causes, we shall find the first group quite prominent.
Namely, those cases in which inebriety seems to spring
out of conditions of surroundings or accident, and from
special external predisposing causes; always associated
with criminality and an inherited insane neurosis.
One of this family group may be illustrated in the fol-
lowing case: C. D., born and reared in a very careful
manner, by strong-minded exemplary parents, surrounded
by every good influence which wealth and social standing
could bring. His father was a banker and speculator,
leading a life of more or less excitement, although per-


Inebriate Criminals.
fectly temperate. His mother was neuralgic, and of a
sensitive excitable disposition. He was in no way
different from other boys up to sixteen years of age,
when his parents both died within a year, and he
came into possession of a large amount of property.
He fell into the hands of some sharpers, who rushed
him through a short career of dissipation, both robbing
and entangling him with a gang of gamblers and thieves.
From this time he became an accomplice of gamblers
and thieves, and three-card monte men, alternately drink-
ing and associating with the lowest of this class. At
twenty-two he served two years in prison for burglary.
At twenty-six, twenty-eight and thirty years of age he
served short sentences for swindling and drunkenness. Then
his friends placed him in an inebriate asylum as a periodical
inebriate. He did well until he regained physical strength,
when he displayed the most audacious criminality. Reason-
ing and acting from the lowest motives; bringing in spirits
and becoming intoxicated for the purpose of committing
violence; when the drink craving was over exhibiting
great penitence, and all the time stealing and appropriat-
ing whatever he could find. All sense of right and wrong
seemed absent. His entire study seemed to be to procure
the fullest gratification of every emotion and passion. He
drank constantly, and when restrained became revengeful,
and was the center of intrigue, defying all efforts to con-
trol him unless by physical force. He was not passionate,
or very irritable, but fawning and penitent, and at the same
time taking advantage of every opportunity to both drink
and steal. He was discharged and went back to his old
circle of surroundings, and is now serving a sentence of
five years for larceny.
This is a strongly marked case, where accident of con-
ditions and surroundings produced a criminal inebriate
from an organization with large passions and only aver-
age moral and mental powers. He may have inherited
a weak, impulsive, nervous system from his parents; this,
with bad surroundings at a very susceptible period of


70
T. D. Crothers.
life, would only follow a natural law in developing this
way.
Another case, with more marked predisposing influences,
has fallen under my observation :
H. O., father a clergyman and very eccentric; mother
very irritable and passionate, sometimes doing violence;
the grandfather on his mother's side was drunken; some
of his father's family were of doubtful reputation. Both
parents dying when he was five years of age, he was taken
by an exemplary farmer and brought up in excellent sur-
roundings and influences; and was in many respects a
model young man; a member of a church, with a quiet
manner and easy disposition; inclined to melancholy.
At eighteen he went to the city as a clerk in a
large house. Here he fell into bad company and drank,
and finally proved to be a defaulter, and was sent one
year to prison. On coming out he went back to the
city and became a bar-keeper, leading an irregular life
of drinking and general dissipation. From this time he
became an accomplice of thieves, receiver of stolen
goods, and traveled about the country in the in-
terest of criminals, and with apparently no business.
At length, he was convicted of bank robbery, and
sentenced for five years. After serving this sentence, he
was employed as an auction clerk and runner. Some-
times he would remain for months sober, then drink
very hard, commit some violence, be arrested and serve
a short sentence. He was brought to an inebriate
asylum, suffering from delirium tremens. Recovery was
slow, and he seemed very penitent, giving much promise
of permanent restoration. A few weeks later, he was
caught surreptuously selling liquor to patients, which he
had stolen from the railroad freight depot. All disguise
was thrown off, and he boldly, from this time, defied all
authority, stole and planned all sorts of means to procure
liquor and money; rarely drinking himself so that it could be
noticed. He submitted to restraint, when it was sustained
by force, without opposition ; seemed to possess no delusions


Inebriate Criminals.
71
except to gratify a malicious spirit and the lowest cravings
of his nature. He was expelled, and, on his way to New
York, was arrested for highway robbery and sent to
prison, where he died of consumption a few months later.
This case was more positively the result of inheritance than
the first. Had he remained on the farm, he would probably
have lived a very quiet life, and been a good citizen. But a
change of circumstances and conditions made him a criminal
inebriate. The diathesis was present and its peculiar train
of exciting causes developed them.
A presentation of some of the more general causes
at work, will make our treatment of the subject clearer.
The conditions and surroundings which develop inebriate
criminals exists in all our large cities. They are bad
sanitary conditions, with irregular unhealthy living, sleeping
in bad rooms, insufficiently lighted and ventilated, and
living on bad, unnutritious food, also in a bad mental
atmosphere. Add to this the continual indulgence of all
the impulses and passions in surroundings full of the
contagion of bad examples, and the result is inevitable;
there is here a constant widening and perversion from
the natural standard of mental and physical health.
Exhaustion and drinking begin early, followed by degen-
eration, which effects the entire organism. Ambition dies
out, except for the most selfish gratification. Crimnality
grows out of these surroundings as naturally as weeds
spring up in a neglected garden. The evils they suffer
from perpetuate themselves and grow more and more
rank.
All effort to rise to better conditions of living and
acting involve the exercise of powers, which are either
wanting, or are feebly developed, or long age crushed out
by the predominence of other elements.
As criminals, they always lack the boldness of experts,
usually, they are followers acting under the influence
of others, and are sneak thieves, petty swindlers, gamblers,
ready to engage in any scheme that will furnish sources
of gratification to their passion, without much danger


72
T. D. Crothers.
or special labor. As inebriates, they drink insanely for
a time, governed by circumstances and conditions.
If we examine this class more minutely we shall find
that they divide again into two groups, and as such
may be studied practically in our asylums.
The first class came from bar-rooms and low haunts
of every character; they usually are without any fixed
employment, and have been reared in idleness.
Originating in the middle and wealthy classes, or in
those inheriting large amounts of property, they have
grown up without any fixed purpose in life. Not un-
frequently they have squandered their patrimony, and
been placed in a position where all efforts to help
themselves have more or less resulted in failures.
They are ordinarily marked by a weak mind and
unbalanced judgment, suffering from neurosal and men-
tal troubles, and filled with delusions of oppression and
wrong at the hands of others.
Conscious that society is at war with them, and its
methods antagonize the full play of their passions, they
accept the situation and never seek to change or vary
the conditions. But they rapidly become beggars, crim-
inal paupers, robbing their relatives and friends; also
lapsing into communists, full of all the small vices, ready
at any moment to aid in crime, or take advantage of any
weakness, licentious and drunken at all times, and resort-
ing to the lowest devices to gratify their impulses. Syph-
ilis and general degeneration are common; improvidence,
fawning and audacity are marked.
In many cases they possess an average or superior
brain power, probably coupled with a defective moral
force and general want of control. From accident of
surroundings all the lower elements of nature are devel-
oped.
They are more prominent in inebriates than as crim-
inals, and often do criminal acts under the cover of ap-
parent drunkenness. This class are the skeletons haunting
their friends continually for money and support, rarely


Inebriate Criminals.
committing noted crimes, but always in centers of low
dissipation.
The second group is made up of clerks, traveling men,
peddlers, gamblers and swindlers of all kinds. They are
higher up than the last class, and possess a degree of
activity, which is evidence of a more active brain power.
Quack doctors, police lawyers, defaulters and patent
swindlers are of this class. They most frequently inherit an
unbalanced organism, a distinct or obscure diathesis ;
and have a family history of insanity, epilepsy, inebriety,
syphilis, criminality, cancer and consumption.
Like the first class they are largely the outgrowth of
the surroundings, originating in bad sanitary and moral
influence in early life. The worst phase of this class are
seen on the frontier, as miners, speculators and gamblers;
or in business centers of large cities, as brokers, agents
and middle men, who are ready with any excitement or
excuse to defy law or order.
As communists and railroad rioters they have attracted
much attention for some time. Frequently they are filled
with delusions of wealth and power, are superstitious of
fate and chance, and alternate between hope and despair.
Failure follows in nearly all circumstances of life and
is attributed to others, and the wrongs they suffer at
their hands, while complaining bitterly of the dishonesty
of others they continue to cheat and drink in an aimless
impulsive way. Not unfrequently they use stimulants to
conceal the real motive and to shield them from the con-
sequences of crime.
During the past two years they have appeared in the
temperance work in great number, and have been noted
as defaulters in coffee-house enterprises, and as lecturers
recounting their experience, and soliciting help to build-
up again, etc.
With a degree of sharpness and low cunning that is
rarely obscured by drink, they have found the various
temperance movements of to-day a field for the fullest


74
T. D. Crothers.
play of their talents, which they are not slow to attempt.
They may be truthfully called the temperance tramps of
the day.
As inebriates they are noted for their marked periods
of sobriety, and the unexpected insane-like relapses which
seems to be partially under the control of the will.
After the fullest gratification of the disordered impulses
stop short and seem to recover. They commit crime in
this impulsive unreasoning way, confusing courts and
juries as to the motive present. In asylums and in
prisons they are always the most hopeful and are sure
to create sympathy and gather about them friends, which
they sooner or later victimize..
In both of these groups the surroundings or predis-
posing criminality and inebriety are about equally devel-
oped, sometimes one predominates over the other, and
in some cases they exhibit much skill in concealing the
one or the other; chronic suspension or enfeeblement of
the will is present in all cases.
They never realize anything but the fullest gratifica-
tion of all their faculties as the ideal of life, and crimin-
ality and inebriety are the best means to this end. Like
all the other classes, they suffer from neurosal disorders,
such as exhaustion and various chronic diseases.
In the second general division, most of the cases inherit a
special degeneration of the nerve centers. Either a non-devel-
opment or a general perversion of functions and structure, they
are both born inebriates and criminals.
This class are usually marked in every community,
their irregularities of living and mental peculiarities as
well as physiognomy cannot be mistaken. They appear
as inebriates in all grades of crime and are seen in prisons,
hospitals and workhouses all over the world ; although they
are not so commonly seen in inebriate asylums as the first
class, yet they are frequently studied in courts of law
and insane asylums as types of all inebriates. Not
unfrequently they are moral imbeciles, that drift up and
down the world like ships without a rudder or purpose.


Inebriate Criminals.
75
In a study of the general symptomatology, the irregu-
larities of life and want of physical development are
prominent. They are commonly noted by a large, coarse
frame, or an overgrown head and imperfectly developed
body; angular projection of the face, such as the eyes,
nose and mouth, out of all proportion; the presence of
moles or freckles; the hair thick, coarse and lengthy, or
thin and straggling, etc. The entire body seems to be
stamped with signs of imperfect development and de-
generation. In some cases all these external signs are
wanting. This class of men are found in the lowest
stratum of society, performing the most menial work, or,
higher up, they are soldiers, sailors, bar-keepers and
adventurers, highway men, burglars, etc., following civil-
ization like parasites, the most lawless and dangerous of
men. They are also seen along the line of rivers, canals,
and on the sea boards, etc.
They are committed for crime against both person
and property, and constitute over sixty per cent. of all
the inmates of prisons and jails. Not unfrequently they
occupy places of trust high up in society, and, when
tempted fall precipitately, and puzzle experts and judges
to determine between insanity and criminality and the
measure of responsibility.
The inheritance of disease is more marked in this class
than all others. Dr. Stevenson remarks: “There can
be no question but that heredity exists in the mental as
well as the physical world, and that the diminished
stability of organism and perversion of physical function
are transmitted with as much certainty as the germs of
disease; that brain structures receive certain tendencies
from inheritance which bind it down or control its
future, or that it has a certain capacity for impressions
and energy of organism which goes with it always after.”
This expresses clearly the doctrine of heredity which
is now accepted as a well established fact. The inebriety
of this class is of the same order of neurosis as insanity,
and depends upon some molecular change of nerve tissues,


76
T. D. Crothers.
which, coming down from parent to child, fixes the moral
and physical character with much certainty.
In other words, it is a symptom of physical degenera-
tion of the nerve centers--an outward expression of an
inner condition of development like that which generates
low and vulgar ideas, having their counterpart in brutal
instincts and words; always connected more or less with
diseased and undeveloped nerve structures. All this is
confirmed by clinical histories of numerous families, where
for generations the criminal, insane and inebriate neurosis
has existed, developed in one or more of the family
The descendants of these families are criminals, inebri-
ates, idiots and paupers. These are by no means unusual
instances, and can be traced in many sections of the country.
Such persons possess a distinct neurosis which manifests
itself either in inebriety, insanity, epilepsy, criminality or
pauperism; or very commonly two or more combined in
one.
This degeneration is probably not always tangible to
any physical examination, but later the autopsy and mi-
croscope may indicate distinct cell changes. Many of
these cases are purely psychical, that is only known by
special symptoms, which are often in themselves very ob-
scure, and sometimes associated with much intellectual
vigor and genius, startling their friends by their strength
and weakness. The impairment or loss of the higher
moral faculties, leaving the intellectual clear, is a field of
much obscurity, and beyond the fact that such is the case
little is known.
With this brief statement of the general facts which
seem to indicate the condition of organism and origin of
these cases, we shall pass to a special consideration of
some of the groups. First are those in which the inebriety
seems more prominent than the criminality. They are seen
quite frequently at inebriate asylums. Usually suffering
from general exhaustion, they recover slowly and enter-
tain delusions amounting to delirium at times. They are
very penitent during this time, and exhibit a humility and


Inebriate Criminals.
77
determination to reform that is almost abject. On recov-
ery they become sensitive, assuming and boastful, and all
the low criminal tendencies come out prominently. They
interfere and meddle with a malicious spirit, creating
trouble everywhere; are extremely slanderous and boast-
ful; delighting in low stories and low thoughts; complain
bitterly of deprivation of their liberty; find fault with
everything, and are changeable in diposition and insolent
beyond measure. They are untruthful to an extreme de-
gree, and have no respect for their word or the judgment
of others. They drink at all times and places, using all
kinds of intrigue to accomplish this end. They will
steal anything from their best friends, such as articles of
clothing, furniture, and even food from their families and
children to procure drink. Nothing can exceed the
degradation and suffering which they relentlessly inflict
on their nearest relations to gratify this one object.
In an asylum they are always running away, drinking
and bringing liquor for others; stealing articles for the
pawn shop; and often not drinking to intoxication, but
aiding others beyond that point. They are often the
agents of mere designing men, who take advantage of
their situation when drinking to stimulate them to crime,
which they are ever ready to engage in. In all situa-
tions they are continuously criminal in thought and act,
and inebriates with every opportunity. After a wretched
life from the station-house to the jail or prison, and the
low haunts of large cities, always hunted down like beasts
of the chase; they become exhausted and suicidal, either
dying by their own hands, or going into the insane asy-
lum.
The second class are more prominent as criminals than
inebriates. They are cool and calculating, total destitute
of any moral sense. Drink at times very hard, then
remain sober under the press of some circumstances for
a long time. As an illustration : One of this class, B,
drank nothing for over two years (although living in a
center of great temptation), that he might get in a position


78
T. D. Crothers.
to accomplish a crime. When this was over he was very
intemperate. Often they are victiins of vicious, uncon-
trollable passion and impulses over which they are power-
less. Epilepsy, insanity and pauperism are common
phases. They are wanting in pity or lasting kindly senti-
ment. Have little or no moral reason to check them,
and never seem to realize the evil which follows their acts
or the suffering they cause others. Turning against their
best friends on the slightest pretext, they have no affection
except the most selfish, when this is broken, treat all as
enemies, etc.
Prudence is wanting in nearly every one of this class,
and is only stimulated and controlled by selfish interest
or fear of punishment. In some cases violent passions
such as hatred and revenge, seem to control or be the
motive power in drinking. In the asylum nothing but
force and locks and bars will make any impression.
Sometimes they remain sober for a long time and seem to
recover, but the criminal cunning of their nature and want
of kindly sentiment are always apparent. Often they cloak
all their diseased impulses to accomplish some purpose
and exhibit great skill, appearing in the role of reformed
men, gathering about them a wide circle of influences
and credulous friends, then all unexpectedly victimizing
them all, and relapsing as both a criminal and inebriate.
There are many cases on the border land of insanity,
who both talk and act like the most insane of men, and are
unaccountably vicious and drunken; these extremes seem
to follow each other with startling rapidity. Audacity
is one of the most prominent mental traits of this class,
and is always of a low grade, usually the blind impulse
of a low, unreasoning man. These cases are usually the
result of certain conditions of inheritance from which
recovery is difficult and rare. They are sooner or later
crushed out in the march of events.
There is another class not so prominent but more
familiar to managers of inebriate asylums which combine
many of the symptoms of all the other classes. Inherit-


Inebriate Criminals.
79
Hip
ing the unbalanced organism and frequently the special
criminality of the last class, they are like the first class
creatures of the surroundings, and molded by conditions
of life and success. Always combinations of great ambi-
tion and weakness, impulsive and unreasonable at times
full of great expectations and constant failures. At one
time drinking hard or committing petty crime, thoroughly
discouraged and reckless, then buoyant with hope and
daring schemes for the future. Without prudence or
judgment they always fail; then resort to stimulants to
drown their feelings, or in reaction from the change.
They are sober men in the high tide of expectation, when
all is clear and the path smooth, but from the first
obstacle or discouragement, drink precipitably. When
they come to the asylum, are melancholic and rave
against fate, and after a time have great expectations of
getting well, but never work for it, trusting it all into
the hands of their friends.
Although planning for the future they seem to be
governed by the knowledge of their past failures, and
relapse on the slightest temptation or source of irritation.
After a few weeks residence in an asylum, they
clamor to be released, and make all their surround-
ings very disagreeable; often relapse and get turned
away; go to another asylum, and react the same scenes
over. In meantime try various methods for cure, keeping
their friends buoyed up with hope, that is continually
disappointed. At any time they are plunged into the
deepest melancholy, and not unfrequently commit sui-
cide. If they commit crime it is of a petty character
and against property. They are often filled with delu-
sions that they are the exception to the rule, and can
do what others cannot, and will escape as others do not.
These cases come from good families and surround-
ings generally, and are often sporting men and politicians,
and leaders of new movements of parties, and new creeds
of religion, or active patrons of lotteries and games of
chance, buyers of chances in Wall Street, and pools at
hii


80
T. D. Crothers.
a horse race. If they win anything they drink in ela-
tion, and when drunken for a time grow melancholic and
want someone to help them to get well. These cases
end often in paralysis, epilepsy and suicide. Such are
some of the most prominent facts which a study of
these classes reveal.
We come now to the practical consideration of treatment.
Here we find the management of inebriates passing through
the same stages as that of insanity. The care of the insane
was for many years without system and classification, and
this was and is one of the greatest obstacles in the suc-
cessful treatment of this class. The testimony of writers
and observers are unanimous in condemning the system
which places all classes of the insane together. The
effect on the mind by contact with others of a differ-
ent form of disease is not unfrequently the starting point
of a condition more or less chronic. The general want
expressed by all observers is facilities for a more perfect
classification so that the surroundings shall aid and not
present any obstacles in recovery.
In an examination made two years ago of the alms-
houses in New York State, the fact was demonstrated
that a large per cent. of the inmates were born and bred
in those places. From want of proper classification and con-
ditions of surroundings there have sprung up forces which
produce annually a large number of paupers, or so infected
others that they could never rise from these surroundings. If
this is true of pauper homes and asylums, where the lowest
grades of mental and physical development are gathered,
where the higher moral forces are blunted, and the
susceptibility to surroundings lessened; if this is true of
insane asylums where the cloudy and distorted reason,
and the confused intelligence and consciousness of the
the present and past exist, only in part realizing its con-
ditions and surroundings, what may we not expect in
inebriate asylums where the acute sensitive brain and the
the impulsive reason responds to the conditions and
surroundings as the needle follows the magnet?


Inebriate Criminals.
81
If classification is the indispensable condition of the
successful management of these institutions, how much
more so in inebriate asylums, where the patients suffer
from both a physical and psychological disorder, requiring
more than locked wards and agreeable rooms ?
We must add to our physical treatment and forced
abstinence, protection from contagious moral forces that
intensify and destroy all healthy growth towards the
higher levels of life. The want of this proper classification
diminishes the practical results of all our asylums, and
gives credence to diverse theories and deductions. Our
authenticated statistics of thirty-three per cent. as perma-
nently cured should be doubled, and the public should
recognize in inebriate asylums the most practical charities
of the age.
In our struggle against the scepticism and incredulity of
an ignorant public, we are prevented from making proper
classification by want of facilities and means. The acute
and chronic cases are forced upon us, and we can make
but little division except from some pecuniary standard.
Our asylums must be self-supporting and we cannot dis-
criminate between the patients of a State institution or an
endowed asylum. Hence the acute, chronic, criminal,
insane, epileptic and pauper inebriates are seen side by side
in all our institutions.
All the bad effects of contagion and the perils of
temptation with the difficulties of management are in-
creased to a high degree.
I am confirmed in this statement by the experience
of all observers, that every asylum for inebriates in this
country is suffering more or less from the presence of
this criminal class.
The liberty of our asylums and the kindly appeals to
the higher moral nature, which they do not possess or is
feebly developed, make no impression, but rather gives
opportunity for more easy deception and imposition on
the good will of those about them.
Appeals to their religious sentiment not unfrequently


T. D. Crothers.
give them a kind of education which they are quick to take
advantage of in the future, developing religious impostors
who never fail to use this power to their advantage.
If the restraints are imperfect we loose the confidence
and cooperation of the patient and stimulate his mind into
opposition and constant endeavors to thwart and destroy
its effect.
Unless our discipline is sharp and stimulating in all its
parts and rigorously enforced, we are educating these men
into methods of intrigue, and building up contaguous forces,
increasing the difficulties of management and lowering our
reputation in the public estimation.
In 1873, before the American Association for the Cure
of Inebriates, I concluded a paper “On the Management
of Inebriety in the Albany Penitentiary,” as follows:
“ The sharp discipline of prison life, filling the mind with new duties
and ambitions employing the energies in physical labors, is particularly
fitted to strengthen and develop the feeble impulses and to control the
diseased longing, this is the basis of reform.
“ Military discipline and occupation of both body and mind indicate
the most hopeful promise for the future.” etc.
These statements were based on the observation of
criminal inebriates, and are correct, but do not apply to
the management of other inebriates. If we admit patients
of this class we must have the means to enforce obedience
and make relapse almost impossible.
They must be separated from others and placed under
a rigid military discipline, which will have care of all
their habits and surrounding, punishing for all violations
with certainty and exactness, and under no circumstances
relaxing the military surroundings in less than from two
to four years.
As in an insane asylum the acute maniacs who are
violent and destructive need special care and watching,
while the harmless demented need but little more than
shelter and food, so the criminal inebriate must have
enforced condition of living and surroundings, while
inebriates of other classes need beside, the physical treat-
ment, the direction and guidance of an asylum.


Inebriate Criminals.
83
Their is another class of patients called repeaters who
are compounds of criminals and pauper inebriates, although
quite frequently wealthy or have wealthy friends. They
go from one asylum to another like tramps, and bring
odium on all, disobey the rules, are sources of infection
and annoyance to the management, and are often taken
as types of all others.
Without facilities for classification or means to enforce
long residence or total abstinence, we are throwing away
time and opportunity in all efforts to help or reform this
class. There would be hope in the present system of
punishment in jails and penitentiaries if the sentences
were made for years instead of months.
The English prison reports indicate a number of
recoveries from inebriety among those of this class,
sentenced for a period of years.
The danger of the present system is that short sen-
tences intensify and fix their condition, isolating and
building up a dangerous class from which recovery is rare.
This is owing to the imperfect system of classifica-
tion, by which all criminals are treated alike, and without
regard to marked difference of intellect, development and
character. I repeat, the inebriate criminal must be classified
and treated by distinct methods. He must be separated
from the ordinary patients of an asylum, and only by
this means can we show the public the true value of our
work. The time has arrived when we must be estimated by
different standards than that set up by the self-important
lunacy specialists, or the superintendents of insane
asylums, based on superficial studies of the pauper and
criminal inebriate; or the authoritative dictum of the
judge, founded on vague scientific quotations from books
more or less obsolete; or perhaps the imperfect study of
some case of a chronic character.
The public must realize that inebriety can not be un-
derstood and managed successful except by continuous
study in asylums in the hands of competent men.
The key which shall unlock the mystery of many of


84
T. D. Crothers.
the wide-spread disorders growing out of the use of alco-
hol, will be found only after a long study of the entire subject.
I will stop here, only adding that our work is a pioneer
one, and that stretching out in every direction are divi-
sions and topics of this subject which we must study and
understand, before we can build up model asylums and
manage them with the success that it is possible to at-
tain.
A résumé of what we wish to be prominent is in-
cluded in the following :
1. This class of inebriate criminals are numerous,
and are generally studied as types of all others. And
unfortunately they furnish the basis upon which much of
the literature of inebriety is founded.
2. They are composed of several classes more or less
distinct, requiring a comprehensive study of condition
and surroundings.
3. As patients in inebriate asylums they are ex-
tremely difficult to manage ; often bringing odium upon
the asylum and receiving little benefit from it.
4. In the treatment they should be classified and
be put under strict military discipline, in which labor
is a part of the treatment, and this continued for
months or years.
5. A removal and classification of this class in our
asylums will increase the per cent. of recoveries largely.
A more thorough study of the different classes of in-
ebriety will reveal many facts and clear away much of
the confusion at present existing.


Art. VIII.--Outline Therapeutics of
Chronic Alcoholism.
By C. H. HUGHES, M. D., St. Louis.
THE following are some thoroughly tested formulæ
1 which I have for the past ten years quite successfully
used; some reformations among pretty well advanced in-
ebriates having, through their aid, been effected in my
practice :
When called upon to see a person prostrated from a
long debauch, the friends or patient desiring to end it,
the formula first employed has usually been as follows:
R Kali Brom. - - - - - 3j
Aq. Distill., qs. ft. - - - - 3 jv
Aq. Ammon., fort. - - - 3 ss
Ext. Quassiæ, Ald. - - - - 3 ss
Tr. Capsici - - - - - 3 iij
Aq. Menth. pip. - - - - 3 v
Morph. Sulph. - - - - gr. iij
M. S. Tablespoonful every four or six hours during
the first few days, well diluted with peppermint or other
aromatic water charged with a drop or two of ol. creo-
soti, or half a drachm of Cherry Laurel water of the Phar-
macopæia.
The Morphia in this prescription I withdraw so soon
as practicable, and substitute cannabis indica and hyosci-
amus extracts in minimum doses, if anything more actively
narcotic than the bromides seems necessary during the
day. The one formula, minus the morphia, with gradual
diminution of the ammonia and capsicum, has invariably
proven to be sufficient, especially if an occasional two-
scruple or half-drachm extra dose of the bromide of am-
monium or of sodium is given, largely diluted in not less
than eight ounces of water.


86
C. H. Hughes.
Hypnotic doses of chloral at night are always given in
plenty of water to avoid burning the lips and throat, in-
sure quick absorption and gastric tranquility. Thirty to
forty grains given in this way at the patient's usual time
for sleep rarely disappoints. One dose of chloral in
twenty-four hours is enough.
A hypodermic injection of hyosciamine may be admin-
istered in its stead, but the sleep from it in alcoholism,
seems not to be so refreshing as that which follows chloral.
The ammonia and capsicum in the formula may be
increased till the toper is satisfied from their taste and
effects that he is taking something that supplements alco-
hol and fills the vacuum in the morbidly hungry stomach
and nervous system, provided not over forty drops of
aq. ammonia are given as a dose. The morphia may
likewise be temporarily increased without the patient's
knowledge of the name of the drug.
The bowels, of course, must be attended to in the be-
ginning. If they are not depurating themselves and the
system by a salutary diarrhea, Rush's old reliable ten
and ten of calomel and jalap is the best initiative cathar-
tic; after this any of the saline laxatives suitable to the
patient.
Every ingredient of the above formula is to be with-
drawn in the course of a week or ten days, except the
potassic bromide and the bitter extracts, the others being
supplemented by pure water. The bromide and the bit-
ters are usually directed to be used so long as any ap-
pearance of restlessness or neurasthenia remains. In some
cases I have had the patient take noon and night half-
drachm doses of some bromide for six months together
with celerina and coca during the day.
The precaution is always observed of having the
patient carry a little of the original formula in his inside
vest pocket, to be used on the emergency of a return of
the drink craving. I am now keeping, and have kept
some men who were advanced drunkards sober in this
way. This combination is certainly a valuable auxiliary


Outline Therapeutics of Chronic Alcoholism.
87
to resolution and galvanism, and has been the means, as
already said, of effecting reformation in some instances.
The combination makes the impression on the throat and
stomach of an alcoholic bitter, and similarly affects the
brain and nerves. It is a prompt, diffusible stimulant in
the beginning, and its final influence is tranquilizing.
A pungent bitter tonic, and warming to the stomach,
and whose after effects are tranquilizing to the nervous
system, is the best form of tonic for the toper, and with
them, strychnia and the lacto or hypophosphites may be
combined at the pleasure of the physician.
Art, IX.-Oculo-Neural Reflex Irritation.
By Geo. T. STEVENS, M. D., Ph. D., New York.
A MONG important causes of functional nervous
11 affections recognized by the best authorities on
such subjects, are: 1.–Various irritations, from whatever
cause, of peripheral nerves. 2.-A predisposition on the
part of the subject of such affections.
While other causes, such as a change in the quality
or quantity of blood, or some general disturbance of
nutrition play their part in the production of functional
nervous disturbance, the two first mentioned are doubt-
less admitted to be preëminent.
This being admitted, it follows that it is of supreme
importance to determine, as far as possible, all sources of
such peripheral irritations, and every reason for such
predisposition to nervous affections. While the statement
just made is trite, it is, nevertheless true that because of
the frequent obscurity of the irritating or the predispos-
ing cause, functional nervous diseases are for the most
A Paper read at the International Medical Congress, at London, England,
Angust, 1881.


88
Geo. T. Stevens.
part treated empirically, and the immediate or remote
cause of the neuralgia, the chorea or other affection is
wont to receive, by far, too little attention or effort to
ascertain its exact nature.
Should the inherent predisposing tendency to neuroses
and the irritating influence starting from a certain point
of the nervous system be found to be frequently associ-
ated, and should we be able to locate a very important
source of both immediate and predisposing influence, to
which too little attention has been directed, the object of
this brief paper will have been accomplished.
It is a principle generally admitted that an irritation
of a nerve may induce disturbance in the functions of
other nerves, even at a distance from the nerve irritated,
and also that the same kind of excitation in the same
nerve may under different circumstances, induce widely
different effects in distant parts.
An eminent writer (Dr. Brown-Sequard) has stated
this principle, as follows:
“ The same peripheric cause of irritation acting on the same centri-
pital nerve may produce the greatest variety of effects, including every
functional nervous affection or disorder.”
Keeping this principle in view let us inquire whether
the eyes can become a source of reflex irritation, and if
so, whether they can be regarded as a frequent source of
nervous disorders, and as a reason for an inherited tendency
to such disorders.
An injury to an eye, such as the thrusting of the
point of scissors through the ciliary region, or the lodge-
ment of a foreign body within the globe, or a grave
disease which causes cicitricial degeneration of the front of
the organ so frequently induces reflex phenomena of such
serious character in the uninjured eye that it is now
universally conceded by ophthalmologists that such injured
and diseased eyes are dangerous and must be sacrificed
as a defense against the reflex or sympathic disease in
the remaining eye. But if an injured eye can set up a
sympathetic irritation which may be fatal to an uninjured


Oculo-Neural Reflex Irritution.
89
one, then if the principle above stated be true, the same
kind of irritation originating in an injured or diseased eye
may also give rise to disturbances in distant organs, for
instance, the heart; the kidneys or the muscles of the
extremities.
If we admit that this statement is theoretically true,
we are still led to inquire whether practical demonstra-
tions of this theoretical truth have been observed.
As a partial reply to this reasonable inquiry, I refer to two
cases reported by myself more than a year ago in the
ALIENIST AND NEUROLOGIST, bearing precisely upon this point.
I will not here repeat the details of these cases, but
will briefly state that in the first instance a girl thirteen
years of age had, five years previous to her visit to me,
thrust a point of scissors into one of her eyes, and was
brought to me suffering from sympathetic irritation of the
other eye. During the time intervening between the
date of the injury and this visit, she had been a sufferer
from violent headaches, attacks of intense suffering in
the stomach, probably neuralgic, and from what proved
to be of greatest interest, a severe form of diabetes
insipidus. This disease had run a uniform course, and
the quantity of urine passed daily had been astonishing.
The injured eye was removed, and the operation was fol-
lowed by an immediate and surprising reduction in the
amount of urine passed.
Although it is now nearly four years since the removal
of the eye, there has been no serious return of the uri-
nary trouble or of the intense neuralgic affections.
In the second instance, a child, the subject of a very
prominent staphyloma, was also an epileptic, suffering
from fits occurring from once in two or three days to
once in a month, and like the girl in the preceding case,
subject to diabetes insipidus. The deformed eye was
removed, and from the time of the removal (more than
three years ago), the child had not, at a recent date,
when I saw him, suffered a single convulsion, nor has he
had any further trouble from the diabetic affection.


90
Geo. T. Stevens.
I need not prolong this paper by adducing other sim-
ilar cases, although several such have come under my
observation. These cases are sufficient to show that reflex
irritation not only may but does extend from the nerves
of the eyes to distant parts.
But if injuries and gross diseases may provoke distant
disturbances, are we to look for reflex causes in the
various conditions which produce difficulties in the func
tion of accommodation or in the proper adjustment of
visual lines ?
Reverting to the principle quoted at the beginning
of this paper, we must admit that as refractive errors and
muscular insufficiencies of the eyes do induce asthenopia,
which is a nervous irritation, not usually in the eye itself
but in its surroundings, then the same causes may
react upon more distant parts.
The brief limit of this paper does not permit an elabo-
rate recital of the manner in which these causes act nor
of the special forms of nervous disturbances most frequently
observed as resulting from causes which would produce
asthenopia, but the results of observations in several hun.
dred carefully recorded cases of such diseases as neu-
ralgia, chorea, insomania, headaches, and even epilepsy
have fully confirmed the opinions long since expressed by
me that difficulties in performing the function of sight
are among the prolific sources of nervous diseases.
I have at various times reported many instances* in
which this fact has been strikingly illustrated.
I will here add but a single illustration of the practi-
cal value of this principle :
Mr. F. S. H., aged 32, consulted me at the request of
his attending physician, Dr. Wm. H. Robb, of Amster-
dam, N. Y., March 12, 1880. The patient was a man
• See Transactions Albany Institute, 1874-75—Chorea Transactions of New
York Academy of Medicine, 1876. Refractive Lesions and Functional Nervons
Diseases. New York Medical Record, September, 1876. Light in Its relation to
Disease Vew York Medical Journal. June, 1877. Relations between Corneal Diseases
and Refractive Lesions of the Eye. International Medical Congress, Philadelphia,
1877. Two Cases of Enucleation of the Eyeball, ALIEXIST AND NTUROLOGIST, Jan-
nary, 1880. Ocular Muscular Defects and Nervons Troubles. Transactions New
York State Medical Society, 1880, etc.


Oculo-Neural Reflex Irritation.
91
apparently robust, but was as he informed me an epileptic.
His epileptic attacks commenced eight years previous to
this visit, and had occurred with regularity, except during
a short time in 1877. The fits occured about once in
two weeks, severe attacks usually alternating with mild
ones.
The patient was subject to constant headaches in the
temples and brows, and had habitual pain in the lumbar
region. For many years previous to the epileptic disease
he had been subject to most violent attacks of sick head-
aches, but these had, in a measure, been replaced by
the epileptic occurrences. He was excessively nervous
and restless, and habitually rose from his bed to walk
the floor at night. He had always been constipated,
a condition from which his only relief had been the
daily use of cathartics.
I could detect no cause for all these nervous mani-
festations, except in the condition of the eyes. There
was found insufficiency of the external recti muscles of
two degrees at twenty feet. There was no apparent
strabismus. A partial tenotomy of one of the internal
recti muscles was made with great care, and he was found
immediately to have ability to overcome a prism of ten
degrees with the external recti muscles, while his con-
verging ability remained unimpaired.
The patient returned to me a few days after the
operation, expressing the greatest satisfaction at what he
considered a radical change in his whole condition. He
was already free from headaches, his nervousness had
disappeared, and his sleep was better than for years. A
year and a-half has now passed, and in a letter written
to me a short time since, he says: “I feel that I am
perfectly well.” He takes no more cathartics, has no
headaches, rests well at night and has had but three
attacks of petite mal.
A great many cases might be adduced to show that
refractive errors and muscular insufficiencies are prolific
sources of sick headaches, neuralgias, chorea, hysteria and


92
Geo. T. Stevens.
other nervous disorders, but I refer to cases already
published in confirmation of this part of my subject, and
now pass to a most interesting phase of this investigation.
If it be admitted that difficulties of refraction and of
association of visual lines may be important causes in
producing nervous affections, we have then a rational
explanation of many cases of the hereditary tendency to
such complaints; for if neuralgia, chorea and other forms
of nervous disorders be caused for instance by hyperme-
tropia, then we may readily see why the children of a
hypermetrop, who has suffered, perchance from one or
another form of these disorders, may be affected, not
necessarily with the same form of disease, but with one
of the forms likely to be produced by hypermetropia.
For while it is not at all probable that neuralgia, for
instance, is of itself an inherited condition, we know
that hypermetropia is directly inherited. If it has caused
neuralgia in the mother, it may also cause it or some
other nervous affection in the child.
Thus, while it is illogical to regard chorea as a direct
heritage from neuralgia, it is logical to suppose that the
same physical characteristic may induce the one or the
other.
During several years I have kept a careful record of
the family histories of the majority of my private patients
who have refractive and muscular troubles of the eyes,
and am sure that no one can look over these records
without being convinced that much of the mystery of
inheritance in disease is explained by the fact of the
inherited physical form of the eyes and physical propor-
tion of the ocular muscles.
There can be no doubt that the form of the eyes and
the general condition of their muscular apparatus are
hereditary features, hence, if these being unfavorable may
induce disease, they become hereditary predispositions to
disease. After several years of careful consideration of
this subject, I am led to the following conclusions :
1. That among the peripheric influences which generate


Oculo-Neural Reflex Irritation.
93
.
nervous affections, the irritation arising from a perplexity of
exhaustion of nerves in performing the functions of adjust-
ments of the eyes must be regarded as of great importance.
2. That when a family tendency to neurotic affections
is found, the inherited tendency is often transmitted in
the form and condition of the eyes.
3. That inveterate cases of nervous diseases not
amenable to other forms of treatment, will often yield to
the simple process of relieving the eyes from muscular
or refractive disabilities.
Art. X.-Life of Chiarugi.*
Translated by Joseph Workman, M. D., Toronto, Can.
THE illustrious Professor Morselli republishes in the
1 Gazetta del Manicomio di Macerata, with the view
of making known the great name of Vincenzio Chiarugi,
the celebrated letter addressed by Livi (September, 1864,)
to Brierre de Boismont, in relation to the priority of Chi-
arugi in the reform of the government of the insane.
We have great pleasure in reproducing this letter in
our pages, in order to make known in Sicily, where our
journal chiefly circulates, the two distinguished names of
Chiarugi and Livi.
ILLUSTRIOUS COLLEAGUE.—It is now more than a year
that I have owed you this reply. Truly the quality of
the creditor, a person of such excellent genius and medi-
cal learning as you are, and the quality of the debt,
which is the honor of my country, Italy, should have
rendered me more solicitous to pay it. But you, who
• Translation from Il Pisani Grzetta Sicula, for May to August, 1880, Nos. 3 and 4
of Second Series. Editors, Gaetano Loggia and Bernardo Salemi Pace, Palermo,
Sicily.


94
Joseph Workman.
are as courteous as wise, will excuse me, and will also
pardon me that I reply to you publicly, as making amend
for my involuntary neglect, and because my words thus
publicly given, will be less unworthy of yourself and of
my subject.
In the assembly in June, 1863, of the Medico-Psycho-
logical Society of Paris, in the discourse on phrenological*
science, at which you sat among the most distinguished,
in taking under examination certain of my writings, and
especially that entitled “Delle frenopatie considerate rela-
tivamente alla Medicina forense,” having reached a certain
point, you proceeded in these precise words:
"To us it is painful to find in this work a phrase which
may be pungent to France, unless it may be regarded as
an effervescence of love of country. Mons. Livi, speaking
of the reform of the treatment of the insane, asserts, in
very strong terms, the honor of Vincenzio Chiarugi, who
had announced this reform (sic) eight years before Pinel,
in his treatise on insanity, published at Florence in 1793.
He also cites another Italian physician, Daquin, who
wrote on the “ Philosophy of Insanity” in 1791. Mons. Livi
might also have added the name of Tuke, who in 1792
published his first prospectus of the Asylum at York.
But in what respect is, as we shall always call it, the
glory of Pinel lessened, if some good sort of man (sic)
had contemporarily with him, or a little before, enter-
tained the thought of ameliorating the lot of the insane,
and had effected it? To record their names is an act of
justice; but we must acknowledge that Pinel fecundated
the idea in his genius, and introduced it (here stands the
fort) into practice.”
So far, you. Permit me now to repeat my words, which
gave occasion to your reproof. I speak of the movement
of reform which agitated the Italian minds in the last
century, some time before the French revolution:
“In this universal movement of strong minds, which
• Italian Alienists do not employ the word phrenological, as we commonly do,
in Its Gall and Spushiem signification, but in its true generic sense.-Trans.


Life of Chiarugi.
95
aimed at the rooting out of inveterate injustices, and the
revindication of natural rights, we shall find Italy ever at
the head of all the other civilized nations, if with Grav-
ina and Vico it stood at the head of European legislation,
with Beccaria, Filangeri, Verri and Travanti, it gave the
first hand to every social reform. But in little Tuscany,
in Florence, this labor of reordination was more fervid
than elsewhere. So, from that little circle, from which
went forth that prince of Italian, indeed of European
thought, Dante, and afterwards Galileo, the legislator of
the human knowable, there was diffused a beneficent
light, which failed not to be elevated so high as to be
felicitous to the whole civilized world. All the grand
ideas on which the civilization of to-day rests, some of
which are yet matters of inquiry among the most civil-
ized nations of Europe, were known, and came into prac-
tice for the first time, one hundred years ago. A strange
city, says Giulio Janisse, speaking of Florence, truly des-
tined to transmit all the great ideas which have founded
the glory, prosperity and experience of modern times.
And Michelet, in his recent work, ‘Il Mare,' speaking of
hospitals, says ‘Florence always had the initiative of charity
in Europe.' It was, therefore, very natural that in Florence,
medicine, which had never here been divorced from simple
nature, should so put itself into accord with philosophy,
as to redeem the insane from the evils with which their
adverse condition and human injustice had loaded them.
“But the French, a fervid, enterprising and proud
race, who aspire to the primacy in everything, and when
they have it not boast of it, would award to Pinel the
sole merit of having first broken the chains of the insane.
If, however, numbers have not lost their value; if the
merit of a fact stands in the fact itself, and does not
come to it from the little span of earth in which it hap-
pened; if gossip is not always gossip, from whatever
mouth it comes, the French should, some time, drop this
baseless assertion. In fact, whilst at Paris in the year
1791, the Academy of Sciences proposed the problem of


96
Joseph Workman.
the best treatment of the insane, Florence had already,
four years before, solved it, not in words, but in fact, by
opening the asylum of Bonifazio, under such regulations
as will be forever held (says the good Carlo Morelli),
* as a codex of medico-psychological science and civil doc-
trine. And whilst in Paris the chains were not struck
off at the Bicêtre till 1798, that is, after a ten years'
vociferation of liberty and fraternity, the insane in Flor-
ence had for ten years, been moving around, free and
tranquil, in the numerous lawns of Bonifazio, living a
pleasant, quiet, industrious and contented life ; and whilst
from Bonifazio three-fifths of the patients departed cured
or improved, in Bicêtre and Salpetriere (if Pinel himself
is to be believed) several were seen to perish of hunger.
“The soul of these reforms, without noise, orderly and
peacefully accomplished, was Vincenzio Chiarugi, who, in
1793, that is to say, eight years before Pinel, published
that golden treatise, ‘Della Pazzia,' which even to-day,
after two-thirds of a century, seems in many parts a fresh
fruit of modern science. Pinel, when in 1801 he published
his medico-philosophic treatise on insanity, was so good as
to be the first to slight the modest Tuscan physician, as
one devoid of all spirit of research, and intent only on ex-
amining into the causes, symptoms, nature and treatment of
insanity. It may be that in the study of human diseases,
outside the causes, symptoms, nature and remedies, we
ought to fish for other knowledge, good, if for nothing
else, for the people in the moon, when we may arrive
there; this I do not know; but I do know, and it seems
very manifest, that Pinel drew much from the work of
Chiarugi, without even deigning to name it. Just as, two
centuries before, another Frenchman who boasted of hav-
ing given in a certain book of his, the key of the first
causes and the ends of the causes,' said he had found nothing
worthy of envy in the writings of another Tuscan, although
he made free use of his very important discoveries. The
name of this Frenchman was, for such as desire to learn
it, Cartesio (Descartes), and that of the Italian was Galileo!”


Life of Chiarugi.
97
Now, I should, before all, crave excuse for whatsoever,
too warm, fell from my pen, in writing in defense of an
Italian physician. Comparing now, with calm mind, the
freedom of my rather youthful words, with your virile
moderation, I ought to declare myself vanquished by you
in courtesy. Perhaps it may avail in my excusal, that,
writing in that manner, and (as is wont to be said) per
casa mia, I did not think that some day my poor pro-
duction would cross the Alps (a good fortune which in
Italy so seldom happens even to master-pens), and that
it would be taken under examination in so honorable a
congress of learned Frenchmen, for then polite consider-
ation might have prescribed different language.
I would also entreat that you will not believe me so
blinded by my love of country, as not to see in your Pinel
a man excellent in heart and rich in intellect; for his
heart was delicate, sweet and compassionate as that of a
woman, and it carried him forward to divine the new
reform; his intellect was fine, correct, precise, and had
been disciplined in youth by the study of mathematics,
which guided him in ordering and executing his project.
The name of Pinel will stand forever among the benefac-
tors of humanity, and who would erase it? No one;
unless perhaps it should come into the head of some
second Couthon,* or such as believe in the shades of
those spirited republicans who accused him of being an
aristocrat, or a moderate. But in Italy, believe it, ingrati-
tude will never be one of our sins, however many others
we may have.
It has not been my intention to take from Pinel that
which is his, for that would be stupid injustice; but I
have desired to render to Chiarugi that which is his
due. In fact, nobody in France, or outside of it, speaks
of the reforms in the treatment of the insane, who
ever recalls to mind, even in shadow, the Florentine
• Couthon was a deputy to the Convention, and was on the Commission of Public
Safety- estellite of the ferocious R bespierre. He wrotti) Pinel this little note:
** Citizen Pinel --To-morrow I come to pay you a visit at the Bicêtre; woe to you if
you lodge among your lunatics apy enemy of the people."


98
Joseph Workman.
physician. Eternally it is Pinel, eternally Bicêtre,
eternally Salpetriere; never Chiarugi, never Bonifazio.
But there is something still worse, for in Italy itself
many are the physicians who know of Chiarugi not
even the name; and few those who know him (I shall
say so) by sight; very few those who value him accord-
ing to his worth. This obliges me to unsay what I said
a little while ago—that is, that the Italians have not the
sin of ingratitude. Yes, they have it, most shameful too,
and in the very marrow of their bones, but it is towards
the well meriting of their own country. The life, in truth,
of our own grand intellects, from Dante down to Pelle-
grino Rossi, has ever had a black page which pains and
humiliates us. Rendering therefore to the Italian that
which is due to him, the Frenchman remains what he is.
Both were reformers in their own country, and this merit
is common to both. It remains to be seen which first,
and best, and most speedily effected the reformation.
But in order well to examine the intrinsic merits of
the Italian and the French physician, it is necessary for
the moment to make abstractions of Paris and Florence;
that is to say, we must put the subject naked on its own
pedestal, screened from every dazzling reflex of circum-
stances. Now it will not be difficult to perceive that the
capital of the Grand Nation had then become quite a dif-
ferent center from the capital of the little Tuscany. Grand
ideas and grand discoveries might be born elsewhere, but
France alone has to-day the magic power of making all
the world revolve around her. I will not swear that
“France alone makes war for an idea,” for Savoy and
Nice are, at the bottom, not an idea. But I believe that
ideas, in order to conquer and triumph, ought first to pass
from your country ; thus, to the less clear-sighted, it ap-
pears that they have there had initiation, because they
there acquire that apparent acceptability which renders
them universally agreeable and admissible.
As to what are to-day called emphatically the princi-
ples of '89 (as if principles sprang up, as fungi, in a day),


Life of Chiarugi.
99
they had already borne fruit from the middle of the
eighteenth century. It suffices to read our history. But
this movement of civilization, orderly, tranquil and modest,
was altogether domestic, and was accomplished almost
unknown to other countries. The French revolution came,
and did for us what a torrent would do, rushing headlong
down and inundating the newly cultivated fields, but not
yet clearing off the old growth. The young plants, yet
tender, were all swept away; the older shoots, more
deeply rooted, from the abundant organic detritus, retook
vigor, and, being judiciously pruned of some branches,
that they might take better root, and allow more light to
enter, they again verdantly clothed our country, which,
if to-day it has risen again into life, we, not forgetting
the potent arm of France that aided us, owe the boon to
the richness of the land, and the virtues of the soil
which never permitted the providential germs of Latin
civilization to perish.
But let us return to Chiarugi and Pinel, who, acting
in different theaters, had not equal applause and follow-
ing from their people. Paris, in those days, so much the
more attracted the eyes of all the world, because she was
the great cauldron, where an armed revolution had raised
new ideas to fever-heat-a cauldron which sent forth heat
and steam, and the raging of fire on all sides. Now,
leaving to Pinel that splendor of glory which the great
and powerful nation to which he belonged awarded him,
and content with that modest light that might be cast on
Chiarugi from the little Tuscan bark, let us, with the
sober eye of criticism, see which of the two physicians
first entered on the new path, and which made the better
progress in it.
Permit to me, illustrious colleague, this comparison,
and permit me to be precise even to nicety, and rigorous
to scrupulosity in my arithmetrical and geometrical de-
monstration; because if ever the truth pressed on me,
to-day more than ever it presses, before you and your
honorable colleagues of France.


100
Joseph Workman.
I had reached this point in my letter, when, for the
purpose of study, in turning over the leaves of your An-
nales Medico-Psychologiques (I say yours, because much do
they owe to your able and wise pen), I chanced, in the
sixteenth volume, to cast my eye on your lecture, read
before the Medical Society of Emulation, entitled “ De la
reforme du traitement des alienes, a l'occasion de la notice
biographique sur le medecin Daquin, par M. le Dr. Guillaud
fils.” Hence I fall back a little.
I there read that you, sustaining, as I do, the honor
of Pinel, could not deny to the above-named Italian of
Savoy, the physician Daquin, the merit of an inventor (so
you call it) in phreniatric reform; and you compassionate
that wise and good man, that, alone, and without aid or
disciples, he was only able to attempt that which Pinel,
more fortunate, was able to complete. Even you, drawn
by a sentiment of equity which does you honor, in the
terms of that passage could not but lament the obstinate
silence of Pinel, on the medical work of Daquin, “ The
Philosophy of Insanity." This book, published by him on
the confines of France, ten years before the medico-philo-
sophic treatise of Pinel, and written in French, rich in
philosophy and medical knowledge, it is impossible that
Pinel had not read and profited from. “May it be true
(I take here your own beautiful words) that the bosoms
of the most celebrated men have a hidden fold in which
the weaknesses of our nature squat concealed ? And
amongst these weaknesses must it always be a difficulty
to pronounce or write the name of a rival — that which
a modern writer has so justly called the conspiracy of
silence ?”
Now let it be to me lawful, to appeal from Brierre de
Boismont of 1864 to Brierre of 1854. In men of your
temperament virtuous habits do not wear out with years,
but rather become stronger: the justice which, ten years
ago, you denied not to the above-named Italian of Cham-
bery, why should you to-day deny to an Italian citizen
of Florence? Perhaps you had a presentiment that Savoy


Life of Chiarugi.
IOI
would some day be no longer ours ? But I will never do
you the wrong of believing you to be a prophet. Per-
haps Tuscany had less title to your benevolence than
Savoy? But you are not the man to carry in your
judgments two weights and two measures. Now, if I
shall succeed in proving that the Florentine physician not
only preceded the Savoyard in ideating the reform, but
was able, owing to the matured civilization of the coun-
try, to carry it happily into effect; if I succeed in prov-
ing that Chiarugi suffered from Pinel an injustice worse
than silence — an unreasonable criticism — I may pray of
you excuse for the “rather warm terms,” but I shall have
reason for writing that which I have written, which is,
“that the primacy, not alone of the invention, but also of
the accomplishment of the reform, and of its more ample
and right accomplishment, not to your France, but to my
Italy is justly due.”
Italy, that was the first in medicine to retake the
sound maxims of Hippocrates, and especially Tuscany,
which, through the labors of her great physicians of the
sixteenth and seventeenth centuries (Redi, Boralli, Del
Papa and Cocchi), was the most dexterous and industri-
ous in engrafting art on nature, and the physical sciences
on experimental philosophy, were the lands medically best
adapted to this reformation; nor medically only, but also
civilly, because, as I said, reordination was progressing in
the Peninsula, and above all in Tuscany, throughout the
eighteenth century, with regularity and admirable celerity.
Here, in fact, were abolished torture, the death penalty,
feudalism and slavery; liberty of conscience, liberty of
commerce, civic liberty were inaugurated; it was easy
then to free the poor lunatics from their chains, and Aling
them into the Arno, and to elevate tortured, despised
and oppressed humanity, even in this most miserable por-
tion of the human family.
As far back as the Lorenese Regency, on the proposal
of the wise and generous senator Rucellai, a decree was
issued, that no person, even by paying, should be


102
Joseph Workman.
admitted into any asylum, for custody or treatment, with-
out the preceding establishment of disease, and without
the license of the sovereign. At the present time, in
Tuscany, lunatics cannot be received into asylums without
a decree of the Royal Tribunal in the first instance, nor
can the tribunal issue this decree without a medical cer-
tificate declaring mental alienation — a solemnity of form
which goes to show the importance of a procedure that
deprives a citizen of his personal liberty.
It was truly fortunate for Tuscany to have a prince
so wise as was Leopold; but it was also fortunate for
him to find, in Tuscany, men who, in every department
of discipline and administration, understood how to reduce
to practice, by wise laws, his noble intentions. One of
these men was Vincenzio Chiarugi. The prince, as far
back as 1785, having been apprised of the sad condition
of the asylum of St. Dorothea, had ordered from the
Commissary of the Hospital of Santa Maria Nuova “a
project and a systom for remedy of the confined limits and
the defect in the regular service and the necessary con-
veniencies.” In three years the new asylum was in being !
In the next year the grand ducal printer published the
new regulation, which it is well to repeat it), “will ever
be held as a codex of medico-psychological wisdom and
civil doctrine.” Chiarugi compiled it, and Chiarugi had,
in the hygienic arrangement, directed the construction of
the edifice. Leopold appointed him Medical Director in
1788.
But what was this new asylum — this new mode of
government? You have, my honorable friend, already
seen that a solemn truth was recognized, and a useful
example was given, when a medical expert was associ-
ated with the architect - a truth and an example which
only a few years ago, by a very few administrators, have
begun to be understood. Truly may it be said, Nisi
medicus ædificaverit domum invanum laboraverunt qui ædifi-
cant eam.
Up to that time an asylum meant a concealing den,


Life of Chiarugi.
103
a seraglio, a prison, a sepulchre for the living. The por-
tentous words which Dante read over the gates of the
Inferno, might well have been carved over the door of
every asylum of that day! But Chiarugi determined that
Bonifazio should be really an asylum - a house of safe-
keeping — a place of aid — a place of cure. The four
famous words of Esquirol, “ Loger soigner contenir - et
traiter les alienes,” may to you appear not easily translat-
able into good Italian? Rather should I not say the four
words of the Florentine physician appear not easily turned
into good French? I shall say, yes; for Esquirol wrote
four and forty years after Chiarugi. For hospitals of such
a class, added Chiarugi, the essentials are convenience,
retired site, tranquillity; free and open air ; spacious
apartments, interspersed with gardens and suited to ar-
range the patients in separate classes, according to their
different forms and degrees of mania, and the different
sorts of treatment needed by them.
So said Chiarugi, and so did he. Beautiful and grand
in its exterior aspect; ample, ventilated and salubrious
internally; divided into two equal portions, one for males
and one for females; furnished with all conveniences and
necessary utensils—with baths, corridors, walks and shrub-
beries, Bonifazio included within itself all the best hygi-
enic conditions that science in those days demanded.
About two hundred patients (such was then the number
of the diseased family, not the six or seven hundred in
these times squeezed in,) must have found themselves in
much comfort and freedom. Bonifazio was in fact for a
certain time regarded as a model asylum. Your De
Gerande spoke many words in its praise. Combes wrote
that “a homogeneous idea prevails throughout its primi-
tive plan, and in its internal management, whilst the
architect knew from the first that he was working for a
house of the insane."
Monges, in 1812, speaking of the sad condition of the
European asylums, highly commended the “elegance,
magnificence and neatness of Bonifazio, and the treat-


104
Joseph Workman.
ment there afforded to its inmates.” The celebrated
Guislain, who visited it in 1839, found it still adapted to
its purpose, and praised especially its large corridors,
vast dormitories and refectories, scrupulously clean cells,
pure and free air everywhere, water circulating in all parts
of the building, marble baths; the tranquillity, order and
decency reigning throughout.
Yet in thus expressing myself, do not suppose that I
intend to say Bonifazio now is, in material at least, a
model asylum. God forbid that I should! The man, as
illustrious for goodness of heart as for science, who now
directs it, my master, Prof. Biffi, will pardon me if I here
for a moment usurp his part and his speech. You well
know there is something more powerful than the heart
and science of a physician ; the sloth and obstinacy of
governments that keep not pace with perpetually advanc-
ing science and civilization.
Let me now speak of the internal regulations. The
government of the asylum was assigned to a physician
and an assisting surgeon; these must reside in the hos-
pital, in order continually to attend and watch; a new
example, as Morelli has well noted, which shows the
practical knowledge and the humanity of the reformer.
The patients who were sent to the asylum must be ac-
companied by an order of the magistrate and the Chief
Judge, and a medical certificate in which were stated the
cause, commencement and symptoms, and the principal
pertinent facts. Thus the government, the commune and
the physicians became guarantees to society for the jus-
tice and necessity of the sequestration. Better could not
be. The medical director then, according to the infor-
mation received, and after an exact study of the disease,
put the patient into his proper class. Thus were avoided
the moral injuries of misplacing, and the best attendance
and treatment were secured. The patients were classified
as maniacal, melancholic and demented. Fortunately
Chiarugi next understood the master curative of insanity.
Hygiene for all entering; moral treatment such as science


Life of Chiarugi.
105
counseled and humanity commanded; somatic treatment
such as the morbid, bodily or the pathogenic conditions,
or the complications or consequences of the insanity
called for. Hence æration and ventilation procured with
all study, wholesome and abundant food (flesh meat, six
ounces daily), sufficient clothing, water circulating every-
where for personal cleaning, open passages, permitted
labor, but only by the direction of the physician; all
these provided abundantly for hygiene.
The moral treatment then served to secure to the
patient that calm and tranquillity which, if not a medica-
ment, is yet a vehicle for the most efficacious medica-
ments; and Chiarugi understood this. The patients were
protected from the stupid curiosity of outsiders; chains,
and beatings, and bad words and annoying jestings were
abolished; a discreet and humane deportment was enjoined
upon all; the use of the cotton camisole and leathern
wristlets was permitted in the more difficult cases; reli-
gious practices were allowed, when believed profitable;
pleasing occupations, recreations and diversions were pro-
vided; thus the poor lunatics would naturally find them-
selves in a totally new moral atmosphere, which, to the
diseased mind, is that which pure air is to disease of the
body. To read the work of Chiarugi and the Leopold-
ine Regulations, is to become convinced that the matters
wisely thought out by him were also faithfully carried
into effect.
As regards the somatic treatment, it was such as in
the school of Redi, and from such a physician as Chiarugi
might be expected. Hence every empirical remedy was
shunned, and all systematic medication; there was great
pharmaceutic parsimony; treatment regulated in relation
to the various nature of the morbid elements which had
given origin and fomentation, or were complications of
the phrenopathia. Hence, according to circumstances,
corroborants, tonics and analeptics, or it is true, abstrac-
tions of blood, depressants and regulated diet; hence,
too, baths warm or cold, effusions to the head, excitants


106
Joseph Workman.
or sedatives; and among these modes of cure, insistent
revulsions from the cerebral organ, by means of blisters,
setons, irritants, purgatives, drastics and emetics.
In perusing the work of Chiarugi where he treats of
the physical treatment of mental diseases, perhaps the
science of to-day will find a few new articles of pharmacy
to be added (and some to be avoided.— Trans.]; but I
think it can hardly desire greater therapeutic prudence.
Let us then well fix it in memory, that it may not
escape. On the 19th of May, 1788, the asylum of Boni-
fazio was opened under the auspices of Vincenzio Chi-
arugi. Now, illustrious colleague, you will, from what I
have related, understand that Chiarugi was not merely un
uomo dabben (a good sort of a man) as you say : you
will agree that Bonifazio was not un idea poetica, which
flows in the brain with the return of the warm air of
spring, but un fatto vero e verde, on which he labored
seriously for three years.
What sort of things were, in that same year, the asy-
lums of Paris ? Let us compare the figures and confront
the results, and we shall see whether, as you have as-
serted, I have permitted myself to be betrayed by an
overweening love of country. Hitherto I have been the
speaker; now I shall leave the speaking to your own
writers — Robin, Tenon, Liancourt, Pinel and Esquirol
himself. I retire.
In the Nouvelles de Medicin et de Chirurgie of the year
1789, we read the most horrible depiction of the Salt-
petrierre; it is the Abbate Robin who writes. It is true
that his visit was in 1787; but if a Parisian medical jour-
nal did not hesitate to transcribe his words two years after,
and if record of undertaken reforms does not appear until
long after, it is reasonable to believe that the evil and
the shame still lasted in 1789. I shall not follow the
philanthropic abbate in his visit of the dolorous prison;
I have cited the journal; that will suffice. I shall quote
things even more terribly true.
Robin speaks of the patients, “massed in fours or more,


Life of Chiarugi.
107
in narrow cells; a dirty sack of straw, with vermin crawl-
ing through; rats running in troops by night, eating the
clothes, the bread, and, in fine, the flesh of the patients,
so that six hundred livres a year were spent in poison
for them by the administration; lunatics left naked or,
with some tattered covering on their backs; they were
yellow, livid, covered with scabs, and it would be a
miracle should they survive a year.. Many, especially of
the women, prefer to stay out in the courts; denned in
little wooden houselets, chained, badly clad, the sun
burned them, its rays blinded them, the rain bathed
them, the cold and the snow froze them; they were cov-
ered with large boils ; inwardly consumed with so great
suffering; poisoned in their insanity worse than before,
death was to them a blessing; the more delicate perished
in little heaps! What misery on the one part! What
inhumanity on the other! It appears almost incredible ;
in the very writing of the words my pen almost seems to
drop blood.”
Robin, abbate as he was, and without medical knowl-
edge, yet by the intuition of his heart, I shall say so,
saw clearly whence the word for reform in the treatment
of the insane must come; and in that writing he gives
advice very wise and opportune. But it remained only
words. And words also remained the regulation ordered
by Louis XVI. for the French asylums. The physician
Colombier was the writer of it, and it is truly such as to
do honor to the mind that conceived it. It is divided into
two parts; the first relates to the construction of an asy-
lum; the second to the administration, service, diet and
medical treatment. But to any one who will attentively
examine it, it will fall far short of the Tuscan regula-
tion.
About the same time Tenon equally lamented the sad
lot of the poor lunatics shut up in the Hôtel Dieu. Nar-
row rooms with four rows of beds; lunatics tied down by
threes and fours in a bed, continually fighting and scold-
ing; adjoining a chimney and a furnace for heating water


108
Joseph Workman.
for the baths, constantly kept hot. Tenon proposed a
new asylum, but with chains annexed.
To these chains not even Viel, the architect of the
civil hospitals of Paris was opposed, when he was ordered
by Louis XVI. to build some cells for women at the Salt-
petiere. It is not therefore to be wondered that the
Duke de Liancourt, in 1791, in reporting to the National
Assembly on the prisons and Hospitals of Paris, showed
himself very severe against the work of the architect.
Speaking of the asylums he uses these words: “In
addition to the defects of the place, the want of every
care, the bullying of the patients over one another in
their limited space, are to be added the continual vexa-
tions which the lunatics suffer, abandoned to the incite-
ments of the curious who come to visit them, and the
very bad usage of the attendants who ought to serve
them.”
In this same year the Academy of Sciences of Paris
offered a prize to whoever should best solve the problem of
the treatment of the insane. Pinel won the prize, and in
'92 he was nominated medical chief of the Bicêtre.
Whilst then, in Florence, the insane had for four years
found themselves elevated to the dignity of sick persons,
and were protected, treated and aided as such ; at Paris
they were still regarded as ferocious beasts; with chains
on their legs, victims of famine, thirst, heat and cold:
abandoned to a human ferocity worse than every adverse
element. While, therefore, Italy had already given birth
to phreniatric reform, and in the course of a few years
had seen it grow into adult life, France was groaning in
the throes of a parturition difficult, painful and protracted;
and had it not been for the genius and heart of Pinel,
who undertook the function of her accoucheur, and the
fact that provident nature seems to bring forth, at certain
times, minds fit for the work, who knows whether the
creature would have come forth alive and well ?
Truly. Pinel had a great heart and great genius,
greater indeed than that of Chiarugi. Chiarugi possessed,


Life of Chiarugi.
109
it may be said, good sense, that practical country sense
which became personified in him, and, without any effort,
elaborated the reform; that Tuscan civilization it was
which had trodden down the relics of medieval barbar-
ism, that found in him an interpreter and minister, as it
found in Neri, Gianni and Talvanti, men who had drunk
the spirit of reform with the first breath of life, and re-
formed modestly, tranquilly and without knowing it.
But in France the progress was not so easy; great,
it is true, was the fever of reform and of reconstruction;
but fever sometimes brings delirium. In that unbridle-
ment of reason in that terrible inundation, ever augment-
ing, of popular tyranny, it was difficult to make clearly
and correctly heard the voice of justice and truth. Pinel
succeeded, but only in part. All tyranny is suspicious,
and that tyranny was superlatively so. Whilst by one
part Pinel was marked in the black-book as one of the
aristocrats or moderates, on the other part it was refused
to him to withdraw the chains from Bicêtre; the urging
of Pinel was sinisterly interpreted, as though they saw a
conspiracy against the public safety.
It required full six years of supplications and solicita-
tions to enable Pinel to remove the chains from Bicêtre.
But it was not a legal provision - a general law; it was
an experiment and no more. Only of forty* lunatics
were the hands and feet unshackled ; among these were
some who had been enchained from thirty-six to forty
years. One of these unhappy creatures, who had been
confined eighteen years in the bottom of a compartment,
on reaching the light of the sun exclaimed in exstasy:
“It has been so long since I saw anything so beautiful.”
Well then, what freedom was given to these unfor-
tunates ? From chains of iron their arms passed into the
camisole of force; they were loosed only at night. It
was certainly an alleviation, but the alleviation of a
thirst which is quenched with a very bitter draught.
Not only did they bind the poor lunatics with iron
• Pinel himself says torty. Esquirol and Pinel (Jr.) say eighty.


IIO
Joseph Workman.
chains, but they must hold back every other reform ; so
that I know not what hygienic, physical or moral treat-
ment could be tried on human beings held in the state
of wild beasts. I do not, therefore, marvel that Pinel
lamented, at least in the commencement, that the treat-
ment and attendance of the insane in the Bicêtre was
impossible, because of the want of baths and every other
commodity, and a totally demoralized administration;
several of the insane were condemned to perish miserably
of anguish and hunger. It was the slow work of time,
it was the ardent will and virtuous temper of Pinel, aided
afterwards by his worthy scholar, Esquirol, that at a
later period brought the Parisian asylums up to a position
satisfactory to science and humanity.
Pinel, therefore, before the new century, outlined the
reform, he did not complete it. But, had the example of
Paris imitators in the rest of France? It is sufficient to
read what Esquirol wrote on this head, in 1818, to the
Minister of the Interior: “Nude,” said he, “were the
lunatics I saw-covered with rags-stretched on the
pavement, a little straw to defend them from the damp
cold. I saw them grossly fed; deprived of air to breathe,
of water to slake their thirst, and of things necessary to
life; I saw them committed into the hands of whippers, a
prey to their brutality; I saw them in narrow, dirty, fetid
receptacles, without air or light, chained in certain dens,
such as wild beasts are penned in and kept secure." He
afterwards speaks, among other things, of wooden cages
for the furious-of stone beds-of the sick famishing on
black bread, with a few dry vegetables, or never cooked;
of asylums in which there was given, every two days, a
loaf of three pounds to each, and a broth of water; he
spoke of iron collars, of harlots, pestilants and convicts
living among the insane. And, in short, of what does he
not speak? It worries me to wade through such revela-
tions of misery!
If then members have not lost their value; if history
is history; if to think out a reform and put it in practice


Life of Chiarugi.
III
before all, solicitously, and in that manner which science
counsels, and the civilization of the time conceded, is
a greater merit than to think and very tardily to carry
it into effect, less solicited and complete, not to Pinel,
but to Chiarugi, not to France, but to Italy, it is just, in
in this department, to assign the primacy which pertains
to her. Enough have other nations taken away, or
unjustly retained, from the great ancient mother.
If adverse fortune and the sense and imperfectly
enfranchised arm, not yet permit the entire revindication
of the sacred soil of Italy, let there at least be no one.
who will deny to us the pacific conquests of intellect;
where, not war, but emulation (non guerra, ma gara) and
a common intention for the good and the true ought to
be. To you, therefore, most noble son of that France,
whose origin and history signalize Italy as the eldest
sister, to you, the friend of Italy of long standing, it will
not be reluctant to tender in the name of science, even
this leaf to the stem of the old Latin mother; I know of
no more elect genius, nor any more courteous mind on
whom to devolve this noble office.
It is now necessary to meet yet another demand.
Might not Pinel, at the least, boast of priority in the
publication of his new phreniatric doctrine ? No, you
have yourself denied him this with regard to the Savoyard
Daquin; permit that I to-day deny it with regard to
Chiarugi, who published his Trattato Medico-Analitico
della Pazzia, in three volumns, in 1793, that is to say,
eight years before Pinel published his Traite Medico-
Philosophique. It is quite true that Pinel, in 1791, had
responded quite laudably to the problem proposed by the
Royal Academy of Paris, on the best government of the
insane ; but he had not then published the writing; and
in every respect we may oppose to it the “Regulation
for the Reformation of Bonifazio,” printed in Florence, in
in 1789. Be it remembered, if you wish, that Pinel, in
1798, published an article on “Intermittent Insanity,” and
another entitled “Research and Observations on the


II2-
Joseph Workman.
Treatment of the Insane,” having in that same year pub-
lished his elaborate work, “ Nosographie Philosophique,” in
which, in the part on neuroses, he proceeds to treat also
of mental diseases. Of this, which Michet styles emphat-
ically, “a real chef d'oeuvre of a philosophic spirit,
which has introduced the germ of an imperishable revo-
lution,” be it allowed to me to introduce some amend-
ments, pertinent to the subject of this letter. In that
book, mental diseases are distinguished in four forms,
mania, hypochondria, melancholia and hysteria, mania is
but the climax of hypochondria and melancholia, and has
its morbid seat in the epigastrium; for this doctrine he
is indebted to the teachings of Plato, Plutarch and Seneca ;
Nothing, we are told, of any value is to be sound, unless
what was written by Arietus, Celius, Aurelianus and Alex-
der of Thrales: the moderns have been utterly dumb.
What! though the work of Chiarugi had been issued
six years before, and Wait had translated it into the
German language, at Leipsic, in '95, and Peter Frank had
spoken of it with praise in his work “Praxeos Medicæ Uni-
versa Precepta.” Notwithstanding these facts, we incline to
the belief that Pinel did not then know of the work of
the Tuscan physician, of which I shall say no more than
this, and I shall say it in the wise words of Carlo Mo-
relli: “The simplicity and clearness of the plan of the
work, the richness and opportuneness of the erudition,
the perspicacity of its criticism of the opinions and facts
of others, collated by his own industry, the brightness
and fecundity of the reasoning, are treasures which can
not be regarded otherwise than as highly instructive."
But worse than the silence, at that time, of Pinel, were
the contemptuous terms in which, three years after, in
the introduction to his Traite Medico-Philosophique de la
Folie, he wrote of Chiarugi's work. Behold how jeeringly
he unloads himself of his judgment of the work of Chi-
arugi — of that work which he should have studied pro-
foundly, and from which (unless certain concordances
deceive us), we shall say that he sagaciously profite d.


Life of Chiarugi.
113
“Ever," writes he, “to follow the beaten paths—to treat
of insanity in the general in a dogmatic tone, then to
consider it in particular—and to return once more to this
old scholastic order of causes and diagnostics, to fill up-
such is the task accomplished by Chiarugi. The spirit of
research is hardly shown in his works, unless in a century
of observations which he has published ; and of these very
few afford conclusive inductions."
“ Toujours suivre les routes battues !” And yet Pinel
had before lamented the vacuum in anterior medical cog-
nitions of insanity! Where, then, were the beaten paths ?
“Parler de la folie en general d'un ton dogmatique, con-
siderer en suite la folie en particulier !” What! speak at
first of a disease in general, and afterwards in particular;
to summarise under the chief heads the affinities and the
sensible and common species of diseases; and afterwards
to distinguish the saine diseases according to certain vari-
ations—variations constituted by the various groupings in
nature of the same phenomena—is this contrary to medi-
cal logic? Or are not all monographies thus founded ?
“ Parler d'un ton dogmatique !” We once had a certain
saint in Tuscany, I would say in Italy, who taught us not
to believe in masters (scientific is meant), sooner than
every other nation in the world. This saint was called
Galileo, and he has had here, in experimental science at
least, a following and a sincere faith; and in this true
faith we desire to live and die.
Where, in the work of Chiarugi, Pinel found his dog-
matic tone, we in truth know not, since on his first
page he declares his “wish to read only in the book of
nature, and to follow only the example of the divine
master of Coos;” whilst he modestly declares his "hunger
for philosophic knowledge,” and that he is animated by
no other spirit than that of “observation, on which his-
toric knowledge rests,” and whilst, further, the whole book
is but the simple and exact application of these rules.
“Revenir encore à cet ancien ordre scholastique de causes,
de diagnostique, de prognostique, d'indications à semplis ! ”


114
Joseph Workman.
Here (I believe) every physician will descend from
the clouds to hear a doctor reprove another doctor for
his pedantry in searching out the causes, the phenomena,
the prognosis and the symptoms of disease. Either are
diseases a phantasy, a charade, a rebus, an arcadian
pastoral, a geometric theorem, and then they should be
put into ottava rima, or solved by an A plus B=C process;
or much rather are they a reality, a difficult and tremen-
dous reality, loading us down, and then must we explore
them on every side, eviserate them in order to nullify
and crush them out. But what ? Was it not also ped-
antry in Chiarugi to have sent out of Bonifazio two-thirds
of his patients, cured whilst at Bicêtre, some even died of
famine? Verily, I am hard pushed to comprehend Pinel.
“L'esprit des researches ne se montre guere dans son
ouvrage ?” From this sentence also it is seen that Pinel,
having taken up his pen in destructive temper, rushes it
forward over false lines of wrathful criticism, very differ-
ent from that which his right mind and high-born soul
should have given forth. Yes, I repeat it, badly advised
in these wards was Pinel. And yet, for these few words
which are truly a discord, we shall not deny to him that
genius and wisdom, which in him were truly grand, whilst
his disposition was benevolent even to heroism, modest
even to diffidence of himself, and reserved even to tim-
idity. No, it was not pride, nor individual ambition that
rendered Pinel so unjust to a rival, or (better to say) to
an antecessor, for Pinel never had these sentiments. It
was, in place of these, offended national pride, from
seeing France forerun by another country in this reform
that put the words into his mouth. Of this very national
pride, super abounding in the French, would that a few
drops circulated in the veins of the Italians; for, though
it is sometimes the counsellor of rash acts, or injustice,
it is yet the best guardian of the dignity of a people,
and, moderated by consciousness of itself and respect for
others, it is the moving impulse to every noble enter-
prise.


Life of Chiarugi.
115
One final matter, most esteemed friend, remains to me
to express in conclusion of this too-long letter. Having
thus striven to revindicate to my country, Italy, the
primacy in phreniatric reform, I would not have you believe
me so purblind us not to see how far, as regards asylums,
Italy to-day falls behind France and all the other civilized
nations. Yes, the first has become the last; and, worst of
all, we Tuscans, who gave the word to advance, are now
in the rear of all; and I say this so much the more
freely and openly, because I know that my honorable
colleagues of these provinces are in full accord with me.
Up to 1840 it could be said that Italy had always
conserved a certain superiority in the matter of asylums
for the insane. The wise and temperate traditions of
Chiarugi continued in Bonifazio. Linguiti, in Aversa, and
Pisceri, in Palermo, had opened up new and untried ways
in the treatment of the insane. And if in these men the
heart and imagination ruled more than physical science,
yet they left behind them good and useful customs,
which, carried over the mountains and beyond the sea,
have proved most fruitrul. Nor less meritorious for wise
reforms, in the middle of the present century, have been
Galloni, at Reggio, Gaulandi, at Bologna, Lodoli, at
Siena, and Mussari, at Perugia. Physicians, both with
words and works, have not stood idle; but governments
have little, or badly, responded; still, the condition of the
insane was everywhere improved. Chains were abandoned
in all places; only in Rome, under the shadow of the
keys did they still linger,
Miserable, on the contrary, were the conditions outside
Italy, though in France less so than elsewhere, “save
some rare exceptions” (these are your own words), “the
insane were placed in defective, bad asylums-sections of
hospitals, poor-houses, prisons, many were yet loaded with
chains; the greater number languished in filthiness—of
medical aid there was none, or it was restricted to the
few; the days passed in continuous idleness were the
cause of permanent incurability and degradation.”


116
Joseph Workman.
It was on the occasion of the law of 1838 that France
shook herself up, and with her the other civilized nations
also shook up.
In a short time after, as if by enchantment, asylums
were seen to spring up, which included all the perfections
demanded by science and humanity; governments and
provinces worked sedulously in these new movements of
civilization. France fortunately found a generation of
physicians who were both heartily willing, and of excellent
heart and genius, to whom, with full confidence, she
entrusted the undeterminate family of the disinherited of
reason. England, Germany and Belgium followed the
standard bearing nation; those old serraglios, those cages
and those damp and dark dens were torn down, and the
chains were thrown away, as remnants of barbarism and
documents of infamy; sound reason made amends for the
long injustice against diseased reason. Humanity took
heart.
But what of Italy? Italy then saw the other nations
pass her; for, whilst she moved with slow pace, they ran
with the speed of steam. Some partial refixings, some
outside varnishings there were, but these profited not at
all the work of reconstruction, large, wise, liberal as it
proceeded fervidly beyond the mountains; physicians
preached to their loss and to their shame, but they
preached to the desert. All that their genius and
good will could give, they gave; but the main instrument
with which to work was utterly wanting—the asylum.
The old Piedmont alone succeeded in giving to Italy, new
in plan, a model asylum, in that of Bassens, of Savoy.
It was beautiful golden money, fresh from the mint, in
the midst of many coins of brass, old and corroded.
Unfortunately, it is ours no longer. France, pardon me,
carried away the golden coin, and so made herself more
rich, but we remain with the brass money, poorer than
before.
How long must this misery endure ? You visited Italy
two years ago (1862); you saw with your own eyes how


Life of Chiarugi.
117
it is with us. You found, all over, physicians, both for
zeal and intellect praiseworthy (the last of whom I may
call myself), men well deserving of a better fortune; but
you did not find a single asylum worthy to be compared
with those, so commodious, spacious and pleasant, of
France, Germany and England. Many of us are reduced
exactly to the condition of the decayed rich, who may
be seen to wear a garment that was handsome and fitted
well in its time, but now it is no longer becoming. We
may leave out the thought of the cut, which is now quite
out of fashion, but we must show (which is still worse),
the patches and cords all over; yet we do not feel em-
barrassed or troubled in our members; we manage by
mending and brushing every day, to appear at least clean
and decent; but our misery presses out through the
stitches of the old cloth.
How long is this to last? To some a new dress has
been furnished. Milan, the ever-rich and generous Milan,
is about to abandon the damp and sad Senevra, that
“ kennel of the alienate," as it has been called, and to
carry them away to breathe the mild and sweet air of the
lovely hills of Busanza. In the country of Borromeo and
Beccaria charity and science have always reached the
hand in aid of misery and humanity. There live three
physicians, Castiglioni, Verga and Biffi, who are the pride
and honor of Italian phreniatry, and who have ever openly
defended the cause of the poor insane. No one doubts
that the new asylum, when completed, will be worthy of
the country and the times.
From Milan thought carries me to Venice. Poor
Venice! There, in the midst of the lagoon, 'is a solitary.
island, which is an asylum-a true colony of alienates.
You would perhaps desire greater space, an ampler edi-
fice, more symmetry ; but you could not certainly desire
more appropriate assistance, nor a more tranquil, orderly,
convenient and consoling manner of life than is there en-
joyed by a family of over four hundred patients. It is
science, in accord with charity, that has built and sus-


118
Joseph Workman.
tained, in the midst of the waters, this ark of safety and
of peace for the miserable shipwrecked of reason; the
hospital brothers are they, who are to the institution
brothers and physicians at once, and who have ruled it
for very many years. Italy cannot but be grateful to
them.
In the other parts of Italy I know not what is in
preparation. I shall tell, on my own part, what is in
course of provision in Siena. Here a fraternity of lay
brothers, bound by the ties of religion, have long de-
voted themselves to works of beneficence. To me eulo-
gizing is not befitting, neither is it called for. The piety
and faith of ancestors have made the establishment very
rich; it depends on the society, and they support it.
The coming year will see the foundation laid for a
new asylum for four hundred patients. Charity has done
its work. Medical science and architectural knowledge
will each do their share.
Pardon me, my dear and honorable friend, this much
too long letter, which, if it for a moment puts my name
into contrast with yours, that enjoys a European fame,
I fear I should be taxed with temerity, but I hope not
to be blamed with erroneous judgment; not the badly
chosen cause, but the badly presenting defenser, is to be
lamented. You, gentle and benevolent as you are, will
pardon the temerity, compassionate my littleness, and for-
get my fastidious questioning in an embrace of scientific
brotherhood; of that brotherhood which is the more
lovely to behold the more closely it binds the distant
and unequal, and, while it lowers not superiors, encour-
ages and ennobles inferiors.
Long may you live for the good of science and dis-
eased humanity; and believe me, with fullness of esteem
and affection,
Tutto vostro,
Carlo Livi.
Siena, 8th Sept., 1864.


Art. XI.-Epileptoid Aphasia Superseded
by Eczema,
Note by C. H. HUGHES, M. D., St. Louis.
FORMERLY MEDICAL SUPERINTENDENT OF THE MISSOURI STATE LUNATIC
ASYLUM, CONSULTING PHYSICIAN TO THE MISERICORDIA
ASYLUM FOR THE INSANE, AND TO THE FEMALE
HOSPITAL, ST. LOUIS.
CEVERAL years ago, a middle aged German gentleman
living in the interior of Missouri, a patient of mine,
felt a peculiar tingling sensation, followed by a numbness
beginning in the middle fingers of the left hand, and
rapidly traversing upward until the face and head were
reached, the same sensations were felt in the tip of the
tongue, center of forehead, and over left eye. This was
followed by confusion in the head, dizziness, sense of
fullness, headache, and inability to recall words of two
syllables. These head symptoms would last all day, and
then disappear. These phenomena reappeared after
regular intermissions for several years. Finally, an eczema
of the scalp and face set in, and they came on no more.
He was cured of the eczema with bichloride of mercury
washes, and iodide of potash and arsenic internally, and
cephalic and cervico-brachial galvanism as a precau-
tionary measure against the return of the epileptoid and
aphasic symptoms. The latter symptoms have never
reappeared, and the eczema is all gone at this date,
January ioth.


SELECTIONS
ANATOMY AND PHYSIOLOGY.
Are Medical Depanumber of the indicate thed the circum-
Sitect, Jesse bra
THE BRAIN Weight AND FUNCTIONAL Activity.—Dr.
Ambrose L. Ranney, Adjunct Professor of Anatomy in
the Medical Department of the University of the City of
· New York, (May number of the New York Medical Journal.)
The shape of the cranium may indicate the relative size
of the different parts of the encephalon, and the circum-
ference of the head and the height of the skull above the
orifice of the ear may also relatively indicate the meas-
urements of the cerebrum and its basal ganglia (which
are enclosed within it). The variations in the skulls of
the different nations indicate an amount of brain which
is in direct ratio to the facial angle of Camper. The
average weight of the brain of a healthy adult of the
Caucasian race has been given, by most of the prominent
investigators upon this subject, as about fifty ounces in
the male, and some six ounces less in the female. In
the new-born infant, the weight of the brain in the two
sexes is more nearly alike, being about eleven ounces for
the male child and ten ounces for the female. The
rapidity of growth of the brain is not uniform throughout
the different periods of life, since it grows rapidly until
the age of seven years, then less rapidly until the age of
forty is reached, when it attains its full development, and
after that age it decreases in weight about one ounce
for every period of ten years. The comparative weights
of the component parts of the encephalon are, in approx-
imate figures, about one-fiftieth of the entire weight for
the pons Varolii and the medulla oblongata taken together;
one tenth of the entire weight for the cerebellum; and
the balance of the total weight for the cerebrum and the
basal ganglia inclosed within its substance. These pro-
portions also show a slight variaton in the two sexes, but
not to so marked an extent as to render this statement
far from a correct one. It may be stated, as a rule,
that the relative proportion of the cerebrum to that
of the cerebellum is greater in the intellectual races ;
and that the cerebrum is developed in individuals in pro-
portion to their intellectual power, although the absolute
and the cerebellue proportion may


Selections
121
size may not be taken as a guide to the quality of the
mind, since it is undoubtedly true that the brain can be
improved in quality by exercise, as well as the muscular
tissue. That there are important individual differences in
the quality of the generating nervous matter is evidenced
by the fact that some sınall brains actually accomplish
more and better work than larger ones, and that many
women often show a higher degree of mental acumen
than men, in spite of the fact that their brains are lighter.
PSYCHIATRY.
"Wafineme insane progresection time to
who is shut up
Though there
use. my experience
LORD SHAFTESBURY ON THE IMPORTANCE OF EARLY
TREATMENT OF THE INSANE. — Lord Shaftesbury, at a
meeting of the Medico-Psychological Association of Great
Britain, in July, 1880, in replying to a toast to his health,
after referring to his connection with lunacy work since
1828, and the great progress that had been made in the
care of the insane since that time, said, in regard to
the confinement of the insane :
“We must be very careful indeed how we hastily
let loose upon the public persons whom we are not
quite certain have been restored to the power of self-
control. The tendency now is to let out everybody
who is shut up, and henceforward to shut up nobody
at all. * * * Though there were in former times
great instances of cruelty and abuse, my experience
of the various asylums-private as well as public-is
not only favorable to the highest order of intellect, but
to the truest and deepest sentiments of humanity
towards the poor creatures who are there confined.
“I hope that nothing will ever be done in legislation
that shall, in the least degree, prevent the early treat-
ment of all cases of lunacy. I say this because there is
a very great fear-it is a natural fear-of curtailing the
liberty of the subject, and people are justly fearful lest
persons should be improperly confined upon insufficient
evidence and have the stigma of insanity fixed upon them.
I know the difficulties which abound upon this point; I
know the extreme delicacy with which it is approached; I
know that it happens that the first development of eccen
tricity is put down as if it were the proof of a long-seated


I22
Selections.
disease, but I know also the benefits which attend early treat-
ment, and that if a larger proportion were taken in due time
an enormous proportion would be restored to health. There-
fore, I hope that nothing will be done which will throw
unnecessary impediment in the way of early treatment by
a mistaken delicacy in regard to the 'liberty of the subject.'”
REMEDIABLE INJUSTICE TO THE INSANE.—There can be
no greater injustice committed towards anyone than to
expose family afflictions to public criticism. This is
being constantly done by the lunacy trials in this State, Ills.
The daily papers frequently state that attendance on
the courts on “insane day” is becoming a fashionable
pastime, as much amusement is then and there to be
had. Those who attend these trials do not dream of
the useless cruelty they are inflicting on the friends of
those being tried like criminals for a disease. Very
frequently the question of the support of the patient
comes up, and people in moderate circumstances must
feel deeply the stigma of being heralded forth to the
woríd as the relatives of a pauper. As an argument
for the law, it may be urged that the liberty of the
citizen needs some such protection. The lunacy law of
Illinois can easily be shown by statistics to give no
more protection than the laws of various other States
not requiring proceedings of such publicity. The aver-
age juryman is incapable of deciding such abstruse
questions as insanity, and the supposed aid given him
by medical evidence is accepted only so far as it
chimes in with his preconceived ideas on the subject.
There are but few physicians in the State who cannot
cite cases of hysterical monomania, of monomania simplex,
or of epileptic insanity, which have been pronounced,
time after time, sane by these sapient juries, although to
their relatives, friends and residents in their vicinity
they were very troublesome and dangerous. The
lunacy laws in Illinois should, therefore, be amended
in such a manner as to provide more privacy and
greater security for life and property. As it stands
now, it is easier to commit a dangerous case of mon-
omania to a prison than to send it to an asylum.-
{ Chicago Medical Review, Nov. 5, 1881.
tay be urgeection.
paupeat the luna co givet ates
Itistics to
' States
life anprovide erefore, scous. "Icinity
nia to casier to


Selections.
123
: 123
PATHOLOGY.
RAPID DEATH FROM HEMORRHAGE INTO THE Pons
VAROLI AND MEDULLA OBLONGATA.—Dr. Julius Mickle, of
London, contributes a valuable paper and an interesting
case on the subject. His resume of the literature of this
subject is instructive, as well as the case and post-mortem
history which accompanies the paper. We give the paper
slightly abridged:
Forty minutes is the shortest time in which, in their great
experience, Drs. Wilks and Moxon have observed death
after encephalic hemorrage. Among the cases of excep-
tionally rapid death I have seen recorded, was one in which
death was apparently instantaneous, save for a single gasp.
Here a small aneurismal sac on the left middle cerebral
artery had given way, and blood was found in the
subarachnoid cavity at the sides and base of the brain.
In another instance, rupture of a similarly placed aneu-
rysmal sac was quickly followed by death — apparently
within a very few minutes, at most. In a third and
rapidly fatal example, the sac was on the posterior cere-
bral artery, and the blood burst into the right lateral
vent icle of the brain. In a fourth case, sudden hemor-
rhagic effusion was followed by death, “within five
minutes at the most.” Much blood was effused under
the arachnoid, chiefly at the base. There was blood
also under the spinal arachnoid, mainly in the dorsal
region. No aneurism was found. Malpighi, of illustri-
ous memory, died suddenly. In the right lateral ventricle
of his brain were large clots, and the blood-vessels were
distended.
If, in the next place, one refer more especially to rapid
death from hemorrhage into the pons Varolii and medulla
oblongata, the easily available examples seem to be rare.
In one instance of hemorrhage into the pons Varolii and
fourth ventricle, rupturing the valve of Vieussens, the
patient, seized with epileptiform convulsions, died “a few
minutes afterwards." The inost rapid of the other cases I
have noticed on actual record were those in which death
followed hemorrhage into the pons in one hour, an hour
and a half, and two hours. Nevertheless, one systematic
writer states that, when extensive, such lesions may destroy
life in from a fourth of an hour to several hours; and by


124
Selections.
another it is stated that large and suddenly produced lesions
in the central parts of the pons may cause death in "a few
minutes, a few hours, or a day or two."
The usual explanation of more or less rapid death
from hemorrhage into the pons Varolii, or more particularly
into the medulla oblongata, is suspension of the respiratory
function from injury or inhibition of centers in the medulla
oblongata ministering to respiration.
Suspension of respiration in a warm-blooded animal, in a
state of activity, leads to a cessation of general muscular
movements within five minutes, or even three, and of circu-
lation and of cardiac contraction within ten minutes. The
non-aëration of the blood causes its retardation in the pul-
monary capillaries, engorgement of the right heart, and
accumulation in the venous system. The imperfect arte-
rialization of such blood as does find its way to the left
heart, and is thence propelled into the conduits of the
systemic circulation, and its deficient volume, exert a
depressing influence on the sensorial and other nervous
centers; the contractility of the heart is weakened, and
its movements cease, there being embarrassment (from
venous distension) of the right chambers of the heart,
and cessation of the normal supply of arterial blood to the
left chambers, and to the coronary and other arteries.
In hemorrhagic lesion of the particular kind at the
present instant under consideration, the circulation of car-
bonized blood in the medulla oblongata cannot rouse by
its direct influence—and to direct superactivity—the res-
piratory centers in the medulla oblongata, compressed
and functionally rendered inert, or even organically
destroyed, as these are, by the clot and by the pulpi-
fication of nervous tissue. Moreover, under the condi-
tions of this particular injury, the circulation of blood
through the medulla oblongata must be more or less
checked. Hence there are not so likely to be the efforts
of extraordinary respiration, observed in some other cases.
Again, the very completeness of the destructive lesion may
also, in cases like the one below, prevent the occurrence
of the convulsions so apt to accompany lesions of these
parts. In the case related, artificial respiration was fully
carried out; and thereby was completely obviated one
mode in which death may occur after hemorrhage into
the pons Varolii and medulla oblongata.
What, therefore, was the cause of so rapid a death in
this case? There would be a powerful impression, such


Selections.
125
as is comprised under the somewhat wide and somewhat
vague term “shock.” Sudden, severe injuries of the
cerebro-spinal nervous system may weaken or check the
heart's action, as in concussion of the brain, injury to the
spinal cord, or in lesions of the peripheral expansions of
the nerves, as exemplified in crushing of the limbs, burn-
ing of the surface, and rupture or perforation of viscera.
But something more than this occurred - something
differing in certain respects therefrom. Here the disrup-
tion, mechanical violence to the nervous tissue near, and
perhaps affecting, the center of the vagus nerve in the
medulla oblongata, might well excite a powerful inhibitory
influence upon the heart. In many ways may be effected
a powerful excitation of the inhibitory nerve of the heart,
and consequent stoppage of the latter; the arrest of the
heart by electrical excitation of the spinal cord, or of the
vagi divided at their origin. Brown-Séquard and others
long ago found that irritation of the medulla oblongata
and upper spinal cord caused sudden stoppage or diminu-
tion of the heart's action; and that the same, or destruc-
tion of the medulla oblongata, may cause sudden death
without agony or convulsion.
Here also, owing to the suddenness of the lesion, there
may have been some of that tumultuous displacement and
vibration of the cerebro-spinal fluid, upon which Duret has
laid stress in explanation of the phenomena of concus-
sion.
As to the role of artificial respiration, it will be seen
how, even in the subjoined case, its use was followed by
a slight, though only momentary revival, as evidenced by
the pulse, and by one or two slight efforts at respiration.
Artificial respiration may well be employed in all cases of
similar lesion where respiration fails. The lesion in ques-
tion may be of just such severity as to cause death, and
that rapidly, unless its immediate effects be tided over by
artificial respiration; after which the natural function may
reassert itself, and life be prolonged, and may perhaps be
preserved. Considerable hemorrhages in these parts are
not necessarily and always fatal.
Schiff, from his vivisections, announced some years ago,
that when, in fulminant “apoplexy," death impends from
paralysis of the medulla oblongata, artificial respiration
should be used; and by this means Corso resuscitated a
patient all but moribund from traumatic intracranial hemor-
rhage. Death took place fifteen days later; and there were


126
Selections.
I
the gray matter muscles of iceordt show
found fracture of the skull, with injury to the brain, and
hemorrhage on the right side extending to the medulla
oblongata.*
In this relation, it is well to bear in mind how well
endowed is the respiratory function; how many are the
parts, both afferent and efferent, which contribute to its
maintenance; how experiments long ago showed that, in
lower animals, no portion of the medulla oblongata is abso-
lutely necessary to respiration, which depends also upon all
the incito-motory parts of the cerebro-spinal axis, and on
the gray matter connecting these parts with the nerves
animating the muscles of respiration; while the experi-
ments of Volkmann and Vierordt showed how excitation
of all or many parts of the body contributes to rouse res-
piratory functions.
CASE. — W. W., 98th Regiment, was admitted, at the
age of 27, on June 17th, 1867, having become insane in
India.
In August, 1878, epistaxis occurred.
On February 23rd, 1879, a severe attack of double pul-
monary congestion with pleurisy set in, which passed into
pneumonia and resolution.
On March 31st, 1879, at 10.20 A. M., sitting up in bed, he
vomited heavily, turned livid, fell back insensible, with the
pulse still beating. The pupils were equal, and insensitive
to light. Artificial respiration was at once instituted, and
a momentary improvement showed itself; but this improve-
ment ceasing, Dr. Mickle immediately performed a rapid
tracheotomy, and then continued artificial respiration for
upwards of an hour, but without any avail. Death must
have taken place within seven or eight minutes of the sud-
den vomiting and collapse, up to which moment there were
no objective symptoms whatever.
Necropsy.—The pons Varolii slightly ruptured in front,
ploughed up and pulpified internally by blood, and for the
most part occupied by blood-clot. The upper and posterior
part of the medulla oblongata also invaded. Hemorrhagic
infiltration and softening to within one-third of an inch of
the nib of the calamus scriptorius. Some clotted blood
was lying by the left side of the medulla oblongata; also in
the interval between it, the pons and the cerebellum; in the
subarachnoid space beneath the cerebellum ; in the fourth
• The utility of the procedure is also well shown in a case of another klnd than
those now under notice a case in the Warneford Hospital, in which artifcial
respiration was used by Drs, Homer and Wilson, and Mr. G. W. Crowe.


Selections.
127
ventricle, extending thence, via the iter, into the third ven-
tricle; and, finally, about the circle of Willis, and Sylvian
fissures. The effusion had evidently all proceeded from
the pons. The cerebellum was of fairly healthy appear-
ance. The cerebral meninges were moderately congested;
the arachnoid was slightly opaque, and the pia mater
slightly edematous, over the superior and lateral surfaces
of the brain. Cortex and medulla somewhat hyperæmic.
No hemorrhage in the lateral ventricles. Nothing unusual
in the appearance of the optostriate bodies. The right
hemisphere was 20 ounces; the left, 194; the cerebellum,
53; pons and medulla oblongata, 11; fluid and blood from
the cranial cavity, 41 Auid ounces.
MONOCULAR BLINDNESS FOLLOWING HEAD INJURIES. —
A paper on the above subject, by Prof. Leber and Dr.
Deutschmann, appears in the last number of the Archives
f. Ophthalmologie.
In these cases the sight of one eye is lost before any
ophthalmoscopic changes are visible; later on atrophy of
the optic disc supervenes without any changes in the rest
of the fundus. The authors point out that if the loss of
sight and subsequent atrophy depend on an injury to the
nerve, that injury must be behind the point at which the
arteria centralis retinæ enters its substance, or there would
be hemorrhages and effusion into the retina; while it must
be in front of the commissure, or the blindness would not
be confined to one eye.
The observations of Holden are quoted, who showed
from an examination of eighty-eight cases of fractured base
that in 90 per cent. a fracture of the roof of the orbit
existed, and in 60 per cent. this involved the optic fora-
men; and from these it is concluded that the loss of vision
in such cases is due to compression or tearing of the optic
nerve in its passage through the foramen.
Ten cases of head injury followed by blindness of one
eye, more or less complete, are quoted. In one of these
there were symptoms pointing to general injury, and vision
of both eyes was affected; of the remaining nine, four had
marked symptoms of fractured base, while the remainder
were comatose for various periods.
The defect in vision was observed in all the cases as
soon as consciousness was recovered. In all the cases
(six) in which the injury could be localized, the blindness
was on the same side as the injury: it was complete in
the one eye in six cases; in the other three there was


128
Selections.
e amble no cope week on
an ave disc appear altered in siz Holder,
considerable amblyopia, with diminution of the visual field.
At first there were no ophthalmoscopic changes, but after
an average period of three weeks the first signs of atrophy
of the disc appeared; this later on became complete, the
vessels not being altered in size.
From the observations of Holder, showing how fre-
quently fractures of the base involve the optic foramen,
from the considerations which localize the injury between
the point of entry of the arteria centralis retinæ and the
optic commissure, and from the impossibility of explaining
the symptoms in any other manner, the authors conclude
that the monocular blindness is due to compression of
tearing of the optic nerve, produced by a fracture passing
through the optic foramen. In some of the cases the
globe was much protruded; this could hardly have been
by blood from the ophthalmic artery, or the retina circu-
lation would have been interfered with, and it probably
indicated that the fracture extended along the roof of the
orbit.—[Specialist.
ATHEROMA OF THE BASILAR ARTERY.–At the meeting
of the New York Pathological Society, November 9th, 1881,
Dr. Van Giesen presented a specimen of Atheroma of the
Basilar Artery. The patient was 46 years old and free
from hereditary taint, but had syphilis fifteen years before.
In 1875 he had heat stroke, but recovered in a week.
Over application to work brought on severe headaches and
strabismus which, after rest, disappeared. In 1878 the
headaches again returned and paralysis of both eyes.
Memory of remote events good; of recent events, poor.
Appetite good; grasp strong. Ptosis of both eyes. No
nodes over tibia. Two scruples of iodide of potassium a
day made no improvement. Strychnia, iron and quinine
was then given, followed by a course of bi-chloride of mer-
cury and iodide of potassium. The ptosis of left eye disap-
peared under this treatment, and right eye became
much better. He complained of severe pains in right
elbow and shoulder. Convulsions occurred, and several
slight attacks of paralysis. October 16th he had a
violent convulsion with complete loss of conscious-
ness; no elevation of temperature: no frothing at the
mouth. On the 18th recovered consciousnees and sat up
in bed. On the 27th he seemed as well as usual. On
November 6th he felt unusually well, but on coming from
the bath staggered, fell unconscious to the floor and died
in six minutes.
the 27th recovered conscino frothi


Selections.
129
At autopsy, the pia mater was found congested and
the basilar artery at the base of the brain showed well-
marked atheroma. At the root of the choroid plexus was
found a small bean-shaped body. The question suggested
was: What was the immediate cause of death?
THE RELATIONSHIP OF DIABETES TO INSANITY.-Dr.
Santos shows, in Annales Med. Psychol., January, 1880,
that diabetes sometimes alternates with insanity, in the
same manner as pulmonary tuberculosis is known to do
In many cases of diabetes, there exists a specific mental
disturbance, characterized by depression, and occasionally
leading to suicide. The intensity of the symptoms is
directly proportionate to the amount of sugar in the
urine. Later in the course of the disease, the patient
sinks into a state of quiet apathy, talking to himself,
but is without delusions; this condition often lasts until
death.—[Phia. Med. and Surg. Reporter.
A CASE OF CONGENITAL ABSENCE OF THE Right HEM-
ISPHERE OF THE CEREBELLUM was reported by Mr. Pearce
Gould, at a recent meeting of the Pathological Society of
London, found in a man who died at 80 years of age.
He was a quiet, rational, steady man, filling the position of
gardener at one place for sixty years. The cord and
cerebral hemispheres were normally symmetrical, and no
other nerve lesion is reported in the case. The man
seems to have got through life well with the limited
amount of cerebellum nature gave to him.
A DAGGER WOUND IN THE BRAIN WITHOUT SYMPTOMS.-
The Journal de Medicine et de Chirurgie reports the case of
a man who, in a fit of insane passion, drove a dagger ten
centimeters long down into his head from the top, with-
out loss of intelligence, sense, or motion. By the aid of
two surgeons and some machinery the dagger was with-
drawn, with the thanks of the wounded man, who imme-
diately afterwards walked to his carriage. The point of
the blade struck the occipital fossa.
A CASE OF CONGENITAL ANOPHTHALMOS, resulting from
intra-uterine causes, with normal sized orbits, but without
foraminæ optici, is reported in Archiv. d'Ophthal., I., 5.
Bands of connective tissue substituted the nerve-fibre in
the optic nerves. The two anterior corpora quadrigemina
were atrophied; the posterior corpora were normal, while
the external geniculate bodies were wanting.
Chiruren, drove the the aid itha


130
Selections.
THE RELATION Which EXISTS BETWEEN TUBERCULOSIS
AND INSANITY.-Dr. Clouston, in the Journal of Mental
Sciences, for April, 1863, showed, that of 828 patients who
died with tubercular disease at the Royal Edinburgh Asy-
lum, 153 passed rapidly into the state of chronic insanity,
the acute stage being of very short duration, the patients
all manifesting a decided tendency towards chronicity.
He also noticed that the prognosis relating to mental
recovery was eminently unfavorable, and that apparent
recoveries proved to be only remissions. In these cases
where the development of the two diseases seemed to
Dr. Clouston to be nearly contemporaneous, was not the
tuberculosis the result primarily of the escape or emigra-
tion of the lymphoid cells into the connective tissue of
the lungs, owing to this state of leucocythæmia in the
patient? I think that this condition occurs more fre-
quently than we are aware of, especially in persons who
inherit the predisposing neurotic element or morbific force.
That there exists such an hereditary neurotic or morbific
element or force, present in both insanity and phthisis, I
most firmly believe; and I also believe that there is a
correllation of morbific force which renders these diseases
mutually convertible. I have repeatedly seen this borne
out by undeniable facts, children of one family being
affected with both insanity and phthisis in many different
instances.—[Dr. E. Mann in Va. Med. Monthly.
M. DEBOVE's METHOD OF PREPARING THE SPINAL CORD
FOR MICROSCOPIC SECTIONS.—Place the cord in a four per
cent. solution of bichromate ammonia for three weeks, then
in a solution of phenic gum for three days, and for three
days more in alcohol. Sections may then be cut with
great facility. They should be placed in water to pre-
vent curling. They are then immersed in a saturated
solution of picric acid for twenty-four hours, and colored
with carmine for about twenty minutes, the picric acid
acting as a mordant.–Archives de Neurologie.


EDITORIAL
GUITEAU AND HIS TRIAL.- Whatever views may be
held respecting the full responsibility of this wretched
character for the distardly act he has committed, his a
history, as brought out in the trial now going on, gives him
no common place among ordinary murderers, for the ordi-
nary motives which operate upon ordinary minds seem
not to have moved him to commit this heinous crime.
Whatever difference may exist as to his responsibility for
the crime, his mind is the “phenomenal mental organiza-
tion of the century." This term, applied to him by an
eminent psychological expert writing to us from the
scene of this remarkable trial, correctly characterizes the
Washington prisoner. If he be a sane man, no other
sane man like him ever lived; if he is insane, his insanity
is an exceptional case in the history of morbid pyschology.
It matters little what becomes of the wretched life for-
feited for the dastardly crime, but it does matter if such
a psychical phenomenon should be executed before science
shall have determined into what category of mind to
place him. Certainly enough has transpired in the history
of his singular conduct and career to create grave doubts
as to his entire sanity, as the details of the crime are
dispassionately reviewed, while suspicions equally strong
find lodgment in the mind as to his irresponsibility.
“Not less interesting to the student of morbid
psychology than the well-defined, well-recognized forms
of insanity are those obscure, anomalous conditions of
mind which occasionally appear, but in regard to which
he fails to find any light from the standard books,” wrote
that Coryphæus in psychiatry whose voice, though now
silent in the grave, yet speaks with the potency of
authority.
“Though more numerous, probably, than they are
generally supposed to be, yet they are comparatively so
rare and so imperfectly understood, that for the most
part, after exciting a little temporary curiosity, they pass
away and are forgotten. And yet they must ever con-
stitute an important class of mental disorders, for the
reason that their existence, however infrequent, must
necessarily modify conclusions that might be drawn from
the more common forms of mental disease.”


132
Editorial.
and other it be
Psychiatry will not loose sight of Guiteau, though his
exact mental status may remain in question until long
after his life is ended, when he will take his place along
with either the Corniers, the Cangleys, the Freemans, or
Bellinghams.
The life of Guiteau is of little moment compared with
the psychology and jurisprudence this trial shall illustrate
to after time.
Whether the desire to convict in a case where sanity
appears more doubtful than irresponsibility shall lead to
judicial instruction and expert testimony at variance with
the actual facts of psychological science, to become a
sort of precedent for future trials, whenever the question
of insanity connected with capital crime shall be raised,
is the all important question to psychiatry. Whether
the Court instruct that insanity should be proved be-
yond a reasonable doubt, or whether the prisoner have
the benefit of the doubt and a subsequent satis-
factory inquisition into his mental condition is not so
material for this case alone, as for others in which a
different instruction by the Court in Washington may be
invoked as a precedent to the detriment of the more
helpless and friendless insane hereafter. Whether in
order to establish the prisoners insanity experts shall
assert the existence of a form of insanity so plain
that only the incapable or the dishonest expert would
deny it, or on the other hand they shall deny the
existence of forms of mental aberration, not the most
common, yet plainly demonstrable, whatever reasonable
objection may be urged to their nomenclature, is likewise
important to the fair name of psychiatry.
BATTEY'S OPERATION AT THE INTERNATIONA CONGRESS.-
An interesting discussion on this subject was elicited by
Dr. Battey, of Rome, Georgia, the originator of this opera-
tion, in which the eminently conservative and experience
founded views of the distinguished physician who first
called professional attention to the propriety of this radi-
cal operative procedure, bear most favorable comparison
with some of the enthusiastic opinions of Battey's own
zealous and less discreet followers. That there is a legiti-
mate field for ovarian exsection has been clearly demon-
strated by the eminent American who first performed,
and continues to perform the operation; and it will be
one of the least perishable of the laurel leaves in Bat-
tey's chaplet of enduring fame, that the head which con-
zeal. Some of the enthe bear most favoriety of this radi


Editorial.
133
ceived this really valuable operation has been able to
rationally weigh the indications for and against its per-
formance. It is significantly suggestive that Dr. Battey,
with his wide repute and well-earned fame, should have
found occasion to perform the operation but sixteen times
in ten years, that Spencer Wells should discountenance it
entirely, that Mathews Duncan should have but once sanc-
tioned it, that Martin, of Berlin, should regard it as rarely
necessary, while Lawson Tait, of Birmingham, should have
excised sixty-five ovaries within a little over two years.
The Nymphomania, so to speak, which seized upon Baker
Brown some years ago, apparently ending in a quiet and
harmless amentia on the subject, seems to have broken out
in a new direction, and oöphorectomy may become as great
and unreasonable a craze as was clitoridectomy.
Especially among the extremely youthful and extremely
aged wielders of the scalpel, whether founded in prurient
curiosity to see how unsexed women would act, or in
spite, that so much sexual activity should remain in the
other sex after it has waned in our own, can not be
determined. It is certain that these operative impulses
are not always founded in clear, cool, unimpassioned rea-
soning as to their therapeutic necessity.
That there is a field for the operation in lunatic asy-
lums especially, as Goodell asserts, can not be denied ;
but even there, distinctions must be made in cases. There
is a field for this operation outside of the asylums, too,
but a more circumscribed one than many adolescent sur-
geons suppose. If the neuropathic diathesis could be
obliterated with the removal of an ovary the area for
oöphorectomy would be greatly enlarged, and the aspirants
after surgical fame might keep themselves busy with bril-
liant operations. But since there are other factors to
consider in arriving at the therapeutic indications and
forming correct prognoses, it is well for the operator before
applying the knife, to inquire whether he has the requisite
observation and judgment respecting possible neuropathic
antecedents in many cases to justify so summary an
operation.
That gynæcological reasoning which discerns through
the speculum special and exclusive channels of communi-
cation with the brain, not revealed by physiological or
anatomical research, and never dreamed of in regard to the
other sex, is as untenable as the emotional condemnation of
the operation, simply because it “unsexes the woman,” when


134
Editorial.
this is the very thing demanded in those instances where
the procedure is justifiable at all. Battey's proposition,
that “no part of the human body ought to be invested
with such dignity and value that it may not properly be
sacrificed to the whole,” is an axiomatic statement; and
his recommendation that “in case of any grave disease
(of ovaries), which is either dangerous to life or destruct-
ive of health and happiness, which is incurable by any
other and less radical means, and which we may reason-
ably expect to remove by the arrest of evolution or change
of life,” is a very proper foundation for the performance
of normal ovariotomy, and such cases do really exist.
Dr. C. FAYETTE TAYLOR'S PAPER on the “Influence
and Reflex Disturbances of the Sexual Functions in
Women,” read, December ist, before the New York
Academy of Medicine, in which the authur cited typical
cases that had proven intractable because their real
reflex nature had been unrecognized, cases where the
nervous disturbance was due to strong unsatisfied passion,
and cases caused by unnatural excess, elicited consider-
able discussion. One member, who is an enthusiastic
alarmist on the subject of preputial irritation, with the
faith of a Rabbi in the neuropathic prophylaxis of cir-
cumcision, whose name always brings before our mind
that typical picture of the little boy with the long
prepuce and distorted limbs and visage, characterized the
paper as unfit for the consideration of the society or the
profession, while Dr. Mundè and others thought it an
emimently proper subject for discussion.
Dr. Taylor may have too highly colored the influence
of the sexual passion-overexcited or unrequited-in
women in general, but it would be difficult to overdraw
it in special cases. No man of large experience in the
observation of nervous diseases of women, especially
hysteria, hysterical insanity, eroto-mania, erotic melan-
cholia, the dementia of masturbation and the migratory
gangliopathy of sexual irritation (if the term be allowed us),
a theme upon which one might record a volume of
clinical observations, can either doubt that the subject
can be overdrawn in special instances or be out of place
before an assemblage of medical savants. One cannot
pass through the female wards of a hospital for the
insane and witness there the wrecks he may see among
them from sexual desire, unsatisfied or morbidly over-
active, or count among his hysterical cases the number


Editorial.
135
whose unstable nervous organisms might have been kept
in normal equilibrium by judicious and timely marriage,
without wishing that the prophylactic therapeutic resources
of our art were something different from camphor, chloral,
valerian and opium, or the bromides. Nor, look at the
members of many neuropathic families under his observa-
tion, saved from mental derangement by timely and
happy marriages, while the less fortunate remainder have
displayed the inherent latent nerve instability in hysteria,
insanity, dipsomania, or their neurotic kindred, without
wishing the subject had been more discussed before
experience had revealed the misconception of the past.
There is an aspect of this question which was
not touched upon at this discussion, namely, the how
and to whom such persons ought to be mated to
arrest and avert descending neurotic degeneracy in
offspring, and the question is one for the medical adviser,
especially for the family physician.
The subject, as Dr. Barker said in the discussion, is
“one of great practical importance." True, it is a delicate
one but it is also vital, and while deploring the evil,” as
Dr. Garrish remarked, “we must recognize the good of
a free discussion." There is room for much diffusion of
knowledge on this subject.
CHEMICAL RESTRAINT IN FEBRILE DELIRIUM.—After the
supporting plan of Grave's, of Dublin, famous for having
introduced the plan of literally feeding fevers and such
specific medication as may seem to be required in cer-
tain special forms of febrile disease, we know of no
better auxiliary than moderate tranquilization with the
Ammonium bromides during the day and chloral hydrat at
night. Limited quantities of these agents are restful and
supporting, while to arrest the cerebral disintegration of
delirium at the natural time for sleep with the patient,
is, to some extent, recuperative for the next day's combat
with the disease. The extent to which chemical restraint
should be carried in febrile delirium has not yet been fully
determined by the profession, while in maniacal and
alcoholic and other forms of toxic delirium it is considered
proper to stop erratic brain action as effectually and
summarily as practicable. Our plan has been to impose
absolute restraint upon the cerebral cortex during a part
of every night at least by chloral, and during the day to
modify the morbid psychical display with bromides. To


136
Editorial.
ylence of the securing perse cases.
restrain morbid action without arresting physiological
disintegration are the points to be considered.
We have briefly referred to this subject elsewhere
(St. Louis Med. and Surg Jour., Nov. '81.), but would be
pleased if some of our readers would avail themselves of
our space to discuss the subject in extenso.
CEPHALIC GALVANIZATION FOR EPILEPSY.—After ten
years of satisfactory trial, we can speak with some confi-
dence of the value of cephalic galvanization as an efficient
auxillary in securing permanently curative results in the
treatment of many of these cases.
It may be regarded as claiming too much, but the
statement is verified by experience, to say that fully one-
half of our cases including epileptoid disease and traumatic
epilepsia, have apparently recovered after eighteen
months of electric treatment, conjoined with the bromides,
Fowler's solution, and sometimes chloral hydrate. Strych-
nia, nitrite of amyl and nitro-glycerine have in some
cases been superadded for special indications. Twelve
cells of an ordinary constant current portable battery-
the Galvano Faradic Company's, or McIntosh—for five
minutes every alternate day are sufficient to tranquilize
the cerebral cells, and so impress the cervical sympathetic
as to aid in bringing about that stability within the brain
which makes the discharging lesion an impossibility in
curable cases. Sponge electrodes should always be used,
and a painless, unirritating, steady current employed. Of
the remaining half of our cases, the paroxysms in very
many have been kept in permanent abeyance by this
means, and all have been more or less benefited. We
are at a loss to understand why any author pronounces
epileptoid more difficult to subdue than epilepsia. We
have not found the former less manageable.
BUCKNILL'S VIEW OF HYPNOTISM—ANOTHER WORD FOR
DR. BEARD.–Our distinguished friend, Dr. John Charles
Bucknill, under the above caption, has written a note to
the New York Medical Record, in which, while taking
exceptions to Dr. Hammond's method of criticising Dr.
Crichton Browne and insisting that character is an essential
factor in the estimation of the verity of the psychological
displays of the hypnotized subject, bears the following
cautious testimony to the psychical verity of hypnotism :
“Forty-four years have passed since I saw Dr. Elliotson's hypnotized
patients, the Misses Okey, in the University College Hospital. They
certainly were impostore when they declared they saw Black Jack sitting


Editorial.
137
on the foot of any bed on which a dying patient lay ; but Dr. Elliotson
believed in them and sacrificed himself for his belief. Three or four
years later I saw a number of hypnotised patients at Elliotson's private
house, whom I did believe and still do believe were not imposters; but I
arrived at this conclusion upon data of moral probability alone, and not
from any physiological test. These data were that I found a number of
epileptic patients coming to Elliotson's house daily to be hypnotised for the
relief of their malady without fee or reward given or received, and without the
slightest publicity. It was at a time when public interest in the matter had
withered down to its roots, and Elliotson assured me that he never in his life
had received a fee from or for any mesmerized patient ; and I quite believed him.
The circumstance did not present to my mind—which was quite sceptical enough
- any appreciable motive for imposture.
“Since then I have seen a good deal of mesmerism and of hypnotism,
which is the synonym for its simpler forms, and a great part of it, I am
convinced, upon moral data, was flagrant imposture. Last year, however,
I had an experience which brought Elliotson and his patients vividly back to my
memory in the observations, which through the kindness of Monsieur Charcot, I
was able to make of his patients at the Salpetriere. Their abnormal states of
unconsciousness seemed to be far more varied than those of Elliotson's epilep-
tics, and I should be indeed surprised if the accomplished physician who
was investigating them, bad been willing to eliminate the moral charaeter
of each patient as no factor in the case.
When one thinks of the deceptions habitual to hysterical patients, of
the stocial endurance of pain for the smallest reward or advantage which
one sees in jugglers, malingeres, fakirs, etc., and when one reflects that
states of consciousness are absolutely the secret of those in whom they
occur, it does seem to me incontrovertable that phenomena connected with
or attributable to abnormal states of consciousnnss cannot be appreciated
with any satisfactory degree of exactness without some knowledge of the
moral character of the hypnotised subject.
The True LEGAL CRITERION OF IRRESPONSIBILITY for crime
where insanity is pleaded, to be in accord with the facts
of morbid psychology, should be inability, not alone ren-
dering the individual unable to distinguish right from
wrong, but such disability by reason of disease, disorder-
ing or convulsing the mind, as to overpower or pervert
the natural understanding or will, rendering either of
them wholly subservient to, or incapable of resisting the
promptings, suggestions or impulsions of disease, regard-
less of the doubtful condition of the mental consciousness
as to right or wrong in the abstract. An insane person
may show knowledge of the right or wrong of a particu-
lar act in the estimation of the law, and yet not perceive
its criminality with reference to himself, either by reason
of delusions or momentarily blinding morbid impulsions ;
or, perceiving its criminality and wrong, like one convulsed


138
Editorial.
rotection the inght and founda.
sane are just!
juries instead of aty is to continudance with
by the resistless but conscious or semi-conscious sobbing
and laughing of hysteria, can not of himself resist the
morbid impulse. The mind may be convulsed with a
morbid idea as the spinal cord can be, by a morbid
movement. The facts of epilepsia, apoplexia, catalepsy,
ecstasy, trance, somnambulism, the cerebral automatism of
chronic alcoholism, the peculiar sequlæ of epilepsia while
in the epileptic circle and the many other auto-amnesic,
semi-conscious and deuto-psychic states familiar to psychi-
atry, as well as the facts of delusional monomania, emo-
tional and moral insanity and the commoner forms of
mental derangement in certain of their states and stages,
exhibit the restricted and defective psychological founda-
tion of the legal test of knowledge of right and wrong,
as applied to the responsibility of the insane; and law,
which is framed for the protection of the weak against
the strong, should see that the rights of the insane are justly
guarded by rulings in accordance with the nature of
insanity; if insanity is to continue to be tried by courts and
juries instead of examined by commissions of medical inquiry.
If the rights of the real insane are to be regarded
instead of that popular prejudice which rules the hour
against the “insanity dodge,” courts should recognize
the fact that a great deal of crime is due to disease as
well as to depravity, and instruct so that if real, ex-
empting disease exists, its unfortunate victim may not be
condemned as a criminal. Making examples of real
lunatics does not deter real criminals, and ignoring the
facts of disease and its effects upon the mind lest some
criminals, aided by sharp attorneys and false testimony,
might escape justice on the plea of insanity, is not justice
to the helpless insane, who ought to be protected by the
courts in every right and by rulings that may secure a
just understanding of their disease.
The sum of the whole matter is this: If disease so
involves the mind as to change the individual's normal
relationship to crime and its lawful penalty, either by
deranging his natural understanding of unlawful evil, or
destroying his natural powers of resistance, he should be
consigned to the care of the alienist physician in an asy-
lum for the insane rather than to the jailer or the hangman.
Public PREJUDICE AGAINST THE “INSANITY Dodge,” as
it is called, as an excuse for capital crime, has grown so
strong in some parts of this country that the real victims
of insanity stand little chance for having meeted out to


Editorial.
139
Svictim of di with the bg. diseased in this Sealife has
them that “justice tempered with mercy” so vaunted by
the law. The days of the witchcraft craze seem to have
come again, and the idea of satanic possession seems to
seize upon the public mind whenever some poor, helpless
victim of disease commits an atrocious crime, absolutely
inconsistent with the natural character and solely due to,
and only explicable by, disease.
Such a case recently occurred in this State, when Dr.
Smith, of the Fulton Asylum, whose whole life has been
spent in studying insanity, and the editor of this journal,
pronounced a poor woman insane after careful personal
examinations and study of the evidence throughout the
trial, finding undoubted mental disease and delusions.
Four other physicians, including the woman's husband,
testified to her insanity likewise. She had murdered the
child of the latter, tried to kill her mother, her suckling
babe, her husband and herself under a melancholic delusion.
Only four jurymen were convinced by this direct medical
testimony, and no fact on the trial showed motive or
other influence than disease. The remaining eight jury-
men acknowledged after the trial that they paid no atten-
tion to the expert testimony. The public prejudice against
the plea of insanity on excuse for crime was also illustrated
when the New Jersey Legislature, resolving itself into a
body of insane experts, passed a resolution declaring Gui-
teau to be a sane man.
GUITEAU'S PLEA.—The nation mourning its late Chief
Magistrate so suddenly sent from life to death by the assas-
sin's bullet, it is in no fit mood of mind to calmly consider
the mental condition of the creature whose crime has
caused its sorrow. Inconsolable grief mourning the lately
loved and lost is not receptive to argument, and will not
be comforted by a plea of insanity.
Posterity may ask inore calmly and reason more clearly
as to the cause of the assassin's unparalleled morbid
egoism, his “maladjustment through life to his environ-
ments,” the open manner of the crime without intention
of escape, without accomplices, or evidence of conspiracy
or promise or reasonable hope of reward (when the man-
ner of the crime is considered), or other adequate external
cause, and discern the defective and deranged mental
organism that made such a crime possible in this country,
even though it never forms a correct estimate of the pre-
cise degree of Guiteau's guilt. Guiteau is being tried too
soon after the crime for an impartial verdict.
ise or rout accomplif the coming
Soon degree of Gyer forms a me possible


140
Editorial.
THE DEAD PRESIDENT AND His TREATMENT.—Dr. John
T. Hodgen, whose deserved eminence is due as much to
his logical acumen in the solution of pathological prob-
lems as to his extensive experience, has by request,
reviewed the President's case in the North American
Review for December, giving the weight of expert medical
discernment to all the essential ante and post-mortem facts
in that important case.
The following are his conclusions :
“ In reviewing the history of the case of President Garfield, I can find
no reason for adverse criticisid of any part of the management. I do not
find that anything that was done, either at the examination or in the
treatment, tended to hasten death, or in any way to unfavorably influence
tbe progress of the case. Any probing beyond the inner surface of ihe
ribs I believe was of no value. It was never possible at any time prior to
the post-mortem examination to have known of the existence of the sac of
pus revealer at the examination, or to have known the existence of an
aneurism of the splenic artery. Possibly a careful examination by auscul-
tation might have indicated the existence of an aneurism, but the artery
on which it was situated could not be known, or its relations determined.
Had the site of the ball been known, it could not have been removed. Had
the site, character and relation of the aneurism been known, the vessel
could not have been ligated. Had the presence of the pus cavity been
recognized, it could not have been evacuated without hastening the fatal
termination.
“Finally, if the pus cavity bad disappeared harmlessly, if the aneurism
had been spontaneously cured, if the bullet had remained encysted, the
injury of the spine, with the carious conditions of the bones, and the ulcer-
ating intervertebral cartilages, must have left the President a deformed
invalid.”
The PsychicAL SIGNIFICANCE OF PUNNING.A suddenly
unnatural propensity for punning, like the propensity to
use profane language, to rhyme, to read words backwards,
etc., in one who never before practiced those things, espe-
cially to make puns on sacred names and subjects and
inappropriate puns is often indicative of mental disorder.
From this the psychiatric editor of the Chicago Medical
Review infers dementia when any of its exchanges displays
a little humor, losing sight of the fact that the change of
mental habits and not the habit itself makes the act appear
morbid. . For example: If the Chicago Medical Review
would suddenly change into a witty sheet and perpetrate an
occasional pun, it would be at least prima facia evidence
if not of dementia, of prodromal insanity ; wit or humor
being foreign to the natural character of that prosy
journal.


Editorial.
141
THE TRANSITION FROM NERVE-STRETCHING to nerve liga-
tion and compression as therapeutic measures, is easy and
natural. Dr. Mudd, of this city, some time ago suggested
some new uses of ligation, and now compression of the
nerve-trunks with the finger tips is recommended. We
suspect that the benefit sometimes derived in epilepsy
from compressing the carotids, is the result rather of
compressing the nerves behind them. Cedersjöld has
found compression valuable in writer's cramp, loco-motor
ataxia and facial neuralgia. The benefits of massage
and of rapid mechanical vibration are of undoubted value
in painful affections, as well as the interrupted and con-
stant galvanic currents.
Two DRACHMS OF CHLORAL HYDRATE TAKEN AT ONE
DOSE WITHOUT FATAL EFFECT.-A hysterical patient of
my neighbor, Dr. Daniel Kuhn, recently took something
over one ounce at a single draught of bromidia (which is
a proprietary compound of fifteen grains of chloral, fifteen
grains of potassium bromide and one-fourth of a grain of
pure cannabis indica), without fatal effect, and the stomach-
pump was not employed. The doctor kept the patient
constantly moving about, and treated her by frequent
cold spongings, and every hour gave twenty drops of nux
vomica tincture for six hours. The patient appeared a
little used up the next day, but is now well.
THE EFFICACY OF LAMBERT'S LISTERINE as an agree-
able and efficient antiseptic is well attested by reputable
observers to whose attestations of efficacy we are enabled
to add our own testiinony as well as to its most agree-
able odor. The value of CELERY in depressed nervous
states as an auxiliary to more active treatment has seemed
to me undoubted, and in the absence of an afficinal prep-
aration the CELERINA prepared by Richardson & Co., has
been of great value. In the treatment of nervous ex-
haustion and general debility some form of phosphorous
is often demanded, and the employment of some good
preparation of Malt is likewise of value. For these purposes
the well known Horsford's Acid Phosphate and Trommer's
Extract of Malt have been much used and justly recom-
mended.
BROWN-SÉQUARD'S ADMISSION of psycho-motor reflex
centers and the concession with which he concludes his
pricis before the late International Congress, that “we
have recently made considerable advances"_" in diagnosis
to add ourº whose attestati is well atte:


142
· Editorial.
by recent researches on localization of disease in the
cerebro-spinal centers," brings him much nearer to Fer-
rier, Charcot, Pitres, Championiere, Jackson and other
localizers, and is a quite satisfactory confirmation from a
once antagonistic source of the principal claims of the
doctrine of cerebral localization as un fait accompli.
SUBSCRIPTIONS for 1882 are due with this number and
new subscribers are in order.
We have no complaint to make of our friends in regard
to payment of subscriptions after bills have been sent, but
please remember the amount of needless office labor saved
to us by each subscriber sending forward his annual sub-
scription at once.
ACKNOWLEDGMENTS.-It gives us great pleasure to
acknowledge the many congratulatory letters and words of
encouragement spoken and written about us, at home and
abroad, and we are glad to know that our regular readers
have been well pleased with the ALIFNIST AND NEUROLO-
GIST.
We should have been better pleased, however, if some
of the many friends of the JOURNAL had pointed out to us
some of our deficiencies. Judgments are enlarged by
friendly criticism, and as we aim only to be useful and
true to the profession and the department we cultivate,
and are without entangling professional alliances (to use a
diplomatic phrase), or personal animosities, we are in a con-
dition to receive and bear fair criticism with equanimity. I
We thank the contributors likewise, for the thoughtful,
observant and careful papers they have contributed. We
thank, also, another large and numerous class of careless,
thoughtless and unpractical writers, for having sent us so
few papers to read and return during the year. We also
acknowledge our indebtedness to our collaborators, some
of them, however, might do more work if they would try.
MUSCLE REFLEX is the term Gowers proposes to sub-
stitute for tendon reflex, maintaining that the knee phe-
nomenon, for example, is elicited by the movement of the
muscle. A blow on a tendon is communicated to the muscle,
thence transmitted to the spinal center and reflected, and
the best reflex response is elicited when the tense muscles
are struck.


Editorial.
143
described Shield climbservationical conce
IN MORAL INSANITY the lesion of intelligence is so hid-
den from view that its existence is rather theoretical than
demonstrable in many cases. It is that form of "insanity
which exists sometimes with an apparently unimpaired
state of the intellectual faculties,” according to Pritchard.
Pritchard permitted no theoretical conception of mind to
override discerning observation, and he did not invent the
term to shield crime, but adopted it because it better
described a form of insanity which is allied in appearance
only to depravity and because it has undoubted cerebral
disease for its basis. The disorder of the will is more appar-
ent in moral insanity than of the reasoning faculties; but
whether the intellect is or is not deranged - and it is in
most cases— the term is a good one, as expressive of the
morbid antithesis of crime.
Dr. Abadie's PATHOGNOMIC SIGN OF EXOPHTHALMIC
Goitre is spasm of the levator palpæbræ superioris, this
muscle remaining immovable, exposing the sclerotic when
the eye is turned downwards.
ANOTHER ASYLUM CONFLAGRATION.—The State Institu-
tion for Idiotic and Imbecile Youths, near Columbus,
O., was recently burned to the ground, but we have heard
of no attack on the Association of Superintendents of
Asylums for the Idiotic and Feeble Minded, in consequence.
“THE EDUCATED PHYSICIAN having looked back upon the
career of his profession in the past and mastered its rela-
tions to the present, ought to feel that his work underlies
all other work for humanity, and that even his single,
fleeting life enters into the corporate immortality of a
beneficent and powerful organization.”- President Eliot, of
Harvard.
Post-GRADUATE Schools of the St. Louis and Missouri
Medical Colleges are announced. The object of these
shools is to give practitioners of medicines and recent
graduates special facilities and advantages, that cannot be
realized in the usual courses of instruction as now estab-
lished in the best medical schools. These are good moves
in the right direction. The Missouri school course begins
February 20th and continues six weeks. The St. Louis
school term will commence in April, and lasts one month.
PERSONAL. — Dr. Richard Gundry, formerly Superin-
tendent of Asylums for the Insane in Ohio, now of the


144
Editorial.
Maryland Hospital for Insane, has been made Professor of.
Materia Medica and Diseases of the Nervous System in the
College of Physicians and Surgeons at Baltimore.
Chas. Gulath, importer of Rhine Wines, 2613 Caron-
delet avenue, St. Louis, Mo., advertises his excellent wines
in this number of the JOURNAL. We have tested their
purity and commend them.
Prof. Vulpian has resigned his position as Dean of the
Faculty of Medicine (Paris), and Prof. Béclard selected as
his successor.
OBITUARY.
real' glory of our life in struggling exile when ch period
Cirrly years of his day in toxicolo cignola (Modena),
FRANCESCO Selmi.—Selmi, of Vignola (Modena), was a
real glory of our day in toxicology. After passing the
early years of his life in struggling against his straitened
circumstances, he was driven into exile when he had
reached his desired position. In the preparatory period
and the early epoch of our national revival, he took a
very active part in politics, for which he had abandoned
his beloved studies; but he resumed these when he was
nominated Professor of Pharmaceutic and Toxicologic
Chemistry in the University of Bologna. It was then that
he undertook his powerful and highly prized publication,
the “ Chemical Encyclopædia," and devoted himself with
the greatest ardor to original researches. Among these,
his studies on Ptomaine represented a glorious discovery,
and produced a true revolution in toxicological science.
Our Revista was one of the first to proclaim its high
medico-legal importance, as it was one of the organs
selected by him for the publication of his important
labors, two of which appear in our present number.
His studies were the moving influence which led to the
inception, in the past year, by the Minister of Pardon and
Justice, of the inquiries relating to cadaveric poisons, and
of these investigations, unfortunately now suspended by
his unexpected death, he was the promoter and the soul.
His age at death was sixty-four years, but his fevered
ardor for science was still youthful. All will remember


Obituary.
145
him at the Congress of Alienists in Reggio last year, at
which he communicated to us his important researches on
the urine of paralytics — researches which perhaps contain
the germ of another valuable discovery; and all will
remember him in that venerable aspect, and gentle, pale
and suffering physiognomy, in which there beamed those
eyes so full of intelligence and youthful fire.
The fatigues, long endured in his most laborious life,
and that above all which he underwent in his studies,
and which his love of science prevented him feeling, but
which his organism felt only too much, showed very
clearly the traces of a progressive wearing-out; all these,
combined with a life passed in his last years continually
in the midst of putrefying animal matters, were the causes
that brought about his departure from life, which followed
a very short illness, and took place on the 13th of Au-
gust ultimo.
How many studies commenced, how many new
researches contemplated, how many new horizons and
discoveries anticipated, which with his febrile activity he
would in a short time have certainly brought to light,
lie now in the sleep of death with his inanimate remains.
But his existence has been one of those that leave a
luminous trace, which does not vanish in a long revolu-
tion of time; it has been one of, those energies that make
an active and fruitful impress on science, and never is
arrested, but moves as long as motion continues. His
most eminent studies, at first combated, derided and
contradicted, but afterwards accepted, and very soon after
unjustly claimed as the property of others, now form the
point of departure of so infinite a series of researches, that
we cannot foresee to what end they will conduct that
science which investigates the chemistry of dead and
living bodies. The influence of his potent initiation will
long be felt in the field of his studies, and his name will
stand in the history of our polical and scientific resurrec-
tion as that of an apostle of love of country and a martyr
of science.-Ibid.
PROF. BOUILLAUD. —The illustrious Prof. Bouillaud,
cotemporary of Gratiolet, Aubertin, Broca and the Daxes,
whose early demonstrations of cerebral localization opened
a pathway to fame for Broca and Ferrier, has lately died
at the ripe age of eighty-five years. Our foreign journals
come to us, each containing a tribute to the cherished
and immortal memory of this “master of so many genera-
which investinguence of his portand his


146
Obituary.
H
a Brain; natal treatise o favorite s
always one treatise on the enche, pub-
tions of scientists.” An eminent neurologist, native of a
country not the home of Bouillaud, thus voices the con-
current sentiment of the present generation, as an appro.
priate monumental inscription to his memory.
“ His fame in neuro-pathology dates from 1825, when,
in his clinical researches relative to the loss of speech from
cerebral lesion, he placed the seat of language in the
anterior lobes of the brain ; at the same time he pub-
lished his clinical and philosophical treatise on the encephalon.
Neuro-pathology was always one of his favorite studies,
and even recently he presented to the Academy of Med.
icine of Paris a communication in which he noted with
complacency, that all the advances made by the studies
of the present day, on the functions of the brain, had but
confirmed the views held by him in 1825;—a glory, this,
which certainly is not reserved for many writers.”—TAM-
BURINI in Revista Sperimentale, etc., Reggio-Emillia, Italy.
Dr. John William DRAPER, who died at his home, at
Hastings-on-the-Hudson, January 4th, was born near
Liverpool, England, May 5th, 1811. He began his studies
at the University of London, and completed them at the
University of Pennsylvania, in 1836. In his early life
he taught at Hampden-Sydney College, Va., but from
1839 to 1873 he filled the chair of Chemistry and Physi-
ology in the University of New York. He was a literary
scholar, a philosopher and a scientist of no mean rank.
His works on physiology and on the “Intellectual Devel-
opment of Europe," being universally known to the
profession and the world of letters. He added his share
to the good name of medicine, and his profession will
gratefully remember him.
NOTES FROM THE HOSPITALS.
BIENNIAL REPORT OF STATE ASYLUM AT FULTON. Mo.--
Total number treated during the two years ending Nov-
ember 29, 1880, 871; males, 518; females, 353; of whom
364 were discharged, as follows: Recovered, 132 males;
86 females ; much improved, 13 males, 6 females; station-
ary, 22 males, 21 females; died, 44 males, 40 females.
Following the statistical details we have a lengthy and
carefully written report which includes the duties of


Hospital Notes.
147
officers, attendants, and all affairs relative to the good
management of a large hospital.
The excess of male patients in the hospital is attrib-
uted in the main to the excess of male population in the
State, but reference is made to malaria as a cause of
insanity, and the more frequent exposure of males than
females to its poison. This is a subject worthy of further
investigation.
For the purpose of inducing the Legislature to make
something like adequate provision for the insane, the
whole subject of early and judicious care and treatment
of insanity is discussed, and we sincerely hope that this
effort to place the matter before the public will have the
desired effect, and that the General Assembly will be
guided in its action by those whose experience renders
their proposition worthy of consideration.
The employment of the insane evidently receives at-
tention at this institution, and it is gratifying to read the
report upon the methods used to induce patients to work,
and the labor performed by them. There is much in
this report which we recommend to the reader whose
eye may fall upon our brief epitome.
VERMONT HOSPITAL ANNEX.—The trustees of the Ver-
mont Hospital for the Insane, by and with the advice of
Dr. Draper, its superintendent and physician, have lately
purchased an estate known as the Miles' School property,
located sufficiently near the main hospital for the requi-
site oversight and communication by the asylum resident
officers, which they propose to convert into an annex to
the main institution, that will accommodate twenty or
twenty-five patients with a proper corps of attendants.
It is designed by this means to furnish a place of tem-
porary occupancy, particularly in the summer season, for
certain convalescent and chronic, but not demented
patients, who might be better satisfied by this kind of
modified connection (attached yet separated) with the asy-
lum, and thus promote the aggregate benefit.
Any measure which promises to promote the peace,
tranquility and happiness of asylum households ought to
be approved. A certain number of these annexes in con-
nection with all State asylums are desirable, each super-
intendent and board of trustees being the best judges of the
number from the number and character of their population.
“WE HAVE NOT ATTAINED perfection in the construction
of lunatic hospitals, in their management or in their


148
Hospital Notes.
medical treatment of this terrible disease, of whose nature,
etc., we have yet much to learn. But I rejoice in the
sign of progress that I see on many a side. Now on
the retired list as I am, I am deeply interested in the
promises of a good time coming."-Extract from letter
of a retired asylum superintendent and ex-president of the
Association
DR. ELSBERG's New FIELD.—The trustees of Dartmouth
College have elected Dr. Louis Elsberg, of New York,
Professor of Laryngology and Diseases of the Throat in
Darmouth Medical College. Dr. Elsberg has resigned
the professorhip which he heretofore held in the medical
department of the New York University.
The New MichiGAN ASYLUM for the insane has been
located at Traverse City, overlooking Grand Traverse Bay.
Dr. Henry M. HURD, Superintendent of the Insane
Asylum, Pontiac, Mich., has gone to Europe. “Bon voy-
age," doctor.
REVIEWS.
APOLOGY.-If during the past year any criticism in these pages has
hurt the feelings of any one, we disclaim all harmful intention We have
endeavored, like the good surgeon, to inflict only necessary and so far as
possible painless wounds in order to heal greater evils, and like the best
of surgeons, too, we may have made an occasional mistake. We have not
songht to stab like the assassin, for we would promote true professional
life and usefulness rather than destroy or impair it.
“ IL PISANA, GAZETTA SICULA DI SCIENZE MEDICHE E PSICOLOGIE."
It is with profound gratitude and sentiments of the most sincere esteem
and fraternal obligation, that we cender to the talented and distinguished
editors of the above most valuable periodical, our thanks for the privilege
spontaneously awarded by them, of exchange of issues. We have received
the numbers for 1880, and that for the half of 1881, and when we say that
we have read their contents with equal interest and admiration, we but
faintly express our appreciation of their excellence. It is certainly as hon-
orable to Italy as it is gratifying to the citizens of America, that their
press, in every department of science, is now giving such unmistakable
proofs of emancipated mental vigor; and that in the department of psychi-
atry they are giving such promise of leading proficiency. It will be with
equal gratitude on our part, and, we trust, gratification on the part of our
readers, that we shall avail ourselves of the advantage of occasional repro-
duction of the able articles presented in the pages of Il Pisana. In our
present issue we present the powerful and truly patriotic letter of Carlo
Livi, written in 1864, to Brierre de Boismont, in vindication of the claims


Reviews
149
of his countryman. Chiarugi, to the honor of the grand theoretical and
practical reform in the treatment of the insane, which was initiated at the
close of the last century. It is not saying too much for this document to
characterize it as the production of a master mind, and of an honest and
earnest love, not only of his country, but, which is yet better, of truth and
justice.
Livi, in vindicating the honor of Chiarugi, and thus redeeming from
oblivion the name of a great benefactor to humanity, does not permit him-
self to fall into the too common error of depreciating the merits of Pinel.
He loved Italy well, but he loved truth still more; and he has, in our
belief, given in this famous letter abundant proof of both facts.
We doubt not that to the great majority of our readers, the facts given
to light by Livi will be as new as we confes3 they have been to ourselves,
and if for no other reas n than their simple historic value, they cannot fail
to be highly valued. At our distance from the seat of controversy, and
bound to France, as every American must be, by the ties of gratitude for
aid in our struggle for independence, we can hardly be suspected of any
feeling of partiality towards her "elder sister"; and when we say that it
mortifies us to learn that the great and good Pinel exhibited, in his treat-
ment of Chiarugi, a littleness of spirit alike discreditable to himself and
his country, we but give utterance to a very painful tact.
“Thx NURSE AND MOTHER” have lately received deserved attention
from one of St. Louis' most reputable physicians in the form of a neat
manual of one hundred and sixty pages, from the enterprising publishing
house of J. H. Chambers & Co., of St. Louis.
The manual is designed for the guidance of Monthly Nurses and
Mothers, and comprises instructions in regard to pregnancy, preparations
in regard to childbirth, minute directions as to care during confinement
and for the management and feeding of infants. The author is Dr. Walter
Coles, M. D., Consulting Physician to St. Ann's Lying-in-Asylum, Member
of the St. Louis Obstetrical and Gynevlogical Society, St. Louis Medical
Society, etc., a St. Louis physician, well and favorably known to the profes-
sion as a safe, careful, and observant writer on many practical subjects.
'The book is valuaile and should be in the hands of all for whom it has
been prepared. It is beautifully bound in cloth and gilt and would make
a handsome and useful present for wife, young mother or nurse..
A LIBRARY OF MEDICAL AUTHORS of repute so cheaply gotten up as
to be within the pecuniary resources of the least favored, financially, in
the profession is a dissederatum.
If the type be clear and the paper good, even though the covering be
only paper, such books, in such unpretentious bindings, at small cost.
enable persons of limited means to become familiar with a great number
of classic medical authors, whose valuable contributions to the literature
of the profession might otherwise be as a sealed book to them.
The books of this library of Bermingbam & Co. are well worth the
price charged, ranging from ten to thirty-five cents per volume, and they
can be sent through the mail at litt'e cost. Physicians now have an
opportunity throuyh this cheap scheme of Bermingham & Co. to supply


150
Reviews.
the profession with good books at small cost, of examining late British
classic writers to their entire satisfaction, and they can provide for the
* survival of the fittest" on their library shelves by ordering the best in
sheet or cloth binding.
The writers, whose works appear in this series, are all well-known to
the profession. The series thus far published embraces: “A Practical
Manual on Diseases of the Rectum,” by Henry Smith, F. R. C. S., Surgeon
to King's College Hospital; price 25 cents. “Clinical Lectures on
the Diseases of Women," delivered in St. Bartholomew's Hospital; by J.
Matthews Duncan, M. D., LL D., F. R. S. E., Etc.; price 30 cents. “A
Manual of Venereal Diseases;” price 20 cents "Indigestion and Bilious-
ness." by J. Milner Fothergill; price 35 cents. Other standard works are
announced to follow. Bermingham & Co., 1260 and 1262 Broadway, N. Y.
The series appears in several monthly numbers like a medical peri-
odical, and the price is $8.00 per year.
“ FAVORITE PRESCRIPTIONS OF DistixGUISHED PRACTITIONERS, WITH
NOTES ON TREATMENT.” By B. W. Palmer, A. M., M. L. In one hand-
some 16mo. volume of 121 pages; tlexible cloth; price $1.00. Also issued
by the same firm.
“ ANATOMICAL STUDIES UPON THE BRAINS OF CRIMINALS "* should
receive more attention than has yet been bestowed upon the subject, with
a view to find out the relationship of cerebral atypie to criminal conduct.
There is something in the conduct of so many of the criminal classes so
strangely at varience with their best interests, that certain scientists have
been led to look to vicious heredity and anatomical variations from the
structure of the normal brain for an explanation. Among the latter is
Prof. Moritz Benedict, of Vienna, whose book on the anatomical studies of
the brains of criminals is a valuable contribution to anthropology,
medicine, jurisprudence and psychology, and especially interesting and
instructive to all who have to do with the criminal classes. We do not
regard the demonstrations of the author as conclusive, or bis conclusions
as final. He is somewhat of a pioneer as yet in a field not yet fully
explored, but the work will set the reader to thinking, and some who
have special opportunities to observing, in a manner they may not have
thought or observed before.
T'he book is very properly directed to the director and surgeons of a
prison, " as it was through their disinterested and self-sacrificing assistance
that he (the author) was enabled to furnish the foundation stones” (wbicb
he claims are in his book) “ towards a natural history of crime.”
In the editorial department of one number (last October), when
referring to the authors conclusions on this subject before the Interna-
tional Congress, we gave our opinion of the insufficiency of the author's
collected demonstrations to fully prove his positione.
The scope of the work may be correctly gleaned from its preface.
Referring to the old time conviction, “that man thinks, feels, desires and
acts according to the anatomical construction and physiological develop-
* A contribution to anthropology, medicine, jurisprudence and psychology, by
Moritz Benedict, of Vienna. Translated from the German by E. P. Fowler, M.D.,
of New York. Published by Wm. Wood & Co., 27 Great James Street. 1881.


Reviews.
151
ment of his brain," he thinks the criminal as well as the non-criminal class
furnishes data which testify in favor of the proposition. “An inability,"
he asserts, to restrain themselves from the repetition of a crime, notwith-
standing a full appreciation of the superior power of the law (society) and
a lack of the sentiment of wrong, though, with a clear perception of it,
constitutes the two principal psychological characteristics of that class to
which belongs more than half the condemned criminals. A consideration
of no less importance is the fact that the same defect of moral sensibility
and will, may remain concealed by superior mental organization and dex-
terity in criminal contrivance, or it may be observed through complica-
tions with mental disorder."
This contribution of Benedict's upon the cerebral constitution of
criminals exhibits mainly deficiency-deficient gyrus development-and a
consequent excess of fissures, which obviously are fundamental defects.
These defects, the author finds “evident throughout the entire extent of
the brain and, a priori this was to be expected, as otherwise the inclination
to faulty action would have found compensation through other brain
factors."
The author regards crime as “in no way analogous to monomania, it
results from the psychical organization of a unit, and its particular form of
expression is determined by social circumstances.
“ That an atypically constructed brain cannot functionate normally,"
is regarded by the author as 80 evident as to leave no ground for discus-
sion."
The author modestly hopes " that this publication will be a grain in
the great sowing of wbich the harvest shall be a true knowledge of the
nature of crime, and that thesis and antithesis may conduct to a lasting
foundation."
The book is well translated on a little less than two hundred pages by
Dr. E. P. Fowler, of New York, and gotten up in good style, on good
paper, large type and copiously illustrated by photo-engraving of
atypical criminals' brains.
The book would prove of interest to a number of jurists who are
constant readers of the ALIENIST AND NEUROLOGIST.
6: WALSH's PHYSICIAN'S HANDY LEDGER” and “ WALSH'S PHYSICIAN'S
COMBINED CALL-BOOK AND TABLET," 1882. Published by Ralph Walsh,
M. D., 332 C Street, Washington, D. C.
Whatever saves labor to the physician is a conservator of cerebral
waste, and to the busy practitioner the rest gained by substituting
- Walsh's Handy Ledger and Walsh's Physician Combined Call-book” is
happiness. The time thus saved is more than money earned to him.
Even moderately successful medical men in practice are often overworked
in brain and body, and Ralph Walsh, in preparing these two indispensable
books has conferred a real benefit upon the profession. We commend
their utility to all to whom the saving of time in keeping accounts is an
object.
RIVISTA SPERIMETALE DI FRENETRIA, E DI MEDICINA LEGALE.—The
third fasiculus of the seventh year of this rich and magnificent journal is
now before us. Its articles and miscellaneous matter cover 274 pages ,


152
Reviews.
printed in beautiful clear type on superior paper, with four valuable plates
attached. It is a publication not merely honorable to Italy, but highly
creditable to the whole alienistic specialty of Europe, and we say no
more than justice and truth demand, when we assign to it the front rank
in the forces of Psychological Psychiatric science.
The present number contains ten original articles, whose length unfor-
tunately prevent's reproduction in our present issue. The number of
critical notices and reviews, is truly imposing, and we need not say that
all are instructive; but to attempt selections from such an embarrass des
richesses is an adventure altogether beyond our courage. Should time
however, and lingering strength permit, we may in the next number of
the ALIENIST, reproduce some of the contents of this Revista, under the
hope that our readers may not fail duly to appreciate then, which is, ot
course, a matter of serious consideration to every publisher who must feel
it to be alike his duty and his interest to cater providently and prudently
for the tastes and mental digestive powers of his subscribers.
“THE DETROIT CLINIC” is a new sixteen page weekly exponent of
clinical medicine and surgery, which “will not burden the profession with
lengthy or voluminous editorials, but give, as its name indicates, clinical
reports in all departments of medicine.
To this end it will utilize the vast clinical resources of the hospitals
and dispensaries of Detroit. It will also seek to “ establish medical educa-
tion on a higher basis."
The specimen number before us is well gotten up, on good paper, with
clear type, and contains, besides editorial and selected matter, seven prac-
tical articles by seven professors or teachers in the Detroit Medical Col-
lege, which shows what that faculty can do in the way of writing, and
that they are not ashamed to air their views in print. We wish the new
journal and the Detroit Medical College success. We expect hencetorth
to see lively times in the medical journalism of Detroit. Drg. Walker,
Owen, McGraw, Sharley, Webber and Reynolds are the editors.
Their aggregated ability ought to make a journal worthy the confi-
dence and support of the profession of the North-West.
ASSASSINATION AND INSANITY.–Guiteau's case examined and compared
with analogous cases from the earlier to the present times, by William R.
Smith. This is a well prepared historical study of the subject; not over
lep gtby. Apropos to an important psychological question of the day,
that of Guiteau's insanity and will interest every reader of this journal
-medical or legal. The editor is a lawyer of ability and editor of the
Law Central, Washington, D. C.
Books, Monographs, Etc., Received.
Necrosis and Elimination of Almost the Whole Bony Apparatus of
Hearing, in Almost Complete Form; Recovery. By D. S. Pollack, St.
Louis, Mo. Reprinted from the Archives of Othology, Vol. X., No. 4,
December, 1881.


Books, Monographs, Etc., Received.
153
The Dangers and Duties of the Hour. By Wm. Goodell, A. M., M. D.
State Preventive Medicine-First Annual address of Connecticut. By
John S. Butler, M. D., late Physician and Superintendent of the Connec-
ticut Retreat tor the Insane, Honorary Member of the Medico-Psycho-
logical Society of Great Britain, and President of the State Board of
Health,
Reform in Medical Education the Aim of the Academy. The annual
address delivered before the American Academy of Medicine, at its sixth
annual meeting, in New York, September 20th, 1891. By Edward T.
Casswell, A. M., M, D., of Providence, Rhode Island, Pres. of the Academy.
The Prognosis of Laryngeal Phthisis. By Wm. Porter, A. M., M. D.
Reprinted from the Archives of Laryngology, Vol. ii, No. 4, Oct., 1881.
How to Use the Bromides. By Geo. M. Beard, A. M., M. D. Re-
printed from the Journal of Nervous and Mental Diseases, July, 1881.
Rudolph Virchow. An address, introductory to the course of lectures
of the term 1881-82. By A. Jacobi, M. D., Clinical Professor of Children.
Reprint from The Medical Record, October 22, 1881.
Physiology in Thought, Conduct and Belief. By Daniel Clark, M. D.,
Medical Superintendent, Asylum for the Insane, Toronto. Reprinted
from the Canadian Monthly for April, 1881.
The Care of Some Classes of the Chronic Insane. By Henry P.
Stearns, M. D., Medical Superintendent of the Hartford (Conn.) Retreat for
the Insane. Reprinted from the Archives of Medicine, February, 1881.
Annual Report of the New York Lunatic Asylum for 1880.
Prospectus of the Rocky Mountain Medical Times, a monthly journal
of Medical, Surgical and Obstetrical Science. Edited by Thomas H.
Hawkins, M. D. and Frank A. Disney, M. D., Denver, Col.
The Unhygienic Condition of Dwellings in Certain Localities in its
Relation to Dependence and Pauperism. A paper read at the Annual Con-
vention of County Superintendents of the Poor. Held at Lansing, Micb.,
January 18th-20th, 1881. By Dr. E. H. Van Deusen, Member of the State
Board of Charities and Correction.
Thoughts on Insanity and Its Preventable Causes. By H. Wardner,
M. D., Superintendent of the Minois Southern Hospital for the Insane at
Anna, III. An address delivered at DuQuoin, I., January 19th, 1881,
before the Southern Illinois Medical Association. Reprinted from the St.
Louis Medical and Surgical Journal, April, 1881.
Anæsthetics Medico-Legally Considered. By J. G. Johnson, M. D.,
Brooklyn, N. Y. Read before the Medico-legal Society of New York,
meeting of December 7, 1881. Reprint from the Bulletin of the Medico-
Legal Society of New York, Vol. iv., Nos. 7 and 8, May-December, 1881.
Recent Progress in Mental Disease. By Charles F. Folson, M. D.,
Lecturer on Mental Diseases, Harvard Medical School. Reprint from the
Boston Medical and Surgical Journal, October 27, 1881.
Insanity with Malarial Anæmia and Cachexia. By Wm. Julius Mickle,
M. D., M. R. C. P., London. Medical Superintendent, Grove Hall Asylum,
London. Reprint from Practitioner, November, 1881.
Constitutional Sypbilis; A Critic Criticised by G. M. B. Maughs, M.
D. Reprint from the St. Louis Medical and Surgical Journal, May, 1881.


154
Books, Monographs, Etc., Received.
Is the Obstetric Binder Necessary? By Henry P. Wenzel, M. D., ot
Milwaukee. Reprint from the Transactions of the State Medical Society
of Wisconsin.
Atlantic City as a Winter Health Resort. By Boardman Reed, M. D.
Second edition.
The City of Mobile and Contiguous Country about the Gulf Coast as
a Winter Resort for Health and Pleasure of Invalids, etc. By William H.
Anderson, M, D., 1881.
Report of the Western Kentucky Lunatic Asylum, Hopkinsville, Ky.,
for 1881.
Annual Report of the Eastern Lunatic Asylum, Richmond, Virginia.
Fifteenth Report of the Trustees of the Connecticut Hospital for the
Insane, State of Connecticut. 1881.
Reports of the Butler Hospital for the Insane, January 26th, 1881.
Seventh Annual Report of the Superintendent of the Cincinnati
Sanitarium for the Year Ending November 20, 1880. Cincinnati, 1881.
Report of the Superintendent of the Nebraska Hospital for the Insane.
Lincoln, Nebraska, 1881.
Report of the Nova Scotia Hospital for the Insane, for the year 1880.
Halifax, N. S.
Twenty-Seventh Annual Report of the Trustees of the State Lunatic
Hospital at Taunton, for the Year Ending September 30th, 1880. Cincin-
nati, 1881.
Report of the Pennsylvania Hospital for the Insane, for 1880. By
Thomas 8. Kirkbride, M. D., Physician-in-Chief and Superintendent.
Annual Reports of the New Hampshire Asylum for the Insane, 1881.
Manchester, 1881.
Report of the Lunatic Asylum of the State of Georgia.
Fourteenth Biennial Report of the State Lunatic Asylum at Fulton,
Missouri. Jefferson City, 1881.
Sixth Biennial Report of the Trustees, Superintendent and Treasurer
of the Illinois Northern Hospital for the Insane at Elgin, October 1st,
1880.
: Annual Report of the Asylum for the Insane, Kingston, Ont., for 1880.
Fourth Biennial Report of the Trustees, Superintendent and Treasurer
of the Illinois Southern Hospital for the Insane at Anna, October 1st,
1880.
Twenty-second Annual Report of the Longview Asylum, Carthage,
Ohio, for 1881.
Thirty-first annual report of the State Lunatic Hospital, at Pittsburgh,
Pa., 1881.
Report of Inspector General of the Insane of New South Wales for
1880. Dr. F. Norton Manning, Inspector General.


THE
ALIENIST & NEUROLOGIST.
Vol. III.
APRIL, 1882.
No. 2.
ORIGINAL COMMUNICATIONS AND PREFERRED TRANSLATIONS.
Art. I.--" Rande" (Charles C. Scott)--A
Medico-Legal Record.
By ONE OF THE EXPERT WITNESSES.
AT the February term, 1878, of the Knox County,
1 Illinois, Circuit Court, Judge Arthur A. Smith pre-
siding, was tried on an indictment for the murder of
Charles Belden, near Gilson, Ills., Charles C. Scott, alias
Frank Rande, alias Frank Durande, alias Frank Sander-
son, alias George Alexander, alias Frank Holden, alias
Frank Green, alias Frank Mills, alias Frank Davis, alias
Frank Warner, alias Frank Orton, alias Charles Van
Zandt.
After the killing of Belden, Scott shot and killed one
of the police officers in St. Louis who attempted to
arrest him. Frank Rande being Scott's favorite and most
famous alias and self-preferred nom de plume, and the
name under which he was indicted, we give it preference
in our caption. He adopted the nommes de guerre of
“Knox County Desperado,” “The Brilliant and Daring
Young Bandit of the Wabash,” and of the “ American
Brigand," bestowed upon him by the press. He gave to
his photographer (Hunt, of Galesburg), this description of


156
Expert Witness.
himself, to be placed on the backs of the thousands of
“cartes de visites” which he had printed and sold to
defray the expense of his trial. His picture is taken
with a scowl on his face, a navy revolver in his right
hand and another belted to his side, while he rests his
right arm on a mantel-piece, the hand which holds the
revolver dropping down.
On his “photos” he gives also the place of his birth,
Claysville, Penn., and age, thirty-eight years.
A great deal of excitement attended the trial of
Rande at Galesburg, growing out of the desperate record
and defiant manner of the man; the circumstances under
which the Gilson murder was committed; the startling
incidents connected with his arrest, ending in the death of
officer White, at St. Louis, his own recovery from a
shot through the lungs, and the plea of insanity which
was interposed in behalf of the prisoner. Fortuitious
circumstances in the prisoner's behalf also attended both
these murders, rendering it doubtful in the estimation of
many legal minds whether he could, if convicted, be hung
for either of these crimes, a knowledge of which added
to the prisoner's bravado and to public anxiety. Rande
appeared to fear nothing but mob violence.
In his satchel, which he concealed under some leaves
while escaping from his Gilson pursuers, was found a long
pocket-knife, a large shears, a leather strap and a bur-
glar's “knuckle.”
A good deal of egotism, bravado and wickedness were
shown in Rande's career, together with an accurate
memory, quick temper and quarrelsome disposition, and
a fair, but by no means thorough or regularly acquired
education. He had been a country school teacher in
his youth and early manhood. His chequered life is
well set forth in the following hypothetical case, which
bears upon its face the evidences of the man's supreme
and reckless wickedness; and it is here introduced as
illustrating an exceptionally good appreciation, for a law-
yer, of the essentials to constitute a successful plea of


“Rande”-A Medico-Legal Record.
157
insanity, and as showing also the better appreciation of
the nature of the disease by the prosecution than by the
attorney for the defense, who presented the plea of
insanity. By the many qualifying circumstances, speci-
fically set forth therein, which were omitted by the
defense, it reveals that true conception of the distinction
between the reckless daring and bravado of depravity
and the aimless or delusion-impelled violence and improprie-
ties of mental disease. It was presented by Mr. J. J.
Tunnicliff, State's Attorney in this famous trial, and is a
true embodiment of the testimony portraying well the
chequered and wicked career of a reckless, prison-hard-
ened character, while it shows at the same time the man's
entire sanity, as the sequel of his life also confirms, he
having, ever since his sentence, served the State of Illi-
nois, without the loss of a single day's work or a solitary
meal or night's rest, in the capacity of harness-maker in
the Joliet Penitentiary.
HYPOTHETICAL CASE.-Suppose a young man, in 1853,
at about fourteen years of age, is thrown from a wagon
into the dirt road and receives an injury "all over," causing
three or four minutes unconsciousness, but is restored to
consciousness after being held by his father; appears to his
father not to be the same person he was before the accident
-the father being the only one to testify to this fact.
After the accident he pursues his school studies and
becomes a school teacher.
In the time intervening between the accident and his
becoming a school teacher, neither his brother nor any
other member of the family besides his father notice any
change in him. He appeared to a person who attended a
a literary society with him once a week as a quiet,
affable, self-possessed young man of more than ordinary
intelligence.
Nothing remarkable appears in connection with his
school teaching, except a personal difficulty with another
young man about a young lady whom he admired.
Nothing remarkable appearing in his career until
about 1863 or 1864, after he marries. In three or four
months after his marriage his wife dies. Immediately
upon the death of his wife he manifests great grief and
emotion, gets down on the floor in agony, and, at the
him. He apth him once
more than


158
Expert Witness.
grave tries to force himself into it, but is prevented by
persons present.
He reproaches his sister immediately after the death
of his wife with having been the indirect cause of his
wife's death, by reason of not administering, on her own
judgment, roots and herbs which she might have got and
given her; after her death he goes off for two or three
days at a time, appearing to his father at that time wild
and irritable, absent-minded and forgetful at times; saying
things at one time which at another time he wonld say
he had not said ; his father trying to induce him to work
in his blacksmith shop, but could not always get him to
do so, and when he did he would make things which he
would afterwards throw away, they not being satisfactory
in his own opinion, but, in his father's, being made very
well. He would, at this time, just after his wife's death,
say he was a ruined man and would never be of use any
more. Told his father he must go away, that he felt
so confused in his mind that he could not stay.
His father endeavored to induce him to remain, but
he goes to Minnesota about a year after his wife's death,
where he remained, in all, about five years, returning on
a visit at the expiration of about two years. During
those five years he acquires possession of a house and
mill site and farm in Minnesota. While in Minnesota,
he married again-his wife still lives, but not with him
(no reason for the separation appears in the testimony).
During his residence in Minnesota, he writes to his
married sister such a glowing description of the advantages
of that state that he induces her husband to sell out with
a view of removing to Minnesota, but subsequently, by
letter and returning to Iowa, he induces his brother-in-law
to change his mind. While in Minnesota he made his
living by hunting and trapping, living in summer in a
log house unchinked and partly roofed, cooking out of
doors. Thought a mill sight was a good one, which
another thought was not a good one. Then returning to
Minnesota from his visit, he remained until the completion
of the five years before mentioned, then returning to his
old home he comes dressed in a dirty buckskin coat
which he says he would not give for the best coat he
could buy in town, and which coat he seemed proud of,
though the rest of the the family disliked its appearance.
He brings from Minnesota things that others could see no
value in, viz.: steer horns and skins of animals, which he
another tho from his fore mentio in a dirthe bes


“Rande"-A Medico-Legal Record.
159
any time loseth of tim not appear consider
regards as worth a great deal of money, which he said
could be worked up into knife handles, etc. Was much
elated with the trophies of his trapper's life.
Returning home, he remains about a year, goes to
visit the grave of his wife, but does not recognize it, and
appears to his father about the same as before he went
to Minnesota. Being a gunsmith himself, he says he will
make gunsmiths of his boys and make a great deal of
money.
Appears during his long absence from home to have
changed his religious beliefs, saying “religion was all
poppy-cock, and he did not believe in God, Hell or the
devil.”
There was no insanity in the Scott family except his
father's brother, and none on the maternal side. The
person here supposed has never been epileptic or adjudged
insane by any physician, it not appearing that he has
inherited an unstable nervous organization. He has never
had apoplexy or any delirium or fever in his head at
any time in his life, and it not appearing that he had at
any time lost much sleep in his life, or that his appetite
for any length of time has been insufficient, inordinate
or capricious, it does not appear that his pulse has been
abnormally accelerated for any considerable length of
time, or that the temperature of his body has been above
or below what was natural, or that any other of his
physical functions have been for any considerable length
of time deranged; no evidence appearing in regard to
the condition of the man's tongue, or going to show that
the skin or any of the secretions are or ever were
unhealthy, and the testimony, in regard to his expression,
not being uniform, some saying that his eyes were rest-
less and rolling, and some saying that his appearance was
natural, and not differing from that of other men so as to
particularly attract their attention.
Suppose such a man should say and do things as fol-
lows: Calls upon his sister after an absence of several
years, on Sunday, in a wagon with his children, and upon
entering the house she chides him for coming upon Sun-
day, offers him a chair which he does not observe, but
remarks, "Sister, I am afraid I am not welcome.”
Suppose at one time of his life that he expresses a
belief that his wife had been taken from the grave; that
at another time in his life, after preparing a garden, he
took a hen with her brood that was in the garden, by the
con


160
Expert Witness.
legs and feet and mashed her. And on one occasion,
about the 14th of August, 1877, while at his sister's house,
armed and fearing pursuit (for which fear he had reason-
able ground), he said “they were after him," and appeared
so agitated and excited to his sister, that he made an
impression upon her mind that he was dangerous and
insane; talking loudly, so loudly that in order to quiet
him her little daughter was placed in his lap.
Suppose that immediately after the burial of his wife,
he seemed to his mother and others not to act like him-
self, and she thought him insane; that she gathered up
some tinware to take care of and put away, when he got
them and threw them over the room. She took him a
clean shirt and he wiped his feet on it; that at another
time, having escaped from jail, he took a mule without a
bridle, and after riding all night, the mule brought him
back to the place he started from—this fact contributing
to make the effect on his mother's mind that he was
insane.
Has given his father's books to his children (Fremont's
Travels) who could not read, and upon being remonstrated
with for being so careless, replied: “Why, if I had not
read books I would be as big a fool as the rest of you.”
Suppose this man goes out hunting in his best clothes
and lies down on the ground. Suppose he borrowed a
dime from his mother to buy a piece of a steel square
with ; this being another one of the acts which led his
mother to say: "Charles, you must be crazy.”
Suppose on an occasion having differed with his father
about bail, his father having been angry for the fruitless
help he had given him by going on his bond, and after
having come out of the penitentiary in May, he goes to
Iowa in August, 1877, but does not go to his father's
house, but to that of a neighbor. He meets his mother
there, and to her he looked so wild and talked so strange,
she then said: “ Charles, you are crazy.” He then said
"he had been in the penitentiary.” He was tolerably well
dressed, and talked about going to get him a home.
Suppose, at this time, after having been in the peni-
tentiary and been discharged, while on a visit to a neigh-
bor's (Morrison's), he thought somebody was after him and
went out to look for him. About this time he gritted
his teeth at his sister, who had said if he was going to
do anything more of a bad character she would shoot
him down.
The had been "Charles, de so wild and meets his nather's


“Rande”-A Medico-Legal Record.
161
Suppose to his brother he does not appear deranged
until after his first marriage. Suppose some members of
father's family were ashamed of his buckskin clothes.
Suppose this man becomes an attaché of a circus and
tries to persuade his brother, who is a small blacksmith
with stock not exceeding one hundred dollars, and not
making more than a bare living, to join him in the refresh-
ment business, saying this brother could make three dol-
lars where he was then making one. Suppose, by his
business tact and management, he succeeds up to this
time in acquiring a team and stock of refreshments, and
tools for the gunsmith trade, and is actually making more
money than his brother, whom he wishes to aid by hav-
ing him join him in business. .
Suppose he proposes when the circus season is over
to engage at his trade of gunsmithing in Yankton, Dakota
Territory, and to this end proposed to ship his lighter
tools to Yankton and his portable forge to Omaha, until
such time as he shall have occasion to use them; Omaha
being on the route to Yankton.
Suppose that in 1871 he told his brother he would
come out all right. Suppose that after the 14th of last
August, he appeared to his brother a great deal stranger
than he ever did before; if crossed was “on a high
horse," appeared actually insane, and his sister did not
like to be in the house. Suppose that he was not paci-
fied when his brother told him that he need not fear the
indictment that appeared to be hanging over him. Sup-
pose, about this time, his brother proposes to him to go to
Kansas or San Juan Valley. About this time his mind
was so undecided as to whether he would go to San Juan
Valley, Minnesota, Texas or the Diamond Fields of South
America.
Suppose he thought of starting a museum and men-
agerie, with some petrified wood and minerals and some
animals he had, including prairie wolves he proposed to
catch where he had been trapping. Suppose he thought,
or imagined, he could get rich in South America, at the
Diamond Fields. Suppose that in all this talk, at this
time, he seemed to his brother to be “wild and inco-
herent.”
Suppose, when told by his brother that “ he believed
him crazy," that he put his hand to his head, and said :
“They drove me mad.” .
Suppose at the time he made threats against the


162
Expert Witness.
officers of the Indiana penitentiary, and that no physi-
cians have ever known of, or testified to, his insanity.
Suppose that this man, on one occasion, having to go to
some place, secreted himself on the brakes, or under
part of a railroad train. Suppose that, on another occa-
sion, upon being arrested for burglary, he jumps the
train and escapes from the officers.
At one time when told by his brother that he was
crazy, he would talk very loud, and say his brother was
crazy.
Suppose that this man, in 1871 and 1872, appeared to
one man to be broken down mentally and physically,
In Minnesota he was very good-humored, and killed
a deer and cooked venison for his guest, Mr. Morrison.
Suppose a person, after his return home from Minnesota,
regarded him as rattle-brained. His eyes were very
bad, his countenance sallow; that after he had been in
jail at Ottumwa, and sympathy was expressed to him,
he made no confession. After he had broke jail, suppose
he seemed deranged to the same person and could not
continue to talk on the same subject; seemed afraid some
one was after him, and was considered insane and unsafe
by this same person, being a sister, who considered him
unsafe for six years. That to this same sister, last
August, or thereabouts, his head was full of schemes,
and when asked as to what he was going to do, some
times said he was going to Kansas, sometimes to Dakota,
sometimes to the Diamond Fields, so that she told him
his mind was not right; whereupon he frowned upon his
sister, and told her his mind was stronger than hers.
Suppose upon one occasion being reminded he was
poor he said, irreverently, Jesus Christ would furnish him
money. Supposing this man, during the five years he was
in the penitentiary, passed under an alias and withheld his
whereabouts from his family, that after coming out he
assumes another different alias and various aliases to con-
ceal his true identity. Suppose, further, his conversation
on one or two occasions in his life, the attending circum-
stances not being given, has been regarded by one or
a few as rambling or incoherent. Suppose during his
childhood his mother regarded him as the pride of her
life, that after he has come to man's estate members of
the family never have known him to drink intoxicating
drinks, that he spent five years of his life, from the spring
of 1872 to the spring of 1877, in the Indiana Northern
he Brains to Kance was a


“Rande”-A Medico-Legal Record.
163
slighseif after for finds the to carry ouears res
penitentiary ; that, on being admitted to the penitentiary,
he told an officer there that he intended to beat the insti-
tution, meaning thereby to escape.
That during these five years in prison he is known to
eat and sleep as well as other persons. He is seldom, if
ever, on the sick list in prison, and comes but once during
all those five years under the surgeon's care for having
slightly wounded himself after having threatened to kill
himself after a difficulty with one of the prison guards.
That the doctor finds the wound a very slight affair ; that,
being offered a good knife to carry out his intent, he declines
to do it; that, during his five years' residence in the
prison, he gets into personal altercations and quarrels a
number of times with prisoners or guards. Spends much
of his time, when unemployed and unobserved, in writing
on the backs of chairs and other articles and strips of
paper mainly for the purpose of exciting mutiny and
making his escape; that these notes and plans conspiring
to escape were generally written to the sharpest and the
shrewdest of his fellow convicts. That he is several times
punished for these breaches of discipline, compelled to
wear a ball and chain for some time, solitarily confined
for a short time for punishment, and three or more times
whipped during all that five years with a whip called cat-
of-four-tails, but not so as to draw blood; that he worked
at chair making. Suppose that this man, after being
released from the penitentiary becomes practically a tramp,
and while going through the State of Illinois he engages
himself to and works for a number of parties during
harvest at three dollars per day; that he always did his
work to the satisfaction of those who employed him, and
appeared to them in every way sound in mind and healthy
in body.
What is your opinion weighed by the mental condition
of the person herein described ? Would you consider him
sane and responsible or insane and irresponsible ? Would
you consider this person sufficiently sound in mind to
know the difference between right and wrong, and suffi-
ciently sound in mind to appreciate the quality of his
moral acts ?
Drs. E. A. Kilbourne, of Elgin, Ills; H. F. Carriel, of
Jacksonville, Ills., and the writer concurred, though Dr.
Carriel was not put upon the witness stand, after hearing
all the testimony as to the prisoner's sanity, and Drs.


164
Expert Witness.
Kilbourne, and Dean, of St. Louis, testified also from fre-
quent personal observations, the latter having treated
Rande's wouud, that there was no insanity in the prisoner.
The hypothetical case presented by the defense lacked
that correct appreciation of what is essential to a sus-
tainable plea of insanity, in that it omitted to show the
causes of the prisoner's immoral and erratic conduct to
have had their origin in disease instead of rational, though
not always proper, motives and influences. The defense's
attorneys, however, affected to be so thoroughly satisfied
of the insanity of Rande, that, though their own medical
experts, through sickness and other causes, could not be
present to testify, they were willing to leave the question
of the prisoner's mental status to the judgment of the
medical experts summoned for the people, and the writer
has reason to believe from personal conversation with at
least two of the attorneys for the defense, that they
really thought they had a strong case of insanity; mistaking,
reckless and erratic immorality for disease. Exceptional
conduct, though it may raise reasonable suspicions of
insanity, does not establish the existence of mental disease.
We shall not take the space or time to analyze this
“brigand's ” character further than is shown in the
hypothetical case. There was no hereditary or acquired
taint of scrofula, syphilis, cancer, epilepsia, apoplexy,
insanity or other profound diseases of the nervous system.
The prisoner had always been a temperate man. It was
his boast that he never drank, nor smoked, nor chewed.
His parents-one upwards of, and the other nearly three
score years and ten — were remarkably vigorous for their
years, and testified clearly and with good memory at his
trial. He was not habitually constipated; had no insom-
nia; no increase of temperature or pulse, and neither
delusions, hallucinations nor illusions. Rande’s apparent
indifference, rather nonchalance, during his trial, was not
due to dementia, for he was then planning and contriv-
ing to secure his defense and maintenance, but to a con-
sciousness that he could not be hung for his crime, and


“Rande”-A Medico-Legal Record.
165
he was used to the penitentiary life and did not greatly
dread it. Dementia is a nearly entire obliteration of some,
with great impairment of all the mental faculties.
His was not homicidal insanity, for the homicidal
maniac does not so well discriminate between friend and
foe, or shoot so well for defense or escape.
He was not a kleptomaniac, for he did not steal
regardless of utility or value. Rande could work some
in iron, and scraps of iron were more valuable to him
than if he had possessed no such knowledge. He had,
however, never completed his trade. He had been
raised on a farm, but when his wife died, he felt as
many other sane men had done before him, and have
done since, under similar sudden bereavement, that he
must leave the scene of his misfortune. He sought
and found new scenes and associations, and these new
scenes and associations (and not disease) changed his
character. The many aliases assumed by him for the
rational but reprehensive purpose of escaping the legal
consequences of his felonies and crimes, reveal as much
of his true character as his criminal history. They con-
tain no suggestion of delusion, but, on the contrary,
show a correct appreciation of the relationship to his
environments, and a harmonious adjustment, considering
his chosen career of crime to his surroundings.
It is singular that the plea of insanity should have
been thought of in connection with such a character.
But that it was seriously offered in extenuation and
defense of a criminal career clearly traceable to natural
causes, shows the misconception in the legal mind, in
some quarters at least, of what constitutes insanity, and
a misunderstanding of the methods by which medical
minds discriminate between immitigated folly and vice,
immorality and criine, and the same appearances of
immoral and unlawful conduct, stimulated and impelled
by morbid mental action. Medicine has its rational
methods of investigating fact as well as law, but the
lawyers do not, or will not, always understand them.


Art. II.--Animal Magnetism.
RECENT STUDIES COLLECTED BY DR. G. SEPPILLI,
OF REGGIO-EMILIA, ITALY.
Translated by JOSEPH WORKMAN, M. D., Toronto, Canada.
[CONCLUDED.]
IN the property before mentioned, possessed by subjects
I artificially put asleep, of executing a movement after a
received sensation, lies a part of the secret through which
the experimenter puts them into dependence, apparently
immediate, upon his will. Hansen, e. g., put into the
mouth of his subject under experiment a potato, and
invited him to eat the sweet pear, accompanying, how-
ever, the invitation with audible movements of mastication,
and the hypnotized ate it. Heidenhain put into the
mouth of a hypnotized a cucumber, and made him eat it,
by executing before him the necessary movement.
From all that we have yet shown, it is clearly seen
that in the magnetic dream all the intellectual activity of
the subject under experiment is subordinated to the
sensorial impressions which he receives, and that he
necessarily follows the ideas and images of them, which
they awaken in his mind. The intelligence of the
hypnotized, aroused from its stupor by means of the
stimuli which act on the sensorial apparatus, follows freely
its course, and enters into a state of singular activity, as
is testified by the color, vivacity, precision, nature and
multiplicity of the ideas manifested by some somnambu-
lists opportunely interrogated.
It is not, however, to be believed that the phenomena
we have described are equally verified in all the subjects
brought under hypnotism. There rather are very great


Animal Magnetism.
167
differences between one and another, which renderit
difficult enough to formulate any general rule. It is
certain, however, that the more frequent the magnetic
sleep is provoked, so much the better opportunity is
given for awaking and directing the attention of the
somnambulist in the manner desired. It is noteworthy
that the magnetic sleep is ordinarily manifested in the
same individual with identical phenomena. Diversities of
results depend also on the degree of intensity of magnetic
sleep. In fact, the excitement of the intellectual and
reflex faculties of imitation is specially present in that
phase of hypnotism in which the magnetic sleep is rather
light, which Richet justly calls the period of excitement.
But, if the magnetic sleep is very profound, a complete
mental inertia is observed, which no external impression
is capable of breaking up, and the possibility of provoking
hallucinations is denied. The magnetic sleep is more
complete and profound when it has been provoked by
fixation of the sight on a brilliant object, than by the
magnetic passes.
A question of very great importance to be solved is,
whether, and if so, how much the persons remember in
the waking state of what has happened to them, or what
they have done in the period of artificial sleep. It was
observed that the individual awakened from the magnetic
sleep, in which he had received sensorial impressions,
accomplished diverse and complicate acts, and manifested
hyper-ideation, preserved no remembrance of them.
Questioning him in a general manner as to what had
happened, what he had found in his sleep-he replied
almost always in these words: “I do not know.” Baillif
mentions a woman to whom during her provoked sleep
it was announced that her mother was dead, notice of
which had been kept from her for several days. She
was very sadly impressed by the intimation, but on
awaking she remembered nothing of what had been
related to her, or of the sensation felt by her.
In those cases in which the hypnosis was very pro-


168
Seppilli— Workman.
found, remembrance of the circumstances which accom-
panied it, even when these were recounted to them, had
become impossible to the individuals. At other times, on
the contrary, when the magnetic sleep was rather light,
it was sufficient to give a hint of this or that thing done
by them, in order that being thus put on the track, they
might remember and describe whatever they had said, heard
or done in the hypnotic state. Here we have repeated
the same fact as is observed in dreaming. It often hap-
pens to us, when waking in the morning from sleep, that
we remember nothing at all of a dream we have had in
the night, or at the most we possess only a vague and
confused idea of it. But if, in the course of the day,
there should fall under our observance something that
made a part of the dream, remembrance of it suddenly
comes into our mind, and we find ourselves in a position
to reconstruct it in great part. Heidenhain relates sev-
eral examples of provoked awaking of memory, after dis-
appearance of the magnetic sleep. He hypnotized a
student of medicine, and whilst he drank before him some
water in such a manner as to render the movements of
deglutition audible, and moved the arm, the student imi-
tated him perfectly. On waking he did not remember what
he had done, but when Heidenhain said to him: “Were
you not thirsty ?" He replied: “Now I remember, I
drank.” Heidenhain spoke into the ear of his brother
hypnotized, a verse from Homer, and then awakened him.
In order to make him recollect the verse, it was sufficient
to give one word of it. Richet, also, indicating to one
magnetized by him, what he had said, aroused in him
the memory of it, which was at first completely deficient.
But it will be asked: How are the phenomena of the
magnetic sleep, such as the excitement of the memory
and the imagination, hyperactivity of ideas, the rapidity
of reaction to external impressions, to be reconciled with
the complete oblivion, or the very vague remembrance
which the hypnotized exhibits when he awakes, of what
happened to him in the sleep?


Animal Magnetism.
169
To explain this apparent contradiction, we must remein-
ber that the cerebral activity is manifested under two dis-
tinct aspects—that of the conscient and of the inconscient.
The conscient activity, or consciousness, is constituted of
knowledge possesssed by the ego of its own acts, that
which happens within itself, its relations with the exter-
nal world. On the contrary, into the inconscient activity
of the brain, denominated also automatism, all those
actions enter in which the ego takes no part, nor is
aware of any; but these acts are combined and directed
so as to resemble those which the ego perceives, wills
and directs. Now, this automatic activity, which is, in
the normal condition, associated with the conscient, has
in the magnetic state a very great part, and dominates
the whole scene. Many facts prove this, and above all
the paralysis of the will, the spontaneity of actions, pre-
sented to us by the hypnotized.
We can, of ourselves, by means of the will, modify a
given order of ideas, substitute it by another, govern the
sentiments and passions, but he who is put into the mag-
netic sleep, is, so to say, the slave of ideas and sensa-
tions which have been provoked in his mind; he is
subjected to their whole influence, and he expresses by
the attidudes of his body and the expression of his physi-
ognomony the sentiments which agitate him.
The memory also of things, and of past acts, pre-
sented in the magnetic sleep, is very well explained by
cerebral automatism. The studies accomplished by modern
psychologists on the phrenological conditions of memory,
which depends on the conservation of certain states and
their reproduction, lead very logically to the supposition,
that all the acts which we perform leave some vestiges,
traces or residues in the nervous elements, or, as Maudsley
says, produce in these a certain effect, which disposes
them to functionate anew in the same manner. Ribot
even adds that memory presupposes not only a specific
modification of the nervous elements, the nature of which
we however know not, but also the formation of associa-


170
Seppilli-Workman.
tions among them, determined by some particular event.
He calls these dynamic associations. In proportion to the
repetition of our acts, they always become more organ-
ized in the nervous element, and though in the beginning
they are voluntary and conscious, in time they become
less so, till at length they are performed without the con-
currence of the will, or of consciousness.
It being admitted, as related to physical acts (ideas,
images, perceptions, sensations), that their representations
become deposited, organized, in the cerebral cells, and
more precisely in those of the cortex, it may be held
that every time these cells enter into a state of activity,
these ideas, etc., are aroused, and become more or less
lively and intense, and are manifested externally by
special phenomena. This reproduction of conserved psy-
chical states, constitutes the psychic memory, which may,
or may not, be accompanied by consciousness. In hyp-
notism we have reason to believe that the psychic memory
is inconscient, automatic, or, at the most, allied to a state
of consciousness which has a minimum of intensity, since
how otherwise can be explained to us the complete
oblivion, or the very vague and confused recollection of
those submitted to the magnetic sleep? In this state the
sensorial perceptions, the images of things, the ideas suc-
ceed with such rapidity, that, so to say, they have not
time to reach the field of consciousness, or they merely
graze it, so that the conscient memory, that is, the con-
sciousness more or less immediate of the facts, is either
completely annulled, or is manifested in a very slight
degree.
The reflexes of imitation, the docility and promptitude
with which the somnambulist, without any force obeys
the commands received, are so many proofs that in the
magnetic sleep the individual becomes a mounted machine,
a very automaton. He receives sensorial impressions, yet
these are not transformed into conscient sensations, but
immediately into motor reactions, that have the character
of voluntary acts. Nor should this seem strange, when it


Animal Magnetism.
171
is considered that a very great part of our movements
are awakened and directed by internal or external impres-
sions, of which we have no consciousness whatever. In
walking along the road, whilst our mind is given to some
thought, we avoid obstacles without being conscious of
them. He who is writing a book has not his mind occu-
pied with the mechanical part of his work, that is, the
penmanship, which is performed mechanically, but on the
contrary with the psychic part. A practiced pianist
executes with precision a piece of music which he has
before him, whilst thinking of something else, just because
the sensorial impression from the musical notes is suffi-
cient to put his fingers in motion, although he has no
consciousness of his actions. When we speak, the words
follow our thoughts, and neither the will nor the atten-
tion takes any part in the movements of the parts des-
tined for verbal extrinsication; their movements are
naturally outside the range of consciousness. In these
cases it is the organic memory that comes into play ;
that is to say, there is a reproduction of motor acts,
which, by repetition; become definitely organized in the
nervous elements (dynamic associations), so as to give
the capacity for automatic occurrence.
It has at length been demonstrated that automatism
appears as a general law which regulates the greater part
of vital manifestations, and we are permitted to execute
the most complicate acts without need of the ego, or
conscient entity. Hence the hypothesis most consistent
with physiological data, and which may harmonize with
the reflexes of imitation, appears to us to be the follow-
ing: that, in the hypnotized, the sensorial impressions
reaching the central organs give place there to material
modifications, and that these, next, in their turn, become
the point of departure of the activity of those nervous
elements in which the movements are organized; or, in
other terms, that they may call forth the dynamic asso-
ciations already acquired. Therefore the motions have
all the characters of intelligent movements, as though


172
an.
Seppilli— Workman.
they depended on a voluntary and conscient activity.
In conclusion, automatism is the essential character of
the magnetic sleep; it embraces both the somatic and
the psychic spheres. It might be said that magnetic
operations, like certain substances that act upon the brain
and the intellect, paralyze the conscient, but not the
automatic ego; that is to say, they act on the more deli-
cate, the more elevated part of the subject, taking away
the will — the spontaneity of proper acts; or, as Heiden-
hain expresses it, they hinder those expressions which,
in the waking state, determine a clear perception, and
thereby a conscient representation, from passing, in the
hypnotized, over the threshold of consciousness.
Having reached this point we may be permitted to
add, that the law formulated by the talented Prof. Her-
zen, on consciousness, finds its application in provoked
hypnotism. My very good friend, Dr. Buccola, one of
the most distinguished and able cultivators of positive
psychology in Italy, made us acquainted with this law in
his most valuable memoir, read before the Third Freni-
atric Congress, held at Reggio-Emilia, entitled “The
Physical Law of Consciousness in the Sane and the Insane."
Herzen, setting out from the postulate, that the nervous
elements are disintegrated by functioning, and reintegrated
after having functioned, has shown that, in physiological
conditions, consciousness accompanies only the disintegra-
tive phase of the nervous elements, and never the rein-
tegrative, and that the intensity of consciousness is in
direct proportion to the spontaneity of nervous disinte-
gration, and in inverse proportion to the facility and
rapidity of central transmission. In fact, observation and
experiment have demonstrated that the central conscient
acts require for their accomplishment a much longer time
than the inconscient or automatic acts, and that the
former are accompanied by a great quantity of the pro-
ducts of decomposition, and the latter, on the contrary,
by very slight disintegrating processes.
This being admitted, if it be considered that autom-


Animal Magnetism.
173
atism is the phenomenon dominant in the provoked sleep,
and that conscious activity entirely fails, or exists only
in traces, we should hold that the disintegration of the
nervous elements ought not to reach a very intense
degree. This must have been demonstrated by the
rapidity with which ideas, images and sensations succeed
in the magnetized subject, and by the prompt and imme-
diate transformation of sensorial impressions into motor
sensations—two facts which confirm the celerity of trans-
mission of the nervous currents, by which the psychic
cellular elements do not become so long and so intensely
disintegrated as to produce consciousness, and hence that
degree of memory which accompanies it. (Buccola.)
We desire not to pass over in silence some special
facts relative to the remembrance of circumstances and
events which have accompanied the magnetic sleep.
Thus, even from the time of Braid it has been noted
that some of the hypnotized had forgotten, in their
waking state, all that had related to the period of their
provoked sleep, but they presented afterwards the singu-
lar fact of remembering it very well when the sleep was
again induced in them. Richet, e. 8., put V. to sleep,
recited to her some verses, and afterwards awaked her.
She had no remembrance of them. Being again put to
sleep, she perfectly recollected the verses which had
been recited to her, but, on awaking the second time,
she showed she had forgotten them. Nervous pathology
offers to us examples very analogous to this case. Maca-
rius relates of a woman affected with natuaral somnam-
bulism, to whom a man had offered violence, that on
awaking she had no remembrance of the attempt. Having
fallen again into an access of somnambulism, she related
to her mother the outrages. An American girl, Macnish
informs us, fell into a prolonged sleep, at the end of
which she had lost memory of all she had learned. Her
memory had become a tabula rasa. She was obliged to
learn anew to spell, read, write and calculate, and to
recognize all the objects and persons that surrounded her.


174
Seppilli—Workman.
In a few months, she fell into a profound sleep, and
when she awoke she was found in the same state as before
her first sleep, she had all the recognitions and recol-
lections of her youth, but had completely forgotten what
had passed in her two accesses of sleep. Through four
years and upwards she passed periodically from the one
state to the other, and always under a long and profound
sleep. She had, therefore, two modes of existence, an
old one and a new: in the former she possessed all the
primitive cognitions ; in the latter the cognitions acquired
after the disease came on; in the old state she wrote a
good hand, in the new it was poor and clumsy. If she
was seen by persons in one of her two states they could
not understand her real condition until they had seen her
in the other state—(Macnish, quoted by Taine). In this
case, two distinct memories existed; on appearance of
one the other vanished; memory of the old state returned
in its succession, and the like obtained as to the new
state.
The case of Felida X , described by Azam, is
celebrated. Felida is a woman who was born in 1843.
She is subject to two states very distinct: in the first,
which shall be the normal state, she presents all the
phenomena of a hysteric neurosis; it is of sad character,
she speaks little, minds her work, has the affective senti-
ments but little developed, and is much preoccupied about
her own ill health. In the second state, which Azam
calls her second condition, Felida completely changes
character, ideas and sentiments. She becomes gracious,
gay, sensible, equally inclined to sadness as to joy, is
very attentive to her affairs, and hardly ever laments
about her health. But in her second condition, Felida
perfectly remembers all that had passed in her two
different states; having re-entered her ordinary condition,
she loses completely the memory of what she said or
did in the second, just as if it had never existed; but
she does not lose memory of the antecedent normal
periods. The periods of the second condition were at


Animal Magnetism.
175
first distant and short, but afterwards they became always
longer and more frequent, so that her second condition,
which in 1858-59 represented but one-tenth of her exist-
ence, afterwards equalled and, finally, surpassed the first
condition, so that in 1876 it occupied, almost entirely,
her life. It will not be superfluous to record the diverse
interpretations given of this truly singular and interesting
case. According to Azam, it consisted of an alteration
of memory, an amnesia which existed in the first state,
and the difference in the character and the affective
sentiments of the patient was the consequence of this.
Herzen believes that the difference of the ego in Felida
in her first state, and of her ego in the second, is derived
from two different feelings of existence, to each of which
a different consciousness of the ego corresponds, a con-
sciousness which she in each of her states considers as
her true normal ego. She has, therefore, in reality, two
consciousnesses, which succeed in alternation according
to the actual state of her cerebral hemispheres. This
case, according to Herzen, demonstrates the capital
importance of memory, for the continuity and identity of
the consciousness. In her first state, Felida has no con-
sciousness of her second condition, because she does not
remember it. Despine holds, on the other hand, that all
the phenomena presented by Felida in the second con-
dition, as well those of her life of relation as of the
psychic sphere, are but a series of automatic cerebral
reactions to sensorial excitements-reactions in part due
to habits taken on in part direct from the inconscient
psychic faculties inherent in the brain, and precedently
developed in the conscient state. In her first condition,
Felida is ignorant of her second, because in this the
conscious activity of the brain has not shared with the
acts of its automatic activity.
Sometimes in the state of hypnotism that phenomenon
ha's been noted, which is known more properly under the
term duality of personality. The hypnotized artributes to
others the ideas which belong to his own mind, and the


176
Seppilli— Workman.
words uttered by himself, and he holds long conversations
with imaginary persons. A patient of Richet, when in
somnambulism, said the Sultan was proposing to her to
enter his harem. She at the same time found the question
and the reply, speaking in a loud voice when answering
and simply moving her lips when the sultan was asking
the question.
This fact, also is not in disaccord with what is
presented in our daily observation. How many times
has it not happened in dreaming to talk with persons,
to carry on discussions, to be commoved, and to
react to their words whilst experiencing sensations of
every sort ? And truly all this is due to the state of
excitement of our imagination, through which the mental
reproductions assume all the aspect of reality.
Maury relates that in one of the clearest dreams he
had, he sustained with an interlocutor a discussion on the
immortality of the soul, and both of them placed value on the
arguments opposed, which were no other than the objections
he urged against himself. This splitting which is effected
in the spirit, he adds is a phenomenon of the memory;
we retain in mind the pro and the contra of the question,
and in our dream we bear relation to two different
beings—two opposite orders of ideas. Duality of person-
ality is common enough to be met with in mental
diseases. The lunatic, hearing his own voice, believes he
hears that of another person; he holds long conversations
with imaginary personages, whilst it is himself who thinks,
hears and wills with his own brain. Not a few of the
insane believe they have, in their own bodies, a spirit
that masters their thoughts, opposes their deliberations,
speaks without being questioned and makes reply to
what they are thinking of. Maury had occasion to see
an insane woman, who believed she was in discussion
with a judge who had caused her to lose an action.
Here we bring to end the analysis of the phenomena
presented by hypnotism. From it, provoked somnam-
bulism clearly appears to have its proper place among


Animal Magnetism.
177
those special states, of which the nervous system is the
seat, and not a few of these have many characteristics in
common. We have seen that it is between provoked
somnambulism and hysteria, that the analogy is more
specially conspicuous, as, in the one case as well as in
the other, general anesthesia visive disturbances, muscular
hyper-excitability, catalepsy and psychic and somatic
automatism constitute the most salient features of the
symptomatic picture, so that it does not seem to us
erroneous to say, that when hypnotism intervenes, a state
analogous to that of nervous hysteria is produced artifi-
cially in normal subjects. We have therefore studied to
put into relief the fact, that some of the phenomena of
hypnotism may find a plausible explanation in the dicta
of physiology, and to remove from them that thick veil
of mystery which once enveloped them, obscuring what
was in them of truth and reality.
To say that the studies hitherto accomplished on
hypnotism are complete would be an error, especially as
relates to psychic phenomena. Researches on somnam-
bulism are proceeding continuously, and with repetition,
by means of which, facts already acquired are confirmed
more and more, doubts and uncertainty as to those not
yet demonstrated are removed, and knowledge of new
facts progresses.
In the interest of science we would hope that, in good
time, men would cease to negative a priori whatever con-
cerns animal magnetism, as many have done and still do,
and cease to content themselves with rather combating it
with the arms of ridicule. Our duty is to search, to
experiment with vigorous method, and then to judge.
“Happy they,” exclaims Richet, “who content themselves
with negation, and believe that all has been said when
they have affirmed that it is impossible!” Let us not
hide the fact that in somnambulism there are some mar-
velous, inexplicable phenomena; but is it therefore logical
to deny its existence? We ought to be persuaded that
the nervous system is so complex in its structure and


178
Seppilli— Workman.
functions, that the more it is studied, so much the more
shall we find ourselves confronted by unexpected facts
that appear strange in their essence and elude explana-
tion. Let us bear in mind the words of the illustrious
Bernard, when he observed the extraordinary and sur-
prising effects produced by metals: “There are some
things in the nervous system of which I am ignorant, but
I find I am still more ignorant, after what I have dis-
covered.”
Art. III.-On the Co-existence of Hysteria
and Epilepsy, with Distinct Manifest-
ations of Two Neuroses. *
HYSTERO- EPILEPSY WITH DISTINCT CRISES CONSIDERED
IN THE TWO SEXES, AND PARTICULARLY IN MAN.
By M. D'OLIER.
Abstract by E. M. Nelson, M. D., St. Louis.
W E have had occasion to note at Bicêtre, in the
course of this year, a certain number of patients
presenting, on the one hand, violent hysterical attacks
and on the other, attacks of epilepsy.
This coëxistence of hysteria and epilepsy is not a new
observation. It was long ago mentioned and described,
in the female sex. In 1836, Beau distinguished the hys-
teria coëxisting with attacks of epilepsy and that which
coëxists with vertigo. But it is Esquirol who appears to
have first insisted upon this point in his Traité des Mala-
dies Mentales (1838, vol. 1), where he says, p. 284: “There
are hysteric patients who are at the same time epileptics.
.... With a little practice one would recognize very
well, when the attacks are separate, to which of the two
• Memoir which obtained the Esquirol Prize in 1881, by M. D'Olier, Interne of
the hospitals of Paris.


Co-existence of Hysteria and Epilepsy.
179
diseases the convulsions belong to which the patient is
actually a prey.” Finally, Landouzy (Traité de l' Hysterie,
1846), gives to the coëxistence of the two neuroses, with
distinct attacks, the name of hystero-epilepsy with separate
crises. This application can no more be preserved to-day,
the name of hystero-epilepsy being specially reserved for
the old hystero-epilepsy with combined crises (Landouzy)
hysteria with mixed attacks (Briquet), epileptiform hysteria
of Tissot, Dubois (d'Amiens), etc. M. Charcot has, in
fact, shown that we deal here, not with a mixture, in
proportion more or less equal, of hysteria and epilepsy,
as was believed at first, but with a morbid condition
clearly distinct. The first period of the attacks which
alone reproduces the type epilepsy in the outline,
differs notably from true epilepsy by the complete
absence of petit mal and vertigo, by the influence which
compression of the ovary exercises upon it, and espe-
cially by the complete absence in the state of mal hystero-
epileptique of the elevation of temperature, which is one
of the most remarkable characteristics of the mal epilep-
tique.
To-day the tendency is to consider hystero-epilepsy
(hysteria major), of which we have in a few words just
traced the history, as the complete type of hysteria, of
which the other forms would be only more or less modi-
fied forms. M. P. Richer indicates in his thesis this
opinion of M. Charcot, who, he says, sees in hystero-
epilepsy only the most intense degree of hysteria. Fol-
lowing out this idea, he proposes to demonstrate in his
work that the regular attack can be shown variously to
consist of numerous varieties which it is possible to refer
to the principal type. The common attack of hysteria is
only an attenuation of the severe attack or hystero-
epilepsy.
The distinct existence in the same individual of hys-
terical attacks and of attacks of epilepsy is not so excep-
tional a fact as might be believed at first. M. Beau,
who has studied at la Salpétrière, has reported it twenty


180
D'Olier-Nelson.
times in 276 patients. There are at this moment at
Bicêtre in a service of 234 male patients, 222 epileptics
and idiots, and twelve cases of hysteria, of whom eight
especially are very remarkable. This proportion of nearly
one-twentieth of hysterical patients would doubtless appear
considerable if one thinks that hysteria in men is still
considered very exceptional.
It is interesting in the point of view of the influence
of sex upon the production of hysteria to compare these
figures with those Beau gives with reference to la Sal-
pétrière : there were then in his service among 273
patients, 209 epileptics, 19 hysterical patients, 13 doubtful
cases, 32 hystero-epileptics, or, in total, a maximum of
64 hysterical patients in 273 — that is to say, a little less
than a quarter.
So, all things beside being equal, the relation of fre-
quence of hysteria of one sex to the other would be that
of one-fourth to one-twentieth, or practically one hysteri-
cal man to five women.
However it be as to that proportion, seven of our
twelve patients are at once hysteric and epileptic, and
the two diseases develop in them separately. In the five
others, and especially in three of them, may be noted the
old mixed crisis or severe hysteric attacks.
The different modes of existence of hysteria and
epilepsy, when manifestations of the two neuroses remain
distinct, have been summed up by M. Charcot in the
following table :
1. Hysteria supervening in a patient already epileptic.
2. Access of epilepsy supervening in a subject previ-
ously hysterical.
3. Convulsive hysteria coëxisting with epileptic vertigo.
4. Epilepsy developing upon the results of hysteria,
non-convulsive (contracture, anæsthesia, etc.).
We propose to pass in review successively these differ-
ent morbid combinations, in woman and in man; it is
this last class of facts which will constitute the personal
part of this study, the observations for which we have


Co-existence of Hysteria and Epilepsy.
181
collected with the assistance and under the direction of
our master, M. Bourneville.
We do not ignore that thus to formulate the plan of
this memoir is to consider as settled the preliminary
question of hysteria in man which still remains in dispute.
Few physicians, however, maintain to-day the old doctrine
founded upon the genital origin of the disease. This
error, says M. Bernutz (Dict. de Méd. et de Chir. Prat.,
t. xviii. p. 189), against which so great a number of
physicians have protested since Ch. Lepois (1618) that it
would be impossible to cite them all, is actually refuted
by a collection of facts such that there is no more to
expect, and the celebrated disputes with which are asso-
ciated the names of Louyer-Villermay, Georget, Landouzy,
etc., could have only a historic interest. Numerous exam-
ples collected in these last years prove definitely that
hysteria may affect the masculine sex without losing for
this its habitual physiognomy. It does not this even to
the ovarian hyperesthesia, which finds its analogue, in a
functional point of view, in a testicular hyperästhesia, and
in a topographical point of view in a hysterogenic zone
limited to the iliac fossa, the compression of which has
more than once sufficed to arrest attacks, just as if there
was an ovary concealed behind the abdominal wall.
(Here follows the clinical history of a youth thirteen
years old, in whom the cutaneous sensibility was alike
and normal on the two sides. Sight, hearing, taste and
smell were a little less delicate on the left side.]
There were present several hysterogenic zones (by
which term he designates limited areas of hyperæsthesia
where compression almost always determines the phen-
omena of painful irradiation, and in some cases determines
pronounced attacks). There was, ist, clavus hystericus
located at two centimeters from the vertex; pressure on
this point produced a pain extending all through the head;
there existed at this spot spontaneous pain before the
attacks; 2d, rachialgia at the level of the fifth, sixth and
seventh dorsal spinal apophyses; 3d, a zone in the


182
D’Olier-Nelson.
seventh left intercostal space, four or five centimeters from
the vertebral column; 4th, zones in the fifth intercostal
spaces a little in front of the axillary line; pressure on
these points produced lancinating pains radiating into the
abdomen; 5th, at the upper part of the sternum; 6th, in
the flanks; 7th, in the iliac fossæ (ovarian region) espe-
cially on the left.
The attack was preceded by an aura, characterized by
the sensation of a ball which arose from the pit of the
stomach to the larynx, where it produced strangulation;
the ascent of this ball occupied about four or five minutes :
then followed dazzling sensations, vertigo, ringing in the
ears, sense of constriction about the forehead, finally, loss
of consciousness.
The attack began then with abdominal cramps and a state
of very pronounced rigidity, giving place very soon to violent
clonic convulsions, free movements and balancing back-
ward and forward, interrupted from time to time by more
or less complete arcs of a circle. Then followed the phase
of resolution and of delirium, manifestations the most bizarre
sometimes very brief (laughing, interrupted words), some-
times, on the contrary, very prolonged, and appearing
then to constitute a veritable state of somnambulism;
the child with open eyes understands what is said to him,
is amused at the persons who surround him, but speaks
not a word; sometimes it was possible at these moments
to make him write his name and address. Sometimes
there appeared to exist hallucinations of vision; the
expression of the child expressed terror; he repelled with
anger all the assistants, spit upon and even clenched his
fist at his relatives whom he recognized no more, the
instant after, having recognized his father on touching
his beard and the ring which he wore on his finger, his
expression indicated joy. In other cases he thought that
he was playing with his companions, made gestures and
let fall some exclamations.
This state might be prolonged ten minutes and more,
then the rigidity occurred and a new attack commenced.


Co-existence of Hysteria and Epilepsy.
183
This might occur five or six times in an hour. When the
final delirium took place, the patient announced sometimes
that the ball descended, and indicated its course with his
finger; then sometimes there were tears, sometimes an
abundant flow of clear urine. He retained no recollec-
tion of what had passed. During several months, these
attacks took place daily in the afternoon, at almost an
exact hour. Just as among most patients of this sort,
the state of the sensibility has frequently varied, and at
different times there has been observed a left hemianæs-
thesia, very distinct, although incomplete. This patient
has been notably benefitted by hydrotherapy.
As has been seen, there is no doubt as to the nature
of the disease; it is clearly hystero-epilepsy, and in this
case it is presented to us free from all mixture.
Let us examine now the various modes of its associa-
tion with epilepsy :
$ First.—Hysterical attacks coming on in a subject already
epileptic. “In this case," said M. Charcot, “hysteria is
in some sort grafted upon epilepsy in its own time, that
is to say at the epoch of puberty, under the action of
diverse causes and peculiar moral emotions.” This com-
bination is much the most frequent in both sexes. We
shall give a rapid summary of the celebrated case of this
sort observed by Landouzy in a woman.
OBSERVATION II.-Mme. X., epileptic from birth, and
having never had any symptom of hysteria, was married at
eighteen. Impressed by the coldness which her husband
soon manifested towards her, Mme. X., whose attacks of
epilepsy were not augmented, commenced to complain of
smotherings, of spasms of the throat, and soon veritable
hysterical convulsions without loss of consciousness and
without change of the countenance were added. Yet the
attacks of epilepsy were neither more frequent nor more
intense than formerly, and were always characterized by
a frothing mouth, livid face, stertorous respiration fixed
eyes, etc. This state lasted about two minutes, after
which the patient remained for an hour moody and listless.
The attacks of hysteria, on the contrary, appeared with-
out regularity and at times of chagrin. They were
epile. manIni


184
D'Olier-Nelson.
her knee daynions they see in
announced by suffocation, strangling, the ascent of a ball
from the epigastrium to the neck; finally, they terminated
by convulsions with semi-loss of consciousness, then by
cries. The attack was generally terminated by vomiting
and the voiding of urine. Pregnancy produced modifica-
tions of this state only in the two last months, when the
attacks of epilepsy became a little more frequent, but the
attacks of epilepsy disappeared. They returned after the
confinement, but disappeared entirely a little later when
M. X. was more attentive to his wife.
We might add to this fact the following observation,
made at la Salpétrière and which we have been enabled
to complete in the point of view which we take, thanks
to the courtesy of Prof. Charcot.
OBSERVATION III.—Mich. (Louise), twenty years old.
No family history. Menstruated at seventeen years of
age, always irregular. Epileptic attacks since the age of
fourteen years and a half; it appeared certain that they
appeared before the attacks of hysteria. For about eight
years, she has had spells of weakness, especially when on
her knees. She was very impressionable.
One day at school, while she was amusing herself with
her companions, the first attack came unexpectedly.
From that time they reappeared every twenty-five days
for six months. Precise information is lacking as to this
part of her life, and especially as to the convulsive crises.
What followed would lead us to believe that she was
already at that time both hysterical and epileptic.
She entered, successively, la Salpétrière, then the
asylum of Evreux; finally, her father took her, but the
attacks reappeared, accompanied with new phenomena ;
the patient spoke to no one, and refused nourishment.
She was then taken to la Pitié, where several times they
had recourse to the stomach tube.
Since she has been at la Salpétrière, Mich. has presented
distinct attacks of hysteria and epilepsy. These last are
preceded during several minutes by a sort of aura,
during which the patient is like a fool and gives way to
violent actions, then falls like a mass without conscious-
ness; the initial cry is rare. The convulsions are tonic,
then clonic; there is great pallor of the face and stertor.
The patient almost always bites her tongue. These attacks
have constantly increased in frequence since her admis-
sion. They come as well by day as by night, and are
From companion school, whilmpressional especiall


Co-existence of Hysteria and Epilepsy.
185
more frequent at the menstrual period. There is no
nocturnal incontinence of urine.
Besides these attacks the patient has vertigo. The
attacks of hysteria are altogther different in character.
They are almost always excited by violent passion, to
which the patient is very subject, and they recur only
two or three times in a month. There is never an initial
cry: the attack is in some sort limited to the epileptoid
period; there is tetanic rigidity of the whole body; the
arms are fixed at right angles and the hands clasped upon
the head. There are no clonic contractions and scarcely
any stertor. The limbs remain rigid for several minutes
after the last period is terminated. The patient has left
hemianæsthesia. She presents decided intellectual impair-
ment; memory is dull and speech embarrassed.
[A tabular statement of the number of attacks of
epilepsy and hysteria during 1878-79-80, shows that in
the former year the number of each form of attack was
almost exactly equal—188 of the former, 189 of the latter.
The ratio has changed at the same time that the number
of attacks of each sort have diminished. In 1880 there
were 53 attacks of epilepsy to 24 of hysteria. Thus the
tendency is toward a disappearance of the hysteria leaving
the epilepsy alone.]
We shall cite again in brief the observation on the
patient Wilh., reported in detail in | Iconographie Phot.
de la Salpétrière (t. i., p. 33). This observation, said M.
Bourneville, in presenting to us in the same individual
attacks of unquestionable hystero - epilepsy and those
plainly epileptic, will dissipate the doubt, if there exist
any, on the subject of hystero-epilepsy viewed as an inde-
pendent disease. Unfortunately we do not know which
of the two, the hysteria or the epilepsy, were first estab-
lished in this patient. We are not authorized to consider
this as a case of secondary epilepsy, and it is on this
account that we place it here and not in Section 3. We
believe, however, that in consideration of the great fre-
quence of the hysterical attacks in the beginning, and the
progressive increase of the epileptic seizures since they
have appeared, this question might be solved.


186
D’Olier-Nelson.
OBSERVATION IV. is the history of a girl seventeen
years old, who had characteristic attacks of hystero-
epilepsy and epilepsy. There was left hemianæsthesia.
From September to the end of December, 1875, she had
eighteen epileptic seizures and twenty-two hysterical
attacks. In 1876, the epileptic seizures predominated in
a notable proportion over the hysterical attacks, fifty-four
to fifteen; and this predominance was pronounced in the
last half-year (first half-year, 22 seizures, II attacks ;
second half-year, 32 seizures, 4 attacks). The seizures
occur most frequently at the time of menstruation. The
hysterical attacks ceased but the epilepsy persisted.
Here follow five analogous observations concerning
men or male children. These are stated at length in
order to establish the relation of the hysterical attacks.
OBSERVATION V. - Duval (Victor), 32 years, entered
Bicêtre, service of M. Bourneville, April 8, 1880. No
neuropathic antecedents in the family. Convulsions from
birth to two years old. From seven to nine years night-
mares. He then went to school and was intelligent. At
twelve and a half years there was the first seizure of
epilepsy, which came on without known cause. Six
months later there were nervous attacks which lasted all
day from sunrise to sunset. These attacks, which began
with tremblings, had lasted a month. He had about the
same period St. Vitus' dance (?). After this month of
paroxysmal attacks there was an intermission of fifteen
days in the convulsive manifestation, and then the attacks
of epilepsy reappeared. The sister of the patient, who
gave this information, said that the seizures and the
attacks could be very easily distinguished.
In the epileptic seizures there was no aura; in the
hysterical attacks he knew beforehand when he was going
to have one, and at the same time he trembled as if he
were cold. In neither case was there an initial cry. In
the former he fell like a lump, and frequently was injured;
in the latter he had time to lie down, and did not injure
himself. In the former there was general rigidity, lasting
less than a minute; no information as to this point in
the latter. In the former, clonic contractions for several
seconds; in the latter, great movements; arcs of a circle,
cries and groans prolonged sometimes for ten minutes.
In the former, stertor, frothing at the mouth, biting of
the tongue; in the latter, carphologia — the patient
Tuis attacks wn caus
eriod St. Vithere was an intend then the a
same periodings, had Sunset


Co-existence of Hysteria and Epilepsy. 187
Laughter. He waspoke aloud the latter, aftentinued twelve
ith the seizus attacks choren with a newera no tears nor
attempted to catch imaginary objects. In the former
there was profound sleep, which once continued twelve
hours without awaking. In the latter, after the delirium,
he sighed and spoke aloud. There were no tears nor
laughter. He was soon taken with a new attack.
The nervous attacks coëxisted for four or five years
with the seizures; he had them two or three times a
month. The seizures came every two, three or six weeks,
or at longer intervals, for seventeen years. The nervous
attacks disappeared at this time, and the seizures then
came almost every week. .
His memory was not sensibly diminished, but instead
of the affable character which he formerly had, he became
slothful, discontented, dishonest and subject to violent fits
of anger.
After a first stay at Bicêtre he went out in 1878 and
married. During the time of his marriage he had fits only
at night. His wife, of whom he tells much ill, left him
in March, 1880. He returned to Bicêtre in April. His
intelligence was notably lowered; his memory was weak-
ened; he sometimes was at a loss for words. There was
improvement under the use of bromide of potassium.
As may be seen, this case strongly resembles Land-
ouzy's; just as in Mme. X. the hysteria was here only a
transient affection developed in an epileptic, who con-
tinued to have the epileptic seizures after its disappear-
ance.
OBSERVATION VII. relates to a lad of seventeen years,
who entered the service of M. Bourneville, at Bicêtre, as
an epileptic. He presented, like the preceding, epileptic
seizures, clearly distinct from the hysterical attacks.
These, moreover, occurred only in series, while the seizures
always presented singly. The patient was greatly benefited
by hydrotherapy.
OBSERVATION VIII. refers to a man 32 years old,
who entered the insane division of Bicêtre December
20th, 1865. This patient also had paroxysms of both
sorts, entirely distinct, as also did a boy of ten years,
who forms the subject of Observation IX.
OBSERVATION X. gives in full detail the case of a man
42 years old, who suffered from well characterized epilepsy,
with a phase of agitation and maniacal delirium, and also
from hysterical attacks marked by aphonia, strangling,
Pota
e hyrfly


188
D'Olier-Nelson.
trembling, trismus, anæsthesia and hyperästhesia. Having
died from phthisis, an autopsy revealed an old meningeal
as well as pulmonary tuberculosis.
§ SECOND.—Epileptic seizures coming on in a subject
previously hysterical.
Here it is rather the epilepsy which controls the scene.
That is the superadded disease. This combination would
appear to be more rare than the preceding.
However it be, the transformation of hysteria into
epilepsy is found already mentioned in the older writers
(Willis, Hoffman, Van Swieten) as witness this phrase
cited by Dunant, “ Passio hysterica sæpius, observata fuit in
epilepsiam mutari” (Van Swieten Comment, sur les aphor.
de Boërhaave).
According to Landouzy, the transformation from hys-
teria into epilepsy is very rare, which allows the supposi-
tion at least that he knew of cases.
We read, finally, in the thesis of Briffaut (Rapp. de
l'hysterie et de l'epilepsie, 1851): “One may see at la
Salpétrière the hysterical patient becoming epileptic,
remaining the one and the other, which constitutes
hysteria-epilepsia (with separate or mixed crises) or else
the epilepsy dominating and in some sort superseding the
primitive hysteria.
Epilepsy succeeds to hysteria, says says Briquet, in
young girls affected with serious hysterical troubles, and
frequent attacks of convulsions, after which it is mani-
fested in headache, heaviness, tendency to coma, and
diminution of the intellectual faculties.” According to
this author, it is this fact which Willis had noted in the
following passage: “ Postquam hæc ægrotans per quatuor-
decim menses ejus modi paroxysmis crebra vice repentibus
obnoxia degisset demum epileptica evasit, ut quoties mali
insultus rediret, in terram prostrata ovaro sybia, cum spuma
oris alüs que symptomatibus caduci pathognomicis, corre-
piretur.”—(De morbis convulsivis, cap. 5, obs. 4.)
M. Briquet himself gives an observation of this nature,
in which the following is a summary:


Co-existence of Hysteria and Epilepsy.
189
OBSERVATION XI.—Mlle. X— , 20 years of age, no
epilepsy in the family. Mother hysterical. Hysteria
developed gradually in the patient until there were
complete attacks. After six months from this condition,
which was still increasing, the patient became more and
more apathetic. There was continual severe cephalalgia.
Her intelligence declined more and more, and this young
lady ended by acquiring the aspect of an idiot, when
gradually there appeared attacks very different from the
first. These attacks took her unexpectedly as she was
going or coming in the wards; then she fell prostrate,
her face upon the ground, with complete loss of conscious-
ness, made some grimaces with gurgling in the throat;
after five or six seconds she would arise and continue her
course as if nothing had happened. These were epileptic
seizures. On the contrary, the hysterical attacks were
distinguished in this, that the patient would feel them
coming on; they were characterized by cries, convulsions,
and terminated by sighs and a curvature which would
last twenty-four hours. There was an attack of one
sort or the other almost every day. The state of this
young girl went on gradually depreciating, and, finally,
she was sent to la Salpétrière as an incurable,
In spite of the authority of Briquet's name, we
would say that in the absence of the only signs which
would permit us, perhaps, to-day to fix the diagnosis
with certainty (course of the temperature, influence of
compression of the ovaries and of the bromide of potas-
sium), we should be very reserved as to the nature of
the epileptiform manifestations mentioned in this obser-
vation.
§ THIRD.—Convulsive Hysteria co-existing with “petit
sort twenty-four by sighsharacterizedient woulatta
she waste went on past every day as an att
mal.”
Beau mentions in his memoir that in 273 patients that
he had examined, two presented at the same time hys-
terical attacks and epileptiform vertigo. In one of them
the attacks of hysteria disappeared, but the vertigo per-
sisted. The observations are unfortunately not reported.
The following is a summary of a case of this sort,
observed by M. Dunant:
OBSERVATION XII.—Louise —, 36 years old; men-


190
D'Olier-Nelson.
first at e
n het op peperie vertig
struated first at twenty-one years. Before the commence-
ment of her disease she experienced frequent losses of
consciousness (probably epileptic vertigoes like those she
has had since). Her memory was greatly impaired. The
first convulsive attack occurred at about twenty-two years
old, a month after she had undergone a severe shock
from the death of her brother, who had blown his brains
out.
In the observation made at the time of her admission,
no mention is made of attacks of hysteria major. She
has, according to the report of every one at the asylum,
frequent attacks of giddiness, which take their course as
follows: If the patient is not standing, she arises without
letting fall what she holds in her hand; she loses con-
sciousness, and makes no response to questions addressed
to her. Her face becomes pale, and her expression is
that of an idiot. At the end of a minute or two intelli-
gence rapidly returns. The hysterical attacks come on
most commonly at the time of menstruation. The patient
feels them coming on and demands to be restrained.
During the days preceding them there is insomnia, and
her character is irritable. Later appear the ball in the
throat, dysphagia, laryngeal spasms; finally convulsions.
During the period of delirium, the patient cries out that
she sees assassins, blood, etc., and an expression of hor-
ror is depicted upon her face.
OBSERVATION XIII. is very similar to the one just
related. Observation XIV. relates to the case of a youth
of seventeen years at Bicêtre, in whom vertigoes coëxisted
with convulsive and delirious attacks. The delirium in
the patient bore strong analogies with epileptic mania,
yet the disturbances of sensation, the presence of hys-
terogenic zones, and the violence of the clonic convulsions
favored the diagnosis of hysteria.
§ Fourth.—Seizure of Epilepsy supervening in a subject
presenting only a few hysterical, non-convulsive symptoms.
“We possess,” says M. Charcot, “one case of this
sort.” M. Aug. Voisin also says that we can distinguish,
with Dunant, a group of epileptics who present some
symptoms of non-convulsive hysteria.
The observations to which allusion has been made by
During thosphagia, laryne. Later ap


Co-existence of Hysteria and Epilepsy.
191
these different authors, have, unfortunately, not been pub-
lished. We have ourselves observed no fact of this sort.
In approaching the end of this exposition of the differ-
ent combinations which hysteria and epilepsy may assume
when their manifestations remain distinct, it seems that we
should not close without speaking of a special kind of
mixed crises which appear not to be considered as attacks
of hystero-epilepsy.
In these cases, in fact, the patients remain after their
attack plunged in stupor or coma; furthermore, there exists
no trouble of sensibility persisting in the interval of the
attacks; in short, epilepsy clearly rules the scene. We
observe at the same time sensations of globus, of strangu-
lation, of epigastric distress and hallucinations of sight and
hearing. Such are, for example, the observations reported
by M. Billod, which may be summed up thus :
OBSERVATION XV.—Scih., 21 years, epileptic since one
year old. Neuropathic antecedents. A half hour before
his seizures the patient feels sensations of tingling and
weakness in the legs, a sort of intoxication, an intense
headache, soon followed by convulsions. During the
seizure the patient has a sort of half consciousness, feels
horrible pains in the head and extremities, thinks himself
choked, and feels a ball constantly ascending from the
stomach to the neck. Everything else is as in other
attacks of epilepsy. After the seizure there is stupor, a
semi-intoxication.
OBSERVATION XVI.-Lecl., 19 years old, epileptic since
eleven years. No hereditary predisposition. Seizures
announced two days beforehand by sadness, headache,
tingling in the limbs. Commencement variable; some-
times by convulsive movements of the lips, sometimes by
nystagmus, strabismus or dilatation of the pupils. The
seizure may be incomplete-limited to a momentary loss
of consciousness, or to a cramp affecting only the left side,
where the convulsions are always the strongest. During
the seizure, the patient preserves a half consciousness,
which enables him to catch some words of the conversa-
tion, and to have a sensation of a tearing pain in the fore-
head and joints. After the convulsions there is profound
sleep, like that of apoplexy.
headiness in the Pedient feels sensatio A half hourse one


192
D’Olier-Nelson.
OBSERVATION XVII.-Bond, 21 years old. Seizures
preceded by pains in the stomach, epigastric distress; then
troubles of vision and clonic convulsions; then sensibility
is abolished; the patient neither sees nor hears, but he
does not lose consciousness, and has hallucinations of sight
and hearing. Globus hystericus. Stupor after the seizure.
OBSERVATION XVIII.-Seizures announced by epistaxis
and cramps. Tonic and clonic convulsions without loss
of consciousness. The patient recalls what is said about
him during the attack. Sensation of globus going from the
axilla to the epigastrium and neck; respiration convulsive,
face livid. The seizure ends with a veritable seizure of
mania of half an hour's duration.
These singular cases show us once more what a
multiplicity of forms may be presented by the combi-
nation of hysteria with epilepsy, which we seek to analyze
and to group; but what we wish specially to call
attention to in these observations is the mode of com-
bination of the two neuroses; hysteriform symptoms are
here confounded with the seizures of epilepsy; there is
not only coexistence but coincidence of the two diseases.
Is it necessary, then, to consider this new pathological
complexus as a simple mixed attack, that is to say,
as belonging to hystero-epilepsy as it is understood
to-day? We think not. As we have already said,
the absence of permanent disturbance of the sensations,
the character of the convulsions sometimes dominating
on one side (Obs. XVI.); finally, the consecutive sopor-
ous sleep or stupor appear to show sufficiently in
these cases that the base of the disease is true com-
mon epilepsy, clearly distinct from the epileptoid phen-
omena of the hysterical attack, Such are the reasons
for which we have these facts as types of a special
group, of one of the modes of coexistence of epilepsy
and hysteria.
We recognize further without difficulty that we
should discuss these facts only with the utmost reserve
if we recollect that they were taken at a time when
we still had no clear notion of the hysterical attacks,


Co-existence of Hysteria and Epilepsy,
193
such as we possess now. We possess to-day means of
diagnosis, among others the course of the temperature,
the influence of compression of the ovary, of the testicle
or iliac fossa in the masculine sex, and the effect of
bromide of potassium, which would doubtless permit us
to determine more exactly the part which pertains to
each neurosis.
If we recapitulate now in view of the sum of the
facts which we have just examined, we see that our
observations confirm (except in one case) the four methods
of the coexistence of epilepsy and hysteria mentioned
by the authors. They show us also and specially that
facts absolutely analogous can be found in men. In a first
group of cases (Obs II. to IX.) we have seen hystero-
epilepsy coexist, we might better say cohabit with
epilepsy primarily established in the subject; the two
diseases then arise distinctly and remain separate in
their manifestations. A subdivision of this same group
is represented by Obs. X., where we see the epilepsy
only repeating itself with hysteriform symptoms. A
second and third groups comprise the cases in which
seizures of epilepsy or only vertigoes (petit mal) occur,
in connection with hysteria, then the principal and
primitive disease. Finally, we think there is place for
considering a fifth group, comprising the patients whose
attacks include at once epileptic phenomena and hys-
teriform symptoms, and which appear, nevertheless to
differ from hystero-epilepsy.-[Annales Medico Psychologi-
ques, Sept., 1881.


Art. iy.-Some Hints Relative to the
Prevention of Nervous Diseases.
By John CURWEN, M. D.,
SUPERINTENDENT OF THE STATE HOSPITAL FOR THE INSANE, WARREN,
PENNSYLVANIA.
TT is a true but trite maxim that mind directs and con
1 trols matter, but it is an equally true statement that
corporeal matter conditions mind, and it is to some of
these conditions, with their antecedents and consequents,
only briefly referred to in the books, and some rarely
stated, except in special monographs, that it is proposed
at this time to direct attention with a view to their prac-
tical bearing on the treatment of certain forms of disease
and disordered states.
Much has been written on the reciprocal influence of
mind and body, but unfortunately too little attention is
given to the matter when the necessity arises for a prac-
tical application of the principles involved, and herein lies
the reason of the failure in the treatment of so many dis-
ordered conditions.
The necessity of a sound body to insure the sound
and normal action of mind is constantly dwelt upon, but
how few of those, who thus speak so decisively on the
subject, have clear and definite views of what really con-
stitutes a sound body; or more strictly what amount of
attention have they given to the minute deviations of
structure which, unless carefully guarded, may lead on to
serious disease or death, and just at this point we find so
many of these conditions of matter which exert such a
baneful influence on mind and its normal action.
While a great deal has been written on the hereditary
tendency it is obvious to those who have thoroughly


Hints Relative to the Prevention of Nervous Diseases.
195
examined the subject, that there are considerations to be
given for the proper explanation of certain conditions of
the brain and nervous system, which do not seem to have
received that careful attention which their importance
actually demands.
It is freely admitted that there are mysteries con-
nected with this whole subject which have not yet, and
probably never will be satisfactorily explained; but in this,
as in all other matters connected with the elucidation of
disease, every physician is in duty bound to use all his
efforts and energies to remove as much as in his power
may lie anything which may tend to produce or keep up
any irregular or diseased action, and aid in the discovery
of whatever may tend to cause disease.
That peculiar mental and physical traits and charac-
teristics, special diseased states or tendencies are constantly
transmitted from one generation to another, no one will
deny, any more than that the likeness of the parents or
grand-parents may be recognized in the children or grand-
children. Every one must have noticed the fact, that in
many families there are one or more children who are
distinctly different in their mental organization and moral
condition from all the other members of the family, and
this is often so strikingly manifested from their earliest
years as to attract the attention of others than the mem-
bers of the family.
Facts have come to the knowledge of the writer which
seem to him to offer a clue which, if properly and intelli-
gently followed, may lead to an explanation of such pecu-
liarities. a
A gentleman of education belonging to a highly respect-
able family became insane, and in tracing out the history
of his case, the following facts were clearly ascertained :
That when about two years of age he had an attack of
paralysis, which so impaired the use of one of his legs
that ever after he was obliged to use crutches. There
was a degree of shrewdness and smartness in all his men-
tal manifestations in many respects above the average,


196
John Curwen.
that a
lon, as
the
but at the same time it was ascertained that he had
always been in temper and disposition, as well as in his
moral traits, different from the other members of the
family. In a conversation with a sister, a lady of great
intelligence and observation, she made the statement that,
during the time the mother was pregnant with this brother,
the family were living in the country during the whole
summer season, and the father was compelled by his busi-
ness to go into the city every day, and the cholera was
very prevalent there during that summer. The mother
was constantly worried and anxious lest her husband
should be attacked with cholera and brought home very
ill or probably dying. To use the lady's own words: “I
believe that this constant worry acted injuriously on the
child with which mother was then pregnant, and that
brother's mental condition and bodily frame were injured
and impaired by that constant state of fret and anxiety.
I have observed in my own case that I can see in the
dispositions and character of iny own children the traces
of the state of mind and bodily health in which I was
when pregnant with them.” A similar testimony could
be had, it is fully believed, from nearly every female with
a family who would carefully examine into the matter and
compare her own state during pregnancy with the char-
acter and disposition of the child afterwards.
The following case was reported by Dr. A. Robertson,
of Edinburgh, in 1874: “The parents of S. S. are people
in a very respectable position in life. They have a family
of twelve children; neither of the parents themselves, nor
any of their relations, nor any of their children, with the
exception of this girl, have ever shown any symptoms of
mental disorder. While the mother was pregnant with
this girl she suffered from a severe attack of Asiatic
cholera, from which she barely escaped with her life.
During this time she showed some symptoms of mental
disorder. She entirely recovered her former health, both
of body and mind, after her confinement. The child, S.
S., with whom she was pregnant while in this state of


Hints Relative to the Prevention of Nervous Diseases.
197
health, has from birth been quite different from the rest
of the family. The girl's bodily health has been good,
but her moral sense deficient. As a child, she was diffi-
cult to manage. On reaching the age of puberty, she
displayed want of control over her sexual propensities.
She consorted shamelessly with the male sex, and was
the mother of an illegitimate child at the age of fifteen.
She refused to say who was the father of the child. Her
character seems indeed bad throughout. She would not
engage in any useful occupation. She avowed her hatred
of her family—as her father well expressed it, her conduct
after the birth of her child was perfectly unbearable, and
her language was anything but dutiful and daughter-like.
She used foul language to her father and mother, threat-
ened to kill her sister and commit suicide.”
If any one is inclined to doubt and say that this is
going back to the old theory of children bearing certain
marks, in consequence of the forcible impression on the
mind of the mother of some particular object, it may be
stated in reply, that the evidence of trustworthy persons
must be taken when the facts are so clear as to leave no
other explanation possible, even should these facts be at
variance with our preconceived notions. It is clearly as
reasonable and proper to insist that the brain and the
nervous system may be impressed by a particular condi-
tion of the mother during pregnancy as to insist that the
likeness in all the facial features to either father or mother
may be impressed on the children, part of them bearing
the strongest resemblance to one parent and part to the
other in every respect. Is it unreasonable to draw the
inference that, while the healthy features and character
of the parents may be imparted by some as yet unknown
law, so that one child shall resemble the father and
another the mother, not only in outward form and feature,
but in temper, disposition and peculiarities, that a dis-
ordered condition of the brain and nervous system may
be induced by a particular state of the system of the
mother during pregnancy, particularly when that state


198
John Curwen.
may be one very strongly calculated to impair the integrity
of the vital functions or of the nervous organization ?
No one has yet been able to formulate any law which
regulates such conditions, but we know most certainly
that such things exist beyond any dispute and cavil. No
observing physician doubts the fact of the transmission of
disease, and the tendency to disease of different kinds,
from parent to child. It may be, in many cases, a tend-
ency, and only a tendency, while in other cases it is
actual, unquestioned disease. In what manner this tend-
ency may affect the different organs, more especially the
brain and nervous system, is yet a matter of the merest
conjecture. It may be a mere weakening of the part, or
a limiting of the growth, so that it shall not reach full
development in the minuter portions, or it may be in the
line of degradation of tissue or structure. That the brain
and nervous system are conditioned by the intemperate
habits of the parents, or by occasional indulgence in the
use of intoxicants, is proved beyond all dispute by the
facts of idiocy and imbecility of children conceived when
one or both parents were under the influence of liquor.
While men may not by the steady and regular indul-
gence in intoxicants seem to injure their own health, or
in many cases their children, there would seem to be no
reason to doubt that the impaired nervous systems of
many of the present and rising generation must be traced
to that indulgence in the parents.
In some it manifests itself in an insatiable desire for
stimulants; in others, by a special irritable condition which
is at times almost uncontrollable; in others, by a weak-
ness and inability to concentrate the thoughts and atten-
tion on any given subject, and so on through all the long
catalogue, from severe disease to a slight tendency to
nervous irregularity and disorder.
Is not the inability to resist the allurements of tempta-
tion to indulgence in intoxicants and the constant inclina-
tion to return to their use, even when the injurious effects
are known, acknowledged and deplored, part of the


Hints Relative to the Prevention of Nervous Diseases. 199
depravity of nervous structure arising from indulgence by,
some near or remote ancestor, and transmitted as a legacy
of suffering by a law of entail more inflexible than any
in human codes? Then, again, the mind is conditioned
by that disordered state of the nervous matter caused by
the constant indulgence in the use of tobacco. The facts
and the evidence on this subject are so strong that the
wonder is they are so little heeded, and the indulgence
of an unnatural appetite should be allowed to interfere
with the healthy exercise of the mind and nervous sys-
tem. If young men holding a good standing in their
studies, and rising in their grade are unable to maintain
that standing, and begin to retrograde as soon as they
indulge in the use of tobacco, is not the inference plain
and indisputable that the brain is injured by the poison
thus taken into the system?
A distinguished oculist of Philadelphia was consulted
by a gentleman who feared that his eyesight was failing.
After a careful examination of the eyes, the question was
asked: “How many cigars do you smoke in a day?”
and the answer showed an immoderate indulgence, when
the plain direction was given: “ You have your choice
either to give up tobacco or become blind.”
Suppose that in the case of such a man, with a sys-
tem over-saturated with the poison of tobacco, if procrea-
tion were possible in such a condition, he should have
exercised his marital rights so that his wife should have
conceived a child, what would have been the condition
of the nervous organization of such a child ? Is it not
reasonable to infer that the whole nervous system would
be sadly deteriorated, very much as in the case of chil-
dren born of parents whose systems, one or both, were
saturated with intoxicants ? It may not be exactly the
same in kind, but no reasonable man can believe that
some serious degradation of structure would not take
place in such a case; so minute it might be as not to
attract special attention, but yet of such character as to
nterfere to a greater or less degree with the healthy


200
John Curwen.
performance of the functions of the different parts of the
nervous system.
It will be said that this argument is founded on the
abuse of the articles mentioned, and no allowance is made
for their legitimate use. But can that be said to be a
healthy legitimate use which grows with indulgence, and
after a time becomes so strong a habit that more than
ordinary firmness and decision age required to break off,
and very many never can break off, but go on until the
man is completely enslaved ; and though in many cases
the man may not severely suffer himself, he will most
certainly entail on his children and his children's children
an inheritance of mental weakness and nervous disease
which will not cause them to cherish a very grateful
remembrance of such ancestors. It is a subject which
should receive the most earnest and thoughtful consider-
ation in all its aspects in these days when so much is
said and so little effectively done in preventive medicine,
whether the increase in nervous disorders and the weak
nervous organizations, so constantly met with, are not in
great part to be attributed to the habits and customs of
the past and present generation in the matter of indul-
gence, in a variety of ways, which gradually weaken the
general physical system, and, as a consequence, interfere
with and derange the nervous and mental.
The asthenic condition of so large a portion of those
the physician is called upon to treat very naturally sug-
gests to his mind the inquiry: Why should this be so ?
And if he will earnestly continue his investigations, in a
truly candid and philosophical spirit, he will most assuredly
be led to the conclusion that a large part of those who
come under his observation have derived that condition
from inheritance, and as part of that inheritance they
have also feeble powers of resistance against disease and
those agencies everywhere around them which tend to
increase their deterioration, but against which they have
not the will or the power successfully to contend.
As physicians our duty requires us to point out the


Hints Relative to the Prevention of Nervous Diseases. 201
known and acknowledged effects which will surely follow
certain causes, or the diseases and tendencies to disease
which will necessarily attend the indulgence of certain
passions and certain courses of living, and labor steadily
and persistently for the removal of these wherever they
may be found to exert a deleterious influence.
Men complain that the effects of evil habits and per-
nicious indulgences are felt to the third and fourth gen-
eration, but they forget, or studiously ignore, the equally
positive law, that the beneficent effects of correct living
and careful observance of the laws of hygiene will con-
tinue to the thousandth generation. Men assert that this
law is intended to apply only to violations of the moral
code, but if they will carefully consider they will observe
that its provisions are equally designed to cover violations
of those hygienic laws, which are as binding in their obli-
gations as those of the moral law, for the obvious reason
that man has a physical as well as a moral nature, and
the laws which govern one are as fixed and unalterable
as those which regulate the other.


Art. V.-Aphasia; Some of its Varieties.
By Wm. Julius Mickle, M. D., London, England.
IN the following three cases aphasia occurred under
I very different conditions. To the second and third
indeed some might be disposed to deny the term aphasia.
Nevertheless, when, among other parts, diffuse disease
affects the region to destruction of which ordinary aphasia
is due, and causes loss of articulate language, as well as
other symptoms, which latter modify the clinical aspects
of the case, one may well look upon the speech-affection
as a variety of aphasia. In both the failure of speech is
partially independent of paralysis of the organs of phona-
tion and articulation. In neither is it a mere result of
profound dementia or of stupor.
First CASE.—In the first of the cases to be described
below a considerable portion of the left cerebral hemi-
sphere had disappeared, the destructive lesion principally
affecting the ascending gyri, the second frontal, and the
supra-marginal. Aphasia was most pronounced and
persistent, and was of the more usual type, yet of the
left third frontal convolution only a very small portion of
the posterior part was involved in the principal and
localized lesion; of the insula only the very outskirts —
the coasts — were affected; but much of the lower part
of the ascending frontal was destroyed.
SECOND CASE.—In this case the aphasia accompanied
atrophy of the cerebral gray cortex in the anterior
regions, more especially affecting that of the left frontal
lobe, including its orbital surface. The gray matter of
the left insula was somewhat more diseased than that of
the right. No gross local destruction affected the motor
tract or zone, yet sclerosis, incipient, and, no doubt, also
of a secondary and descending nature, affected the right


Aphasia ; Some of Its Varieties.
203
side of the spinal cord, as if in dependence upon the
diffuse disease which attained its more extreme degree
in the left frontal lobe. This disease was of syphilitic
origin.
On comparing this with the previous case we find
that although aphasia and agraphia were present in both,
yet the clinical differences were not less marked than
those of the pathological anatomy. In the first case
gesture-language was still retained; in the second, it was
almost completely lost. In the first case the patient
indicated the use and purpose of any ordinary article ;
always recognized the correct name of such article when
it was mentioned, and dissented from any erroneous name
when intentionally applied to it; pointed out his own
name on the nominal roll of patients, and referred the
questioner to the date of his admission there entered ;
understood any simple question or proposition; and, when
not excited or sullen, proceeded to obey directions and
to comply with ward-regulations in an intelligent manner.
In the second case the patient failed completely in many
of these respects, and partially in the rest. In the first
the impairment of memory and general dementia was
not nearly so extreme as in the second. In the first
case anger, dislike and gratification, could be clearly
expressed and strongly evinced in physiognomy, gesture,
and mere phonation; in the second, this only occurred
in a momentary and very imperfect manner. Neverthe-
less, the first patient could not utter a single word
properly, while the second now and then gave utterance
to words or syllables, or repeated some irrelevant, broken
words or phrases, in reply to questions, in an ejaculatory
way, and on occasions a single oath or foul expression
passed his lips.
As to the morbid anatomy, we find in the first case
considerable, and rather sharply-defined, local destruction
and gross lesion in parts of the left frontal and parietal
and right parietal regions; and in the second case a
wide-spread moderate change of the cerebral tissue.


204
Wm. Julius Mickle.
especially in the left frontal region, but without any
very gross localized alteration of the kind observed in
the first case.
THIRD CASE-In this last, as in the second case, was
aphasia without any very gross, rigidly localized lesion,
but in this third case the aphasia was temporary and
recurrent. Here, again, was the portion of cortex most
diseased and wasted that of the left frontal lobe. There
were, however, no marked differences between the two
islands of Reil.
The frequently recurring epileptiform convulsions,
mainly, and sometimes solely, affecting the right side,
were always followed by more or less right paresis or
paralysis, and it was for some time after severe bouts of
convulsions that the temporary and recurring aphasia was
observed. It seemed justifiable to suppose that in this
case there was from time to time post-epileptic exhaus-
tion and functional abeyance of those convolutional
nervous centers and their connections, upon the destruc-
tion of which the more or less persistent aphasia of the
commonplace type depends. And all the more readily,
inasmuch as the part to which these centers are usually
assigned was affected with diffuse morbid change, so that
an additional, though transitory, disablement sufficed to
suppress the functional activity of the part completely,
and to produce a form of aphasia for the time being.
Thus, this case afforded another example of aphasia,
independent of any very gross, local, destructive lesion.
Were it necessary I could bring forward other cases
of the same nature as this third one, and as the second
one too. One such I have already published (Journal of
Mental Science, Jan., 1876). The following are the details
in each of the cases mentioned above:
CASE I. — D. P., military pensioner. He first came
under my care in 1872, with a very imperfect history.
He had been admitted in 1868, at the age of forty-two,
sunstroke being the cause of insanity assigned in the
“statement” accompanying his “certificates," and the


Aphasia ; Some of Its Varieties.
205
patient being described therein as suicidal and danger-
ous, but not epileptic. On and after admission he appears
to have been palsied, unable to speak and subject to
paroxysms of excitement, with disposition to be violent,
destructive and dirty. Subsequently, the disposition to
excitement lessened, and the condition was permanently
much as follows:
The patient could scarcely protrude the tongue, and
when urged to do so he depressed the lower jaw with
the left hand and disclosed the tongue lying helplessly
in the mouth, pale, flabby and swimming in saliva.
Pupils equal, susceptible; the right one oval in shape.
Facial lines and muscular movements more distinct on
the left side, especially when he smiled. He closed
the eyes fairly, but would not attempt to elevate either
angle of mouth. Right hemiplegia was present. In
walking the right leg was swung round, raised high from
the ground, and, advancing shakily, was finally placed
on the ground awkardly and without confidence, toes
outwards; the right arm was quite palsied, the elbow
flexed, the fore-arm semi-pronated, the thumb upwards
and covered by the fingers flexed into the palm. At
one time these parts could be raised and extended
painlessly, but later on any attempt to do this was
unsuccessful and painful.
Articulate speech was completely lost. By gestures
he could explain the purpose and use of any ordinary
article. If, in leading questions put to him, an incorrect
name was purposely given to any article, he shook his
head and looked dissent and slight annoyance, but
assented emphatically the moment the correct name was
applied, and it was at such moments that he made the
nearest approach to pronouncing the words “yes” and
“no." He could not repeat words after one, and made
facial expressive movements to demonstrate this inability.
He laughed at any suggestion that he had only lived a
short time here, and held up about, or quite, the correct
number of fingers to indicate the number of years. In
a similar way he indicated his age with fair precision.
The right hand was quite too paralyzed to admit of any
attempt at writing with it, and though he took the pencil
confidently in the left hand, yet he utterly failed to write
even a single letter. At times, when asked how long he
had been here, he would point to the wall on which
hung a nominal roll of the patients in his ward, and


206
Wm. Julius Mickle.
Lingericcasions hartial baldughout the disease.
sionaks
could always pick out his own name and the date of his
admission. The few inarticulate sounds he uttered were
by intonation made clearly understood as affirmative or
negative, the former resembling “ah,” the latter “oh,"
or “naw," and, respectively, as if resulting from the
attempt to enunciate "yes" and “no.” When pleased,
he smiled and uttered sounds of gratification; when dis-
pleased, he frowned, turned away, and readily uttered
harsh ejaculatory sounds, expressive of anger or dislike,
He would shake or nod the head, and thus express
dissent from, or assent to, any simple proposition.
Objects he always recognized; never a word did he utter
distinctly.
Later on, movement of the right leg became more
shaky, heavy and somewhat hopping; the right elbow
became bent at an acute angle, the fingers more flexed,
the whole limb more rigid and fixed to the side and
chest, and more manifestly somewhat wasted from disease.
Sight was apparently good. Throughout there were
dilated cheek-venules and partial baldness.
On several occasions he was laid up with pulmonary
attacks. Lingering signs indicated slight tubercle. Occa-
sionally he was irritable, obstinate, ill-tempered and even
noisy, with inarticulate cries. He died after an eight days'
illness, beginning suddenly with indications of bronchitis,
pulmonary congestion and tuberculosis, with occasional
vomiting, and, finally, four hours before death, a severe
general convulsion of six minutes duration, in which the
the rigid arm was partially straightened, and after which
the left arm was limp and palsied, and lividity, stupor
and rapidity of pulse and respiration increased. Then,
much bronchial mucus, retching, brown vomit, coma, death.
Necropsy (May, 1880).–Cadaver of medium height and
rather slender frame.
Much local destruction, atrophy and disappearance of
portions of the brain could be traced on its surface. For,
at parts, convolutions had disappeared, and their places
were taken by hollows, partly filled with serum, and
partly with thickened ædematous meninges, sunken, and
adherent to the grayish-yellow, softened, gelatiniform
remains of the destroyed nervous tissues, which readily
stripped away from the subjacent healthy structures.
The left was the cerebral hemisphere mainly affected,
and it was much shrunken and distorted. The destructive
lesion in this left cerebral hemisphere comprised an
the oral connd anallion and with inced afte
Ision of four hoberculosisions of bot days


Aphasia ; Some of Its Varieties.
207
The Savolutional suelst depth. Theyhe lateral v
irregular tract mainly involving parts of the following
convolutions :
1. The whole of the ascending frontal convolution;
except a small narrow band consisting of part of its lower
13 inch, which, though undestroyed yet, was shrunken
below the ancient surface-level.
2. The ascending parietal; most of the lower 14 inch
of it, however, escaping.
3. Much of the posterior half of the second frontal.
4. Behind the sound portion of the lower end of the
ascending parietal the fold therefrom blending with the
supra-marginal, and the anterior part of the supra-marginal
itself, were moderately affected by the same destructive
lesion.
5. The posterior part of the paracentral lobule had
similarly disappeared.
The gaps produced by this destruction and softening
of the convolutional surface of the left hemisphere were
nearly an inch in greatest depth. They extended through
parts of the white substance almost to the lateral ventricle,
undermining the basal ganglia all along their coasts. On
the ventricular aspect the left basal ganglia were some-
what less plump than the right, especially the optic
thalamus.
By the above changes, the undestroyed parts were
much disturbed in their position and relations.
Of the third frontal the destructive lesion affected only
the posterior boundary, where it blends with the ascend-
ing frontal. It was quite sound for a third of an inch
behind the perpendicular ramus of the Sylvian fissure.
Only the outskirts of the insula were affected, and slightly.
At the borders of the lesion the softened, gelatinous-look-
ing, gray matter stripped away readily from the white
substance.
6. To complete the record of the gross destructive
cerebral surface-lesions: In the right hemisphere a change
similar to those just described involved the whole of the
right supra-marginal gyrus, with the exception of a second-
ary gyrus at its posterior part, and it encroached upon
the ascending parietal for the space of an inch at, and
below, its middle. This lesion almost reached the right
lateral ventricle, at the upper part of the junction of the
body of the ventricle with its middle and posterior horns;
only the ependyma and a thin stratum of nervous tissue
remaining to form the wall of the ventricle at this point.


208
Wm. Julius Mickle.
The brain, generally, was flabby and rather pale. The
undestroyed portion of the gray cortex was atrophied in
front, and that of the anterior part of the left hemisphere
was thinner than that of the right.
Weights: Right cerebral hemisphere, 198 ozs.; left,
163 ozs., or 33 ozs. less than right; cerebellum, 5 ozs.;
pons and medulla oblongata, i oz. Fluid from cranial
cavity, 61 A. ozs.
Calvaria thick and dense; dura mater rather too
adherent too skull, thickened, rusty, staining and thin
filmy tissue on part of its internal surface, especially at
the base; patchy opacity of arachnoid, particularly over
the wasted sunken areas. No obvious thrombotic or other
changes in the large arteries about the brain-base, but
both here and in the depth of the great longitudinal
fissure they were surrounded by thickened little fibrous-
looking bodies, as if from the dying away of former
incipient tuberculosis of the meninges. The olfactory
bulbs and tracts were much wasted, especially the left
ones.
Pons Varolii.—The left half was the smaller, and there
was a sclerotic patch near the middle of a cross-section
made at its junction with the left crus cerebri; the latter,
or crus, itself being reduced in size as viewed in cross-
section.
Medulla Oblongata.— The left olivary body was much
the shorter of the two, viz., by one-fourth. The left
anterior pyramid was atrophied, much narrower than
normal, and most of it formed a narrow band, quite gray
and of a somewhat gelatinous appearance, about one inch
in length, commencing at the sulcus between the pons
and oblong medulla, tapering off below at the expense of
the external portion, and dipping, as it were, into the
anterior median fissure at the usual point of decussation.
Some of the outermost fibres of the pyramid were not
included in this gray degeneration. On the posterior
aspect there were no marked differences between the two
sides, yet the locus cerulæus and tania violacea were
more obvious on the left side of the ventricular floor than
on the right.
Spinal Cord. — Membranes opaque and edematous,
much serosity between the arachnoid and the pia-mater
and cord. The gray degeneration with atrophy was traced
far downwards through the right post-lateral column of the
cord, and after keeping in spirit this part was firmer and


Aphasia ; Some of Its Varieties.
209
more fibrous than the rest of the cord. The antero-
internal band of the left anterior column was atrophied,
but was not decidedly either gray or indurated.
Chest. — Old pleuritic thickening and adhesions over
both lungs. Bronchitis, especially in left lung, and extend-
ing to the bronchioles. Right lung congested posteriorly;
a few tubercles in its lower part; a few scattered, minute
sub-pleural tubercles, particularly at apex, and at the apex
some firmish nodules ; also a small putty-like and chalky
mass surrounded by pulmonary fibrosis; bronchial lymph-
atic glands enlarged, especially on right side. Left lung,
281 ozs.; right, 174 ozs.
Heart.—Pericardium universally adherent, strewn with
embedded tubercles of dirty-whitish hue in both its layers,
but especially in the dry intervening neo-membranous and
adherent formations. Left ventricle contracted; valves
healthy. Weight (with pericardium), 10 ozs. Left
coronary artery highly, and right slightly atheromatous ;
the aorta not.
Abdomen. — Right kidney, 44 ozs.; ordinary cysts; a
chalk-like deposit at bottom of one. Part of left kidney
hollowed out and forming a cyst, capsule slightly adherent,
54 ozs. Biliary calculi, consisting largely of cholesterine,
and causing cystic dilatation; biliary ducts filled with
greenish-yellow secretion. Nothing special about other
organs. Weights : Liver, 504 ozs.; spleen, 31 ozs.
Supplementing the commentary preceding the case-
history we remark as follows:
In the above case tubercular pericarditis, a compara-
tively rare condition, was present.
In the fresh state the portion of the cord affected with
the secondary gray degeneration was not indurated.
The convulsion preceding death was followed by palsy
of the left upper limb; favoring the supposition that con-
vulsive incitation had commenced in, or at once spread
to, the far less diseased right cerebral hemisphere as
compared with the left.
The right was fair, yet much of both supra-marginal
gyri was destroyed.
CASE II.-T. N., 2d Batt. 16th Reg't, admitted January,
1878, then aged thirty-six years; service eighteen years.


210
Wm. Julius Mickle.
First attack of mental disease, of duration from March,
1877, and for it he had been previously under treat-
ment in India and at Netley. Constitutional syphilis
was the cause assigned. His character had been good,
his habits temperate; no family history was procurable.
He had been treated for primary syphilis in 1865–66,
at Halifax, Nova Scotia, and with mercury.
At Netley he is said to have had a cranial node,
tenderness on pressure over frontal bone, and irregular
tibiæ.
Mental disease was first noticed at Secunderabad, in
March, 1877. Its advent was insidious; the habits became
changed, the behavior odd. Treated by counter-irritation
to scalp and nape, tonics, and good diet, he became
worse, and finally, before being sent here, was quite
aphasic, unable to write or to copy, demented, strange in
manner, secretive, restless, destructive, of impaired per-
ception and memory, and very dirty habits. Once, at
Netley, under great excitement he seemed to partially
recover speech, vociferating loudly, and pronouncing inco-
herent phrases with some distinctness, but by the next
morning he was as usual. The right pupil was reported
as being dilated.
Without describing the symptoms in detail, after admis-
sion, it may be said that the height was 5 feet 6 inches,
the weight 142 lbs., the face of a somewhat leaden hue,
and thin, sallow, cachetic appearance, the left groin
marked with a bubo-scar, and the right pupil the larger.
Both pupils acted, and reflex consensual backward jerk
followed any movement towards the eyes. He would not
grasp one's hand, but appeared to use either arm nearly
equally well, nor was there, then, marked palsy about the
face; the gait was rather awkward and jerky, and in
walking the right leg occasionally gave way. The
tongue was protruded jerkily, and with it the patient
frequently made clucking sounds. Sensibility seemed to
be fair in the hands; hearing was fair.
Articulate speech was in abeyance, a few ejaculations
and broken words were used, but in an unconsidered,
inappropriate manner; in fact they were merely exclam-
atory and automatic, or emotional, in origin. Scarcely
more than once or twice did he reply “yes” or “no,”
or use one or two other words correctly; the usual utter-
ances were “eighty," "eddy,” “I was eddy,” and others
of like nature, as “popples," " ettles,” “ton;” or “addles,"


Aphasia ; Some of Its Varieties.
2II
lied with quwith the lety of
"pock," "edly.” When plied with questions he became
agitated, slapped the top of his head with the left hand,
and shouted “eddy.” Asked what any ordinary object
was, he either said “eddy,” or slapped his chest with the
hand, and often there was no evidence of any intelligent
appreciation of what such objects were, or of the simple
questions put to him, and many simple directions he
neither comprehended nor obeyed. Yet he would usually
march when directed by voice and gesture so to do,
although on other occasions reiterated commands were
only imperfectly performed, or only led to a few restless
movements. Sometimes he would protrude the tongue
at request, sometimes not. In fact his condition varied
considerably within short periods of time. When requested
to write his name. he merely made irregular up and
down strokes. To the majority of simple questions his
irrelevant reply would be “yes,” or “who,” or “I was
eddy, eddy." When an ordinary article was shown him
he sometimes nodded, as if affirmatively; on its being
intentionally misnamed in order to test him, or, on other
occasions, whatever name he was asked either to confirm
or deny, he would say, “yes, pip, eddy.” Except on one
occasion he was unable to demonstrate or clearly explain
by gesture the object or use of any ordinary article, never
did he name it. Occasionally a monosyllabic oath or
obscene expression was ejaculated. He rarely made any
attempt to express himself by gesture-language. Dementia,
amnesia, aphasia, agraphia and failure of general language
function were obvious.
Afterwards, on various occasions, and from time to
time, the broken words previously used were replaced by
others, but my notes of various attempts at conversation
with him need not be reproduced here. As to tongue-
protrusion and hand-grasping he was very stupid. Thus,
when he had put out the tongue at request, he would go
on putting it out when told to do quite other things.
Singularly in contrast with this stupidity and inaptitude
was the comparative readiness with which he usually
would walk down the room at request. The tongue was
now free from tremor or twitch. For a time, after treat-
ment was first begun, he ceased to be wet or dirty,
except now and then at night. The right lower limb was
somewhat the weaker.
To summarize the notes: Later on, he was more
stupid about obeying orders; the tongue was somewhat


212
Wm. Julius Mickle.
sidste present ms of pulmo subsequent 4 lbs., hess at n
shaky and tremulous; he became very restless at night;
the body-weight, which had fallen 4 lbs., had increased
I lb. under treatment; subsequently it went down to
122 lbs.: signs of pulmonary tubercle and inflammation
were present; over the sacrum, hips, near anus on both
sides, on radial side of right wrist, immediately above
knee, and on dorsal surface of right second toe, sores
appeared and ran a rapid course. The pulmonary symp-
toms worsened; only inarticulate cries were uttered, and
noisily; every movement was attended with marked
tremulousness; passive motion was resisted; the knees
were drawn upward; the trunk was bent forward, and he
were drawnarch 24th, I did., hyd
Treatment. — Pot. iodid., hydrarg. perchlor., ammon.
carb., subsequently with ol. jecoris aselli; and, finally, ol.
jecoris aselli, ferri perchlor., quass., sp. chlorof. At one
period a few hypnotic night-draughts.
Necropsy – Head. — Calvaria thick, of slightly worm-
eaten appearance internally. Rusty-hued patches, and
delicate, filmy, neo-membranes on inner surface of dura-
mater on both sides. Large corp. pacch. Arteries at
base of brain healthy. Olfactory bulbs and tracts some-
what wasted. Streaky and patchy opacity of cerebral
arachnoid, especially on the supero-lateral fronto-parietal
aspects; of like distribution were the considerable ædema
and the moderate congestion of the meninges, and in cor-
respondence with the relative degrees of these changes
were the wastings of convolutions and rounding of sulci,
with subarachnoid collection of serous fluid. Cerebro-
meningeal adhesions were few and slight; in the right
hemisphere they were on the first frontal, marginal, rectus,
first and second temporo-sphenoidal, and subiculum; and
much the same on the left side, where also the third and
ascending frontal suffered slightly. In the right hemi-
sphere the gray cortex was pale and wasted, especially
in the supero-lateral fronto-parietal. regions. The left gray
cortex atrophied, and more so than the right, suffered
perhaps its greatest atrophy on the orbital surface and in
the frontal lobe generally, though almost equally in the
parietal. The left cortex about and near the base, includ-
ing the left third frontal, was paler than in other parts.
On both sides the white cerebral substance was rather
pale and firm in the anterior region.
Gray matter of left insula softer, and more reddish,
and on manipulation more easily splitting up into two


Aphasia; Some of Its Varieties.
213
irregular layers than that of the right insula. Examined
under the microscope, the left insula showed but few
nerve-cells, and these were undergoing degenerative and
pigmentary changes, and granule cells were forming,
whereas in the right insula the nerve-cells were of a more
healthy appearance.
The corpus callosum, fornix and white substance
about the lateral ventricles were unusually firm, as also
was the septum lucidum. The fifth ventricle was very
sharply defined. The lateral ventricles were large, and,
like that of the fourth, their ependyma was rather opaque
and firm. No obvious lesion of basal ganglia. Right
cerebral hemisphere, 16 ozs.; left, 15% ozs.; cerebellum,
5} ozs.; pons and med. obl., I oz. Fluid from cranial
cavity, 5 fl. ozs.
Spinal Cord.— There was sclerosis, apparently of a
secondary descending nature, in the posterior part of the
right antero-lateral column of the spinal cord, but in some
degree diffused through the column, scarcely traceable,
however, beyond the upper eight inches' length of the
cord. This part was not yet gray, but only whiter and
firmer than the corresponding part on the left side. Spinal
veins gorged.
Thorax.–Firm pale clot extending from right ventricle.
Slight dilatation of one aortic sinus of Valsalva, where,
also, was a calcarious mass in the aortic walls, and puck-
ered yellowish depressions. The inner surface of the
aortic arch was wrinkled longitudinally, and presented
slightly elevated, fibroid, whitish and slightly bluish and
transparent formations, overlying small yellowish or cal-
carious patches; or, at other points, the fibroid thicken-
ings, with here and there yellowish deposits; and elsewhere
yellowish and more ordinary patches. Coronary arteries
nearly healthy. Heart, Il ozs. Left lung, lobular and
hypostatic pneumonia, local semi-gangrene in lower lobe,
a few caseous masses in upper lobe; old pleuritic adhe-
sions, 34 ozs. Right lung, middle lobe densely caseous
and adherent to chest-wall; upper and lower lobes tuber-
cular granulations, caseous and inflamed patches; com-
paratively recent pleuritic adhesions, 39 ozs.
Nothing special about any abdominal organ. Kidneys,
6 and 58 ozs.; liver, 584 ozs.
Case III. – D. G., 13th Hussars. On admission, age
thirty-seven; height, 5 feet 7 inches; 'weight, 124 lbs.


214
Wm. Julius Mickle.
the sumelancholier on, Gubsequently have
Before suffering from mental disease this patient had
served in the army for over seventeen years, and, accord-
ing to his army “medical history sheet,” had had suc-
cessively syphilis, acute rheumatism, bronchitis, laryngitis,
chronic rheumatism, acute bronchitis, dysentery, bronchitis,
dyspepsia, hepatis and general debility. He died at the
age of forty-one, and four and a half years after the onset
of mental disease. During his service he was always of
a morose, discontented, querulous disposition. When
mental disease came on he was at first arrogant, defiant,
the subject of mingled exalted and absurd hypochondriacal
and melancholic delusions, and even of a suicidal tend-
ency; and, later on, a condition resembling melancholia
attonita supervened. Subsequently, were hypochondriacal
and melancholic delusions, occasional excitement, hideous
inarticulate sounds, and speech reduced to the ejaculation
of broken phrases. From time to time there were con-
vulsions affecting the right side of the frame and followed
by more or less of temporary right hemiplegia. These
convulsions occasionally passed over from the right and
invaded the left side of the body also. Sometimes they
appeared to be nearly general. Once, and once only,
they affected the left side solely or mainly. It is unneces-
sary to describe here the exact march and special char-
acter of the convulsions as made note of at the moment
of occurrence.
At times the patient was aphasic. This occurred sub-
sequently to various severe bouts of the fits, also followed
by dextral paresis. The words were broken and exclam-
atory; the same word did duty in reply to the most
differing queries, or even a syllable only, as if he could
not articulate more. Simultaneously, the power of swal-
lowing was generally unaffected or fair, and the tongue
and face but slightly paretic. An attempt on the patient's
part to converse, on these occasions, usually ended in a
prolonged repetition of one syllable or word, perhaps
replaced by several others in succession, and uttered in a
drawling, stuttering way. The word or syllable was quite
irrelevant to the subject. For a time afterwards, often
even for days, speech would consist merely of ejaculations.
Impaired sensibility of the right foot and hand to
pinching and tickling were observed after some of the
convulsions. Ataxia of the lower limbs was present; the
patellar-tendon reflex was absent entirely in the right,
and almost entirely in the left leg. The habits were wet
not articulateries, or even a duty, in re
es generally wmultaneouslv ny, as if


Aphasia ; Some of Its Varieties.
215
and dirty. He was the subject of hallucinations or illu-
sions of hearing and touch, and morbid visceral sensations.
Latterly, were temporary conjunctival injection with less-
ening of the usual pupilary mydriasis, and then opacity
and ulceration of the left cornea with persistent conjunc-
tival injection. The left was the more dilated pupil after
the fits, except on one occasion, when the right was the
wider. If a dab was made towards the eyes the head
was jerked away suddenly.
Convulsions recurring and followed by epileptic pare-
sis, continued to the end. Incoherence and dementia
were latterly well- marked. Various treatment was
employed, under which at one time he had gained 8 lbs.
in body-weight. Chronic mild phthisis preceded death by
three years.
Abstract of Necropsy,—Body emaciated.
Encephalon.—Delicate, cellular, loose-textured, soft neo-
membranous formations of the internal surface of the
dura-mater, especially on the left side of the cranium,
also rusty staining; and on the right side some irregular
thickening and vascularity.
Very marked arachnoidal opacity.
Edema of pia-mater.
Meninges, pale and somewhat thickened.
Atrophy of brain ; much arachnoid and subarachnoid
fuid, and 7 A. ozs. of serosity, in all, escaped from the
cranial cavity.
Cerebral gray cortex pale, atrophied in front, and
rather firm, especially in the left hemisphere. The wasting
was most advanced at the tips of the frontal lobes, and
the convolutions adjoining the left third frontal were
equally as atrophied as it. Only very slight, and very
superficial, and non-characteristic adhesion and decortica-
tion, and confined on the right side to the anterior tip of
the marginal gyrus; on the left to the same, and to the
third frontal, the lower end of ascending frontal, and the
anterior part of second frontal convolutions.
White cerebral medullary substance rather pale, slightly
too firm in the frontal regions, particularly in the left.
Brain-atrophy more marked in the left hemisphere, the
left weighing 181 ozs., the right 19 ozs.
Lateral ventricles contained 7 drachms of fluid ; ven-
tricular ependyma somewhat granulated and opaque.
Fornix partially adherent to surface of optic thalmi,
through intervention of velum interposition. Basal ganglia
avity.cray corte the left hof the food frontald very


216
Wm. Julius Mickle.
pale; no marked difference between them on the two
sides.
Some brown staining of meninges on anterior aspect
of medulla oblongata. Cerebellum, 58 ozs.; pons and
medulla oblongata, 14 oz.
Cord. — Posterior columns of spinal cord and medulla
oblongata slightly firmer than the other columns; spinal
cord pale, and apparently slightly wasted; weight, I oz.
As for the rest, there were old phthisical changes,
apical cirrhosis, chalky masses in both lungs, especially
in the left, and some more recent tubercles; caseous and
calcarious bronchial glands; slight incipient cirrhosis of
kidneys; and othing in the other organs that need be
mentioned here, except that the spleen was firm, small
and weighed only 21 ozs. Other weights: Heart, 8 ozs.;
left lung, 174 ozs.; right, 18} ozs.; left kidney, 5 ozs.;
right, 43 ozs.; liver, 513 ozs.
104 ozs.; left:, Heart, 81
Ver, 5171


Art. VI.-Inebriety- A Study upon Alco-
hol in its Relations to Mind and
Conduct.
By T. L. WRIGHT, M. D., Bellefontaine, Ohio.
THIS is a subject too great to be considered in all
its bearings. It will be necessary to content our-
selves at present with an examination of parts of it only.
When we discuss the elements of the mental states implied
in the treatment of our subject, we will perceive a won-
derful outspread of morbid mental conditions, and a sur-
prising complication of unsound mental processes.
Leaving delirium tremens out of the case, as well as
chronic alcoholism; leaving out also those in whom struc-
tural lesions are established—as of the liver, stomach and
kidneys, and which might produce modifying effects upon
the mind—we will, as a preliminary measure, look briefly
at the immediate sensible effects of alcohol upon the
human organism.
It is obvious that to get at the real and true influence
of this agent upon the brain and mind, it will be neces-
sary to observe its impressions as they appear upon taking
a full dose while in a perfectly normal and sober state.
To attain our end it will be best to note the effects upon
one who has a decided constitutional proclivity for alco-
holic stimulation, as such a one will be most apt to drink
deeply; and also upon one whose predisposition is to
drink periodically, as we will be more likely to find him
at times in a normal state, and not loaded with the debris
of previous indulgences. .
It is not presumed that the same unchanging results
will appear in every instance; but, as a rule, a full dose
of whisky or brandy, where the alcoholic eleinent is in
large proportion, will give rise to the following symptoms :


218
T. L. Wright.
The alcohol will seem to act as a shock upon the nervous
centers. The vaso-motor system will probably be impressed
in a very sensible manner. The face will become pale,
and the muscles of the countenance contracted in a semi-
spasm of a tonic character. The eye will appear bright
and glittering, as the spasm affects the muscles of the
eye-ball, producing a tense condition of the anterior sur-
face of that organ. The movements of the eyes will be
jerky and sudden; not deliberate and quiet. This also is the
consequence of the muscular tension. The mouth will be
firmly shut, but will likely be convulsively agitated when
a voluntary movement of it is attempted, just as some-
times is seen in a person suffering from intense cold. The
articulation of speech is imperfect, and the person on
endeavoring to talk is surprised to find that he is incap-
able of speaking in his usual deliberate and correct man-
ner. Respiration also will be performed with something
of labor, consequent upon the rigid state of the respira-
tory muscles. This fact will become more apparent upon
an effort to speak at length, when the words will be
delivered in a panting and labored way, as though one was
tired with running. At the same time there appears a
tension of the universal muscular system, which, without
mental confusion or dizziness, renders general movements
constrained and unsteady. There is indeed a universal
sub-spasm of the entire muscular system. The contrac-
tion of the countenance and individual features is plain
to the eye. The temporal arteries swell out under the
retracted skin, which has followed by virtue of its elas-
ticity, the general spasmodic contraction of the muscular
system.
It will seem upon reflection, that the glittering of the
eyes, and the whip-cord standing out of the muscles of
expression are, as in cases of genuine insanity, really the
physical indices of an approaching. mental disturbance.
They are the sensible muscular or motor reflexes of con- ·
comitant derangement in the ideational centers. There is
nothing gratifying in this situation of the nervous system.


Inebriety—A Study Upon Alcohol, Etc.
219
It does not invite the inebriate to the allurements of
drink. Its continuation, however, is usually very brief,
lasting but a few moments, or possibly an hour, when
other physical phenomena begin to arise. Of these no
note will be taken, as they are out of the direct line of
our inquiry.
As the alcoholic poison invades the ideational centers,
which it soon does when taken in quantities in strict rela-
tion with a strong impulsive proclivity, additional groups
of symptoms become developed. One of those groups
cannot be better described than by adopting Dr. Mauds-
ley's delineation of initial mania (Path. of Mind, p. 397):
“After a precursory stage of depression of longer or
shorter duration, sometimes so short as to escape notice,”
(like the stage of preliminary shock which we have
described), “the patient is often happy beyond measure
in a feeling of unfettered mental power, evincing a supreme
self-confidence and elation. Natural reserve and prudence
are replaced by confident address, by vainglorious preten-
sions, by bold and reckless projects; nothing is difficult
to him; he will sing who knows nothing of music, will
confidently speak at public meetings, though a public
speech would be the last thing he would try when in his
natural state, and withal, he is sly, crafty and untruthful.
He sometimes evinces acute insight; recalls forgotten
ideas; makes witty and satirical remarks; puns cleverly
upon words; hits upon acute comparisons, and displays
eloquence of speech beyond his natural capacity.”
It would be difficult to find a more truthful descrip-
tion of recent intoxication than is contained in this
language. And yet it is really a description of acute
mania. “I then felt so happy,” said a recovered maniac,
"my memory was clear and facile, and nothing fettered
my mind."*
This is the state to which the inebriate desires to
• It is profitable to note the opening symptoms of true mania, and compare them
with acute intoxication. It is true, mania progresses by degrees and stages, until
it becomes a picture of unspeakable horror. So also, intoxication prolonged leads
to scenes of equal misery and woe-as the chemical, and in the end, the structural
changes occur, which lead first to crime and then to insanity.


220
T. L. Wright
attain when he partakes of alcoholic liquors. It is the
field of Elysian bliss which allures him from his place of
honor and manhood, and impels him to enter the haunts
of inebriety and join in the revels there.
The acute mania of intoxication just described, though
conjoined with a certain motor inefficiency not distinct-
ively maniacal—which is superadded to the maniacal con-
dition—soon subsides by reason of the rapid elimination
of the alcoholic poison. By one oppressed with the mor-
bid neurotic temperament calling for intoxication, this
subsidence is not permitted to take place. The happy
state of uncomplicated acute mania is too pleasing to
permit of interruption or postponement; hence, frequent
repetition of the act of drinking keeps up the coveted
excitement.
Now, let us carefully examine what takes place. And
first, we know that mania has a tendency in general to
end in chronic varieties of insanity, even where there is
no alcoholic factor involved. But we will take no note of
that fact, and confine our inquiries to the moral and intel-
lectual aspects of the subject alone. We have said that
the objective point of the alcoholic inebriate is intoxica-
tion; while the rapid elimination of alcohol from the sys-
tem demands a frequent resort to that agent to keep up
the desired excitement.
Here we have a complication. The satisfaction is so
pleasing derived from alcoholic excitement and so enticing
that the natural desire is, when once it is established, to
maintain it, or, if possible, increase its intensity. There-
fore more liquor, and in inordinate quantities, is taken.
Several results follow: One is that the excessive
indulgence may terminate in complete stupor and uncon-
sciousness. Another, and most important one, arises from
a certain property of alcohol, namely, that it chemically
interferes with the oxidation and waste of the tissues.
This complication produces a state of the blood that is
characterized by imperfect arterialization. Such blood
always acts poisonously upon the brain, producing great


Inebriety—A Study Upon Alcohol, Etc.
221
distress and headache; while the prolonged excitement has
filled the cerebral vessels to repletion with this poorly
prepared blood in a stagnant or semi-stagnant state.
Dr. C. H. Hughes, of St. Louis, says: “If we look in
upon the brain with a microscope, we find it composed
of myriads of cells. * * * It is by reason of this
infinite number of these corpuscles—as infinite in number
as the stars are in the firmament, and as infinitely grand
in function—that the motions of thought and perception
go on and impress the material world without, and are
in turn impressed by it.”—[ALIENIST AND NEUROLOGIST,
Vol. II. p. 329.]
In this light, let us pursue our inquiries into the
moral and intellectual effects of alcohol upon the human
being. “We know,” says Dr. Chenery (Journal of Inebriety
Vol. IV. p. 91), “that alcohol acts injuriously on proto-
plasm, changing and destroying its chemical integrity,
and thwarting the evolution of cells.” And again, "alcohol
will coagulate the formative material, and harden the
containing envelope, and retard the development of cells.”
Dr. B. W. Richardson, of the Royal College of Physicians
(we quote from Dr. J. T. Searcy, of Tuscaloosa, Ala.)
says: “It acts on the corpuscles, causing them to undergo
modification of shape and size, and reducing their power
of absorbing oxygen from the air.” Dr. Branthwaite, in
a paper read in the International Congress at Brussels,
in 1880, asserts that “the generally received opinion is
that alcohol diminishes the exhalation of carbonic acid
by the lungs, and diminishes also the quantity of urea;
showing a diminution of tissue change, and consequently,
a failure to completely oxydize the nitrogenous substances
of the organism ;” and he adds that such an action of
alcohol would be accompanied with a diminution of tem-
perature; since an abatement of the oxidation processes
must be attended with a reduction of the heat thus
produced.
The impression caused by carbonized blood upon the
brain is well known. The cerebral pain is something


222
T. L. Wright.
terrific; and the inebriate suffering from that cause does
not fail to try and bring back the pleasing experiences
of his primary intoxication by drinking deeper still. The
consequence is, that while maniacal excitement is again
aroused, it is no longer pleasant and agreeable. But,
being weighted with the distress and agony of a brain
oppressed, and with a system at large surcharged with
effete matter, the excitement takes the form of distracting
frenzy—of unreasoning and desperate methods, and dis-
charges itself as the mania transitoria of epilepsy does
in acts of violence frequently, and of blood and murder
at times.
There is not complete extinction of the reasoning
faculties ordinarily; but the feeling of discomfort is so
urgent that those faculties are not questioned, and the
activity and energy of mania are precipitated in action
under the stress of an unmanageable morbid nerve agony.
It has been said that the natural disposition of a man is
exhibited when he is intoxicated. “One it makes a
furious maniac; another, maudlin and melancholy; a
third, stupid from the beginning.” When the operation
of the stimulant is recent, and it acts upon the unchanged
nervous system, this idea so universal is just. But
after the chemical effects of alcohol begin to declare
themselves, after the carbonized blood and retained urea
begin to sensibly poison the brain at the end of a pro-
longed and profound debauch, then all the natural
faculties and sentiments and idiosyncrasies distinguishing
individuality are lost and overborne by the tremendous
and universal oppression of a new group of poisons,
differing totally in their effects from alcohol. These poisons,
the final results of the chemical reactions of alcohol upon
the tissues, are the same in all cases. They usurp the
place of the normal characteristics in all those subject to
them. Their symptoms, as evinced by the moral and
intellectual processes, overwhelm all others. The symp-
toms are invariably the same, and they are invariably
bad.


Inebriety- A Study Upon Alcohol, Etc.
223
In the presence of those over whom he has power,
the inebriate thus affected is surly, irritable, morose ; is
in a mood which impels him to strike or otherwise abuse
anyone of his household upon the slightest suspicion of a
pretext; much as though he were the victim of epileptic
insanity. It matters not how mild, how affectionate, or
how sympathetic a man may be by nature, and when in
his sober senses, it is a fact that the drunkard always
abuses his family when he has come to the morbid con-
dition now under review.
There is a reason for this conduct quite different from
the inborn wickedness to which it is usually ascribed.
Generally, a crazy man is not aggressive unless he is, or
thinks he is, opposed or checked. Under such treatment,
however, he is apt to be resentful and raging. By
the public at large, the inebriate, as a rule, is given his
way unopposed, lest some scene of violence may take
place. But in his family he is apt to encounter remon-
strance or reproof; even if that should be delayed until
he is sober, he will take it up as though fresh and present
upon the repetition of his debauch, and then retaliate in
violence and fury. Besides, it is true that the drunken
man has sense enough, commonly, to conceive the disgrace,
and shame, and want he is inflicting upon his home and
family. It is a mistake to imagine that the insane man or
the drunken man is totally oblivious to the nature of
his surroundings. The tears, the rags, and the instinctive
fears of his little ones are reproaches, keen and bitter;
and in his frenzy he resents them with maniacal violence.
Insanity is the representation of a state of mind which
is the result of a morbid or toxic impression upon the
brain. Mental acts, thus superinduced, not being the
offspring of evidence and reason, cannot be readily con-
trolled or modified by evidence or reason, but only by
the removal of the morbid process or the elimination of
the toxic agent. Under such circumstances, and upon the
hypothesis of mania and deep inebriation being of kin, it
does not hold entirely good that because the inebriate is


224
T. L. Wright.
comparatively civil to people in general, he is exception-
ally guilty of a mean and selfish tyranny when he is
vicious at home.
There is something peculiarly striking in the intense
and adamantine egoism of an established inebriate. In
his worst moods, his kicks and blows appear to stimulate
him to a more violent and furious renewal of them; as
though his children weeping from his inhumanity, and his
wife cowering under the weight of his fist, might, per-
chance, seem to imagine he surely did not intend to be
quite so harsh, so fiendish. No! he strikes again, and
harder; for he cannot brook the suspicion that he makes
any mistakes, that he can be thought capable of any
course but that one which it pleases him to pursue. No
shadow of error in him.
This stage of inebriation calls for the strong hand of
the law. The man is an abominable nuisance, and he is
equally dangerous with raging maniacs who owe their
frenzy to other causes. But, whether such legal interfer-
ence will possess any virtue tending to the prevention
and cure of alcoholic intemperance in the abstract, is
quite another question.
There is another element in the case of the drunken
inebriate, which, no doubt, has something to do with his
astonishing cruelty. In the insane generally it is a fact
that there is likely to be more or less anæsthesia. In
the alcoholic victim, the alcohol itself, and the ethereal
changes made in it by acids, have an effect to produce
pretty well – marked general anæsthesia. Now, it is a
matter of minor consequence as respects the conduct of
the drunken man, whether he can reason fairly well in
an abstract way, as to the impressions of pain upon others;
the fact is, that since he is not susceptible to acute sen-
sations himself in consequence of anæsthesia, he has to
some extent gone out of himself; and his actions will be
in relation to his present state, and not in relation to his
normal condition of sensibility. Such a man will, in a
great number of particulars, differ materially from a


Inebriety—A Study Upon Alcohol, Etc.
225
healthy man. He will act towards others, at least to a
considerable degree, as though they were like himself,
insensible to pain. Much of his conduct is probably dis-
played with relation to his own insensibility, rather than
to the average sensibility of men in general. The various
hallucinations of certain of the insane—as that they have
swollen to an enormous size; that they float in the air ;
that they are divided into parts—are due to anæsthesia ;
and much of the conduct of the sodden inebriate may
receive an explanation of a kindred nature, without sup-
posing any further hallucination than might be derived
from his condition of anæsthesia, or general insensibility.
At first, in order to intensify his feelings of elation,
and afterwards to disperse the sensations of pain and dis-
comfort which begin to oppress him, recklessly and with
desperation, the spasmodic drinker pursues his course of
intoxication, sinking deeper and deeper into a state of
helplessness and distress, ever hoping that the next drink,
and the next will bring relief, until the stomach, so dread-
fully abused, refuses to respond in function, or retain any-
thing whatever.
Again changes take place. The various emunctories
slowly eliminate the alcoholic element, and the drunkard
is left without the morbid excitement and artificial strength,
while the chemical poisoning already described remains.
Great prostration now ensues. The respiration is sighing,
the pulse feeble, and the motor functions are much
impaired, while the brain, full of stagnant black blood, is
in a condition of the utmost pain and debility.
With the elimination of the alcoholic stimulant, the
state of anæsthesia is also removed. Not the brain alone,
but the entire system is loaded with retained effete
material, which produces upon the sensitive nervous sys-
tem an impression of misery that is beyond description.
The irritability of the prostrate nerves is now intense.
The slightest sound thrills the whole frame; every sensi-
tive fibre is in a quiver of uncontrollable excitement and
morbid apprehension. Anæsthesia being now removed,


226
T. L. Wright
the proclivity to inflict pain and revel in resentful cruelty
no longer exists. On the contrary, the acute hyperæs-
thesia is referred to a similar condition in others; and an
exaggerated regard to the rights and feelings of the outer
world is developed. Any tale of sympathy, or even a
train of sympathetic ideas, will cause the tears of maudlin
emotion to stream from the eyes. The want of moral
feeling associated with the state of anæsthesia, which pre-
vented a right interpretation of the sensibilities of others,
is now reversed; and the acute and morbid exaltation of
all the feelings and sensibilities, begets a correspondingly
acute and excessive sympathy for the ills, physical and
mental, of all those outside of self. Now, after a few
days, the periodic inebriate regains his natural health and
pursues his usual avocations, with a pretty firm determi-
nation to abstain from all future indulgence in alcoholic
drinks. We will see that this resolution will, as a rule,
be broken; and the impulsive inebriate will repeat, again
and again, the acts of alcoholic abasement.
But before inquiring how it happens that he does this,
in the face of what has already taken place in his history,
a few general remarks will be proper. It will be observed
that as yet we have noticed only the more prominent fea-
tures of present intoxication, not the moving cause—the
motive power, which leads to the initiation of dram-drink-
ing, and the subsequent intoxication. The mere treatment
of the drunken state, by law or otherwise, will not banish
the vice or cure the disease. But the effects of this dis-
ease are so decisive and far-reaching, that the removal,
or at least the restraint, of the condition of the human
constitution which leads to a desire for intoxicating
drinks, is surely of the utmost importance. Of these
effects we have only to speak here, as they relate to the
situation and acts of the inebriate himself. No matter
how vital they undoubtedly are in relation to the family,
to society, to the State — criminally, morally and finan-
cially — their relations in this wide sense will give us no
information which will enable us to curb the evil. We


Inebriety— À Study Upon Alcohol, Etc.
227
must go to the periodical drunkard himself, and inquire
what it is, that, being in his constitution, constrains him
from time to time to plunge into the abyss of intoxica-
tion.
The scenes and conditions which we have portrayed
are simply those belonging to well-known forms of mental
unsoundness. Dr. Maudsley says, respecting certain insane
forms, arising from several separate diseased states of the
body, that the maladies acting as exciting causes, impress
no specific qualities or symptoms upon them. Thus, syph-
ilitic insanity, puerperal insanity, hysterical insanity and
climacteric insanity are not modified in character by
exciting causes, and probably all of them are the conse-
quences of remote constitutional proclivities, rather than
of recent local or constitutional diseases. In the drunken
debauch, ranging in form from primary acute mania,
through the epileptic fury, and the final dementia and
paralysis, we have a series, and at times a complication
of actual insane phenomena, differing in quality from
other similar insane states only in the duration of their
existence. It is not enough to say that drunkenness
illustrates insanity. It is better to say that intoxication
is insanity. Many also hold the reasonable opinion that
the temperament calling for the excitement produced by
alcoholic stimulants is an outgrowth of an inherited con-
stitutional neurotic diathesis, just as a common insane
temperament is of kindred origin.
Dr. Dunglison defines the terms dipsomania and oino-
mania, in one particular, alike. They are said to signify
“an insatiable desire for intoxicating liquors.” It will be
observed that the word "insatiable” refers to matters of
sense and physical appetite, rather than to any emotional
or other mental act or condition. Dr. Maudsley says,
speaking of dipsomania: “It is a well-marked form of
mental degradation, if not of actual mental derangement,
which shows itself in a fierce morbid craving for alcoholic
stimulants.” Here, also, the weight of the definition may
be said to rest upon the mere wish to enjoy the particular


228
T. L. Wright.
sense of taste which belongs to the nature of alcohol.
Indeed this is the common view of alcoholic inebriety,
namely, a morbid desire to enjoy that special sense of taste
which it is one of the properties of alcohol to afford.
That there may be a natural liking for the cordial-like
taste of good wine is quite probable. An acquired fond-
ness for the agreeable bitter of malt liquors is not an
unreasonable supposition. But that there exists any tem-
perament or constitutional proclivity for the mere taste of
alcohol, is surely an erroneous supposition. There is no
insatiable desire, or irresistible impulse to enjoy the gusta-
tory sensation imparted by alcoholic liquor. There are
men, it is true, who are fond of the taste of alcohol as
afforded by ardent spirits, but who are not gratified with
the effects of alcohol, and who are not inebriates. It is
no doubt the case, that the drunkard may be pleased with
the alcoholic taste, and the alcoholic influence as well.
But the fact is well known that by far the greater pro-
portion of impulsive drunkards—those who drink deeply,
and drink strong liquors — positively dislike the taste of
alcohol, and gulp it down in haste, instantly thereafter
washing out the mouth and throat. That definition of
dipsomania which indicates that this term designates a
class of persons who, to gratify a mere gustatory whim
or appetite, 'will, in order to enjoy so trivial a pleasure,
plunge self, and family and society into turmoil and
destruction, places the inebriate in a position so detest-
able and wicked, that it is unjust even to him.
There is an objection, therefore, to the definition above
given, and it seems best to say that dipsomania is an
irresistible desire for intoxication—not intoxicating liquors.
This appears to give the true idea of that neurotic state
which impels to intemperance—to that constitutional tem-
perament otherwise known to many as one form of inebri-
ety. When the desire in certain temperaments becomes
overmastering, for the state of intoxication—for the mental
condition of acute mania—the case is very different from
the desire for alcoholic liquors in the gratification of a


İnebriety—A Study Upon Alcohol, Etc. 229
morbid sensual taste, or relish. True, alcoholic liquor,
affording as it does the quickest and readiest way of
securing intoxication, is chosen by the sound mind — not
the unsound — as its agent in accomplishing the morbid
and insane purpose; just as the rational faculties are often
compelled to obey the behests of maniacal authority under
other circumstances.
! When we consider recurrent mania, or view the char-
acteristics of epilepsy, we can readily perceive that there
may be seasons of mental repose and of apparent mental
health, which, nevertheless, under the unconscious opera-
tions of organic changes connected with heredity, do give
way to mania or to convulsions. There is no known rea-
son why the overwhelming desire for intoxication may not
also grow out of organic changes, and come even into
consciousness at stated intervals of time of uncertain
length. Let the periodic inebriate have this credit at
least—that his condition and his conduct are not the out-
come of a base pandering to sensual appetite ; but they
are the consequences of a constitntional impulse to enter
into an excited and morbid mental state of sublime,
though to a considerable extent uncontrollable and dan-
gerous properties. It must not be forgotten that dipso-
mania calls for intoxication — acute mania - only; while
the unhappy conditions connected with, and following
intoxication, must be attributed in a great measure to
certain unexpected and undesirable properties belonging
to the agent (alcohol) employed in effecting the morbid
purpose. They are superadded to the intoxicated condi-
tion, and they are in no wise objects in view when the
alcoholic agent is employed. Thus we see that drunken-
ness approaches more and more to the properties of
insanity, as we inquire more earnestly and particularly
respecting its prominent characteristics.
Let us now proceed to inquire specifically into the
peculiarities and relationships of the inebriate nucrosis.
“ This diathesis is,” says doctor T. D. Crothers, “only the
acute and chronic disease toned down and merged into


230
T. L. Wright.
a predisposition, which is more or less obscure.” That
the inebriate diathesis is frequently the legitimate produc-
tion and offspring of chronic intemperance in ancestry, is
certain. “Alcohol is the must powerful agent we know
of in the production of connective-tissue hypertrophy," says
Dr. Chenery (Jour. of Inebriety, Vol. IV. p. 94), “and thus,
of fibrous encroachments which must result (in the brain)
in atrophy and degeneration of the gray matter.” Such
structural changes are transmissible to posterity, and the
constitutional peculiarities connected therewith, reappear
in it. Of course the natural tendency would be to a
gradual return of the structural vice towards the normal
state; so that any measures which would tend to restrain
the inebriate from access to alcoholic drinks, would favor
the elimination of the morbid conditions upon which the
constitutional neurosis depends. Otherwise the alcoholic
temperament would be strengthened and increased until
such elimination would be impossible ; for when extreme
degeneracy is once established, the only relief is in race
extinction.
Bodily injuries are among the most prominent and
frequent exciting causes of inebriety. Dr. L. D. Mason,
in a tabulated statement of 252 cases of alcoholic inebri-
ety remarks that injuries of the head are more fre-
quently the causes of inebriety than any other. In one
out of every seven of the cases he reports there had
been injuries to the head. Again, other severe bodily
injuries, besides those of the head, had a remarkable
influence in producing an alcoholic proclivity. Of course
it cannot be known how many of the whole number of the
cases reported, owed their predisposing causes to injuries
received, it might be, in a more or less remote ancestry.
. When we consider the fact that the mind and body
are, in a large sense, one; that mental and bodily per-
fection consists in a preservation of a certain natural and
unstrained symmetry between the brain and the corporeal
structure at large, it is readily seen what serious conse-
quences a grave bodily injury would probably inflict upon


Inebriety-A Study Upon Alcohol, Etc.
231
the brain. Dr. H. P. Stearns (ALIENIST AND NEUROLOGIST,
Vol. I., p. 471, declares that a want of due attention to
the symmetrical development, or rather, education of the
brain and the physical body, is an important factor in
founding an insane diathesis. “The physical and psy-
chical should be in harmony."
How widely this harmony is often disturbed, and how
profoundly, we need not say. The loss of one of the
senses, we know, is followed by a sharpening of the oth-
ers. While some mental attributes are possibly obscured,
others are intensified. The brightness of the imagination
of Homer and of Milton, may justly be ascribed, at least
in part, to their loss of the visual sense ; so also, in great
bodily injuries of a permanent character, it is known
that new and remarkable brain adaptations take place.
Absence of brain function, correlative with the lost or
injured physical member, is followed by atrophy of struct-
ure. But it is undeniable that in such instances, just as
in those where there is destruction of an entire sense,
some compensating action is set up in certain parts of
the brain. It is manifest that in all such examples what-
ever may be gained specially, whatever is acquired in
artistic genius, and in instinctive alacrity and intuition; and
however beneficial this all may be to the world at large,
with respect to special departments—still the advantage
is at the expense of the symmetery of the organism.
Such a mind can never be truly well balanced. What is
lost is vital; what is acquired is aesthetic-non-practical-
but of surprising character, filling the mind with wonder
and admiration.
And so "function increases structure ;” and the new
powers develop new brain structure which propagates its
kind. But let us not forget that the brain is now no
longer symetrical. Its balance is impaired; and a thous-
and airy nothings may divert those delicate and wonder-
ful mental tendencies into unknown ways, and precipitate
them into morbid and distressing associations. They
coalesce, perhaps, by the physical conformation of different


232
T. L. Wright.
brains in lines of ancestry; and new peculiarities spring
up no longer aesthetic; no longer invested with the
mysterious powers of the “ulterior reflection.” On the
contrary, they may exhibit themselves in the forms of
neuralgias, asthmas, epilepsy, insanity, and the terrible
craving for intoxication with all its horrors. The oinomania-
cal diathesis may be thus produced, and the well-known
tendency of morbid neurotic temperaments to assume new
shapes and forms, not only in individuals, but in hered-
itary transmission, gives ample opportunity to some
certain neurosis, apparently associated with desirable
qualifications, to assume other and distressing form, as
the developments of life take place in passing time. No
neurotic diathesis, either of an exalted or depressing
character, is attended with happiness. The unbalanced
mind — the a symmetrical body and brain — is always
attended with worry and nervousness, making life wearing
and miserable.
Dr. J. S. Jewell, of Chicago, following the lead of the
distinguished Dr. Geo. M. Beard, declares, in his paper
on the influence of modern civilization on the produc-
tion of insanity, that there is “too much specialization of
nerve function in the pursuits and avocations of life.” It
is not unlikely that the peculiar pursuits and habits of
life alluded to are themselves the consequences of neu-
rotic predispositions, rather than the causes of them.
“It is a fact,” says he, “that civilization as we find it at
present carries with it the causes or conditions of decay,
or even of is final destruction; it is the nervous system
which is to be the chief theatre of the ruin with which
the race is likely to be overthrown.” * *
“In highly civilized communities there is a constant
tendency to a loss of balance in nerve development, in
which the sensitive side of the nervous system prepond-
erates over the motor part of the same. All disturb-
ances of symmetry or balance in development, tend
towards disease.” — (Journal of Nervous and Mental Dis-
ease, Vol. VIII., No. 1.) There is a remarkable instability


Inebriety- A Study Upon Alcohol, Etc
233
of nerve very general amongst the American people,
which is exhibited in various ways. It is a common
thing to see people, many of them of high intelligence,
who seem to be incapable of attending to serious affairs,
unless there is some subsidiary employment on hand which
acts as a kind of nervous balance-wheel. In some, such
employment may take the form of whittling; but it is more
frequently smoking cigars or chewing tobacco. This may
be a very small matter, but it means a good deal. It
shows that the leven of the neurotic temperament per-
vades a large portion of the population, and spreads
without definite boundaries. Too much subtilty, too
exaggerated a process of fining in a civilization is organiz-
ing, not healthy. A civilization associated with and largely
dependent upon neurotic traits is certainly morbid.
We must beware, however, of too great generalization
and refinement, lest we find that the normal is the
exception, and the abnormal is the rule amongst
men—to the destruction of responsibility and of legal
authority.
We forbear any further study of the evident relation-
ship of the oinomaniacal diathesis with the great family
of neurotic temperaments—whose mutual transformations
are well known—than may be contained in the allusions
inseparable from the pursuit of the general topic. What
would be the fate of the predisposition to intoxication;
whether it would remain latent, and gradually fade away,
or take on some of the other neurotic impersonations,
were it never to encounter the influence of intoxicating
stimulants, can not be told. But the fact is certain, that
could it be separated and restrained from the presence
of the chief exciting cause of intoxication, namely
alcohol, the phenomena of drunkenness, as they have
been depicted, would be impossible.
It is not necessary to enter at length into the discus-
sion of impulse. The periodic inebriate drinks upon
impulse, and frequently an impulse that he is powerless
to overcome. The only qustion is: Can an impulse be


234
T. L. Wright.
so urgent that it cannot be conquered by the will ? Dr.
Fordyce Barker, in the Guiteau trial, defined irresistible
impulses as follows: “Perversions of emotions to such a
degree as to produce a conduct entirely at variance with
the individual's former life, and to such a degree as to
completely control will power, would constitute an irre-
sistible impulse." It is the universal verdict that impulse
does not come from reason and judgment. “Good
impulses,” Maudsley asserts, “come from good feelings-
bad impulses from bad feelings.” “Impulses to action
come not from the understanding but from the feelings,”
is the doctrine of Compte. “Stress of function,” says the
former authority, "might be no more than normal to a
powerful and well regulated mind, but would be fatal to
the stability of an ill regulated mind in which the feel-
ings habitually overswayed reason.” This is directly
applicable to the desire for intoxication which arises, not
through reason, but through the feelings and emotions,
connected with, and growing out of the oinomaniacal
diathesis. This neurosis in activity simply points to an imbe-
cility of the understanding with reference to the state of
intoxication; and, in the words of an eminent authority,
“it would be as easy to argue away the temperament as
it would be to reason away the outcome of that tempera-
ment.” This strong language, however, would only be
really correct in such cases as where the demands of the
temperament upon the feelings were so urgent as to
oversway the judgment and will.
There is no desire to impress the idea that all excessive
alcoholic indulgence is the result of morbid impulse.
Much of it, doubtless, arises from a vicious propensity to
revel in low ideas and associate with low companions,
affording a certain occupation to minds too base to engage
in manly avocations. Such persons can restrain their
appetite at will; and to such, severe punishment will
prove reformatory, and will avail to promote the general
good. For in these subjects, like others, when the alcohol
takes possession of mind and disposition, the humane traits


Inebriety-A Study Upon Alcohol, Etc.
235
are lost and wickedness and danger reign sole masters.
Another class of drunkards may be named that is
less culpable — that in which there is, to some extent, an
inebriate diathesis, but which is not so uncontrollable as to
overwhelm the reasoning powers, and give to feeling unre-
strained sway. Such persons may refrain by a great effort,
but they have truly a life-long conflict before them.
Neither of these classes should be confounded with those
inebriates'in whom the neurotic state is the unquestioned
product of pronounced structural lesions or modifications
in body and brain.
Well marked cases of periodic inebriety are incapable
of refraining from the use of alcohol. The impulse is irre-
sistible.* Science and facts concur in this. Reason is
not questioned; and the feelings — the emotions rule the
conduct. Will is imbecile, for there is no reasoning, no
judgment, no conviction. An aborted will may be called
impulse — an incentive to conduct in obedience to morbid
neurotic force.
There are certain facts in connection with the neurosis
calling for intoxication, which seem at first glance to
antagonize the idea that alcoholic predisposition may be
irresistible. Chronic drunkards sometimes reform and never
again indulge in liquors. How is it that the established
habit of intemperance may be destroyed, while the same
habit in its earlier stages is irresistible? Here, unques-
tionably, a law of heredity, or evolution, appears in force.
“No man knows of a certainty his own character,” for no
man can say with assurance what trait of character the
process of evolution may bring to the surface, as life pro-
gresses; what trait, which, in due season, may represent
some idiosyncrasy or peculiarty derived from an unknown
ancestry. Not only may the neurotic temperaments
change, one into another, in the same individual, so that
• "Of all the hindrances to evangelization in Scotland,” says Dr. Blaikie, “the
most terrible is that presented by the traffic in strong drinks. There is hardly a
street. ward or parish vhere drink-shops are not like the stars of heaven for multi-
tude. The authorities argue that if people have a desire for drink, it is all the same
whether it is to be got within ten yards of their door, or twenty; whereas it is the
perpetual sight of drink that kindles the desire for it. I could resist five public-
houses on my way home,' said a man who knew the snare, but I cannot resist
twenty.'


236
T. L. Wright.
the disposition to intoxication may be replaced by some
other less obtrusive neurosis; but the passage of time,
introducing new and strange family traits, may also elimi-
nate, at some certain stage of life, the predisposition to
intoxication, even without introducing some other charac-
teristic. Hence, some temperance or religious revival may
find a drunkard who, from mere force of habit, keeps up
an intemperate course of life, and by severe moral impres-
sions it may destroy what has now become simply a habit,
no longer enforced by neurotic stress. Something of this
kind is occasionally seen in the strange recoveries of bed-
ridden people, who, at first suffering from real disease,
have become in time the victims of imagination after the
pathological condition has departed. Thus also the
sufferers from chronic rheumatism may be suddenly and
mysteriously healed by the application of some pungent
mental or bodily shock; and it is far from uncommon to
see the helpless hystero-cataleptic rise up and go about
her business upon the application of a powerful religious
impression.
Again, it sometimes happens that a person will take
to hard drinking in middle life, who previously had no
desire for intoxication. Here we perceive the establish-
ment by evolution of a neurosis which belongs to the
family train, but the development of which is referred to
the constitutional changes of progressive existence.
These apparent exceptions only prove the rule, and
aid in establishing the proposition, that the oinomaniacal
diathesis belongs to the great family of neuroses, which
are interchangeable, one with another.
This at once suggests the impossibility of the true,
unquestioned, spasmodic inebriate, refraining from the
indulgence of his nervous stress calling for intoxication.
This view is practically indorsed by every writer of
importance on this subject. The universal panacea for
dipsomania is restraint. Dr. T. D. Crothers declares that
“no case can be treated unless absolutely removed from
alcohol.” “Proper restraint,” says Dr. Gurdon W. Russell,


Inebriety- A Study Upon Alcohol, Etc.
237
“is necessary.” “ Restraint is an important factor in the
treatment of oinomania,” is the decision of Dr. L. D.
Mason; while Maudsley says, in relation to the treatment
of the impulsive drunkard, “restraint is truly needed.”
And so on, the unvarying decision is, that restraint is
essential to the successful treatment of oinomania. This
restraint, of course, means the forcible restriction, either
by moral or physical power, of the inebriate from access
to alcohol.
The universal dictum of these eminent authorities, not
witnesses to testify, but judges to decide of the necessity
of such restraint, implies the equally universal conviction,
that the neurotic drunkard is incapable of restraining his
propensity to intoxication; that, in fact, the impulse to
drink is at certain times irresistible.
This may be esteemed to be a form of insanity, or it
may not; but it certainly is such a condition of mind,
that the individual is incapable of controlling it by volun-
tary power in at least one important direction.
There is certainly some affiliation of the thorough
inebriate with the lunatic. Insanity is the profound dis-
turbance of the functions of the brain, as they relate to
reason and judgment, consequent upon actual disease of
that organ. Such disease compels brain function to
assume relations out of harmony with its surroundings,
and with the mental store of experience. Is not the toxic
effect of alcohol, altering and depraving the cell structure
of the brain, disease ? Are not the poisons, urea, and
carbonic acid, in the circulution, efficient and unvarying
causes of morbific operations in the brain tissue ? Can
any morbid or pathological process affect the brain under
any circumstances whatever, unless it is founded and pre-
dicated upon some toxic agent? Malaria is toxic; and
sudden and profound nervous shock, whether centric or
excentric in origin, is toxic, just as lightning is toxic.
By such agents only disease of the brain is inaugurated,
its functions wrecked or misapplied, and insanity estab-
lished.


238
T. L. Wright
In the various opinions expressed respecting the rela-
tions of the inebriate with alcohol, the former is usually
placed at a disadvantage. Alcohol is regarded as emi-
nently respectable. It is viewed as a symbol of power.
It represents agricultural and manufacturing interests. It
is a source of wealth and of fashion; and with it are
associated the ideas of stocks, and bonds and revenue.
The ruin wrought by it, on the other hand — the estab-
lishment and propagation of nervous and mental diseases,
the crimes for which it is responsible, the taxes and hard-
ships incident to the establishment of jails, penitentiaries,
hospitals and insane asylums, with their necessary officials,
attendants and equipments, to say nothing of domestic
wretchedness and want-are not often mentioned in their
proper relations with alcohol. As the originator of all
this woe, we hear only the denunciations of the personal
drunkard ; and, as though he were the willing and vicious
cause of it, he is viewed with detestation and horror.
Hence the cure of all the evils of intemperance is often
thought to be contained in the punishment or the isola-
tion of the individual inebriate.
That inebriate asylums are of very great utility ample
experience has demonstrated. But that asylum treatment
shall be extended to the innumerable hosts of habitual
drunkards is out of the question. Let alcohol be the
object of restraint rather than the inebriate. Let the
familiar appearance of the dram - shop cease to be
familiar, arousing as it does, the emotions and feelings
out of which springs the irresistible impulse to drink.
Let the astounding spectacle of a place of public resort,
where people are invited to come and partake of intoxi-
cating liquors be forever banished from sight.
Surely he who, being free from disease himself, doles
out the coveted liquor to the inebriate is, of the two,
more to be blamed for the sure and swiftly following
disasters which arise from intemperance. But more guilty
than either are the laws of the land which hedge in the
business of dram - selling with “rights,” and which


Inebriety— À Study Upon Alcohol, Etc.
239
protect those rights. And the great load of responsibility
for the untold and the unspeakable desolation wrought
by dram - selling rests, after all, upon the sober and cal-
culating people at large, who make these laws, and afford
this protection ; demanding and receiving in recompense
(in the way of dram - shop tax) a share in the tear and
blood-stained profits flowing from the dreadful business.
Art. VII.- Legislative Acts for the Control
and Care of Inebriates.
By T. D. Crothers, M. D., Hartford, Conn.,
ROTH
nn
SUPERINTENDENT OF WALNUT LODGE.
THERE are many reasons for supposing that the first
1 legal measures recognizing the physical character of
inebriety were in the Roman Empire, in the second century,
of the Christian Era. Ulpian, the Roman jurist, in A. D.
140, wrote that inebriety was a disease which should be
recognized and controlled by law.
Several references are made to such laws by the old
writers, which were probably passed, but never put in
practical operation. From the sixteenth century, many
legal measures having reference to inebriates, particularly
lessening the responsibility of crime committed during
this state, appear on the statute-books of nearly all the
European nations. In modern times the first special
enactment for inebriates as diseased persons, begins with
the projection of the asylum at Binghampton, N. Y., in
1854. From that time a number of special laws relating
to means for the control of institutions have been passed
in some of the States, but no general act giving full
powers of control appeared. In 1872 the parliament of


240
T. D. Crothers.
Victoria, in Australia, passed the first general inebriate
act in the world. This gave magistrates full power to
commit inebriates to special institutions for their control
and cure, and also provided that they should be retained
for periods which the judge and managers of such asylums
would determine. The act was a general copy of the
lunacy laws of both England and this country, in the
methods of examination, commitment and control. An
amendment was added to prevent action for damages on
account of mistakes that might arise. In 1874, the State
of Connecticut passed the second general law relating to
this subject. The law was drawn with care by the most
competent men, and has been considered the best and
most practical of all efforts to reach this class.
The following is the full text of the law:
AN ACT CONCERNING INEBRIATES, DIPSOMANIACS AND HABITUAL
DRUNKARDS.
Be it enacted by the Senate and House of Representatives in
General Assembly convened :
SECTION 1. Whenever any person shall have become
an habitual drunkard, a dipsomaniac, or so far addicted
to the intemperate use of narcotics or stimulants as to
have lost the power of self-control, the court of probate
for the district in which such person resides, or has a
legal domicil, shall, on application of a majority of the
selectmen of the town where such person resides or has
a legal domicil, or of any relative of such person, make
due inquiry, and if it shall find such person to have
become an habitual drunkard, or so far addicted to the
intemperate use of narcotics or stimulants as to have lost
the power of self-control, then said court shall order such
person to be taken to some inebriate asylum within this
State, for treatment, care and custody, for a term not
less than four months, and not more than twelve months;
but if said person shall be found to be a dipsomaniac,
said term of commitment shall be for the period of three
years: Provided, however, that the court of probate shall
not in either case make such order without the certificate
of at least two respectable practicing physicians, after a


Legislative Acts for the Control and Care of Inebriates. 241
pime of said
the opinion
case may be
an habitual become, as one of said ment, which
personal examination, made within one week before the
time of said application or commitment, which certificate
shall contain the opinion of said physicians that such
person has become, as the case may be, a dipsomaniac,
an habitual drunkard, or has, by reason of the intemper-
ate use of narcotics or stimulants, lost the power of self-
control, and requires the treatment, care and custody of
some inebriate asylum, and shall be subscribed and sworn
to by said physicians before an authority empowered to
administer oaths.
Sec. 2. Any person committed as a dipsomaniac to
any inebriate asylum in this State, under the provisions
of this act, may, after one year of treatment in said
asylum, be permitted by the managers thereof to go at
large on probation and without custody or restraint, tem-
porarily, or for a term of time, when and under such
conditions as the managers of said asylum shall judge to
be for the best interests of such patient.
SEC. 3. The managers, trustees or directors of any
inebriate asylum established by the laws of this State,
may receive any inebriate or dipsomaniac who shall volun-
tarily, or by the persuasion of others, make application to
be received into such asylum, and may retain such inebri-
ate or dipsomaniac for a period of not less than four
months, nor more than twelve months; and they shall
have over such inebriate or dipsomaniac the same legal
power of restraint as is given them by this act, in the
case of persons committed directly by any court or other
proper authority.
Sec. 4. Whenever any information shall be received
by any judge of the supreme or superior courts of this State,
that any person is unjustly deprived of his or her liberty,
by being confined or restrained in an inebriate asylum of
this State, such judge, at his discretion, shall appoint a
commission of three persons, who shall hear such evidence
as shall be offered touching the case, and, without sum-
moning the party before them, shall have one or more
private interviews with such person, and shall also make
due inquiries of the physician and superintendent having
charge of said asylum. Said commission shall, within a
reasonable time, make report to said judge, and if, in their
opinion, the party is not legally detained, or is fully cured
or recovered, said judge shall issue an order for his or
her discharge.


242
Î. D. Crothers.
Sec. 5. The commission provided for in the fourth
section of this act shall not be repeated, in respect to the
same party, oftener than once in six months.
Sec. 6. Persons placed in any inebriate asylum, under
any of the provisions of this act, may be discharged by
the managers in whom the government of the institution
is vested, pursuant to such rules and regulations as they
may from time to time adopt in relation to patients and
the management of the institution.
Sec. 7. The estate of any inebriate or dipsomaniac,
received by or committed to any inebriate asylum, shall
be liable for his or her support therein ; and the costs
and expenses of any of the proceedings herein provided
for, shall be paid in the manner and by the person or
party that the court or judge before whom the case shall
be had, shall order and direct, and such court or judge
is hereby authorized to issue his execution for such costs
accordingly.
SEC. 8. It shall be the duty of any officer of the law,
such as police sheriff or constable, to aid, or assist in the
arrest and confinement of patients, when called on by the
managers or attendants of any inebriate asylum, estab-
lished under the laws of the State.
Approved, July 25, 1874.
The English have a law on this subject, which, how-
ever, is cumbersome, and will not prove practical. The
Connecticut law is clear, and, so far, it has seemed to be
well adapted for the purpose intended.
The Australian law has been amended until it is simi-
lar to the Connecticut law, in allowing patients to legally
commit themselves for a short time.
It is a curious reflection on the legal intelligence of
the world, that only three laws exist giving full control
over patients, in three different quarters of the globe.


Art. VIII.—Simulation of Insanity by the
Insane.*
By JAMES G. Kiernan, M. D., Chicago, Ill.
AMONG the questions of interest, from an alien-
1 istic standpoint, which have been brought up for
examination by the Guiteau trial, this question stands
preëminent.
If (a fact of which I believe most firmly there can be
no question), there exists an abnormal mental condition
in this criminal, and if he be regarded as a case of
primary monomania, the primäre verrucktheit of the Ger-
mans, the manie raisonnante of the French, simulation is
what might have been expected. Assuming this to be
the case, his simulation is of rather a peculiar type
Insanity, 'as claimed by him, is different from the idea of
insanity as held by alienists, and is simply a quasi-legal
plea that he was inspired by the Deity to remove the
President; his free will was destroyed, and, according to
him, a man without a free will is in the legal sense insane.
To use his own phrase, he is “Abraham mad but not
crank mad.” Strictly speaking, Guiteau did not feign
insanity, but used a legal quibble. This plea was fatal to
a belief in his insanity, already existent in the minds of the
more intelligent laity, and had a very similar effect on a
large number of the profession.
Yet such a plea of insanity was a very natural one on
the part of an insane lawyer, and as the subject becomes
therefore of special interest, I have undertaken to exam-
ine the cases of simulation of insanity by lunatics reported
in the literature, supplementing them by three cases coming
under my own observation.
• Read before the Chicago Medical Society, March 20, 1882.


244
James G. Kiernan.
These cases, while not frequent, are not excessively
rare.
The Section on Mental Diseases of the International
Medical Congress of 1876,* unanimously adopted the fol-
lowing conclusion: “It is not only not impossible for the
insane to simulate insanity for any purpose, in any but
its gravest forms of profound general mental involvement,
but they actually do simulate acts and forms of insanity,
for which there exists no pathological warrant that we
can discover in the real disease affecting them.”
Dr. Nichols, † of Bloomingdale Asylum, New York, at the
conference of experts on the Guiteau case, cited the case
of a man who committed murder under, as he believed,
the command of the Virgin Mary, who appeared to him
in the flame of a candle. Two young lawyers were
assigned as his counsel; they advised him to feign
insanity, which he did, under the form of dementia.
The experts, Drs. Nichols and Ranney, detected both the
sham and the real insanity, and had him sent to an
asylum, where his insanity became unmistakable. Dr. Ray,
in his discussion of the case of Trimbur,f says:
“The criminal classes to which most of these siinu-
lators belong know as well as any one else, that the plea
of insanity is one of the dodges whereby people now
escape the punishment of their crimes, and they may not
forget to act accordingly when they are insane. Trimbur
being unconscious of his real insanity, but with mind
enough to understand his situation, and to remember what
he had heard about insanity in connection with crime,
concluded to make a show of being crazy.”
Dr. Workman|| cites the case of an insane man who
had escaped from his asylum and killed his wife during
an insane fit of jealousy; the man professed to the doctor
to be completely amnesic while under trial for murder,
denied that he had ever been under the doctor's charge
or that he knew anything about the asylum. The doctor
• Transactions of the Congress, pp. xix , xx.
+ Chicago Medical Review, Vol. IV., p. 544
1 American Journal of Insanity, October. 1874.
1 Cited by Dr Hughes, Transactions of International Medical Congress of 1876,
p. 1007.


Simulation of Insanity by the Insane.
245
stated to the jury that the man was both simulating
insanity and was insane. The prisoner was acquitted and
sent to the Criminal Lunatic Asylum, at Kingston, Canada.
The doctor saw him there two years subsequently. He
then fully recognized the doctor, and, in answer to a
question, said that “he did not want to know the doctor"
when previously examined by him. Had he been sane
he would, as Dr. Workman suggests, have known that
sufficient proof of his past insanity could have been pro-
duced, and he would have abstained from his clumsy
simulation, or he would have acted more cleverly.
Dr. John P. Gray* cites the case of a man who, two
or three days before being admitted was met in the
woods going toward his father's, carrying a gun, and
said he was “going to shoot the old man.” When
admitted he said “he had been out of his head for quite
a while; should think twenty-four hours.”
Dr. E. C. Spitzkat cites a case in which a criminal
lunatic, having all the signs of degeneracy mentioned by
Morel, feigned a type of insanity with religious delusions.
The most systematic article that has, as yet, appeared
in the United States on this subject, and which deserves
particular mention as being the most original contribution
to the subject of psychiatry at the Congress before which
it was read, is that of Dr. C. H. Hughes. I He says:
“The insane appear at times when they have an object
to accomplish more crazy than, and different from, what
they really are; this is the sense in which we use the
term simulation, and this condition is akin to that of
feigning by the sane. Simulation, while it presupposes
a degree of sanity, does not require that the patient
should be wholly sound in mind, and it might be attempted
by a convalescent patient not thoroughly recovered, desir-
ous of remaining longer in the hospital, or for some other
cause."
A case coming under his observation was as follows:
R. S., aged 25, married, had a history of domestic
• Report for 1876. p. 33
+ Journal of Nervous and Mental Disease, Vol. V.. D. 163.
I Transactions of the International Medical Congress of 1876. p. 1110.


246
James G. Kiernan.
difficulties, masturbation and three weeks insanity before
admission. Entered the Missouri State Lunatic Asylum
in April, 1867, and was discharged recovered November
of the same year. He had been a member of a variety
show before becoming insane. Soon after the onset of
his insanity he had been seized with a sudden desire to
preach, and, securing an audience in a country town, con-
ducted the services with such an outrageous disregard of
decency and propriety that he was driven from the pulpit.
At the asylum to which he was sent soon after, he went
through various insane performances, which were increased
or diminished as there was evidence of lack of interest or
the opposite among his auditors.
Dr. Hughes, in another article,* cites the case of a
lunatic who committed murder, and feigned to be more
insane than he was. From certain indications it would
appear that this condition would explain the psychologi-
cal problem involved in the case of Hamlet. As Dr.
Rayt suggests :
“In this scene he adjures his friends if they see him
bearing himself however strange or odd, 'as he might,
perchance, think meet to put an antic disposition on,'
never to let drop the slightest intimation of his design.
This remark, on which the theory of Hamlet's insanity
being feigned is mainly founded, indicates at most an
indefinite half-formed resolve to accomplish a purpose by
siinulating a disease that was already overshadowing his
spirit in all its fearful reality.”
I have myself elsewhere recorded † an instance in
which a case of katatonia feigned one of the symptoms
of that psychosis for a specified purpose. Laehr|| nar-
rates the case of a person in whom there was marked
hereditary taint, who committed a crime against morals,
shammed a form of insanity which he had not, and his
real insanity came out after the sham was exposed.
Pelman, who has made an exhaustive study of the
.
• American Journal of Insanity, October, 1874.
† Mental Pathology, p 572.
| Katatonia, Journal of Insanity, July, 1877.
Archiv. fur Psychiatrie, Band. I.
Irrenfreund, No. X., 1874.


Simulation of Insanity by the Insane.
247
subject, cites many similar cases; as also do Ingels,*
Stark † and Delasiauve. I
My own three cases are as follows:
L. L., aged 48, has had a brother and two uncles
insane; was for a long time a pauper; is somewhat
demented; has at times hallucinations of hearing; com-
plains continually about having tar and grease in his
head, and says he is insane in consequence. He says
but little on these subjects except to the doctor, and for
a long time refused to work as being insane and having
tar and grease in his head. He has found that his state-
ment of being insane and having tar and grease in his
head draw attention of visitors toward hini, and lead to
his receiving tobacco; he is therefore markedly obtrusive
with these statements when in presence of visitors. He
denies that he has hallucinations, and these can be drawn
from him only after prolonged questioning. The patient's
skull is asymmetrical, and he is one of the cases hover-
ing between primäre verrucktheit of the Germans, imbe-
cility and terminal dementia. The contrast between his
concealment of his real insanity, and the obtrusive manner
in which he manifests his assumed delusions is very
marked.
The second case was a case of hebephrenia (the
pubescent insanity of Skae; the primary dementia of
some asylum reports; one of the varieties of insanity of
masturbation), who displayed all the self-importance and
ideas of self-importance found in that psychosis, but who
found that a case of monomania attracted much more
attention than he did, simply because the latter claimed
to have written several of Shakespeare's tragedies; where-
upon he claimed to have written "all of Byron, all of
Shelley and all of Milton.” A simple cross-examination
showed this claim to be a feigned one, and this patient
not infrequently so admitted to the physician, but kept up
making the claim to visitors, although he refrained from
so doing to the physicians themselves.
I have seen one more case. A man who was a victim
of chronic secondary mania, who plunged every morning
into the river for a bath, breaking the ice if necessary to
secure it. This man found that by feigning dementia he
was able to secure tobacco and other little comforts, and
fests himnity, and contraste
e writtened to have... A sim
• Zeitschrift fur Psychiatrie. 1870.
+ Ibid., 1872.
1 Journal de Medecine Mentale, 1868.


248
James G. Kiernan.
he therefore kept this up on occasion, relapsing into his
usual condition when his end was attained.
Dr. Spitzka* has noticed such tendencies among hebe-
phreniacs frequently, both in the United States and in
Europe. I also have called attention to these in another
communication.t
Taking the cases cited by Nichols, Ray, Workman,
Hughes, Spitzka, Gray, Laehr, Delasiauve, Pelman, Ingels,
Stark and myself, it would seem fair to conclude that-
Ist. The insane can, and do feign insanity for a
purpose.
2nd. That the types of insanity so doing are, as a
rule, those in which there is a strong hereditary taint.
There may be a slight degree of dementia, but this can
not be extreme.
3rd. The type of insanity most likely to simulate
insanity is the primäre verrucktheit of the German, the
manie raissonnante of the French, the imbecility of the
first grade of Ray and Nichols, the monomania of Spitzka,
the chronic intellectual mania, or chronic mania, without
incoherence, of asylum reports.
4th The insane may feign insanity when accused of
crime, and a new complication thereby enters into the
question of diagnosis. It may be of interest here to note
that Dr. Ray's theory that Hamlet was an insane man
feigning insanity, will better explain the psychological
problem presented in this play than any theory yet
suggested.
• Medical Gasette March 16, 1880
† Gaillard's Medical Journal, Vol. II., p. 463, 1880.


Art. IX.-The Special Therapeutic Value
of Hyosciamine in Psychiatry.
By C. H. HUGHES, M. D., St. Louis.
I
HE Profession, and especially practitioners in psychi-
atry, having been long familiar with the tranquilizing
and hypnotic powers of hyosciamus in affections of the
mind and nervous system, were well prepared to put
into prompt practical use the excellent concentrated forms
of this efficient drug, lately presented to the profession
in the form of the amorphous and crystallized alkaloids.
Accordingly, we find emanating from various creditable
sources, concurrinġ testimony to the extended utility
and greater potency of these new forms of an
old and tried therapeutical agent, notwithstanding the
unsatisfactory opinions of Prichard and some other
English physicians, since Willis recommended it as a
substitute for opium, due, probably, to variable and
inferior qualities of the drug then in use. Notable
among these reliable witnesses to its efficacy we name
Dr. Geo. H. Savage, himself not an ardent advocate, but
rather an opponent of hypnotic medication in mania,
who reports in the Journal of Mental Science for April
last, a case of mania greatly improved by its adininis-
tration. So much benefited, in fact, that after having
given his patient, on the 14th of June, one-sixth of a grain of
Merc's amorphous hyoscyamine, morning and night, a similar
but single dose June 24th, the effect was, each time, to calm
a rising paroxysm of excitement. The result was
apparently “perfect mental and bodily health for over
three months.” A relapse occurred after injudicious man-
agement of the patient at home, but the subsequent


250
C. H. Hughes.
employment of the drug, under conditions similar to the
preceding, proved it to be as energetic in its action as before.
This patient's case was one in which "a year of other
treatment had done no good.” When the hyoscyamine
treatment was begun the “prospect,” Dr. S. states, “was
as bad as bad could be, for the intervals of sanity were
rapidly becoming less, and her mental state even in them
was not so good. She was more irritable and unstable,
had less self-control and confidence in herself. This
being the case, and hyosciamine at once checking the
return of the attacks and as certainly preventing the
attacks when given with the first sign of return, the inter-
vals becoming longer and longer with this cautious use of
the drug,” the doctor thinks he has “shown the case to
be one in which good has been done,” and we quite con-
cur with him in the good opinion he expresses of hyosci-
amine “to break the tendency to regularity of return in
attacks of excitement,” though we prefer to attribute this
good effect to the power of the drug to calm mental and
psycho-motor excitement, and think it quite as valuable to
check established excitement and break the tendency to
irregular as well as regular attacks of excitement, and
quite as important too, to use it in the one case as in
the other.
This is the testimony of one “very strongly against
the regular use of narcotics,” but who admits their use
“in suitable cases,” and the above is one of them.
Dr. Robert Lawson (West Riding Asylum Reports,
1876), though less sceptical of narcotics in mania in gen-
eral, found it equally efficient as Dr. Savage has.
Though Seppilli and Riva (Revista Freniatria, etc.),
after having exhibited the effects established by the
employment of amorphous and crystallized hyosciamine
in about forty cases of mental disease (mania, acute,
chronic and paroxysmal, lypemania agitata, dementia
agitata), conclude that it possesses no curative action,
and that there are not good reasons for much recom-
mending it; they nevertheless concede that it has two


Hyosciamine in Psychiatry.
251
indisputable features in which it is superior to chloral,
namely:
The facility and non-irritability of its administration by
hypodermic injection, they having made over four hundred
injections under the skin without unpleasant consequences;
and-
The great promptitude and certainty of its action.
In brief, the sum and substance of their experience is
that they are compelled to deny to this agent curative
powers, while they concede its efficiency as a potent
calmative of maniacal excitation.
Since there are no specifics in mania and the pathology
of so many of its forms remains obscure, still necessitat-
ing a symptomatic therapeutic, this must be regarded as
very valuable testimony, coming as it does, from such a
trustworty and discriminating source. The famous asylum
at Reggio-Emilia emits no ignis fatui in experimental medi-
cine and clinical therapeutics.
The testimony of many of our own asylum superin-
tendents, in their reports and elsewhere, likewise confirms
its value. Dr. John P. Gray, of the New York State
Asylum, at Utica, in a paper read before the Medical
Society of the State of New York, Feb. 5, 1880, and pub-
lished in the Journal of Insanity for April 1880, pronounces
it, after numerous clinical observations, not only “a sleep-
inducing remedy, often succeeding in cases of furious
insanity, when other remedies fail, and having the advan-
tage of easy administration,” but “thinks it produces an
effect upon the cerebral nerve-tissue of a beneficent char-
acter.” Though this latter conclusion is conjectural it is
reasonable. The proofs that it acts directly on the idea-
tional centers of the cortex are as strong as the demon-
strations that it influences the vaso-motor center of the
cord.
The testimony of Dr. Hurd, Dr. H. Shaw and other
superintendents of American hospitals for the insane is
likewise confirmatory. It could not be otherwise, for this
agent is simply a new form of an old and well-proved


252
C. H. Hughes.
drug. “Hyosciamine,” as Hartley observes, “is to hen-
bane what atropia is to belladonna. It represents the
activity of the whole plant.” Some physicians, not con-
nected with asylums for the insane, among them Dr. E. C.
Seguin, of New York, and Dr. L. C. Gray, of Brooklyn,
have confirmed, in the main, the testimony of Hartley and
the asylums, both including in their testimony that of
asylum physicians.
A lengthy inquiry into the general properties of so old
and tried a neurotic as henbane would be stale and
uninteresting, and we therefore lightly touch the subject.
Hartley's instructive chapters on belladonna and hen-
bane (and each should be read in connection with the
other, remembering what Binz has said about the chemi-
cal identity of their salts,) having largely exhausted the
subject, while long before Hartley wrote his book (in Jan.,
1869,) professional experience with this drug had been
such that he was constrained to say, respecting its med-
icinal use: “It is so well understood that I shall content
myself with a very few general remarks on this topic;"
and, with what follows, he concluded the record of his
experience with the uncombined drug:
“1. As a general sedative to the heart, it claims our first
consideration; and in functional disturbance arising from
emotion, the subcutaneous use of 4g of a grain of sulphate
of hyoscyamia exercises a most speedy and beneficial
influence. 2. In cardiac and pulmonary asthma, it is the
appropriate remedy, and when used subcutaneously will
often bring immediate relief. 3. In neuralgia it is a pow-
erful anodyne, but in affections of the nerves of common
sensation it possesses no advantage over atropia. 4. In
neuralgic affections of the internal viscera, especially of the
genito-urinary organs, it is more efficacious than belladonna.
Administered in any way, it is an invaluable remedy in
renal affections dependent on the oxalic or gouty diathesis. 5.
In nephritis, both recent and chronic, henbane may some-
times be substituted with advantage for belladonna. 6. In
spasmodic affections of the uterus, the bladder and urethra, the
antispasmodic and anodyne effects of henbane are very
decided. The eneuresis of young persons is very speedily


Hyosciamine in Psychiatry.
253
ameliorated, and ultimately removed, by the judicious use
of this plant. 7. In hypochondriasis, and in epilepsy arising
from emotional disturbances, I have found henbane very
serviceable. It must be given in full doses, and occasion-
ally. In other varieties of this disease, and in convulsive
affections generally, it has proved useless in my practice.”
It remains, therefore, for us chiefly to consider the
special 'uses and effects of hyoscyamine, as deduced from
our own clinical experience with both the crystallized
and amorphous alkaloid. Seguin's report on the use
of hyosciamia as a hypnotic and depresso-motor, to the
New York Therapeutical Society, Feb. 13, contains many
interesting facts, which the interested reader may find
in full in the Archives of Medicine for April, 1881, and
which need not, therefore, be reproduced here.
But to the general practitioner wishing to employ the
new drug, a more instructive guide to its safe administra-
tion cannot be found than that given of its effects by
Dr. J. Hartley. From his “Old Vegetable Neurotics,” we
transcribe his account of its physiological action on man
(p. 322), omitting his confirmatory experimentation :
“ Physiological Action on Man.—Hyoscyamus or its
active principle, when given in small doses and such as
are insufficient to produce positive dryness of the mouth,
rapidly subdues ordinary excitement of the pulse, and
reduces it, within an hour or two, to its lowest rate; that
is to say, to the condition in which it is usually found
after a long period of complete rest of mind and body.
For example, the pulse of a man ordinarily engaged shall
be 80. After a small dose of hyoscyamus (to of a grain
of sulphate of hyoscyamia, or 4 drachms of tincture of
henbane), it will gradually fall to to 60 or 50. In another
person, whose pulse may be 72, we shall at the end of
the same time find it steadily beating about 45. Schroff
states that is of a grain of hyoscyamine reduces the
pulse from 79 to 18. In all my experiments with hyoscy-
amus and its active principle, I have never observed the
pulse to fall lower than 40.
After doses Go to i of a grain) sufficient to produce
complete dryness of the tongue and the hard and soft
palate, the pulse will generally experience an acceleration
of 10 or 20 beats, and be increased slightly in force and
orain) : the in accord


254
C. H. Hughes.
volume. This change in the pulse will be observed in
from 10 to 20 minutes after the subcutaneous injection of
hyoscyamine; the acceleration does not usually continue
for longer than 20 or 30 minutes, and rarely lasts for an
an hour. Then the pulse slowly declines, and gains a
little in force and volume. It usually decreases about 5
beats for every interval of 20 or 30 minutes, until, at the
end of an hour and a half or two hours, it attains its
minimum rate. After a small dose (d of a grain) the
pulse will usually fall without any previous acceleration.
Apart from these accelerating or depressing effects on the
pulse, the following symptoms will be observed after
moderate doses (30 to 24 of a grain): In 10 to 20 minutes
from the time of injection, the tongue more or less com-
pletely dry, rough and brown, the hard and soft palates
dry and glazed, excessive giddiness and a weight across
the forehead, somnolency, the cheeks occasionally a little
flushed, and the membranes of the eye sometimes slightly
injected. After continuing for about an hour, these symp-
toms pass off; and the tongue and hard and soft palates
become covered over with a sticky, acid, offensive secre-
tion, agreeing in all respects with that which follows the
action of belladonna. The pupils slowly dilate during
the latter part of the action of the medicine, and at its
close attain their maximum degree of dilatation.
“If larger doses than 1 of a grain be given, the
above-mentioned effects will be increased, and prolonged
for two or three hours; and they will be accompanied
either by wakeful quiet and usually pleasing delirium,
with illusions of the sight; or with such excessive som-
nolency that the patient cannot keep the eyelids raised
for a few seconds, but, when aroused, lapses again into a
dreamy sleep, broken by occasional mutterings and slight
jerkings of the limbs. In either case, the power of main-
taining the erect posture will be lost, and at the best the
patient reels like a drunken man.”
Bartholow has spoken of this drug as excito-motor in
its effects on the nervous system, while Seguin, with equal
emphasis, considers it a depresso-motor ; whereas it is both,
or neither, according as it is administered. It has the
former effect if given in inadequate and untimely doses,
and the latter, if given in inordinate doses too long pro-
longed in its administration. When judiciously given, as


Hyosciamine in Psychiatry.
255
Prichard and many others since him have testified con- ·
cerning it, “it has no stimulating influence, but diminishes
sensibility and irritability without any previous excite-
ment,” as we have over and over again found to be the
fact, if the dosage of the remedy be exactly proportioned
to the excitement to be overcome, and its therapeutic
effects be not aborted, i. e., if it takes full possession of
the excited brain and disturbed sympathetic system,
immediate sleep will follow, from which the patient most
frequently awakens, always somewhat, and sometimes
greatly benefited. But if several ineffectual doses have
been given previously to the procurement of sleep, it is
likely to leave a degree of languor and depression not
desirable.
It is the ineffectual and excessive doses, therefore,
which both excite and depress our patients. Our aim,
consequently, should always be to take full possession of
the patient's nervous system, as with chloral, and other
like hypnotics, by a single dose. We can not do this
by the employment of the so-called minimum doses, but
a five to ten minim dose of a one grain to the drachm
alcoholic solution of the amorphous non-crystallized alka-
loid, will in general quickly induce sleep in an ordinary
case of delirium and delirious mania. We speak only of
its use hypodermically, as it is not so satisfactory a
remedy for administration by the mouth, having been,
in our experience, much more tardy and uncertain in
its effects when thus administered. Nevertheless, when
thus given it does not cause nausea or pain as morphia
sometimes does, while, like morphia, it sometimes produces
abscesses under the skin.
It is a remedy especially for hypodermic use, and in
its use we should bear constantly in mind its capability to
excite or depress the psychical and psycho-motor centers
of the cerebrum, according to the dose in which we employ
it, and, in some instances, according to the idiosyncrasies and
diathesis of the patient, and we have also, to bear in mind
that when its employment is especially suggested we have


256
C. H. Hughes.
mainly to do with neuropathic organisms, or the insane
temperament, or diathesis, as it is termed, for it is in these
cases where it is capable of being used and does most fre-
quently have the best effect. “Even in cases of cerebral
irritation,” as Hartley states, “henbane may do harm,
unless its action tends to produce hypnosis rather than
delirium” (Old Veg. Neurotics, p. 340 Ed. 1869).
These untoward effects have been very rare in our
experience, and have never happened when we have used
the alkaloid in its amorphous form and hypodermically.
Hartley, too, found its excitant action exceptional.
“In its action on the cerebrum,” he says, “henbane
approaches very nearly to opium. And generally we may
regard it as opium, minus the excitant action on the motor
centers, which is an essential part of the action of the
latter” (Old Veg. Neurotics, p. 339, 1860).
Dr. Reinhard's experiments with this medicine in
mania and epilepsia, in the Asylum at Halldorf (Archiv.
fur Psychiatrie, XI. Band. 2 Heft.), lead him to assign it
only a moderate therapeutic value. He found that it-
a. “Tranquilized and shortened the duration of the
mania and delirium, especially when there was menstrual
disturbance.” We have seen no special benefit in the
latter complication.
b. “ It diminished the number and intensity of epileptic
attacks, especially when the pulse is small or jerking."
Hartley found it only of value in certain forms of
epilepsy arising from emotional disturbance. In other
varieties of this disease, and in convulsive affections gen-
erally, it proved useless in his practice (O. V. N., p. 340).
The latter conclusion is at variance with recent observa-
tions of Seguin. We are not now considering the pos-
sible antispasmodic properties of this agent, which have
probably more indirect than immediate effect upon the
cerebrum.
The disturbed pulse is so common in epilepsia as
scarcely to be an exceptional indication. In our experi-
ence hyoscyamine in epilepsy is of doubtful benefit, not


Hyosciamine in Psychiatry.
257
at all comparable to chloral, as we have already said, in
arresting or shortening the paroxysms.
c. “Reinhard thinks it damages nutrition,” but it does
not, when given only in single full and effective doses at
night; at least we have never observed this effect in our
cases.
d. His caution against its continuous use on account
of its effect on the heart, especially is judicious, for,
like all the therapeutic agents of value of its class, it
is a vaso-motor and cardiac depressent, but there is no
danger; on the contrary, great benefit from a single
full dose given at night time, and followed, as it usu-
ally is, by a prolonged and refreshing sleep. We have
seen an irritable pulse and brain — the latter in a perfect
tumult of erratic ideation — become, after its employment
and a night of rest, regular and normal in their actions,
remaining so for hours, especially in acute delirious mania.
These effects we have seen again and again repeated in
the same and in different cases.
1. The special uses of hyoscyamine thus far indicated
are in delirium, especially maniacal deliriuni, when prompt
and decided arrest of cerebral disintegration is demanded
and psychical excitement must be at once subdued, and
it should always be preferably given under the skin.
2. It is specially indicated in the young and middle-
aged, being less liable to abortive action in them than in
the aged; for though old persons are readily influenced by
henbane, as Hartley has noted, it is apt, for some not fully
explainable reason, probably on account of atheromatous
states within the brain and unequal arterial contractility,
imperfect vaso-motor or cortical impressibility, to aggravate
rather than calm delirium, though we have occasionally
given it with admirable effect in a few old persons who
have not shown much evidence of senile decrepitude. We
have refrained from using it in the aged when there
has appeared the arcus or ptussus senilis, atheromatous
arterial degeneration or other marked evidences of physical


258
C. H. Hughes.
degeneracy-indicative of “the beginning of the end” of
life.
3. The special forms of delirium in which hyoscy-
amine has acted best in our experience are delirium
tremens and incipient acute mania, in which visual illu-
sions of small and near objects torment the patient and
there is constant action. The effect of dispersing visual
hallucinations is probably due in part, at least, to its dila-
tion of the pupil. It is also an especially desirable remedy
in acute and violent cerebritis of the sthenic type, when
cerebral excitement is high and the pupils are contracted.
On the contrary, it is contra-indicated in the indefinite
asthenic delirium of some forms and stages of dementia.
Hartley's caution against its administration in advanced
age, and especially when associated with great muscular
weakness, may well be extended to markedly exhausted
states of the cerebrum, in which structural change and
marked cell degeneration in the cortex, rather than mere
cerebrasthenic and vaso-motor disorder, are the most
appreciable cause of the psychical disturbance.
4. It can not, therefore, be so safely given in post-appo-
plectic delirium, or in that resulting from a cerebral embo-
lus, or suspected softening. It is singular that it does not
answer so well in post-epileptic psychical disturbance as
chloral, but such is our observation; for it exerts some
influence over epileptic convulsions, as Hartiey and
Reinhard * have asserted, but it is by no means compar-
able to chloral enamata either in this or other forms of
spasm. Its influence on the sympathetic may be to some
a satisfactory explanation; but it dilates, when further
dilation is possible, the already dilated pupil of epilepsia,
while it steadies their mobility, the latter effect, probably,
by making the paralysis of the iris fibres complete.
5. Hyoscyamine does not constipate, or produce gastric
pain or nausea, as morphia often does, but then it is not
a remedy for the stomach, and, unlike chloral, its admin-
istration is never followed by headache. Its invariable
• archiv. fur Psych XI. Bd., 2 Heft.


Hyosciamine in Psychiatry.
259
effect of dilating the pupil is both a commendatory and
objectionable property. The indications for dilation have
been referred to, while the undesirableness of this effect,
in many cases, is obvious.
As an alternating remedy to other hypnotics, it is of
signal value when sleep has to be repeatedly induced and
for a long time, or psycho-motor convulsive movement for a
long time, and often, overcome in the same patient; but that
it has any advantage over chloral hydrat, or that it is in
the majority of cases as valuable as chloral, is doubtful.
Indeed, we greatly prefer the latter, when it can be given
by the mouth, largely diluted with water, notwithstanding
we have regularly and for many days in succession pro-
cured prolonged and refreshing sleep in cases of high
maniacal excitement, when nothing could be given by the
mouth, and no other hypodermic acted so efficiently, the
patient going to sleep night after night after a five or six
minim dose of the aforementioned solution of the alkaloid
(gr. j. ad 3 j.). But that it has any specially curative
action on mania independent of its power to tranquilize
and rest the brain through the sleep it induces, we have
had no confirmation from our observations though it cer-
tainly has a beneficial effect in this way, and Nature
recuperates the brain rapidly and effectually in many cases
if ample and timely sleep is regularly induced. We would,
therefore, restrict its use to the less exhaustive forms of
mania and delirium, and for controlling convulsions, employ
it as an alternative rather than as a principal therapeutic
agent.
The position of the patient most favorable for its salu-
tary action is the recumbent one; the time, night time;
the maladies, acute deliriums or manias, preferably of a
sthenic type with active psycho-motor excitation.
It is not equal to morphia in melancholia though it is
a good alternative expedient with quinine, camphor and
cannabis indica superadded, to avoid the establishment of
the morphine habit for the long contined use of which
may be necessary.


260
C. H. Hughes.
It ought to be seldom given, not more than once
in twenty-four hours — notwithstanding it is sooner than
this eliminated and its perceptible effects soon pass off-
and in full doses, and the patient kept recumbent till the
system is fully under its hypnotic influence, when, of
course, no active surveillance will be required. We have
never ventured the experiment of giving it to a maniacal
patient and leaving him or her to go about after its
administration. Such a course, from what we know of its
physiological power, might prove disastrous to a greatly
excited and debilitated maniac by paralyzing the heart;
for, like atropia, in toxic doses it depresses the vagus
as well as the sympathetic and psycho-motor centers. In
subsequent numbers we shall give some clinical illustrations.
Art, X.-Aphasia and Agraphia-Cases.
By D. V. DEAN, M. D.,
SUPERINTENDENT OF THE ST. LOUIS CITY HOSPITAL.
CASE I.—Permanent Aphasia, from Syphilis or Embol-
ism (?)—Mr. C. W. S.. aged 33 years, single, miner,
right-handed, was admitted to hospital, June 14, 1880. He
had had a sore on prepuce, treated as syphilitic, but not
followed by suppurating bubo or by secondary symptoms,
and had had rheumatism previous to April, 1878; in other
respects his personal history was good previous to that
time, when he was suddenly seized with paralysis of the
right side and inability to speak. He said he had been
treated by a physician in St. Louis for eight months pre-
vious to admission, electricity and antisyphilitics having
been employed without effect. Condition on admission:
He had partial paralysis of the right side; was able to
walk slowly with a staff, to flex the arm and hand, with
but a slight grip; could protrude tongue in a straight


Aphasia and Agraphia—Cases.
.
261
line; deglutition and mastication normal; movements of
eyes and lids normal; sensibility to temperature, sense of
touch, hearing, taste and smell, pain, etc., normal; no albu-
men or sugar in urine; bowels regular. Patient could not
speak a word except “no," which was his answer to all
questions, his affirmations being signified by nods. He
wrote with his left hand very slowly but quite volumin-
ously, often sending me and people outside letters of
complaint, being irascible, and much aggrieved at his
friends leaving him at a charitable institution. Whether
we entirely withheld electricity and potassium iodide of
used either or both freely (giving the latter in doses qr)
I to 3 grammes), the result was the same — the slightest
improvement in strength, but no amelioration of aphasia.
Taken away by his friends May 19, 1881.
Case II.—Permanent Aphasia and Agraphia, from Sun-
Stroke (?)—Mr. F. K., aged 36 years, single, sailor and
laborer, right-handed. Patient seems to have been sent
by railroad from Dallas, Texas, to St. Louis, to get rid
of him. Previous to admission to this hospital, he “had
been in police station and around City Hall yard for
about ten days.” Admitted October 12, 1881. He had
upon his person a letter from a physician in Dallas,
stating what kind of food and treatment he ought to have,
and that he was suffering from "heterophemia.” It
appeared that about five months before, he was at work
on the railroad in the hot sunshine, and suddenly fell to
the ground and lost all consciousness, and that ever since
he had suffered from partial paralysis of right side, and
from aphasia and agraphia.. Besides "yes, sir,” and “no,
sir,” used indiscriminately, he could say but a few words,
and his gestures were usually of little help, more being
shown by his features than in any other one way. When
asked his occupation, he motioned about as if it were
something taking him round, and again he would motion
as if it took him around the walls of the building. The
next day he seized a magazine he had laid aside from
reading matter allowed the patients, and pointed to a


262
D. V. Dean.
wood-cut of a girl and a boy in a skiff, and was pleased
when, after a series of questions, I struck upon “sailor.”
So he also pointed to a cut of a chimney, and it devel-
oped, in a similar way, that he was also a hod-carrier on
occasion. He could figure 36 on his left hand with the
forefinger of the right, and could write the same combina-
tion with a pencil, sometimes reversing the figures. He
was interested in an explanation of his ailment, and
watched very intently all the actions and talk of another
aphasic patient who came in during his stay.*
Patient's feet and legs were ædematous. He had sys-
tolic and diastolic murmurs, heard most distinctly at base
of heart, and systolic murmur at apex conducted around
to lower angle of left scapula. Chest was nearly dull
posteriorly on both sides, and crackling râles were heard
over the greater part. He improved somewhat for awhile,
and, for a moment, when first approached, it seemed
sometimes as if he were going to talk right off; but after
two or three words he was at sea. About December roth,
he began to vomit and suffered great dyspnea, and thus
continued until death, December 14th.
Autopsy.-Lungs ædematous; mitral and aortic valves
thickened their outer two-thirds, thinned the inner third.
Vessels of the meninges and of the brain normal; no
thrombus or embolon to be found; no depression of, or
injury to skull. In Broca's region there was a depression
about 4 mm. deep at center and 3 cm. in diameter, light
in color, and perceptibly soft to the touch but not difflu-
ent. On section this portion was not only soft, but the
gray matter was nearly absent, that of the insula and of
of the claustrum seeming to be replaced by white matter.
Did not make microscopic examination.
fieitnth.
"egsecch
uring a pon the ease, find
et his 8 puta!
ym. Shaw, while lecter
tan cantie negnagitant mnamer
erbrizures" conota q me to affa
now. 2oth,
moment be more in the relation . Divi
banned
.. distimet. Patient clients in
This patient D. K. R., whose case I reported in the ALIENIST AND NEUROL-
OGIST, Vol. 1., p. 40, 1880, was admitted November, 9th, and discharged, at his own
reques., on the 12th of the same month, 1881. In the report cited, I suggested that,
as the patient was a comic actor, his progressive improvement in speaking and
writing might be due to the previous cultivation and present activity of the right
speech-cenier which was, therefore, more susceptible to education than is ordinarily
the case in men of his age. This patient has been several times re-admitted, having
bren picked up in " convulsions" in the street, and has come with slight hemi-
plegia on the right side, worse each time. Notwithstanding, his speech and ability
to write are constantly improving. I take this as very good evidence that the theory
was correct.
,
Pedaloomber 17, .
thermission)
join hat siety. Canneyromito with han af, om acco!
para lozs is. Writes vern cred it all with 1. hand nar.
soccombi shqueen sinne ha.contot niet menning
mited morty towhat he praplicies in writing


Aphasia and Agraphia-Cases.
263
CASE III.- Transitory Aphasia and Agraphia, Traumatic,
contre-coup, (?). — Mr. J. D., aged 27 years, single,
gas - fitter, right-handed, was admitted to the hospital
December 27, 1881. He and his friends say he is not a
hard drinker, but had been drinking quite heavily one
day about two weeks before admission, and, while coming
half asleep from a grocery, made a mis-step and fell,
striking his right temple on the curb-stone. When helped
up he could not speak, but was able to walk and to
wash his own face. About the second day he began to
lose the use of his right arm and leg. On admission, he
had abrasions of the cuticle over the right temple, suf-
fered much pain in left temple, had slight general tremor,
and slight paralysis of the right side, and had copious
night-sweats of the whole body. .
He could not write, and all he could say was "yes,
sir,” and “no, sir," indistinctly, in answer alike to all
questions and remarks. When asked his occupation he
pointed to the steam-coils; and his gestures were always
in assent when asked if he was a gas-fitter, and not
satisfactory if any other business were mentioned. The
seventh day after admission his headache began to lessen
and his speech rapidly improved until he conversed freely,
but with a somewhat tremulous voice. He left prema-
turely and against our advice, January 23, 1882, feeling
well, except his "nervousness,” and wishing to go back
to his work. To-day, February 25th, I called on him to
ascertain his condition. He has had to stop his work
from weakness. He converses freely, but with the same
tremulousness; says his voice was naturally strong; has
no pain—no further paralysis of sensation or motion; dis-
tinguishes points of æsthesiometer on ball of first finger
at 2 mm., on back of hand at 3 cm.; no difference of
temperature on the two sides indicated by Hicks' surface
thermometer; heart sounds normal. He writes as well as
before, but is a poor writer.
CASE IV. – Transitory Aphasia and Agraphia, from
Embolism (?)—Wm. McC., aged 22 years, single, laborer,


264
D. V. Dean.
right-handed, was admitted January 9, 1882, for “bron-
chitis,” but had also mitral insufficiency; said that about
three years ago his legs were swollen. He was fast
recovering from his bronchitis when, about one o'clock of
the night of the seventh day after his admission, he tried
to ask a patient passing his bed to fetch him a cup of
water, and found he could not speak so as to be under-
stood. He tried to frame and speak sentences the
remainder of the night, but without success. In the
morning the nurse told him to attend to things on his
table, and he could not explain; and when my assistant,
Dr. Prim, asked him what was the matter, he shed tears
because of his chagrin and vexation at not being able to
make himself understood. After twenty-four hours he
began to say "yes,” and “no,” and after the third day
rapidly improved and was discharged, at his own request,
January 27, 1882. He was then able to speak and write
as well as before the attack. He was readmitted the
next day, and is still here, February 25th. He is very
anæmic, and is not strong. Distinguishes points of asthe-
siometer at 1.5 mm. on the point of the thumb — he says
his thumb, in previous times, used to prickle and feel
numb — and at 2 cm, on dorsum of hands; no difference
of temperature of the two sides; no sugar or albumen in
urine. He says he knew the words, had his sentences
in his mind, but it seemed as if he commenced at the
wrong end of the sentence. If he wished to say, “Fetch
me some water,” when he tried to put his wishes into
execution, it seemed as if his words changed places, and
would say, “Water fetch me.” And when he tried to say
one word he found he had said another.
In the voice, tone and expression of the last three
cases there was a similarity as striking as if a family
trait, and seeming as characteristic as the sound of the
voice of people nearly deaf. The pupils of all three
were dilated.
CASE. V. - Transitory, Partial, Amnesic Aphasia and
Agraphia with Oculo - Motor Monoplegia, of Traumatic
2007


Aphasia and Agraphia-Cases.
265
Origin (?)—Mr. P. B., aged 28 years, single, bar-keeper,
right-handed, has a good personal and family history
as to health. He says that on February 16, 1882, while
he was standing at his desk, in De Soto, Missouri,
a man, with whom he had had some harsh words, hurled
a rough, angular piece of rock through the door-way at
him. The rock struck him on the left side of the head,
and, reflecting at an acute angle, hit a delf water-pitcher,
about six feet from him, and broke it into pieces. The
blow stunned him three or four minutes when he recov-
ered and tried to find the man. Dr. James Keanoy, of
that place, attended to his wound, which appeared to be
only of the integument. Through Dr. K.'s courtesy I
learn that, with the exception of a “strange” feeling in
the left side of the head, the patient had no trouble and
worked until the 24th, when he complained of severe pain
in the same side of the head, which lasted nearly through
the night. At 10 o'clock A. M. of the 25th, Dr. K. found
him unconscious, with hands, feet and face deathly cold;
pulse forty-five per minute and scarcely perceptible ; slight
spasms passing over his trunk every three or four minutes,
but not seeming to affect his extremities; a deep-red rash
gradually extending from the upper part of his forehead
over the rest of his face; pupil of the left eye very much
dilated, of the right normal; and with paralysis of the
left upper lid. At 3 o'clock A. M., the 26th, he regained
consciousness enough to make known his desire to urinate,
relapsing again into unconsciousness for seven or eight
hours. After that he had intervals of partial return of
reason, a few minutes at a time, his pulse, meantime,
coming up to fifty-six beats and full. By the 27th or
28th he sat up, a few minutes at a time, with a dazed,
stupid look. The doctor did not notice any trouble with
the patient's speech after his consciousness returned.
Patient entered hospital March 7, 1882. He had a recent
irregular cicatrix, 3 cm. in diameter, directly upon the
upper, anterior part of the left inferno - antero - parietal
region. If a perpendicular, 7 cm. long, were let fall upon


266
D. V. Dean.
the middle of the upper border of the meatus auditorius
externus, and if from the upper extremity of this line a
line 3 cm. long were drawn forward at a right-angle, the
anterior end of this line would rest upon the middle of
the scar. The coronal suture was easily felt; also the
margin of the temporal muscle, when he moved the jaw.
Patient had ptosis of left lid; pupil of same side dilated;
binocular (crossed) diplopia, and partial amnesic aphasia
and agraphia. He understood Russian, Lettish, German,
English and a little of Turkish, Polish and French, having
been born in St. Petersburg, and educated there and in
Livonia, and having been a Russian soldier, and also
having lived in the United States, in various parts, since
1876. He said he spoke German much more correctly
and fluently than English; but, after his injury, he lost
more of his German words than of his English. He said:
“After I left De Soto I lose my remember.” “I feel
good-deal of danger-feeling (what you call it?) in my
head.” “My eyes I feel good both. I see every this
twice with the two eye.” “ Sky-light” (pointing to an
ordinary pendent gas-light) " I see twice.” “A man threw
a half piece stone and killed me.” “I felt well, only
many matter ran from sore, till ten days after I got killed.
Jesus !” (angrily), “what is it now?” [Hurt?] “ Yes,
hurt; then I lose a great many remember (Jesus! what
you call it now?) sometimes half a day.” “I talked better
before ; now I lost my remember. Yes, words.” When
a word was wanting in English, he would, if asked, try
in German and, perhaps, give the proper word, but would
make as bad mistakes with other words in the German
sentence; and so he found it with his native tongue.
He could readily repeat any word pronounced for him in
German, English or Latin, and could write rapidly until
11 a word failed, when he would lose his patience. He was
weak but not paralyzed; no perceptible difference in grip
of the two hands; temperature in left arm-pit, 36.95 C.;
on left temple, 36.66; on right temple, 36.55; distinguished
points of æsthesiometer on back of both hands at 3 cm.;


Aphasia and Agraphia-Cases.
267
on ball of index finger, at 6 mm. Urine contained no
albumen or sugar; heart sounds, normal. March 16th.
At this writing, patient is improved in every respect. He
remembers a great many of his misused words, without
our calling his attention to them, and tells what were the
words he wanted. For instance, by "danger-feeling” he meant
"dreadful or terrible feeling," or, as he now says,“ neuralgia.”
In the absence of an autopsy, and upon the supposi-
tion that the brain lesion corresponds with the external
one in regional location, this case is of interest, first,
because this region contains the posterior extremity of
Broca's convolution; and, secondly, because the lesion
being near the origin of the first and second frontal con-
volutions contained in the anterior portion of the supero-
antero-parietal region, and a greater distance from the
angular gyrus (pli courbe) — in which latter some have
sought to localize the center for the levator palpebræ
superioris — it (the case) lends some clinical confirmation
to Ferrier's conclusion, from clinical facts, that, if a distinct
volitional center for the levator palpebræ superioris
exists in the human brain, it must be sought in that
region.
CASE VI.—Complete Aphasia and Partial Agraphia, with
Left Brachio-facial Monoplegia, from Traumatism.—Mr. T.
B., aged 36 years, single, laborer, right-handed, while par-
tially intoxicated, March 6, 1882, fell from a scaffold and
landed behind a mule which kicked him in the head. On
his admission to the hospital, on the oth of the same
month, he had two wounds upon his head: A nearly
right-angled one had its point at about the middle of the
squamoso-temporal area of the left side, the anterior limb
reaching to the temporal ridge 2.5 cm. behind the coronal
suture, the posterior limb extending to the middle of that
part of the ridge limiting the inferior postero-parietal area;
and a straight one at about the middle of the right
superior antero-parietal area 3.5 cm. long, parallel with
and 2 cm. from the sagittal suture. Both wounds had


268
D. V. Dean.
been stitched by a physician immediately after the
injury. The one on the left side was healing by first
intention; the one on the right by granulation. The
stitches were removed by my assistant, Dr. Dixon; and, OR,
as the man seemed well and it was supposed, by their
being stitched, they were only scalp wounds, it would
have seemed quite meddlesome to disturb them by an
exploratory examination. On the rith, patient had a chill
followed by fever. He had suffered from “chills and
fever” for six months, sometimes being confined to his
bed. Cinchonidia was administered, but the chills and
fever followed daily, finally accompanied by headache,
nausea and vomiting. The left wound was healed and
was no deeper than the integument which slipped readily
over the temporal muscle; no fluctuation about the superior
wound which was not firmly united. On the 17th I was
called to the patient and found him completely aphasic,
with slight paresis of the lower left face, and paralysis of
the left forearm and hand. He could lift the whole arm
by the deltoid, but he could neither flex the forearm nor
supinate the hand, nor could he grasp with the hand.
On protrusion, the tongue went somewhat to the left.
His right grip was strong and there was no other paraly-
sis. Heart sounds normal; right radial artery very
beaded; left beaded but not so strongly so. No sugar
or albumen in urine. A slight fluctuation was found at
seat of the superior (right) wound; the lips were separ-
ated with the knife and a few drops of pus exuded. The
skull was found to be denuded an area of 2 cm. in
diameter, and a fracture was felt with a slight shelving,
half a mm. in height, not movable. Patient could, a part
of the time, grunt out something a little like "yes,” when
he wished to assent; but he could not speak a word,
which caused him great disgust, for he seemed, though a
little dull, to appreciate all the questions we asked.
Assent and dissent were plainly evinced by his physiog-
nomy and gestures; and he would rise vigorously in bed
and arrange his blankets with some ceremony as if to


Aphasia and Agraphia-Cases.
269
give a complete answer that time; but, failing, he would
give a silly laugh of disgust and lie down and cover up
in such a way as seemed to invite rest and us not to
trouble him more. When asked to write his name (Thos.
Burke), he would seize the pencil with the right hand
and write with passable rapidity, “ Justal Burke, Jusley
Burkes, Justal, Judley all Les,” every time laying his
writing materials aside with disgust, especially when he
read over what he had written. His letters were pretty
well formed. At 7:30 P. M. patient had an epileptic seizure
involving the whole body and lasting five minutes; at
8:10 another, and at 8:27 another. Brown-Sequard's mix-
ture was dropped, and 1-gram. doses of potassium bromide
and chloral were given in enema; it was intended to tre-
phine during the night if the convulsions continued; a
convulsion at I A. M. the 18th. At 4 P. M. patient was
trephined a little outward from, and close back of the
fracture, and the fractured portion was removed, bit by bit,
from this opening, with bone-cutting forceps, the patient
having been etherized; but it did not appear that the
inner plate had been depressed. No pus was found upon
the meninges, and they were accordingly punctured
directly under the seat of the fracture, but again no pus
appeared. Patient had a short paroxysm soon after he
was returned to his bed; no more until 5:10 P. M., the
19th, when the seizure was manifested by clonic spasms
of the biceps of the left side, and of the lower muscles
of the face, same side. The forearm was rapidly flexed
and supinated, the angle of the mouth being drawn up
with each contraction of the biceps. The eyes were per-
manently turned to the left during the paroxysm. No
other muscles appeared to be involved. The deltoid did
not contract. Nitrite of amyl inhaled; paroxysm lasted
forty-three minutes; followed in ten minutes by another
lasting fifteen minutes. Patient slowly failed, having slight
tremors of convulsions for a half minute once in about
twelve hours. When asked, on the 20th, to write his
name, he wrote “ Julthe Henne.” On the 22nd, if asked


270
D. V. Dean.
to press my hand or to put out his tongue, it took him
a quarter of a minute to respond, and then if I asked
him anything else he would repeat his previous responses
1, unless I gave him time to rest. Feeling was delayed for
from a quarter of a minute to nearly half a minute, but
the stimulus (pinch or prick) needed not to be continu-
ous to get a response. Loses use of left lower limb.
Temperature of right axilla, 38.9; of right forearm, 36.9;
of left forearm, 36.5. Patient gradually failed, with con-
stant fever; at 9 A. M., the 23rd, comatose, temperature
40; died at 11:10 A. M.
Necropsy the 24th.-Scalp thickened about the superior
wound. After removing the coverings of the cranium,
the ante-mortem measurements were verified as also were
the depth and the character of the wound of the left
side. No fracture of any part of the skull, besides the
small portion removed by operation during life. Dura
mater not abnormally adherent to the skull; portion under
the opening made by the operation, thickened by exudate
and granulation. On making an incision through the dura
in front, creamy pus flowed freely. Pus lay upon the
arachnoid from the superior frontal sulcus down to the
fissure of Rolando and to the fissure of Sylvius forward
over the anterior extremity and under or orbital surface
of the right frontal lobe, as far inward as the origin of
the middle cerebral artery. It went down on both sides
of the falx (most on the right side) back to the tentorium
and on both sides posteriorly to the corpus callosum,
forward, down to the transverse fissure. A mass of pus
and exudate of considerable consistency, commencing a
little in front of the paracentral lobule, lay upon the inner
half of the right superior frontal convolution, and com-
pressed it in such a way that a bevel was formed occupying
half the upper and half the inner aspect of this convolution
from that point forward. Another mass made a deep pit,
the size of the ball of the index finger, on the inner, orbital,
and frontal aspect of the left frontal or fronto-orbital lobe.





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Aphasia and Agraphia-Cases.
271
At a point in the right ascending frontal convolution nearly
opposite its junction with the superior frontal, the arach-
noid and pia were thickened and adherent to the cortex
I cm. square, and left, when removed, a pit 2 mm. deep.
This was, probably, the seat of the cut purposely made at
the time of the operation, though it was, also, directly
under the fracture. The surface of at least the anterior
half of the right frontal and orbital lobe was softened, and
the anterior extremity was blunt and rounded, the lobe
being thereby shortened. The pia was especially adherent
to the third or inferior frontal, to the anterior half of the
middle frontal, and to the anterior third and inner half of
the middle third of the superior frontal convolution, and,
if removed, brought away somewhat of the surface of the
brain. The adherent parts are shown in the accompanying
cut. No macroscopical lesion of the left third or inferior
frontal convolution could be found, or, inded, of the sur-
face of the left hemisphere farther than the ones I have
mentioned. Transverse sections of the brain gave no
appearance of deeper lesions anywhere. The pus
amounted in all to fully 50 c. c.
Especial interest attached to this case, from first to last-
as to diagnosis and treatment, and as to the pathological
conditions found post-mortem. Patient was right-handed,
unless ambidexter, and had aphasia with left monoplegia.
If the injury on the left · side, over Broca's convolution
affected the true speech center in this case, then there
was no accompanying right paralysis. The wound on the
right side was just upon the supposed motor center for the
left forearm and seemed-before trephining, hardly after-
sufficient to account for the brachial monoplegia ; but it
was not near the right third or inferior frontal convolution
and, if its effects extended to that region and caused
aphasia, why did it not, concomitantly, cause left paralysis
of greater extent? The autopsy does not show that the
left wound had any connection with the aphasia; nor does
it seem certain that the lesion of the ascending frontal
convolution (brachial center) was not caused by the knife;


272
D. V. Dean.
though, if the monoplegia was not caused by a brain injury
at this very place, the coincidence with the results of
physiological experiments and with other clinical cases is
certainly very remarkable. The history of the case does
not show that there was sufficient commotio cerebri to
be the cause of the lepto-meningitis.
as
om
Art, XI. - Acute Dementia Occurring in
an Old Man-Recovery after Two and
One-half Months of Treatment,
By C. H. HUGHES, M. D., St. Louis,
Lecturer on Psychiatry and Neurology in Post-Graduate Faculty, St. Louis Medical
College; Honorary Member British Medico-Psychological Society; Late
Saperintendent Missouri State Lunatio Asylum, Etc.
To differentiate between the dementia of cerebral
degeneration or the disintegration of a coarse
encephalic lesion, and that cerebrasthenia and limited
cortex" dissolution,” which are not incompatible with
mental recuperation, is not always easily done, at any
period of life, especially when the psychical symptom group
reveals only a picture of dementia. And diagnostic and
prognostic difficulties augment if the patients have reached
that advanced age when, in this country especially, the
vital processes are failing and the morbid phenomena of
senility, rather than of acute exhaustion, may be looked
for, when the mind breaks down, and the once well organ-
ized and coördinated forces of the cerebral cortex are
involved in senseless anarchy and aimless riot.
To say of an old man, stricken with dementia, that the
central cell exhaustion revealed in the mental derange-
ment has reached the degree of irreparable dissolution, is
easier than to determine that brain exhaustion rather than
dissolution has taken place, and accordingly, to pro-
nounce a possibility of recovery; for exhaustion, pure and


Acute Dementia, Recovery, Etc.
273
simple in the aged, is exceptional, while the rule, in them,
is “dissolution.” “Dissolution” in the sense in which it has
recently been employed by Mr. Hughlings Jackson, we
think scarcely applicable to many of the cases to which
he applies it, namely, to post-epileptic temporary paraly-
sis, which, like the transient forms of hysterical paralysis,
are more often due to cortex neurasthenia (psychical) than
to “dissolution", though the term might be more justly appli-
eable to more prolonged and less temporary but recover-
able forms of paralysis, than those described by him -
psychical as well as purely motor-like the case we here
record, in which there was, in all probability, no extensive
coarse lesion of the brain.
The article by Dr. Jackson, in Brain, for January,
“On Temporary Paralysis after Epileptiform and Epil-
eptic Seizures: A Contribution to the Study of Dissolu-
tion of the Nervous System,” is exceedingly interest-
ing, and its perusal would prove of value in connection
with the case we here record, but we deem it unfor-
tunate that the term “dissolution” should have
been deemed necessary by the distinguished author to
express states of temporary exhaustive paralysis. An
expression antithetical to that of evolution, employed by
Mr. Herbert Spencer, and more exactly expressive of the
probable pathological facts of temporary post-epileptic
paralysis, might have been selected, showing that the physi-
ological "evolution” is simply in statu quo — arrested, not
retrograded-in these cases. In selecting the term disso-
lution, Dr. Jackson seems to have been actuated by the
Inaxim, “Non progedri est regredi.” Now evolution is neither
dissolution nor involution. It may be either, and it may
be a-volution, a stationary (or nearly stationary) state of
the cortex cells. In temporary paralysis, a period in which
disintegration exceeds repair, may often, for a brief time,
exist befure the point of paralytic exhaustion is reached,
but if the paralysis be really temporary, the exhausted
cortex cells speedily regain their normal tone. They soon
recover the substratum sine qua non of physiological function


274
C. H. Hughes.
Were it otherwise restoration of function could not readily
take place, and this process is not one, strictly speaking, of
“ dissolution.” At another time this subject may engage
more of our attention. The graver and less recoverable
forms of psychical paralysis, are more properly those of
“ dissolution,” for in them there is positive disintegration.
CASE RECORD. — On the 18th day of last September,
there was brought to St. Louis by his physician and
friends, for the purpose of consultation with Dr. John T.
Hodgen and myself, Major R. S. M., whose home is in
a remote city of Missouri. The major is a married man,
aged 64 years, of medium height, good frame and vigorous
physique. His habits of life, mental and physical, have
always been active. In his section he has always been a
man of public spirit and enterprise, and has been pecu-
liarly successful in his undertakings. His occupation was
formerly that of a merchant. Of late years he has been
engaged in banking and in the inauguration and manage-
ment of a street railroad. The latter enterprise being new
to himi, entirely at variance with his life-long training and
acquired mental business automatism, and having associ-
ated with it many harrassing details, and requiring pro-
longed mental attention long after his habitual hours for
rest, precipitated the mental overthrow, an account of
which here follows. Only essential details are given of
the patient's condition at the time he came under treat-
ment. He remained in the city under constant observa-
tion by Dr. Hodgen and myself about one week, after
which time the writer visited him at his home. He
remained quite stationary for six weeks or more, but at
the end of about this time he began to improve and con-
tinued until his recovery was complete-at the expiration
of about ten or twelve weeks. Fifteen years ago he had
vertiginous spells and sometimes fell down. At the time
he first came under our observation he was incoherent in
conversation. There was no spontaneity of thought or
connection, long maintained, of ideas. There was marked


Acute Dementia, Recovery, Etc.
275
failure of memory—almost complete, with occasional auto-
matic accuracy, Said he had no wife, when his wife was
present, but he did not persist in the statement. Said he
had no children; afterwards that he had six, when he has
but three living; afterwards that he had six boys and seven
girls.
Partly told a story of an event of forty years ago,
but could not be induced to completely tell it. Catches
but imperfect glimpses of past fact. Spoke of colored
servant, “Ned,” long since free and gone away; said he
would take care of him till he died. Spoke with some
accuracy about his sons, when prompted.
Appears to have hallucinations of tactile sensation.
Fumbles and clutches at imaginary things, mainly as if
pulling or picking up a fine thread, or hair.
Gets up, sits down, or walks clumsily and slowly, and
in an indefinite manner. Tendon-reflex response to tap
below patella good for both legs. Pupils normal in shape
but vary in size alternately. Some ptosis of eyelid.
Pulse 36, and not full. No atheromatous feel to radials.
Nor cardiac valvular obstructions from this cause. Cuta-
neous sensibility apparently good. Protrudes tongue
pretty straight. Grasp of hands pretty good.
Mistakes the identity of persons. Recognizes strangers
as old-time friends. Has displayed a little aphasia once
or twice. No evidence of syphilis in irides, tibiæ or else-
where, or in history; has had prostatitis and prostator-
rhæa. Had a delusion that persons, women mostly, were
about him, who were not.
Does not realize his surroundings. Though a man of
extensive business affairs he now makes no reference to these
matters. Is at times restless, ill at ease, and wants to
go away from those about him. Bowels have not moved
during the past two days. Has taken bromides to pro-
mote sleep, and some morphia last night. Eats mode-
rately well, mechanically taking what is offered to him,
but has a preference for eggs and milk and refuses coffee.
General appearance one of feebleness and weariness,


276
C. H. Hughes.
though not extreme. Can stand and walk about the room
alone, but is tremulous in his lower limbs when he does
so; needs a little help. Is generally automatic and slug
gish in his actions mentally, and physically, and exerts
mind or body through the suggestion of others rather
than spontaneous self-movement, except in attempting to
leave the room.
To-day, Sept. 21st, he is still incoherent, but somewhat
more vigorous mentally and self-assertive ; has slept most
of the day on a dose consisting of ten grains of quinia, one
of caffein, one and one-fourth drachm comp. syr. hypo-
phos., and six and one-half minims of liq. pot. arsen. U. S. P.
and one-twelfth of a grain of morphia, with one drachm
syr. wild cherry and one of syr, coffee. Has taken forty
grains kali iodidi, an ounce of beef essence and a dessert
spoonful of extract of malt with peptones, besides a pint
of milk, plate of beef and vegetable soup, and other
(solid) food, and a cup of coffee.
There is, to-day, no ptosis. Left pupil twice the size
of the right. Bowels have moved daily and water passed
without medical or surgical aid. Has had tussus senilis
for several years, which is now somewhat aggravated by
a recent cold. Walks pretty firmly and has good mus-
cular strength, and is quite persistent when excited by a
delusion.
The following letter indicates this patient's later mental
status:
DEAR Doctor:
January 20, 1881.
* * I am happy to report progress, and feel encour-
aged. Your admonitions I shall strictly observe, and hope
by Spring to be quite well and stout again. I sleep
pretty well, my food digests well, and I take considerable
exercise, such as does not worry me. Brain-work I
abstain from at the present. I am a little nervous this
morning, and hence cannot write so well as in former
years. Wishing you a long and prosperous life and much
good luck (I have no recollections of ever seeing you),
Yours truly,
R. J. M.
Dr. C. H. Hughes.


Acute Dementia, Recovery, Etc.
277
Notwithstanding the age of this patient, a prognosis
of possible recovery was based upon the facts-
a. That the pupils were both exceedingly mobile.
b. There was no arcus senilis or other satisfactory
evidence of the break down of extreme old age.
C. There was no evidence of atheromatous degenera-
tion in the heart, the radial or the cerebral arteries or
arterioles.
d. There was an antecedent history of good constitu-
tional stamina, good nutrition and mental tranquility.
l. The exciting cause was recent, of short duration
and such as would cause primarily vascular disturbance.
f. There was no positive evidence that the disturb-
nace had extended further. No indications of sanguineous
exudation into the substance of the brain. No apoplexia
or coma.
g. The onset was without apoplexia and sudden.
h. The case came under treatment soon after the
initial symptoms appeared.
i. The intra-cerebral origins of all of the special senses
were unaffected so far as could be ascertained.


SELECTIONS.
NEURO-PATHOLOGY.
SEMMOLA ON THE NERVOUS PATHOGENY OF Addison's
DISEASE.—Six years ago Prof. Semmola, of Naples, read
before the International Congress of Bruxelles a paper in
which he advanced the theory that “Addison's disease is
a disease of the nervous ganglionic centers, and that the
anatomical alterations of the supra-renal capsules were not
to be considered as the starting-point of the illness, but
only as representing the last struggle of trophic disorder
caused by the nervous filaments, which preside over the
function of nutrition in those organs.”
His arguments at that time (1875) were only of a
therapeutical character. At the late Congress he showed
two photographs of the microscopical alteration of some
points of the ganglionic centers, and of the dorsal section
of the spine, that he found in one of his cases, illustrating
a mixomatous transformation of the tissue of the cæliac
ganglion, and leucæmic infiltration of the spine toward the
central canal.
In another case he observed also a fatty degeneration
of some points of the plexus solaris.
The microscopical examination, very remarkably, of the
supra-renal capsules gave negative results; those organs
were completely normal. The conclusion is drawn that
Addison's disease consists of a deep trouble of renal
nutrition caused by disorders in the functions of the sym-
pathetic nerves and of the several nervous centers of
organic life (celiac ganglia, etc.). It commences by a
functional exhaustion of the abdominal ganglion, which
soon deranges the functions of digestion and nutrition;
then slowly follows a histological alteration in the tissue
of those centers, and this pathological condition finally
brings anatomical alterations in the supra-renal capsules
and other organs.
The disorders of the stomach, the cachectic and
asthenic condition of the patient, the falling of tempera-
ture, etc., are nothing but the manifestations of a slow
morbid process which commences by disturbing the work


Selections.
279
of digestion, and ends in weakening the organic oxida-
tions and the nutritive metamorphosis ; that is, in exhaust-
ing the functions of vegetative life, which are under the
control of the sympathetic nerve and its accessories. It
seems to me that in this disease chemical observation
plainly teaches us the pathological demonstration of the
physiological functions of the ganglionic system. . *
The melanodermis, or the morbid pigmentation of the
skin, which is one of the symptoms of Addison's disease,
is also to be attributed to the same nervous cause. There
is every reason to believe that the sympathetic nerve and
the ganglionic centers must have the same trophic influ-
ence in the formation of pigment as they have in all the
chemical proceedings of nutrition. The well-known fact :
of a moral cause — of a deep sorrow having produced a
rapid change in the hair and skin, is a sufficient evidence
in favor of this theory.
The encouraging result of treatment with electricity is
a point of practical value confirming these views.
In the case of six years ago the patient, who at the
commencement was so weak as to be unable to sit up in
bed, at the end of three months could take a morning
· ride of three hours on horseback without feeling fatigued.
With the digestion improved, the temperature became
normal and the coloration of the skin almost disappeared.
Dr. John Dell ’Orto, in the New Orleans Medical and
Surgical Journal for March, gives a completer translation,
of which this is an abbreviation.
ceedings of pigment as thsame trophic in and
CLOT IN THE LEFT CLAUSTRUM, WITH APHASIA (Read
before the Philadelphia County Medical Society, Octo-
ber 26, 1881, by H. C. Wood, M. D.). — This case is one
of a class, says the author, to which attention was first
drawn by Sanders (Archiv. f. Psych. und Nervenheilk., ix.),
the explanation of which is not to be looked for in
the claustrum having any direct connection with speech,
but in the probable destruction of the neighboring white
fibres connecting the gray matter of the island of Reil
with the lower centers. A clot may certainly occur in
the claustrum without aphasia. In the present case, and
probably in all parallel cases, the clot was a large one
and pressed greatly on surrounding parts. The case illus-
trates the difficulties which surround the minute diagnosis


280
Selections.
of cerebral disease. During life the symptoms were sup-
posed to be due to a disease of the third frontal convolu-
tion; and even with the light of the autopsy it seems
impossible to have avoided the error.
Mr. W. R. K., 40 years old; addicted to alcohol in
excess; much exposed as policeman, and in Nevada, had
a venereal sore about 1870, but no specific symptoms
since 1874, and it is uncertain whether he ever had
syphilis. Through February and part of March, 1881, he
complained much of nausea and of a feeling of weight in
the back of his head and down the neck, with occasional
very brief neuralgic headache. At this time there was
transient diabetes insipidus. On March 20th, in the after-
.noon, his speech suddenly changed, and he began to
sputter and mumble instead of speaking out words. He
had intense pain in the head for two days, and followed
by a stupor, in which he lay for several days. The leg
and arm were paralyzed — the leg not entirely. He was
at first heavy and very stupid, but his intellectual powers
slowly came back: he always remained apathetic and
below normal in mental action.
The leg slowly improved — he could walk. His arm
did not improve nearly so much as the leg; the normal
movements could be made, but very feebly. The aphasia
was persistent up to death, but his vocabulary increased
from one or two, to half a dozen words—"yes,” and “no,"
and certain nouns, such as “chicken.” All through the
aphasic condition he was very apt to get angry on
attempting to speak, and, after continued vain efforts,
would exclaim : “Damn it!” Sensation was not affected.
There were no other symptoms save those noted; and on
May 2nd, a second apoplectic seizure occurred, from which
he died May 4th, comatose.
Autopsy.—The liver and kidney: marked fatty degen-
eration. Brain: right side, large very recent clot in frontal
lobes, destroying the structure; left side, clot occupying
whole of claustrum, whose structure had disappeared, and
pressing sharply upon the external capsule - some fibres
seemed ruptured, also some pressure upon the lenticular
nucleus, but no softening.
GLIOMA OF FRONTAL LOBE AND OLFACTORY BULB-HAL-
LUCINATIONS OF SMELL.—Mrs. S., aged 46, first seen Oct. 21,
1881, had been a healthy woman up to last March or
April, when she became more garrulous and less quiet and


Selections.
281
tainly of acalized in the occa
retiring, visiting neighbors frequently and gossiping much
more than was natural to her. Her conversation also at
times seemed strange. One day she declared that a neigh-
boring smith smelt so strong she could not endure him-no
one else being able to detect any odor. These symptoms
increased, and in a little time she began to have head-
aches, which persisted with occasional exacerbations and
were always localized in the forehead. She complained
frequently of a persistent disagreeable odor, and at an
uncertain time began to have "spells,” which were some-
times, if not always, ushered in by a very strong odor.
She would call for a drink, immediately become excess-
ively pale and unconscious, and the next moment “all
the blood in her body would be in her face." It was
further stated that the unconsciousness only lasted for a
brief period, and that frequently there were very decided
“tremblings” of her left arm and leg during the attack.
In the late summer and early autumn she suffered much
from sleeplessness and gradually lost control over her left
arm and leg. At times she had hours of stupor.
When Dr. Wood saw her she was in a mild stupor, out of
which she was aroused with some difficulty ; was rambling
in her talk; had nearly complete hemiplegia; small, very
sluggish pupils; no paralysis of ocular muscles; no loss
of general sensation. She answered his questions fairly
well, but when salt was put in her mouth failed to recog-
nize it; nor could she tell cologne by its odor. Her
brother-in-law coming to her, however, she complained of
his smelling of tobacco; but whether she really perceived
the odor or simply was led by old associations, was uncer-
tain. She complained much of headache and had been
very restless previous to the stupor. On October 23rd
she became coinatose and died.
Autopsy.-Brain normal, except the frontal lobe, which
was enlarged and had its olfactory bulb converted into a
somewhat translucent grayish body of irregular form, in
its widest part twelve millimetres wide and six millimetres
thick, and in length five centimetres. It was composed
almost solely of gliomatous cells. In the interior of the
lobe, coming to the surface at the base of the olfactory
bulb, was a diffused glio-sarcomatous tumor involving the
lenticular nucleus and capsular parts of the frontal lobe,
also apparently the optic thalmus. The gray matter of
the cortex was not generally involved.— Ibid.
Arged and ant grayish-res wide an it was com
the


282
Selections.
SIMPLE Cyst of Cerebellum.-Dr. Sharkey reported to
the London Pathological Society, June 17th, the case of
a patient, aged 22, under the care of Dr. Stone, in St.
Thomas's Hospital. He had been a fairly healthy person,
but had suffered since the age of twelve years from severe
headache at times, and during the last three or four years
had noticed some slight loss of power in the right arm
and leg. Four months previous to admission into the hos-
pital two heavy oaken shutters fell and hit him on the
back of the head. Since then he had constant severe
headache, frequent vomiting, and some, constipation. His
sight had gradually got dim and he suffered from giddi-
ness. Just before admission he had a convulsive attack.
On admission he had inability to walk, though no evident
paralysis of his limbs while he lay in bed. He had double
optic neuritis. He was admitted on October 25, 1878, and
died on November 5, 1878, having been attacked at the
end with violent headache, vomiting, rigors without eleva-
tion of temperature, and finally coma. The post-mortem
examination showed the cerebral ventricles full of fluid,
and the right half of the cerebellum distended by a fluid
tumor. It was not a hydatid, and had no inflammatory
thickening of the cerebellar substance around, nor were
there any hæmatoidine crystals or other remains of effused
blood. The parts surrounding the Auid were simply con-
densed cerebellar tissue, and the fluid contents were com-
posed of serum and a fibrinous clot. Simple cysts of
brain are rare, and their pathology obscure; and the
present case, though an interesting specimen of the dis-
ease, throws no light on its origin. — London Med. Times
and Gazette.
ՀԱՄԵՄԱՏ Ա
erebellar tissues fibrinous clot obscure ; and dis-
STATE OF THE BRAIN DURING THE EPILEPTIC CONVULSION.
- Magnan, in a recent Clinical Lecture at Asile St. Anne,
reported in Le Progres Med., February 4th, describes a
case of epilepsy in which the congestion was so great that
it produced vacủosities in the retinal vessels, which could
only be observed easily at the precise moment of an attack.
He has confirmed this also by experiments upon dogs,
inducing the epileptic attack by the use of the essence
of absinthe. He does not claim an identity between true
epilepsy and that provoked in this manner, but there is
a perfect analogy in the convulsive seizures. By making
openings in the skull he saw that in the first stage there
was instantaneously an intense congestion of the brain.


Selections.
283
NEURO-THERAPY.
Wolff's METHOD FOR WRITERS' CRAMP. — M. Wolff, a
German teacher of writing, has earned for himself a con-
:siderable reputation by his skill and success in the treat-
ment of this class of affections, which are attested by
Nussbaum, Bamberger, Benedikt, Bilroth and Esmarch.
M. Charcot placed under his care two patients suffering
from writers' cramp, who had been treated by himself and
M. Vigouroux for some months without any improvement.
M. Vigouroux (Le Progres Medical, 1882, No. 3), says M.
Wolff cured them in fifteen days. M. Wolff's system
consists in a combination of gymnastics and massage.
He makes his patients execute movements in all direc-
tions with the affected hand for half an hour to an hour
and a half at a time, three or four times a day; and, in
addition, the muscles involved are stretched more or less
forcibly three or four hundred times daily. He also uses
massage and friction, and attaches considerable import-
ance to percussing the affected muscles. The most essen-
tial part is the extension of the spasmodic muscles.
DR. MORTIMER GRANVILLE'S TREATMENT OF Locomo-
TOR ATAXIA.—“The patient is directed to stand with his
eyes closed in his bath, after pouring a small can of cold
water down the spine, and to persevere in the attempt to
do this steadily for, at first a quarter of an hour, and as
his state improves, for half an hour every morning. He
is to be furnished with a chair or rail at hand, to which
he can cling in case of need; but instructed to avoid
using it except in actual danger of falling. When he com-
mences the daily exercise, he will probably for some two
or three weeks make little progress, but after this he will
begin to be able to stand,” etc. Dr. Granville also recom-
mends extensive spinal sinapism at night.—The Practitioner
(London), November, 1881.
TRAUMATIC TETANUS TREATED WITH ESERINE. – Dr.
Thomas Layton reports a case of tetanus occurring in a
boy, aged 11 years, following, after an interval of three
weeks, the wounding of the sole of the foot with a splin-
ter. Chloral, bromide of potassium and cannabis indica
were employed without benefit. Eserine was then admin-
istered in doses of a grain every hour, for several days.
Recovery took place. On two occasions the pupils were
dilated ; at all other times they responded to light. The
begin ee weeks 2 exercise, anger of fallinstructed to whic


284
Selections.
eserine increased neither the tears, saliva or defecation.
New Orleans Med. Journal.
The EYE AND SEXUAL Excess. — Dr. M. Landesberg
gives cases where complete or partial blindness occurred
from unlimited sexual indulgence, and cures were affected
by abstinence. Among them, a young man, aged 19, had
been living with two girls. He went to see them and
knew them both carnally twice or more times each day.
He came to the doctor with failing sight, intense neuralgic
pain and nausea. Cured by a sea voyage to Lima. He
probably left his girls behind him.
THE INFLUENCE OF ERGOTIN OVER THE SWEAT CENTERS
seems to be nearly as patent as its power over the vaso
motor system. Da Costa has lately found it in two-grain
doses, three or four times a day, hypodermically employed,
preferable to atropia, on account of its less unpleasant
after effects, though less prompt in its immediate influence.
early acosta hasaya hypoderes less einfuenc
CLINICAL NEUROLOGY.
NEW CASE OF MYX@DEMA OR PACHYDERMIC CACHEXIA
(CACHEXIA PACHYDERMIQUE). — M. Legrand Dusaulle, of
L'Hôpital de la Salpêtrière gives the following in Le Proges
Medical, Feb. 4, 1882:
Elise, æt. 4, admitted February, 1881, presents
an assemblage of symptoms which recall pachydermic
cachexia, a happy expression of Charcot to designate the
myxædema of English authors, or a form of the cretinoid
state of M. Baillarger.
“The patient's physiognomy attracted our attention by
the similarity it bore to that of Pacha, an idiot of Bicêtre,
whose case was published by M. Bourneville as one of
myxædema. She, also, has the face puffed, transversely
rounded, like a ball; the eyelids are tumefied, immobile,
the eyes scarcely open, the expression mournful, a weep-
ing air; the flattened nose is thickened; the cheeks, livid,
cold, stretched and protruding, contrast with the yellow-
ish white complexion; the thickened tongue almost con-
stantly hangs between the teeth and lips, which permit a
dribbling of saliva. The puffiness of the face led us to
make a general examination of the child, and the same
state of the skin was found on the superior and inferior


Selections.
285
limbs, on the abdomen and flanks, but absent in the
thoracic region. It had the same characteristics every-
where : a disagreeable sensation of cold, to the touch, of
the skin, which is neither dry, nor scaly, nor slimy; the
color livid, especially in the lumbar regions, the nates and
extremities. These latter are deformed and clumsy. In
the hands the palmar hollow is replaced by a convex
surface, the skin is thickened, the fold produced by taking
it between the fingers measures more than a centimetre;
the impression of the finger does not show itself as in
edema, but gives a sensation of resistance, soft and, at
the same time, elastic. There are no adhesions of the
skin to the subjacent organs over which it slides; no
appreciable disturbance of cutaneous sensibility. The
doughy condition of the subclavicular regions, character-
istic of cretinism, is absent. The skin of the neck and
thorax is normal.
“There is little hair, the nails are normal, the teeth
yellowish; the molars are absent; the nares are scarcely
visible; nothing about the digestive, respiratory, circu-
latory, biliary or renal apparatus; nothing about the heart,
no albumen in the urine. The cry is guttural, hoarse and
rare. No goitre, or cranial deformity above the ears ;
no rickety deformity save the remains of a lumbo-sacral
caries, as shown by the old cicatrices of cauterizations.
No other scrofulous phenomena; no syphilitic manifest-
ations.
“In regard to intellectual troubles, the most manifest
are those of complete idiocy. The patient remains in
bed, immobile, in a state of absolute silence, mournful
and mute; she cannot direct the vision, cannot hold up
her head, moves her limbs without definite purpose, can
not stand. Since her admission no change has taken
place—no trouble has supervened.
“This child was born in Paris, of parents neither cretins
nor goitrous. In the family there is an uncle insane, a
maternal sister rachitic; the child has two younger sisters
in good health, with no deformity. At birth this child
appeared healthy and nothing extraordinary occurred,
until, at the age of five months, she was treated for
lumbar caries complicated with convulsive seizures, repeated
five times daily for six months. It was then that the
mother noticed the puffiness of the skin.
“It was not till later that she remarked the appear-
ance of the lower limbs, which she attributed to the spinal
rare.
No Leformity sax old cicatrices syphilitic


286
Selections.
caries. It is also at this time that the hair, quite abund-
ant, began to fall out; that the cry became hoarse and
muffled; that the look lost its vivacity, and that apathy
manifested itself.
"The absence of cretinism and goitre in the family;
the absence of symptoms at birth; the normal shape of
the head and ears; the absence of goitre in the patient
and also of the subclavicular doughiness; the method of
development of accidents at five months by a lumbar
caries, with repeated convulsions for six months, followed
by the falling out of the hair, the tumefaction of the skin
and the arrest of intellectual phenomena; the absence of
tumefaction about the neck and thorax are the peculiar
details which, in this patient, present all the assigned
characteristics of myædema or pachydermic cachexia.
“The child is, beyond doubt, idiotic; but differen-
tiated from other idiots by her pachydermic appearance;
besides, her state is not congenital - it is an acquired cre-
tinoid state. Under what influence? No cosmic hygienic
condition being regarded as the cause, the alienation and
rickets in the family must be taken into consideration;
but, the well-formed skull of our subject defies all sus-
picions in regard to the idiocy as an effect of rickets;
besides, this child has two sisters neither idiots nor cre-
tins. 'In a family where the first-born is a cretin, the
others are generally so,' wrote M. Rambuteau, Prefet in
Le Valais (cited by Ferrers), to the Minister of the Interior,
in 1813. Here, again, our patient would constitute an
except is then, not a simples hygienic causes
But is
“ It is, then, not a simple idiot, it is not a congenital
cretin nor one by reason of hygienic causes (food, air,
water, want of light), with which we are dealing. But is
it a type of myxædema ? Our patient would seem to
be precluded on account of her age (4 years)—no case at
such an age having been published, as yet—the mode of
development and their exciting causes. No published case
has related in it lumbar caries, repeated convulsions
and the simultaneous appearance, or a little later, of the
puffiness; it would seem that the case is farther removed
from the fact that the puffiness is not general but has
respected the neck and thorax, contrary to all known
cases. But is it known how this state of the skin begins ?
Does it come on all over at once, or is it at first local or
disseminated ? Does it end by generalizing itself?
“ Being given a possible relationship between the


Selections.
287
lumbar caries, the convulsions, the idiocy and the pachy-
dermic state, how is it to be conceived ? Must the latter
phenomena be made dependent upon the first? Or is the
idiocy to be made to depend upon the convulsive seizures
or upon the pachydermic state? Can the convulsive
seizures and the idiocy be explained by a gelatinous state
of the connecting fibres, nerve cells or other elements of
the brain, a gelatinous state clearly appreciable under the
cutaneous surface ? All the hypotheses are possible, as
much so as the conception of a fortuitous coincidence
between these pathological phenomena. It is only observa-
tions which can throw light here, and it was to draw the
attention of others to this coincidence that we have
thought it incumbent upon us to publish this case with
all its details. -Ohman-Dumesnil.
A CASE OF TRAUMATIC Post-EPILEPTIC EXHAUSTIVE
PARALYSIS, WITH SOME PERMANENT “ DisSOLUTION.” —
IMPROVEMENT UNDER TREATMENT. By C. H. Hughes, M.
D., St. Louis.—Clinton D. Ely, aged 12; residence, Tipton,
Mo.; a bright boy, well advanced for his years at school
before the accident; fell in April, 1880, from a picket fence,
catching his pants' leg in a fence picket, and struck the
back of his head on some hard substance, causing concussion
and momentary unconsciousness, and making a raised place
on his scalp.
No fracture of the cranium was detected at the time of
the accident, or has been since, and no treatment was then
instituted. Epilepsia in the form of petit mal. appeared the
next day, and has occurred uninterruptedly to the time he
came under treatment, the boy having from one to twenty-
four paroxysms daily. He was put on Brown-Sequard's
solution for epilepsia, and has also taken iodide of potassium.
There are no hereditary nervous affections in the family.
His mother died of consumption at the age of thirty-three
years. Her grandfather died at eighty-three, and her
grandmother at seventy-three. Two of the boy's brothers
are living, and have had no spasmodic trouble. One of
his brothers and a sister died in infancy, the other in
childhood, of gastric inflammation.
After this injury this boy began writing with his left
hand, when before it he had learned to write with his right,
though in many things he was always left-handed. He
sometimes writes his name Clinton Dillon Yly (for Ely)
and sometimes Clinton Ely Dillon.


288
Selections.
şnellebet, but make msi
ad with far that a boyle has been
He is somewhat dazed mentally, impulsive and auto-
matic in his actions.
He can make and name most of the letters of the
alphabet, but miscalls them when pointed out to him in
Snellen's test type at any distance. His pupils are dilated
almost to their extremest limit, but his misnaming of letters
is not due to this fact. He cannot name them aright
through proper glasses.
After one of his spells of excessive epileptic recurrence
last April“ he slept eight days,” (comatose,) and “could only
be aroused sufficiently to get him to eat and drink a little.”
He could read with facility before the accident, and
pronounce almost any word that a boy of his age might be
expected to enunciate correctly. He has been almost
entirely hemiplegic on the left side, and completely
paralyzed in the right arm. He handles both upper and
lower limbs well now, January 15th, and has greatly
improved under treatment, having no paroxysms while
taking his medicine, and being much less automatic and
more spontaneous in his mental actions, brighter intellect-
ually, more tractable to his father's commands, displaying
more regulated volition and less impulsiveness, as brain
force is conserved by keeping the paroxysm in abeyance;
but he is far from well.
The preceeding record appeared in the St. Louis
Courier of Medicine for February, and to it we append
the following subsequent history, contained in two letters
since received from the boy's father:
Tipton, Mo., February 9, 1882.
“The boy is getting along nicely, has had no return
of those spells since the fifth of January and is improving
every way. I think that you would be surprised at his
iinprovement. At any rate I am under everlasting obli-
gations to you for thus far removing the dark cloud from
our home, etc.
TIPTON, Mo., April 13, 1882.
“Dillie is getting along nicely yet; has had no return
of those spells and is improving in the use of his limbs.
His mind is much improved. He is quite cheerful, full of
play, and is much like he was before the accident occurred.”
The dark cloud is not yet permanently removed, as
those know best who have had much to do with traumatic
epilepsia and its sequela. The boy has continued to
improve to this date—April first-and it only remains for


Selections.
289
us to complete the practical record by writing out the
prescription, upon which he will be continued for the
coming several months, at least, if all continues to go well
with the patient.
B Sodii Brom., 3iij; Ammon. Brom., 3j.; Syr. Calcii
Lactophos, zij ; Syr. Hypophos Comp., ziv.; Liq. Potass.
Ars., 3j.; Strychniæ, gr. 1.
M. S. Teaspoonfull three times a day in a glass of
water or milk, before meals.
Give daily, at bedtime, in addition to the above, a
thirty-grain dose of Bromide of Sodium in water. Diet
unrestricted except by digestibility; preferably of milk,
without stint.
Slow Pulse.—Dr. A. Rice, of Bridgeport, Conn., gives
the following account of personal observations on the rate
of his heart-beat: “Lying down, 36; sitting, 38; stand-
ing, 41; after walking one mile, 43; after walking two
miles, 46; after violent exercise, 52 per minute. Beat
counted at the apex beat to avoid error. The other mem-
bers of my family have natural pulses. I first noticed my
peculiarity eight years ago, since which time it has not
changed. I have not been sick enough to know what
effect a fever would have on it. I have no valvular
lesion or other trouble with the organ, though it is at
times a little irregular. My health is at all times excel-
lent. I know of no cause for the slow rate. My age is
under thirty."
UNILATERAL HEMIOPIA IN LOCOMOTOR Ataxia. — Dr
Gowers (British Medical Journal, Dec. 17, 1882) reports a
man aged 40, who was the subject of locomotor ataxia in
.an early stage. After a gradual impairment of sight, he
:suddenly became unable to see in the outer side of each
eye. The optic discs presented gray atrophy; vision of
right eye was qualitative only; with the left he could
read Jager twelve at five feet. The hemiopia was prob-
ably due to some disease involving the chiasma. A
similar case has been recorded by Prietel, which would
seem to indicate that the connection of the hemiopia and
locomotor ataxia was not in this case purely fortuitous.-
Chicago Med. Review.
ere on the organ: all times age i
M. Prevost's EXPERIMENTS ON ANIMALS WITH REFER-
ENCE TO THE TENDON-REFLEXES (recent memoir in Review
.de la Suisse), confirm those of Tschiriew, that section of


290
Selections.
the cord, at the origin of the sixth pair of lumbar nerves,
destroys the patellar tendon reflex. This pair corresponds.
to the third or fourth lumbar in man. Again, lesions of
the cord, on a level or a little above the exit of the sixth
lumbar pair also abolish the tendon reflex, if at all deep
(which confirms the experiments of Tschiriew, contrary to
those of Burckhardt).
Anæmia of the cord, produced in the rabbit by com-
pression of the aorta, modifies the knee phenomenon.
After a few seconds of compression, the phenomenon is
exaggerated during a few seconds, progressively diminishes,
and disappears entirely after a compression of forty-five
seconds.
As soon as the blood is allowed to circulate by remov-
ing the pressure on the aorta, the knee phenomenon
returns, after a lapse of time, varying from fifteen or
twenty seconds to one or more minutes. The reappear-
ance is slower in coming in proportion to the time spent
in compression and to the exactness with which it was.
done.
Anästhetics, if anæsthesia be profound, abolish the
knee phenomenon. This disappearance, during anæsthesia,
may be considered prodromic of collapse.
Like epileptoid trepidation, the knee phenomenon is
transmitted to the opposite side. This is much more
marked in animals in whom the cord has been cut trans-
versely in the dorsal or upper lumbar region, all the reflex
phenomena being intensified.
The ExtremES OF NERVE-STRETCHING.Dr. Kümmell,
of Hamburg, has stretched the optic nerve seven times
in five cases, when the eyesight had been partly or com-
pletely lost from atrophy, with but very slight symptoms.
of disturbance after the operation. He cuts through the
outer and lower part of the conjunctiva near the cornea,
passes a curved hook inwards and backwards and makes
a moderate traction. Some improvement followed in the
cases of incomplete blindness.
Simon is reported in Brit. Med. Jour., Feb. 25, as having
stretched the sciatic in a boy aged five, who had been
under three years' previous treatment for incomplete paraly-
sis of the right lower limb. Increased nutrition in limb
and decided improvement followed the operation, while
electricity, for two years previously, is reported to have failed.
CONTRIBUTION TO THE STUDY OF PARALYSIS BY COM-
PRESSION OF NERves. By M. Vulpian of Paris. — M. Vul-
toploid Prodromic pe


Selections.
291
pian, in a recent communication on this subject, made to
the Académie de Médecine (Bulletin, March 7, 1882), states
that he has lately had occasion to observe in his service
at the Hôtel Dieu a patient who, affected for some time
with arthritis of the right knee, had the limb immobilized
in a silicated splint, and, on that account, forced to use
crutches. During the first months she was not incom-
moded, but a few days prior to her admission the axillary
parts of the crutches had their padding removed and the
bare wood pressed upon the brachial plexus in the axillæ.
She felt pain in the fore-arms and hands; the dorsal region
of the wrists and hands were swollen and an extreme weak-
ness was felt in the arms. The fore-arms and hands were
paralyzed. On her admission to hospital she was enjoined
rest, and the pain disappeared in twenty-four hours; the
swelling also rapidly subsided; the paralysis alone per-
sisted.
There is no doubt whatever that this was a case of
paralysis due to the compression of the brachial nerves by
the crutches.
The author here gives full details, and a minute history
of the symptoms and examinations of the patient.
In this case the pressure acted upon all the brachial
nerves. This is not always the case. Sometimes but one
nerve is compressed. The paralysis in this case was com-
plete for the muscles of the fore-arm and hand of the
right side; incomplete for the corresponding parts of the
left side. The patient leaned more heavily upon the right
crutch.
The paralysis affected, really, almost nothing but the
motor functions. Sensibility was intact. The vaso-motor
and sudoriferous nerves had preserved their reflex action
intact.
Leaving these two latter aside, the question arises, how
sensibility remained intact whilst voluntary motion was
either lessened (left side) or alınost completely abolished
(right side). To account for this, the state of the princi-
pal agents of voluntary motion in the patient must be
examined. The encephelon and cord are evidently out of
the question; we need only look after the motor nerves
and the muscles.
The muscles of the right fore-arm and hand had pre-
served their contractility, to a degree almost normal; but
the nerves no longer acted to make them contract. The
Faradization of the radial nerve, for instance, had no action


292
Selections.
the Faradice muscleste sufficie
on the extensor communis digitorum; whilst the electrodes,
applied directly to the muscle, produced strong contractions.
The state was somewhat similar to that presented by a
frog poisoned with curare.
If the nerves are sufficiently compressed to become
altered, the muscles will not, or will very feebly respond
to Faradic currents. They will contract, however, under
the influence of galvanic currents. The muscles atrophy
rapidly, an example of which is seen in the patient in
that part of the extensor communis which moves on the
right the little finger, and on the left the index.
Vulpian concludes that the same general phenomena
occurs in this form of paralysis (by compression) as in the
radial paralysis is called a frigore, and agrees with M. Panas
who, in 1871, declared that the greater part of the paraly-
ses called a frigore were cases due to compression.
Finally, prolonged compression of nerves may produce
a paralysis of these nerves, characterized by a momentary
interruption, but more or less permanent, of the trans-
mission of excitations from the motor nervous fibres to
the striped muscular fasciculi, although both of these ana-
tomical elements may have preserved their physiological
properties.- [Ohmann-Dumesnil.


EDITORIAL
TRADUCING THE PROFESSION is a practice most repre-
hensible on the part of physicians, which all right-minded
men in the fraternity must condemn, and it is singular
that men and journals, whose speeches and pages are
assurely not faultless, should take pleasure in casting
stones of censure at a body of which they are integral
members, showing by their censorious manner, that they
exact of their profession that impossible infallibility and
unanimity of judgment common to no other professional
body.
Doctors of Divinity, according to the diversity of mental
proclivities, proverbially differ in regard to scriptural inter-
pretation ; Judges differ in the interpretation of principles of
municipal law, one court reversing the decision of another,
and yet the general respectability and credibility of their
professional judgments is conceded; as a class, nevertheless,
ministers and lawyers are “honorable men,” and so con-
ceded by the critics who carp at our calling. True, there
is much of mediocrity in medicine, especially in this
country where doctors are made, or rather have been
made, with such extreme facility. (That time, however,
is rapidly passing away.) But divines and attorneys-at-
law are likewise prematurely born, and there are no more
abortions among medical than among other professional
men, and American Medicine makes a more than counter-
balancing show of great physicians, and the upper rounds
of her ladder of Fame are becoming fuller of great names
with every passing year.
Under these circumstances, notwithstanding the imper-
fections of our profession, due to the fact, common to all
professions, that it is made up of fallible men, living in an
age of the world when the millenium of absolute perfec-
tion has not yet fallen on mankind, it is painful to see
the profession of medicine and its members arraigned by
its own weak votaries, because it is not infinitely more
perfect than the rest of the world ; but more painful still
is it to find it unjustly held up to censorious judgment as
absolutely imbecile, when in fact it is, if anywhere, and
ought to be absolutely stronger — far stronger than any
the
has not vd when the up of falliblack,


294
Editorial.
other profession—namely, in the determination of questions
of disease, especially where cerebral disease and conse-
quent mental aberration are concerned. Accordingly, we
regret to see a medical journal inveighing against “a paid
medical jurist (?)” being “allowed to effect by the voice of
scientific authority the plain judgment of a jury." Why
should not a medical expert as well as other experts be
paid, and in what way does payment for an opinion
necessarily affect the judgment of a medical expert any
more than the payment at so much a visit affects the con-
duct of the general practitioner, especially when expert
opinions are given ?
"It is a matter of common observation,” says the
writer to whom we refer, that “an ingenious examiner of
medical experts, by skillfully stating his hypothetical cases,
can wring from the most unwilling witness opinions on
insanity which will palliate if not excuse every murder not
committed for money.” This is not correct, unless the
assumed facts make a case of mental disease, and if the
symptoms of mental disease are correctly given what dis-
paragement is it to the medical expert if he pronounces
mental disease as existant, any more than it would be to
any other medical expert if he said some other disease
existed, upon being asked to pronounce an opinion upon
a correct narrative of its symptoms. If the hypothesis
contains statements which are not provable fact, it is the
fault of the jury if its fallacies are not found out, and of
the law, that when disease may be proved or disproved by
personal medical examination, that it permits an hypothesis
to supplement the patient.
Again, this medical critic of medical men says of his
brother physician: “He often arrogates to himself very
superior knowledge — holding the shifting speculations of
psychology as valid as fact itself, or pretending that science
is absolute in domains where, in fact, she has a very uncer-
tain foothold. The jury, if of average intelligence and
instructed adequately by counsel, will usually estimate
this learned lumber at its true weight," etc.; and a quota-
tion from a certain Lord High Chancellor is given, to the
effect that there “are very few cases in which any good
came from the examination of medical men.” Utterances
like these, made or indorsed by physicians of influence,
degrade medicine; yet they sometimes come from
men who talk much of exalting the profession. They are
not, however, "from mouths of wisest censure.” We do


Editorial.
295
en ondiment of my self-cony becausa whole,
not like to name the injudicious journal that could say so
much of unjustifiable harm to medicine in so few words,
and on its most prominent page. Perhaps its editors did
not mean so much, or did they not know better? It was
one of the evil utterances of the year that is gone - in
the month of last November - and the exciting cause –
Guiteau—who has had his trial and sentence. May we not
indulge the hope for more temperate and logical judgments
from this source in future ?
Two other journals, one in New York and the other
in a city in the northwest, have animadverted in similar
vein on medical expert testimony as a whole, to the detri-
ment of the profession, simply because the rules of legal
procedure permit any self-constituted expert to testify, as
the embodiment of the special acquirement of the pro-
fession on a subject about which he may be as ignorant
as he is conceited and self-assured, and the introduction
of hypotheses as to disease, which may be as far from
the fact as these editors' judgments are from the rules of
logical discernment.
If skepticism becomes “universal in regard to expert
testimony in psychiatry," as one of these journals asserts
it has already become, it will be through professional
influences exerted by enemies in our own household
striking suicidal blows at truth, whereas the real foe is in
the bench and bar. When they should consent to methods
of inquiry into questions of disease after medical methods
only, designed solely to reach the whole truth as to the
existence or non-existence of disease, instead of suppositi-
tious statements designed for forensic gladiatorial display
only, medical men will not be censurable for disagree-
ment in the diagnosis of hypotheses. We would rather see
our cotemporaries denounce the absurdities and often injus-
tice of the hypothetical case more, and discrepancies in
medical judgments based upon these imperfect representa-
tions of supposed disease, less.
ATTRIBUTING UNDUE IMPORTANCE to comparatively trivial
uterine affections in neuropathic women, is fraught with
consequences so serious, often, as to call for a protest
from the neurologist.
A reasonable amount of respectful and dignified pro-
fessional attention to the female genitalia in proper cases,
sufficient to determine local trouble and remedy it, is not
objectionable, but the constant daily tinkering with the
uterus and its appendages, needlessly making a repository of
king suic exerted bye, it will be these je


296
Editorial.
Syotect them t'should be so their morbid fear be justifies
gynecological art out of the vaginæ of every female who
comes to consult us with a shattered nervous system and
the imaginary notion that her womb is diseased, inflicts
upon these susceptible organism-mentally morbid in their
gynesic feelings — an injury which the profession should
protect them from. Examinations of these patients and
their treatment should be so conducted as to remove and
allay rather than establish their morbid fears, and as little
significance given to the local disorder as can be justified by
an honest regard for the truth of fact, based upon wide
experience, and not that circumscribed morbid“ specialism,”
in the Reynoldian sense, which, founded on restricted
observation, jumps at conclusions and discerns with the
speculum, like the man with the green glasses, everything
of one color. We have no word of censure for that type
of gynecologists who see in woman something more than
her womb, discerning something more than peripheral irrita-
tion, but for that other kind ( illogical reasoners and bad
observers) who, while they find in an ulcerated os the dire-
ful source of all of woman's woes, could see no evil come
from slashing and cauterizing it ad libitum (yet such was
gynecological practice not long ago) who, when they find
the slightest uterine displacement, regardless of the order
of sequence, if coupled with a nervous trouble, or of the
demonstrable fact that hosts of married women have had re-
laxed vaginæs, malplaced uteri, leŭcorrhæas and abnor-
malities in the menstrual fluxes, etc., without accompanying,
and, of course, without consequent nervous derangement.
It is the imitators of the Goodells', the Sims', Thomas' and
Emmetts', who make the mistakes in post hoc propter hoc
conclusions. They may have done so earlier in their
careers (and who of us have not ?) and they may occa-
sionally now (and who of us does not?), but in the inain,
when general experience is larger and judgment has ripened
with age, mistakes are fewest.
We are prompted to indite this, not in the spirit of
cavil, but because of the number of certain of our lady
patients who, having been gynecologized, insist upon our
paying more attention to their wombs, and thus fastening
upon them the gynesic hypochondriasis under which they
labor. In order not to be misunderstood, our rule is to
remedy in these patients, or advise the family physician
to remedy in them whatever is of real importance locally,
and with as little ado about it as possible, and then to turn
our attention to the patient and the patient's mind from
art is thes, who they mas hay
We are lause of the number coized, insist upon mo


Editorial.
297
at Utica Influence Health.” preta s'il est po
to others with a page of moyens," steht
herself. We hope our gynecological friends—and we are
friendly to all honest and broad-minded gynecologists—will
not misinterpret us.
DR. AMARIAH BRIGHAM ON AMERICAN NERVOUSNESS.—
Dr. Amariah Brigham was one of the most accomplished
scholars, closest thinkers and most careful observers of his
day, and he made good use of the rare opportunities for
observation afforded him by his position as superintend-
ent and physician of the New York State Lunatic Asylum,
at Utica. In an interesting little book, written in 1845, on
“ The Influence of Mental Cultivation and Mental
Excitement upon Health," prefaced by the very appro-
priate motto from Descartes: “S'il est possible de per-
fectionem l'espece humaine, c'est dans la medicine qu'il
faut in chercher les moyens,” which very appropriately
adorns the title page of one of the best of our exchanges,
he refers with alarm for the future well being of our race,
to “the excited state of mind which everywhere prevails
throughout this republic, and the vast amount of machinery
which is in operation to perpetuate such excitement, and
the little attention hitherto given to the dangers it may
produce” (p. 136). He thought our mental strain one of
the causes which would certainly lead to the ruin of this
country, and referred to the decline of the Roman Empire
as having been marked by the general predominance of
the nervous temperament especially among the Roman
ladies. The powerful and constant excitement of the
minds of the females of this country, together with their
neglect of proper physical education, threatens dangerous
consequences. Brigham's notes of alarm are worthy of
being heeded still, by the ladies of the land, especially.
His books are good reading, though his prophecies, owing
to the influx of population from abroad and the regen-
erating influences of the rapid expansion of occupied
western territory and the movements of population through
increased facilities of travel to the primitive life habits of
the Far West) have not been fulfilled.
The rapid progress of neurological research since his
book on “ The Brain, Spinal Cord and Nerves” first
appeared in 1840, bring to mind with emphasis his state-
ment then made, that "affections of the nervous system
have always existed and always formed a considerable
proportion of the diseases, and these the most obscure,
by which the human system has been assailed. But they
have vastly increased with the increase of civilization, and
nerve the perimeters of the educationalates and even wit


298
Editorial.
now constitute a far greater proportion of the diseases of
mankind than in past ages, and consequently demand far
more attention.”
One cannot scan the vast neurological literature of the
present day and not feel that Brigham still lives, in influ-
ence, over the medical thought of the present as he lived
in that of his own time. If we turn from Brigham to
Beard we feel that we are listening to the words of cotem-
porary writers as to time, though they are not in all
porary, of course, ASYLUMS FOR Tscotch asylyest
ngs, of DOOR" AEnglish nich, like ey call it
"OPEN-Door" ASYLUMS FOR THE INSANE.—Some of the
superintendents of English and Scotch asylums are boast-
ing of another advance which, like “non-restraint," they
have designated by a misnomer. They call it the “open-
door treatment,” in which none but the chief attendants
have keys. This "open-door” system, as the British Medical
Journal observes, “has prevailed more or less in English
asylums for twenty or thirty years past, and though no
one ever thought to so name it, to the extent to
which it is really practiced there, it has been in practice
in many of the hospitals of this country for quite as long
a time probably. It is no very difficult thing to so man-
age patients in a large State hospital with from four to
five hundred patients, and proper facilities for residence,
groupings and classification, as to have a number of the
halls on the ground floors — say three or four — remain
unlocked, so that the patients may go in and out, to and
from the grounds, gardens, workshops, farms, sewing-room,
bowling-alley, gymnasium, amusement-halls and library at
pleasure. We found it quite practicable to do this with
only from three hundred to three hundred and seventy
patients, sometimes for a considerable length of time.
The doors at Fulton were not locked with keys-a simple
turn of the knob locked them and keys were only pro-
duced to enter such doors as were locked. A good deal
of sensational nonsense is talked to the public in England
about the management of the insane and it makes a false
impression. Every practical alienist has learned that, as
a rule, with the insane the least show of irritating restraint
the better, and yet the conduct of the insane must be
judiciously regulated and in many cases absolutely and
directly restrained, else where is the need of asylums?
If one did not take what some of these Englishmen say
with a grain of allowance, he would be apt to conclude
that the proper plan would be to turn the lunatics out


Editorial.
299
and put the officials in for constructing restraining estab-
lishments for persons entitled to so much unrestrained
liberty.
REMOVAL of Both OVARIES FOR THE Cure of INSANITY.
-Dr. T. B. Wilkerson, of Young's Cross-roads, Granville,
North Carolina, reports in the North Carolina Medical
Journal, June, 1881, the case of a young woman 19 years
of age, in which he successfully extirpated both ovaries
for insanity with strong erotic tendencies of two years'
duration. At the end of three weeks she recovered from
the operation, and there was a gradual improvement in
the mental condition, and three months after the operation
sanity was perfectly restored. As important and impres-
sive an operation on some other organ might have had
the same effect.
CASTRATION TO AVERT DEMENTIA.—Dr. W. L. Folsom,
referring, in a late number of the Michigan Medical News,
to this operation having been successfully performed by
Dr. Josiah Crosby, in 1843, on an intelligent and educated
young man of twenty-two years of age, with the result of
restoring him from a state of mental apathy, immobility,
anthropophobia and “approaching dementia, to active
business usefulness," reports the conviction, which has been
often awakened and repeatedly expressed in the presence
of certain cases of masturbating mania, that there are
many just such cases throughout the land that can be
cured in no other way.
The difficulty in many of these cases is to determine
when the habit is the cause, and when the consequence, of
the mania; to get the patient's consent, and that of his
nearest friends, or guardian, and, in public asylums, to get
such a reasonable amount of professional and public appro-
bation of the operation as would justify an ordinarily
prudent physician-in-chief in exercising his discretion in
resorting to so radical a measure.
In some States, where every pretext for a periodical
rotation in the management of asylums is sought by
politicians, the physician who would unsex half a dozen
lunatics, even though by so doing he restored half of them,
and so far also stopped the perpetuation of the insane
diathesis, (an inestimable saving to the State and a priceless
blessing to posterity,) would not likely long retain his
position. The operation is, nevertheless, in many cases
indicated as a proper therapeutic procedure, and in


300
Editorial.
every case performed would have this compensation
attached to it, viz: that it would be the beginning of the
arrest of the growth of insanity, a "consummation devoutly
to be wished."
THE SHOOTING OF DR. John P. Gray, Superintendent
and Physician of the New York State Lunatic Asylum,
in his private office, on the evening of the 16th of March,
was probably the work of an insane man. The assailant
has been indicted and a commission of inquiry as to his
mental status has been appointed.
In response to a letter of inquiry we received from Dr.
E. N. Brush, Assistant Physician of the institution, a letter
dictated by Dr. Gray, of the same purport and tenor as
that already published in the Philadelphia Medical Times.
Our readers will be glad to know that Dr. Gray is doing
well, and although the injury is painful and may disfigure
him some, the brain is not implicated and the wound not
likely to prove fatal.
The ball (a 38-calibre) entered the face over the left
malar bone, three-eighths of an inch below the external
canthus of the eye, passed diagonally down back of the
nóse, just above the anterior nasal spine of the superior
maxillary bone, emerging in the center of the right cheek,
two and a half inches below the external canthus of the
right eye, and about half an inch back of a vertical line
dropped from that point. In its passage the ball injured
some portions of the nasal and labial branches of the
superior maxillary nerve, and at first there was complete
anæsthesia of the left side of the nose, and of the left
upper lip, with some hyperæsthesia of the right half of
the upper lip. This condition continues, but in a less
degree.
MARY ANN HERMAN, THE FASTING WOMAN, died at the
Clark County Poor Asylum, Jeffersonville, Ind., March 15,
at 11 o'clock, sixty-four days after she began her fast.
She lived in a house by herself, promptly paying the rent
and attending quietly to her own affairs. She was quite
fleshy, weighing about 190 lbs when in full health, but her
fast reduced her to about seventy-five or seventy-eight
pounds. She wore old-fashioned clothing and was very
eccentric in manner. She was, when a young girl, engaged
to be married to a minister, but he died, since which time
she has been a hypochondriac. On the 11th of January last
she commenced the fast which ended her days. On the


Editorial.
301
13th of that month she was in a stupor, and taken to the
City Jail; subsequently adjudged insane and sent to the
County Asylum. Every effort was made to induce her to
eat, but she would not. A few spoonfuls of milk were once
forced upon her, but this is all except a little water, and
that only during the last ten days of her life, that had
passed her lips. The superintendent tried every expe-
dient and resorted to strategy, but failed in his attempts
to induce her to take food. The woman had a powerful
will and was determined to starve herself to death. The
object was accomplished after a fast of sixty-four days.
The nostril tube or the stomach pump, persistently
employed, would have saved this poor woman's life, and
might have driven away her delusion. We once fed a
patient ninety-six days on the most nutritious liquid diet,
he each day protesting that he had no stomach to
retain it. This was troublesome though. It took three
stout men and a physician to feed him, but it was done
once every day, quietly and resistlessly.
He lived many years afterwards, greatly improved in
mind, and always took his food without urging, and gave
up the delusion about the incapacity of his stomach.
But this was not the non-restrained method, for his
own will was to be let alone. Coercion in these cases
is often salutary.
THE CHARITABLE INSTITUTIONS OF VIRGINIA.— A bill pro-
viding for the removal of the boards of directors of all the
lunatic asylums and the deaf, dumb and blind institution
in the State came up in the Legislature lately. Amend-
ments providing that none of the skilled officers nor
trained attendants of these institutions should be removed,
unless for cause were voted down.
It is singular that political parties can not fly a flag
of truce over the dwelling-places of these non-combatant
unfortunates. Here is a good place for the dominant
party of Virginia to begin a civil service reform. The
Constitution of every State in the Union should make the
management of its medical charities at least, sacred from
the damaging touch of politics.
DEAN Swift's DISEASE. — Dr. John C. Bucknill, in a
late number of Brain, pronounces the malady with which
the talented and eccentric Dean suffered through life to
have been Menière's Disease, a more serious malady
afflicting him toward the close of his life. The article, like


302
Editorial.
everything Dr. Bucknill has written for years, is of read-
able interest, profitable and instructive. We quote one
paragraph, regretting we have not room for more:
“We can diagnose his life-long disease as labyrinthine
vertigo, and his insanity as dementia with aphasia; the
dementia arising from general decay of the brain from
age and disease, the paralysis and aphasia from disease of
one particular part of the brain. With all the tortures of
the life-long disease from which he suffered, and its obvi-
ous effect upon his temper in his later years, it is won-
derful that Swift did retain his reason until, in the 74th
year of his age, he was in all probability struck down by
a new disease in the form of a localized left-side apoplexy
or cerebral softening, which determined the symptoms of
his insanity.”
THE ALIENIST AND NEUROEOGIST, edited and published by Dr. C. H.
Hughes, M. D., St. Louis, Mo. This valuable quarterly publication has
entered on its third year, and as an exponent of advances made in our
knowledge of nervous and mental diseases, Dr. Hughes has made bis
journal a success. Not only is the journal a necessity to specialists, but it
is exceedingly useful to general practitioners of Medicine.-Cin. Lancet
and Clinic.
If we shall succeed in filling our marked-out mission
as well as the Cincinnati Lancet and Clinic has accom-
plished its purpose of supplying the profession with a first
class scientific and clinical medical weekly, indispensable
to the profession, our ambition will be fully satisfied. We
have never seen an uninteresting and uninstructive num-
ber of the Lancet and Clinic. It is to the profession what
good commercial paper is to the business world — gilt-
edged.
A distinguishing feature of the Lancet and Clinic is
the number of judicious neurological selections each of
its numbers contain, making it a valuable companion to
the ALIENIST AND NEUROLOGIST.
A FIELD FOR BATTEY'S OPERATION is facetiously con-
ceded by the London Lancet, by which that journal
means a limited area, but it protests that the term field
should not be construed to mean a boundless prairie.
UTERINE MASSAGE, abdomino-vaginal, is likewise not
unreservedly countenanced by the same journal, in those
maladies which, though entailing discomfort and ill-health,
are not dangerous to health, notwithstanding the claim
that certain practitioners, who have found it successful,


Editorial.
303
of their o..command many men magnetism
tes"
“possess a degree of personal magnetism which does not
fall to the lot of many men, and by which they are
enabled to command all those psychical aids on the part
of their patients which are sometimes quite as essential in
the cure of disease as are remedies of a more material
nature."
“The modus operandi consists in gently pulling forward
the cervix uteri and allowing it to fall back five or six
times; the uterus is then gently squeezed between the
two hands in all its parts. The uterus should also be
pushed up and held up in the pelvis by the fingers in the
vagina. The whole proceeding should occupy from ten to
thirty minutes."
The Lancet congratulates itself that “this practice does
not seem to have crossed the Atlantic.” It will doubtless
reach there when the gynecological gentlemen of “per-
sonal magnetism” and “psychical influence” hear of it.
We had not before heard of this magneto-mano-psychical
school of gynecologists.
The Michigan Medical News misunderstands our paper
on “Moral Insanity." We do not place the moral faculties
outside of the brain, nor regard moral insanity as a purely
ganglionic disorder, while there is no doubt of the fact
that moral perversion may, and does, sometimes, result
from primary disease external to the cerebrum, as in
nymphomania, satyriasis, the monomanias and hysterical per-
versions. Won't the News look the paper over again ?
The difficulty in the way of the just recognition of
moral insanity is that medical men will not take the
trouble to differentiate it from controllable vice, because
such a view is unpopular. But we do not understand that
it is the duty of scientists to first feel the popular pulse,
like politicians, before speaking.
CRANIAL PERCUSSION FOR DIAGNOSTIC PURPOSES will be
found of real value in meningitis verticis and other
circumscribed affections, the scalp being first gently gone
over with the fingers to ascertain that no complicating
cutaneous hyperästhesia exists. Dr. Alexander Robinson,
of Glasgow, was, we believe, the first to call professional
attention to this subject in 1877.
“ HOUSEMAIDS' KNEE” and the “Knee Phenomenon.”
A case of this kind lately came under our observation in
the grown daughter of one of our patients, where, after
the subsidence of the intra-capsular effusion there remained


304
Editorial.
cted dhe elicitedly of the hotel
in the affected (left) knee a partly destroyed tendon, the
percussion of which elicited no tendon-reflex phenomenon,
nor was the lower extremity of the quadriceps, just above
the capule, responsive. The right limb, at this point
was responsive.
The RightS OF THE INSANE, IN VIRGINIA, are in jeopardy
by the rotation in the offices of the Insane Asylum
Superintendencies, contemplated in the changes of the
management of these institutions, recently made for political
considerations. These helpless wards of the State are
entitled to protection by the commonwealth from political
invasion and its probable consequences in unskilled medical
service. While the “Old Dominion," that gave to the
world the grandest bill of rights that ever emenated from
human source, is meditating this violence to the rights of her
people's wards, the rights of the insane, in Pennsylvania,
are being looked after by gathering these unfortunates in
from the neglect and self-reliance of the alms-houses of
that State, to the better provision of the hospitals. “Our
aim," writes a philanthropic and distinguished medical
superintendent, “is to clear the poor-houses of the insane,
and the prospect is good of succeeding." Good words
from the land of Penn! The helpless should have their
rights as well as those who are strong enough to fight for
their own. That State is greatest which most zealously
guards the welfare of its weakest citizens.
ACUTE MANIA AFTER SCARLATINA is being noted in the
clinical records of several recent numbers of our inedical
exchanges. Scarlatina, as a cause of mania, is by no
means a new discovery, this, and the other exanthematous
fevers being not infrequent causes of mental derangement,
as the records of all asylums show. Scarlet fever, however,
much more frequently than the other fevers of its class,
leaves cerebro-psychic disease as a sequel, but as the result
of premature suppression or retrocession, insanity more
often follows measles, the suppression of scarlatina being
usually more damaging to the kidneys than to the brain.
A comparative inquiry into asylum records on this subject
would be interesting at this time, and we should be glad if
some of our readers would undertake the labor and give
us the results, since both of these diseases are tangible
physical causes of mental disorder.
THE POWER OF A MORBID IMPULSE in the melancholic
insane, even where reason, aside from the morbid coloring


Editorial.
305
it receives from the perverted feeling, is not perceptibly
deranged, was again vividly illustrated lately in the case
of Mrs. Frank A. Reynolds, who, two years after the death
of her husband and the loss of his property, while serving
as chief clerk in the distributing department of the
Northern Ohio Asylum of the Insane, under the superin-
tendency of Dr. Strong, drowned herself. She knew the
difference between right and wrong according to her own
confessions, and had her insane act been the killing of
another, instead of herself, she would, according to the
decision of Judge Cox, in the case of Guiteau, have been
guilty of murder. Her last words were: “I know that
suicide is murder, but God has abandoned me, and it
matters but little what I do.” Suppose, instead, she had
killed another, and saying and feeling that, though the law
calls it a crime, God wills and justifies it, and that nothing
in her life belied her words or feelings, before Judge Cox,
she must have been executed for an act of disease.
The world has many irresponsible lunatics in it who
know abstractly the right and wrong of their acts before
the law-for an insane person must be exceptionally insane
to forget automatic impressions-and who yet can not
resist their morbid impulses or see their acts in the same
light as they did before disease took possession of their
brain and mind. Moral and statute laws are for others.
The insane are laws unto themselves.
SENATORS' VIEWS OF THE SIGNIFICANCE OF TENDON-
REFLEX, Centralblatt für Med. Weis., are in accord with
our own, and we think time and repeated observation
will confirm their truth, viz. : tendon-reflex, or as Gowers
prefers, muscle reflex, is neither always present in health
or always absent in ataxia. In media veritas est.
THE ALIENIST AND NEUROLOGIS1.–This excellent quarterly journal
bas now entered its third year of existence under direction of the
distinguished Dr. C. H. Hughes, of St. Louis. It has a wide circulation
in the United States, and is well known also in Europe. Our Alienists
should be grateful to this important periodical for its continuous
reproduction of Italian articles. translated by its able and most active
collaborator, Dr. Joseph Workman, of Toronto (Canada). This gentle-
man, though at the advanced age of seventy-seven years, furnishes to
the ALIENIST AND NEUROLOGIST a great many excellent translations from
the Italian, as well as from several other languages, to the alienistic and
other medical journals of the United States and Canada. We admire
the vigorous senescence of the venerable Workman, and we avail of this
ocasion to thank him very warmly for his long and very polite letter on
the merits of our Il Pisani - Translated from 11 Pisani Gazette Sicula di
Scienee Mediczhe e Psicologiche.
It is both gratifying and encouraging to receive from
such competent sources such attestations of appreciation.


306
Editorial.
They stimulate and inspire to increased endeavor, and our
most ardent hope is that our ALIENIST AND NEUROLOGIST may
some day become to this country what Il Pisani Gazetta
Sicula di Scienze Medische Psichologiche is to the medical
and legal professions of Italy...
But far greater than the pleasure we derive from the
above kind expressions concerning ourself and Journal, is
that which we feel at the just tribute to our distinguished
and venerable collaborator, Dr. Joseph Workman, whose
clear head and steady hand, still strong and vigorous as
when we first saw the one and clasped the other, when
we were yet young in the ranks of psychiatry and neu-
rology, have contributed so much to the now assured
success of the ALIENIST AND NEUROLOGIST.
THE POTENCY of PsychiCAL IMPRESSIONS has been again
illustrated, for the ten thousandth time, in the death of
Fred. Miller from fear of hydrophobia. The man had
been bitten by a dog, not rabid, and dwelt upon the
imaginary possibilities till the morbiphobia passed into
mania, and he died with all the symptoms of maniacal
exhaustion, but without a sign of the disease he dreaded,
the fear of which equalled the reality in fatality to him.
The Missouri STATE MEDICAL ASSOCIATION meets at
Hannibal, on the coming 16th of May. A good attend-
ance of the profession, and a profitable and instructive
session is expected.
THE THIRTY-SIXTH ANNUAL MEETING of the Association
of Medical Superintendents of American Institutions for
the Insane will be held at the Grand Hotel, in the city
of Cincinnati, Ohio, on Tuesday, May 30, 1882, commencing
at 10 A. M. A profitable and enjoyable meeting is expected.
TO THE AGNES BOTANIC COMPANY.—The ALIENIST AND
NEUROLOGIST is not a religious journal, its editor is not a
divine, and we are not interested in disseminating the
wonderful virtues of the “Sister Agnes Herb Cure," conse-
quently we can not engage to hand your communications
"to the principal news dealer of our congregation."
Olive Logan thinks Paris, “as a maniac maker is the
champion metropolis of the world.” She thinks it is “no
wonder, in such an atmosphere, that private mad-houses
are as necessary as cafés. The truly provident Parisian
nowadays,” she says, "arranges for his transfer to a
comfortable maison de sante before the inevitable hour of
his lunacy sounds for him. "What is the matter with Olive?
OLIVE? Fincipal newsdesto hand your


Editorial.
307
the reservas
should elanstration of
catly complete
DOSAGE IN NEURO-THERAPY should, in most cases, be
proportionate in quantity to the effect desired, regardless,
sometimes, of the ordinary maximum, with the reserva-
vation that after the administration of a large dose a
sufficient interval should elapse to allow of complete, or
nearly complete elimination.
Ill success in the management of nervous diseases is
often the result of dosage inadequate in quantity to make
decided impression on the nerve system, and too often
repeated, so that irritability instead of tranquilization, and
other bad effects too often follow the exhibition of a good
neurotic agent. A sixty-grain dose of any of the bromides
given once or twice in twenty-four hours will do much
better than thrice the amount spread over one hour inter-
vals. And so with chloral, a single full dose of thirty to
fifty grains accomplishes more tranquilization than ten
grains every hour. Ten grains every hour will sometimes
excite a condition of irritability which four ten-grain doses
blended in one, and given at bed-time in a glassful of
water, would arrest or subdue. The ordinary dose of
hyosciamine and morphia, and all other tranquilizing neu-
rotics, fall under the same law. In many cases a sixtieth
or a thirtieth of a grain of hyosciamine, like a twelfth or
eighth of a grain of morphia, will provoke insomnia and
excite delirium rather than allay or overcome them.
Having once determined to employ a hypnotic, we ought
to use a full dose.
How LAWYERS ARE SOMETIMES MADE.—Prichard refers
to the case of three congenitally idiotic brothers, one of
whom received a blow on the head which brightened him
up a little, and he afterwards became a barrister. His
less fortunate brothers died idiotic.
THE AMERICAN MEDICAL Association will meet in St.
Paul, Minn., on Tuesday, June 6th.


OBITUARY
Dr. Mark RANNEY. - On the 13th of January 1882,
Mark Ranney, M. D., Superintendent of the Hospital
for the Insane, Mt. Pleasant, Iowa, died of an attack of
acute pneumonia. Though he had not been in robust
health for several years he had fondly cherished the hope
that in a few years he would be able to retire to the
quiet of domestic life, and spend the remainder of his
days in those congenial pursuits for which every profes-
sional man has acquired a special fondness. But that
hope he has not been permitted to realize.
Born in Vermont, in 1827, receiving an academical
education, and graduating from the Vermont Medical
College in 1849, he was very shortly afterwards appointed
Assistant Physician of the Butler Hospital for the Insane,
at Providence, R. I. Here, under the care and direction
of that very able and distinguished man, Dr. Isaac Ray,
he remained until 1854, profiting by the experience,
learning and extensive professional attainments of that
eminent alienist. Accepting a position as Assistant Phy-
sician of the McLean Asylum, at Somerville, Mass., he
remained in connection with that institution until 1865,
when he received the appointment of Superintendent of
the Hospital for the Insane, at Mt. Pleasant, Iowa, to the
discharge of the duties of which position he brought the
training, attainments and professional ability acquired by
his long connection with those institutions.
He remained in charge of the hospital at Mt. Pleasant
until 1872, when, on account of a series of various troubles
and annoyances he resigned, intending to spend a year
in travel, in Europe, but was requested to take charge of
the State Hospital at Madison, Wisconsin, and after
remaining there a year was invited by a unanimous vote
of the trustees, again to take charge of the hospital at
Mt. Pleasant.
Feeling that such an election was a full refutation of
all the charges and vexations which he had before expe-
rienced, he resolved to accept the position and do his full
duty. This he did to the satisfaction of all except those
who think that the diligent, conscientious performance of
duty is a reason for doing all in their power to annoy
the travel in he resigning of a seriepital at me.
of thening thetespital ate was requesting to various


Obituary.
309
and disturb those who thus effectively attend to what
they believe to be the duty laid before them. In all the
relations he was called upon to assume, he discharged
what he firmly believed to be his duty, from a conscientious
conviction that, when called to the performance of any
duty, every man is bound to give his best energies and
capabilities to the work.
As Superintendent of the Hospital for the Insane,
lecturer on Insanity to the Iowa University, and every
other position requiring the exercise of sound judgment
and clear convictions, he went forward under the guidance
of correct principles and a discriminating mind, which
enabled him to decide promptly and judiciously what was
really for the best at the time.
That subsequent knowledge may have led him to
modify some of these decisions was only the natural result
of the exercise of that sound, rational common sense,
which teaches all men who will heed its monitions, that
no man has reached that point beyond which he can not
be taught by the lessons of greater experience and
cautious observation
To those who had the pleasure of personal friendship
and acquaintance he was generous, courteous and warm-
hearted, and those who knew him longest and best feel
that the medical profession has lost one of its ablest
members, and the specialty to which his life was devoted
a co-laborer, zealous, earnest, guided by sound principles
and a sincere desire to promote, in the highest degree, the
welfare of the unfortunate class for whose relief the labors
of his life were so nobly and so ardently devoted.
Resolutions by the State University of Iowa.-Inasmuch
as death has invaded our department and removed from
our midst our friend and colleague, Mark Ranney, M. D.,
therefore be it
Resolved, That we set apart and inscribe to his memory
a page of our records.
That through all these years of labor in the Medical
Department of the State University, we have ever found
Dr. Ranney a true friend, a ripe scholar, a courteous gen-
tleman and an enthusiastic teacher.
That while we shall miss the annual visits of our col-
league, we shall ever remember with great pleasure his
association with us in the work in which we have been
mutually engaged, and the deep interest he has ever


310
Obituary.
shown for the prosperity of this department of the Uni-
versity.
That we extend our warmest sympathies to his devoted
wife, in this the dark hour of her bereavement, and beg to
be permitted to drop a tear over the grave of our beloved
and honored friend
That a copy of these resolutions be sent to the family
of the deceased, and to the ALIENIST AND NEUROLOGIST
for publication.
W. F. PECK, Dean.
Iowa City, Iowa, March 1, 1882. 0. T. GILLETT, Sec'y.
BRIERRE DE BOISMONT. — Still they pass away — the
illustrious living to become the immortal dead. In our
last, along with our Draper, and Selmi, of Italy, we
chronicled the death of the great Bouillaud, at the ripe
age of eighty-five years. Now we have to record the loss of
another bright son of France, and by adoption a cosmo-
politan child of psychological science, M. Brierre de Bois-
mont, who, a little younger than Bouillaud, but also at the
mature age of eighty-three years, has lately departed this life
honor-crowned and glorified. France will mourn and miss
him as we yet mourn and miss our immortal Ray. He
was, in his day, the Nestor of French psychiatry. He
has left behind many enduring monuments to his industry
and mental worth, the best known and most enduring of
which are his “Rational History of Hallucinations," and
“ Insanity of Suicide.”
THE DEATH OF Darwin, author of the Darwinian
Theory of Evolution, is announced in London, April 20th,
as we go to press.
is "Rathe best known"uments to his ind. He
NOTES FROM THE HOSPITALS.
RESIGNATION OF DR. BANCROFT.—Dr. Jesse P. Bancroft,
Superintendent of the New Hampshire Asylum for Insane
for the past twenty-five years, has resigned that position.
This step he has long had in contemplation, having given
the best years of his life to the supervision of the insti-
tution. He has brought the institution into the front rank
of asylums for insane in this country, and will leave it in
most excellent condition.
Dr. CHARLES P. BANCROFT, who is the new superinten-
dent of the asylum, entered upon the duties of his office
April 1, 1882.


Hospital Notes.
311
Dr. C. P. Bancroft was born in St. Johnsbury, Vt.,
but came to Concord with his father's family when five
years of age, and is now in the thirty-first year of his
age. His early education was received in the public
schools of Concord, and he fitted for college at Phillips
Academy, Andover, Mass.; graduated at Harvard College
in 1874, and from Harvard Medical School in 1877. He
served a year and a half as a house physician in the Bos-
ton City Hospital, and has been for nearly three years in
general practice in Boston, and during this time has offi-
ciated as dispensary physician. He has had one year's
experience in the Concord Asylum as Assistant Physician,
and while pursuing his medical studies was for two years
at the McLean Insane Asylum, Somerville, Mass.
West RIDING LUNATIC Asylum—The following para-
graph from the review of a report of West Riding Lunatic
Asylum appears in the report for 1882 of the Superin-
tendent of the Independence, Iowa, Hospital for the Insane:
“The complaint has been made that medical officers
of insane asylums contribute little to the common stock
of professional literature. However desirable it may be
that observations should be carefully made and recorded,
and physiological and therapeutical investigations widely
extended, it is infinitely more desirable that minds strug-
gling upwards toward the light, from out the gloom of
meancholia, deep as the shadow of death itself, or begin-
ning to regain steadiness and self-control, after the stormy
chaos of acute mania, should be cheered, aided and
strengthened by those who best understand their troubles.
To accomplish this good, nothing so much avails, at least
among patients of some culture and refinement, as familiar
and personal contact with the medical officer. Upon him
rests the hope of cure and restoration to the world; in
him they put their trust more than any other earthly being;
in his presence they find the highest incentive to self-con-
trol and propriety of conduct. To deserve his approval,
they will put forth wholesome efforts which could never be
excited by the best endeavors of the kindest attendant.”
Yet the fruits of the West Riding Asylum are known
to the medical world in rich pathological and clinical con-
tributions, while the hospital at Independence has made no
sign to the profession of the existence of anything valu-
able within its walls. The hospital superintendent who
notes his observations, fixes and improves his knowledge
and fitness to manage his patients.
W


312
Hospital Notes.
t liber persons wh pleasure cher, as in
BIENNIAL REPORT OF THE INSANE HOSPITAL AT FORT
STEILACOOM, WASHINGTON TERRITORY.-Admitted during
the year ending August 15, 1880, 33; males 25; females
8. Total number of cases during year 108; males 87
females 21. Discharged during year 22; males 20, females
2, as follows: recovered 9; males 8, females 1; improved
4; males 3, females 1; died, 9 males.
Admitted during year ending August 15, 1881, 44;
males 31, females 13. Total number of cases during year
130; males 98, females 32. Discharged during year 34;
males 26; females 8, as follows: recovered 27; males 23,
females 4; improved, 2 females; died 5; males 3, females
2. Remaining at end of year 96; males 72, females 24.
While we learn from this report of the somewhat
peculiar origin of the hospital buildings, which were
vacated and are now renovated barracks of the Fort, of
their primitive and temporary character, as they are built
of wood, we also learn with pleasure that the management
is in the hands of persons who are not only well acquainted
with the most liberal and approved methods of treating the
insane, but that these methods receive much practical
consideration.
The entire report is impressive and the reader is
convinced that it is a production emanating from the mind
of a person fully realizing the responsibility of the situation.
The remarks on the general management of the insane,
their treatment, employment and amusement, are evidently
those of a practical individual who not only accepts a
theory but gives you palpable evidence of its efficiency.
We hope that the Legislature of Washington Territory
will give the managers sufficient money to build a new
hospital, and that Dr. Waughop may continue to chronicle
the results of his energy and ability.
REPORT OF THE INSANE ASYLUM AT WARREN, PENN. —
The first patient was admitted to this hospital December
5, 1880, since which time there have been 255 admissions ;
46 males, 179 females. Discharged-Restored, 3 males, 2
females; improved, i male, 8 females ; stationary, I male,
I female; died, 2 males, 8 females.
The excess of females admitted is due to the fact that
a large proportion of the female patients in the Danville
State Hospital were transferred to Warren after the first-
named institution was partially destroyed by fire.
Dr. John Curwen, former Superintendent of the State
Hospital, Harrisburg, Pa., was elected superintendent


Hospital Notes.
313
of this hospital, June 24, 1881, to succeed Dr. D. D.
Richardson, of Philadelphia, who was chosen superintend-
ent previous to the formal opening of the institution for
the reception of patients, and who, at the urgent request
of his friends, resigned for the purpose of returning to
his original field of labor in the city of brotherly love.
The trustees have reduced the price of maintenance,
etc., of the indigent insane in this hospital to $2.50 per
week. This, it is hoped, may have the effect to deplete
the alms-houses and prevent them from filling up, by
diminishing the pauper class of insane in that state, since
the friends and families of many poor persons can raise this
small sum for their proper maintenance and treatment.
REPORT OF THE INSANE ASYLUM AT DANVERS, Mass. —
Total number under treatment during the year, 1,104;
males 527, females 577. Admitted during the year, 497 ;
males 226, females 271. Discharged during the year, 478;
males 231, females 247, as follows: Recovered, 124; males
58, females, 66. Much improved, 14; males 9, females 5.
Improved, 97; males 38, females 59. Unimproved, 141;
males 62, females 79. Not insane, 8; males 6, females 2.
Died, 94; males 58, females 36. Remaining, September
30, 1881, 626; males 296, females 330.
Dr. Goldsmith begins his report with regret that he has
little hope for the ultimate recovery of a large proportion
of his patients, and invites special attention to the distress-
ing fact that many aged and decrepit insane are brought
to the institution to die rather than to be treated; when,
if their friends manifested a reasonable amount of affec-
tion or forbearance, they could be provided for at home,
or in large cities, they could be as well cared for in the
general hospitals. The doctor is not the only superin-
tendent in the great State of Massachusetts, or any other
in the Union, who suffers from this want of affection on
the part of relatives, or discretion on the part of county
and town officers whose duty it is to provide relief for the
poor, sane or insane.
At Danvers they are evidently making a laudable effort
under difficulties, to carry into effect the open-hospital and
out-door treatment of the insane, as observed by Dr. G.,
while preparing himself for his present field of labor, in
the English and Scotch asylums, particularly Woodilee,
near Glasgow, that perfection of open-door asylums, the
ideal no-lock hospital; but the sane foreigners in this
country of sweet liberty will have to be taught to yield that
ales , female females 3.th regre
30, Dr. Golo for the invites and d


314
Hospital Notes.
obedience to authority to which they so calmly submit at
home, before the most energetic and enthusiastic hospital
management in this country can control the large foreign
insane population by the same methods that govern them
in their native lands.
REPORT OF THE INSANE ASYLUM AT TAUNTON, Mass. —
Whole number of cases treated during the year, 828; males
437, females 391. Admitted during the year, 272; males
152, females 120. Discharged during the year, 140 males,
86 females; of whom 39 males and 18 females had recov-
ered; 17 males and 17 females were much improved; 28
males and 24 females were improved; 56 males and 26
females were unimproved. One female was not insane.
There were 54 deaths; 27 males and 27 females.
This is one of the few reports in which we find cases
reported independent of persons, for while there were 828
cases under treatment there were, in reality, but 813
persons.
Dr. Brown treats the subject of reporting insane cases
and persons at length, but lack of time and space prevent
us from giving an extended review. We also refer with
pleasure to his comments upon the employment and parol.
ing of patients.
REPORT OF THE INSANE ASYLUM AT MORRISTown, N. J.-
Total number under treatment during the year ending Oct.
31, 1881, 772; males 384, females 389. Admitted during
the year, 187; males 108, females 80. Discharged during
the year, 132; males 74, females 58; as follows: Recov-
ered, 35; males 20, females 15. Improved, 40; males 23,
females 17. Unimproved, 8; males 3, females 5. Died,
49; males 28, females 21. Remaining at end of year, 641;
males 310, females 331.
After commenting upon the movements of the patients
and the improvements completed and proposed, the sub-
ject of the proper employment of the insane received
attention at length, and while the article is well written
and evinces care in its preparation, we regret that the
report does not give us the slightest information as to how
the patients are employed or the amount and character of
labor performed. If we are to profit by Dr. Buttolph's
experience and learn of him anything but the best methods
of writing a good report, let us have an exhibit of the
harvest gathered from his fields.


Hospital Notes.
315
DIXMONT HOSPITAL FOR THE INSANE. — If our asylum
superintendents elsewhere would imitate Dr. Reed's praise-
worthy example and invite the several State societies to
meet near their asylums and enjoy the superintendent's
hospitality once in a while, a great deal of professional
prejudice against asylums and their superintendents, now
existing in some quarters, would be obliterated.
We have a sympathetic fellow-feeling for asylum super-
intendents, know something of their trials and needs, and
that which they need most is to be understood aright by
the medical profession and the public.
Medical men do not visit hospitals for the insane often
enough, as guests of their medical heads, to minutely
inspect their practical workings.
The following is the programme of the musical and
literary entertainment given by the Euterpe Club, at
Dixmont Hospital, on Thursday evening, March 16, 1882,
for the diversion of the patients :
Part First. – 1. Instrumental Duet — “ Wandering Jew," Zurg-
miller; Misses Mollie W. Coffin and Ella M. Jackson. 2. Vocal Solo-
“ Beautiful Isle of the Sea,” ; Mr. W. D. Thomas. 3. Declama-
tion - " Jemima's Courtship,” — ; Miss Essie W. Flipn. 4. Vocal
Solo-"Stars the Night Adorning," — ; Miss Mollie W. Coffin. 5.
Declamation-
—; Mr. W. H. Griffith. 6. Vocal Solo-
- ; Mr. F. W. Edwards. Dialogue—"Scene in a Railway Station."
Characters: William Yokil, a Dutchman, Mr. E. W. Connelly; Bryan
Malone, an Irishman, Mr. J. H. Gettleman; Ralp Rufus, an Exquisite, Mr.
Frank Connelly; John Smith, Ticket Agent, Mr. W. D. Thomas ;
Mrs. Prudence Pegg, an Old Woman, Miss Jessie W. Flinn; Miss
Ellen Elder, very stylish, Miss Mame Thomas. Part Second. -
Instrumental Duet—"Les Grelots” (the sleighbells) Boscovitz; Misses
Mollie W. Coffin and Ella M. Jackson. 2. Vocal Solo--
Mr. F. W. Edwards. 3. German Lecture—Subject “Love," — ; Mr. E.
W. Connelly. 4. Vocal Duet—“Home to Our Mountains,” Miss Mollie W.
Coffin and Mr. D, W. Thomas. Courtship Scene from Widow Bedott:
Widow Bedott, Mr. W. Griffith; Elder Sniffles, Mr. A. D. Munn.


REVIEWS
CLINICAL AND THERAPEUTIC RESEARCHES UPON EPILEPSY, HYSTERIA
AND IDIOCY. Report of the Service of Epileptics, and Idiot and Backward
Children, at the Bicétre during the year 1880. By MM, Bourneville and
D'Olier. Publications from Le Progres Medical. 8vo., pp. xxxviii. 73.
The first paper is a concise history, by M. Bourneville, of the condition,
past and present, of the service for epileptics, idiot children, etc., at the
Bicétre. He commences by relating what the condition of this service
was at the time when he entered as a student in 1860, and shows the changes
and advances made from time to time until the latter part of 1879, when
he returned to it in the position of chef de service.
Then follows a paper by MM. Bourneville and D'Olier. A “Note upon
the Blue Sickness-Central Temperature.” They figure in one of their
cases a remarkable and rare condition of the cardiac orifices and great ves-
sels. Several operations carefully made corroborate the generally received
view that, in this affection, the temperature is below the normal standard.
Next comes a “ Note upon a Case of Cretinism with Myxcedema," by
tbe same two observers. Then Prof. Bourneville reports the case of an
idiot who refused to take food. The writer thinks such cases are very rare.
His first "attack of abstinence” was at the age of two years. He took noth-
ing but water and sometimes a little chicken soup, without salt, which he
thought was water. He could not be induced to take any other food at
all. His second fast occurred when seven years old. He had four or five
in the next eighteen months, the longest continuing for twenty-eight days,
during which time he took only water, and chicken broth unsalted; and
during that time he had no passage from the bowels but voided urine
abundantly. The other fasts lasted from two to eighteen days. In all his
fasts he remained lying down, and appeared to have neither fever nor pain.
Under systematic treatment the general condition was greatly improved ;
the epileptic seizures were arrested and with them the tasts ceased.
The following paper is a fully detailed clinical history of a case of
hystero-epilepsy in a young boy of 13 years.
Next we find a report of the result of researches made with reference
to the use of bromide of ethyl in epilepsy, which ends with the following
conclusions :
1st. Dilatation of the pupils at the commencement of the inhalation
of bromide of ethyl is not constant.
2nd. Complete muscular resolution is sure.
3rd. Anästhesia is produced in very variable degree according to the
subject.
4th. The temperature, the secretions, the general state appear to
undergo no modification.
5th. Pulse and respiration are slightly accelerated.
worated.
.


Reviews.
317
6th. There may be a more or less marked trembling of the limbs
during the inhalation, but it does not persist beyond that.
7th. Hysterical attacks are generally easily arrested with the bromide
of ethyl.
8th. The seizures of epilepsy can sometimes be arrested by giving the
medicament during the tonic period; but most frequently the inhalation
remains without effect.
9th. In epilepsy the regular employment of the bromide of ethyl,
administered in daily inhalations during a period of one or two months,
very notably diminishes the frequency of the attacks.
Next come reports of three cases by M. D’Olier. One a case of epilepsy ;
delirium, thoughts of suicide; death from facial erysipelas; irregularity of
thc cerebral hemispheres; anomalies of the convolutions. The second, a
case of partial atrophy of the left cerebral hemisphere; idiocy, Jacksonian
epilepsy of hemiplegic form ; death in an attack. The third, a case of
idiocy, with various complications of physical diseases.
These papers are all reproduced from the columns of the Progres
Medical, where they first appeared. They form an interesting and valu-
able contribution to this special department of neurology.-E. M. Nelson.
PARESIS OF THE SYMPATHETIC CENTERS, SO-CALLED MALARIA; its
Etiology, Pathogonesis, Pathology and Treatment. By Charles T. Reber,
M. D. St. Louis: Geo. O. Rumbold & Co.
The author's aim is to discover the nature of the derangement of the
human organism, caused by “malarial palludal poisoning.” Dr. Reber
maintains that there is a special center in the sympathetic nervous system
that regulates animal heat, the disturbance of which center causes the
phenomena of fever. As to the inter-systemic cause of fever symptoms,
his views are in harmony with the observations of others and not likely to
be overthrown. That he has succeeded in eliminating malaria, as it is
called, as an external or internal hæmic cause of certain forms of " thermal
paresis," as the autbor terms fever, is not incontrovertible.
The book is worthy to be read by the thoughtful and observant; the
author himself being personally known to the writer of this brief notice
as a physician of discerning observation; one of those advanced general
practitioners whose discerment leads him to see that the future of
successful practice of medicine lies in the solution of neurological
problems; one of those observing men who has discovered the certain
drift of sound pathology into neurological channels; accordingly we find
him a regular reader of journals like the ALIENIST AND NEUROLOGIST.
THE SKIN IN HEALTH AND DISEASE, with treatment, classification and
notes on diet and hygiene, is one of I). L. Duncan Buckley's little books,
offered to the profession by the well-known Philadelphia Publishing House
of Presley Blakiston, as an AID TO THE STUDY OF SKIN DISEASE. As a
popular health primer on dermatology, a perusal of its pages will not
disappoint the reader. The author gives both the popular and the
technical names of diseases. The little book is therefore of special benefit
to the medical novice and lay reader, for whom it was designed.
HOME AND CLIMATIC TREATMENT OF PULMONARY CONSUMPTION, on


318
Reviews.
the Basis of Modern Doctrines, engages the attention of J. Hilgard
Tyndale, late Physician in charge of the Rocky Mountain Sanitarium, at
Manitau, Colorado, in a neat duodecimo volume of one hundred and
seventy-five pages, issued from the publishing house of Birmingham & Co.,
and for sale at the low price of fifty cents, which is exceedingly cheap for
the quality of the matter and the good quality of the type, pages and
binding of the book.
The book is fairly well written, has many practical suggestions and
formula of value, and besides the author's own observations, reproduces a
good deal from other authors, especially the views of Dr. Wm. Pepper, of
the University of Penn, himself a good observer ir. the local treatment of
pulmonary cavities.
AN INDEX OF SURGERY, “being a Concise Classitication of the Main
Facts and Theories of Surgery, for the use of Senior Students and others,"
alphabetically arranged, is also a very convenient and useful book for
those for whom it is designed, and cheap at the price at which it is sold-
one dollar. There are better and more comprehensive works for more
money, but none equal to it at double the price. It is an excellent book
for the practitioner to carry with him—a suggestive vade mecum of
practical surgery.
THE FOURTH INAUGURAL ADDRESS of Clark Bell, Esq., on assuming
the presidency of the N. Y. Medico-Legal Society, pronounced Feb. 1,
1882, is received too late for extended notice.
On the subject of MEDICAL EXPERTS the address states :
“Every educated physician is not a competent expert upon inganity or
mental diseases, or on poisons, or indeed any question requiring expert
evidence. A higher test than hitherto made should be placed on the ques-
tion of who are experts, and who are qualified to testify when special knowl-
edge is desired. The wiser men grow in science, the more certain do they
frequently come to the knowledge of how little they really know of subjects
which the neophyte who has read a good deal fancies he understands fully,
and about which he often knows little. The professional man should bave
the courage, the breadth and the wisdom to say “I do not know" in doubt-
ful cases, rather than to state what his idea is, and to make his ideas, or
theories, or beliefs stand as evidence of a scientific fact. Much of what
seems irreconcilable difference in the testimony of medical experts grows
from a want of knowledge in the witness of the questions concerning which
he swears, often positively.
"It should be the laudable object of this society to elevate the standard
of medical evidence, to defin: the true status of medical experts, and to
adopt such tests as would prevent men from coming to the stand as experts,
who had not the knowledge, experience or qualifications for the position."
By which we presume it is meant that the society should induce the
State "to elevate the standard and define the true status of medical
experts," which we candidly indorse. There are at present too many
mediocre and self-constituted medical experts.
The address contains many wise, and, in our view, some otherwise
statements. Among the latter we class the animadversions upon paid
medical witnesses. We do not concur in the view that medical testimony,
because paid for, need be less honest or true. We oppose unpaid medical
service of any kind, and especially favor adequately-paid medical expert
testimony. If the proper price is paid by the State, the right quality of


Reviews.
319
testimony can always be bad, just as the best legal opinions are procurable
by proper fees.
The recomendations for sanitary supervision of public schools, medical
coroners, medico-legal library and safe building for the latter, and the
suggestion for medico-legal commissions when questions of sanity are
raised in criminal trials, are commendatory.
MCLANE HAMILTON* has lately brought out a revised edition of his
concise and practical manual on diseases of the nervous system.
When the first edition of this good book appeared we gave it our
emphatic indorsement, and the present edition enhances our appreciation
of the book and its author, as a safe guide to students of clinical neurology.
One of the best and most critical of English neurological journals, Brain,
has characterized this book as the best of its kind in any language, which
is a handsome indorsement from an exalted source.
The improvements and additions of the new edition will justify its
purchase even by those who possess the old. Many old chapters have been
rewritten, The subjects of cerebral localization with reference to disease
of the brain, of diseases of the cerebellum and of the lateral columns of the
spinal cord, have received much more attention than in the former edition.
The book has been sent us too late to receive that special extended
notice it merits.
A striking feature of the present edition, compared with its predecessor,
is the omission of the many references to a neurological colleague of note
in New York city, who some time past instituted a suit for infringement of
copyright. One may now read Hamilton all through and never see the
name of that author and vice versa. The neurological brethren in New
York seem not to dwell together in unity, nevertheless McLane Hamilton
has written a good book, and his suppression of Hammond's name will not
prevent the latter from being heard from. The New York neurologists are
all capable of speaking for themselves, and they do not consider the adage:
“Speech is silver, silence is golden," as of much weight.
BILHARZIA HEMATOBIA is the subject of an interesting paper by Dr.
David S. Booth, of Sparta, Ill., read before the Southern Illinois Medical
Association, at Carbondale, January 18th, in which the author records a
case that lately came under bis care. We acknowledge our indebtedness
to the author for the paper, and return our compliments.
Nervous Diseases, their Description and Treatment. By Allan McLane Hamilton,
M.D., Fellow New York Academy of Medicine, etc. Second edition. Philadelphia:
H. C. Lea's Son & Co.


Books, Monographs, Etc., Received.
The Effect of Genital [rritation in the production of Nervous
Disorders. By Landon Carter Gray, M. D., of Brooklyn. Reprinted from
the Annals af Anatomy and Surgery, January and February, 1882.
On Ovariotomy. By 'Chos, Keith, Esq., M. D., F. R. C. S, E. Re-
printed from the American Practitioner for November, 188).
Epidemic Convulsions. By David W. Yandell, M, I., Professor of
Surgery, University of Louisville, Kentucky, etc, etc. Reprinted from the
American Practitioner for December, 1881.
A Discourse on the Life and Character of Dr. Richard Oswald Cowling,
a Valedictory Address delivered to the Graduating Class of the University
of Louisville, February 28, 1882. By David W.Yandell, M, D., Professor of
Surgery, University of Louisville.
The Trance State in Inebriety: its Medico-Legal Relations. By T. D.
Crothers, M. D., Superintendent Walnut Lodge, Hartford, Conn., with an
Introduction on the Nature and Character of the Trance State, by George
M. Beard, M. D., New York City. A paper read before the New York
Medico-Legal Society, November 2, 1881.
Uterine Massage as a Means of Treating Certain Forms of Enlarge-
ment of the Womb By A. Reeves Jackson, A. M., M. D., formerly
Surgeon-in-Chief of the Woman's Hospital of the State of Illinois; late
Lecturer on the Surgical Diseases of Women at Rush Medical College,
etc. Reprinted from Volume V., Gynecological Transactions, 1881.
Lacerations of the Neck of the Uterus. Ibid. Read before the Tippe-
canoe County Medical Society, at Lafayette, Ind,, May 6, 1880. Reprinted
from the American Practitioner.
Spinal Irritation. By J. S. Jewell, M. D. Reprinted from the Journal
of Nervous and Medical Disease, Vol. viii., No. 4, October, 1881.
Fort Wayne Journal of the Medical Sciences, a Quarterly Journal of the
Medical Sciences, with a Summary of the Allied Sciences, Editors: W. H.
Gobrecht, M. D., Prof. of Anatomy and Clinical Genito-Urinary Diseases,
Fort Wayne College of Medicine; G. W. McCaskey, Ph. B., M. D., Prof. of
Physiology and Microscopy, Fort Wayne College of Medicine; C. B.
Stemen, M. D., Prof. of Surgery and Clinical Surgery, Fort Wayne College
of Medicine Vol. i., No. 3. Terms, $200 per annum; fifty cents per
number.
Frank Blair's Memory. A tribute to it from Judge T. T. Gantt, as de-
livered before the Blair Monument Association, St. Louis, October 8th, 1881.
The Case of Guiteau-a Psychological - tudy. By George M. Beard,
M. D., New York. Reprinted from the Journal of Nervous and Mental
Disease, Vol. ix, No. 1 January, 1882.
The Case of Guiteau. By Allan McLane Hamilton, M. D., one of the
Government Medical Witnesses. Reprinted from the Boston Medical and
Surgical Journal, of March 9, 1882.


Books, Monographs, Etc., Received.
321
Effect on Women of Imperfect Hygiene of the Sexual Function. By
Chas. Fayette Taylor, M. D., New York. Reprinte 1 from the American
Journal of Obstetrics and Diseases of Women and Children, Vol. xv., No. 1,
January, 1882.
Nerve-Stretching. Select Topics of Modern Surgery, illustrated by
cases from the hospital service and private practice of Drs. Christian
Fenger and E. W. Lee, ot Chicago.
Missouri Valley Medical Journal, St. Joseph, Mo. Editors: W. C.
Boteler, M. D., F. C. Hoyt, M. D., Vol. i., No. 1, January, 1882.
Transactions of the Twenty-Eighth Annual Meeting of the Medical
Society of the State of North Carrolina, held at Asheville, N. C., May
31st, 1881.
The Asylum Journal, for December, 1881. Lunatic Asyluin, Fort
Canje, Berbice, 15th January, 1882.
Genius Resistless; a Pindaric Ode, in tribute to Jenner and Pasteur
By J.J. Caldwell, M. D., Neurolgist.
Trance and Muscle Reading. By G. M. Beard., M. D.
External Perineal Urethrotomy. By Thos. H. Hammond, M. D.,
Kickapoo City, Kansas. Reprinted from the Ohio Medical Journal for
January, 1882.
Transactions of the American Medical Association, vol. xxxii., 1881.
Fourth Annual Report of the Trustees of the Danvers Lunatic
Hospital, for the year ending September 30, 1881.
The Mental Status of Guiteau, the Assassin of President Garfield. By
Walter Channing, M. I., Boston. Reprinted from the Boston Medical and
Surgical Journal, of March 30th, 1882.
We acknowledge the receipt of Dr. WM. Julius MICKLE's book on the
GENERAL PARALYSIS OF THE INSANE, with the author's compliments.
The book comes too late for notice in the Review Department, but the
name and well-known experience of the author upon the subject, upon
which he treats, are sufficient commendation of the book.





THE
ALIENIST & NEUROLOGIST.
Vol. III.
JULY, 1882.
No. 3.
ORIGINAL CONTRIBUTIONS AND PREFERRED TRANSLATIONS.
Art. 1.-A Case of Trance in Inebriety.
By T. D. CROTHERS, M. D., Hartford, Conn.,
SUPERINTENDENT OF WALNUT LODGE.
IN a paper read before the New York Medico-Legal
1 Society, entitled “The Trance State in Inebriety; Its
Medico-Legal Relations,” I mentioned the following facts,
which are clearly confirmed by clinical studies :
1. “The trance state is a common symptom in inebriety,
in which the patient is without consciousness and recol-
lection of present events, and gives no general evidence
of his real condition. This may last from a few moments
to several days.
2. “This state clearly indicates a profound disturb-
ance of the higher brain centers, and is of necessity
followed by impaired judgment and lessened responsibility.
3. “This trance condition will always be found asso-
ciated with a particular neurotic state, either induced by
alcohol or existing before alcohol was used.”
Several medical critics have taken exceptions, first, to
the possibility of inebriety being a disease, and second,
the accuracy of this state called trance.
They admit the possibility of a disease appearing in
the last stages of inebriety, but are emphatic in asserting
that all the early stages are those of vice and sin. The


324
T. D. Crothers.
same conclusions may be drawn with equal certainty from
a history of the first stages of paralysis and insanity.
Nothing can be more emperical than the attempt to
explain the phenomenon of inebriety by moral causes, and
draw dividing lines over fields that are literally unknown.
“At present we are only on the threshold of investigation
concerning the physical causes of inebriety, and also in
most cases are able to recognize the possibility of molec-
ular disease of the brain.” Every case of inebriety is an
enigma which can be solved only from precise scientific
inquiry. The «act of drinking is the outcome of some
morbid condition, some departure from healthy activity,
whose nature and existence must be inferred from a history
of all the factors which enter into every day life.
The trance state is only a phase of inebriety in which
some brain function is suspended. A mental state less
pronounced than epilepsy, or somnambulism, but as cer-
tainly demonstrated as either. Its phenomenon is not
moral, or, as a would-be critic calls it, “the wilful lying
of a depraved inebriate to create sympathy," but physical;
a form of disease either partial or in its incipient state,
which may be seen and studied in all sections of the
country where alcohol is used to excess.
The following case is presented as additional evidence
to those already published, and also because the facts of
the history were substantiated beyond a doubt, and do not
rest upon the statement of the patient.
John M. came from Ireland when eighteen years old.
Both parents died of consumption when he was a child,
and his uncles, on both sides, were drinking boisterous
people. He was employed by a relative as a weigh-
master in a cotton house in New Orleans. He was tem-
perate and of a quiet, retiring disposition, and seemed to
have only one ambition, that of making money. From
the statement of his partner, he was correct in all his
habits, attending closely to business, rarely taking a
holiday, and was thought to be a model young man. At
thirty he married, became a partner of the firm, and moved to


A Case of Trance in Inebriety.
325
New York to conduct a branch house. There is no evidence
that he drank at this time, but he consulted Dr. Hammond
for insomnia and states of nervous trepidation. This was
considered the result of over-work and nerve exhaus-
tion. When thirty-two, his wife died suddenly, and he was
greatly prostrated, suffering from a low form of fever,
which continued for six weeks. This was followed by
increased insomnia and general neuralgia, for 'which he
drank brandy, with relief. During the next year he used
spirits frequently to profound stupor, associated with fast
company, and was seen in gambling places and on the
race track. Two years later the firm failed, and he was
thrown out of business. Then he became a ward politician,
and for the next eight years grew worse, until he became
a chronic inebriate, drinking at all times and places. He
was arrested for assault and drunkenness and sent to
Ward's Island for six months. When he came out he was
employed by an ice company. For two years he per-
formed all duties faithfully, but drank constantly. He was
never stupid or intoxicated so that he could not attend to
his regular work, that of delivering ice and collecting bills
for the company. He complained of loss of memory and
was obliged to keep a note book, and at times suffered
from pain in the head and sleeplessness. In July, 1881,
he was engaged in delivering ice and collecting bills. At
about 10 A. M., he entered a saloon and drank a glass of
spirits, (having drank many times before during the morn-
ing). From this time all recollection ceased. The next
morning he awoke in the station house, and was charged
with grand larceny, but, after hearing his statement, he
was discharged, by paying a fine. During this blank state
after drinking in the saloon, he went out, mounted another
ice wagon, belonging to a rival company, and drove away.
The wagon from which he had been delivering ice was
painted white and drawn by a single black horse. The
wagon he drove off was painted red and drawn by a span
of gray horses. The driver of this wagon had left the
team a few moments, and when he returned finding it


326
T. D. Crothers.
gone went to the police station and reported his loss. In
the meantime John M. continued his usual route, delivering
ice and collecting bills, never recognizing the difference in
the wagon and team. The ice being all delivered he drove
to the central office for a renewed supply. The company's
officers were amazed, but could not make him understand
that he had taken a rival company's wagon. He was soon
arrested by the police, but asserted very positively his
innocence, explaining it as a plot by some enemies to ruin
him. He gave evidence of drinking, but to all seemed
perfectly conscious of his state. Although he could not tell
what had happened, was sure that some fraud had been
perpetrated in giving him less ice than usual to meet the
demands of his route. When not talking about this he
was stupid and abstract, did not speak readily when spoken
to, seemingly dull of hearing. At the station house he
was very quiet, only asking for some spirits. Next morn-
ing he could not remember anything which had occurred,
and was astonished at the events as related. The idea of
persecution had disappeared, and to him it was simply
some drunken fit. He was discharged by the company,
and soon after hired out as a deck hand on a Sound
schooner. From this time, for several months, he drank
beer steadily, and used bitters for loss of appetite and
supposed malaria. On two occasions he complained of
blanks of memory, but nothing made these events promi-
nent. In March, of this year, the schooner was unloading
at the wharf, at Hartford. For some weeks before he
began to use strong spirits regularly every day; also, he
had arranged to remain six months with the captain, on
both a salary and percentage. He was superintending the
discharge of the cargo, and had drank a large glass of
spirits, when suddenly he became oblivious until next morn-
ing, when he awoke in a boarding house in a distant part
of the city. In meantime he had suddenly left the boat
and inquired of the driver of an ice wagon if he could
get a job delivering ice, and was sent to the office. Here
he accepted a position and talked at some length with the


A Case of Trance in Inebriety'.
327
secretary of the company, in a perfectly rational way.
Then he returned to the boat and explained to the
captain that he had found a brother in charge of the ice
company, and felt that he could do better in his employ.
The captain complained bitterly of the injustice of leaving
him, which he defended with great coolness and candor.
He was finally paid, after which he secured a boarding
house and went to bed. Next morning he was awakened
and urged to hurry up to go to work. When it was
explained that he had engaged with the ice company, he
doubted it until he went to the wharf and found out the
facts. The captain drove him away with harsh words, and
finally he went to work with the ice company. He had
received thirty dollars, which the captain held his receipt
for, but could not tell where it had gone. For many
weeks he was in much anxiety to ascertain what had
become of the money. One day he went into the savings
bank to buy a small draft on the bank of England, when
he was asked if he wished his bank book. He was
amazed to find that he had deposited the money in the
bank, and declined to take the book, alleging that it
would be lost. The bank clerk noted that he seemed
under the influence of spirits, but fully conscious of what
he was about. He had intended to send this money to
some friends in Ireland, and why he should put it in the
bank was unaccountable. At this time he came under
my observation. He was, in appearance, a strong, active
man, of good judgment, and very clear on all matters
pertaining to himself and business. He could give no
reason for drinking at first, but now he drank to relieve
a feeling of exhaustion. He considered these blanks of
memory mere attacks of drunkenness, and mentioned that
they were increasing. Sometimes they have lasted two and
three days, then only a few hours. He thinks he always
follows some accustomed line of action, in this state, but
cannot explain why he left the schooner, or deposited
the money in the bank.
He has periods of headache and insomnia at night, and


328
T. D. Crothers.
his health is gradually growing worse. He uses bitters
and strong spirits regularly every day. The following may
represent the facts of the case:
1. The evidence of the trance state in the exchange
of wagons, and his arrest and fine, was fully substantiated
by all the parties who saw him. The second trance state
was equally confirmed by a variety of witnesses and the
strange unusual acts. No doubt other trance states had
taken place, but no evidence other than his own state-
ment could be obtained.
2. The mental operations during this state were of
exceeding interest. In the first instance the mind moved
along accustomed lines of action, and the exchange of
wagons was not recognized because the work was the
same. In the second instance the mind acted from some
unknown impressions, and along unusual lines. Probably
the sight of the ice cart revived old recollections, and stim-
ulated a desire to engage in this work again. His coolness
when settling with the captain, and the falsehood about his
brother, which had no existence, and the deposit of
money in the bank, were unusual phases of this state.
3. The history of inebriety was clearly founded on a
defective inheritance, and undoubtedly developed by over
work, with general neglect of healthy living; later, the
the shock from grief and business reverses exploded the
tendency to inebriety.
The practical conclusion from these facts is, that
inebriety must be studied and recognized as a physical
disease; then the forces and laws which govern its rise ·
and march will be understood, and the remedies and
means of prevention applied. The trance state has a
medico-legal significance that cannot be estimated, and
demands careful study by competent men.


Art, II.-The Epileptic Change, and Its
Appearance Among Feeble-Minded
Children.*
By Isaac N. Kerlin, M. D.,
MEDICAL SUPERINTENDENT OF THE PENNSYLVANIA INSTITUTION FOR
FEEBLE-MINDED CHILDREN.
THE purpose of this paper is to recapitulate some of
1 the experiences encountered among imbecile and
idiotic children who are or who have been epileptic; also
to apply a theory originating in the recent pathology of
the disease, to an analysis of these experiences; and
finally, to consider our relations as medical superintendents
to the whole subject.
From an examination of the history of three hundred
imbecile children, between the ages of five and sixteen,
I find that sixty-six or twenty-two per centum are now
epileptics; that one hundred and fifty-six or fifty-two
per centum have in their antecedents the history of the
epileptoid family of diseases, but are not epileptics at this
date; that is, one hundred and fifty-six of three hundred
feeble-minded children either have been epileptic or
present some one or more of the neurotic conditions
which frequently follow or are introductory to the epileptic
state ; finally, of the whole three hundred cases, there
were seventy-eight in whom there was neither epilepsy,
paralysis nor chorea; or, in this examination there is
twenty-six per centum of idiocy, uncomplicated with any
of the cited disabilities. But, as I have included in
this latter number, children in whom there are infirmities
of speech, irregularities of gait, &c., it will be interesting
to examine further these seventy-eight epileptic exempts :
Six are mutes.
Nine are semi-mute.
• A paper read before the Association of Medical Superintendents of American
Institutions for Feeble-Minded Children.


330
Isaac N. Kerlin.
Fifteen have imperfect speech.
Eighteen are uncertain in their gait.
Nine are deaf.
Six have imperfect vision.
Three are marked hydrocephals.
Six are demi-microcephals.
Three have muscular tremors.
In fact, our analysis leaves only fifteen of the whole
three hundred who are of sound physical health and
unimpaired organisms; or, strictly speaking, fifteen weak-
minded children in whom there are neither obvious nor
pre-existing complications, excepting such as spring from
their own inherent stupidity-imbeciles pur sang.
Now, these three hundred cases are not wholly
selected either from those who have been admitted to ou
institution, i. e., the better grade of our applications,
or from those only who have been refused, i. e., those
whose infirmities render them objectionable in a “training
school;” but they are taken from the line of our appli-
cations, of the refused and accepted alike, according to
the completeness of our blanks of inquiry and our
opportunity for observation. I think it safe to say that
these three hundred cases represent the average state of
idiotic and imbecile conditions as they appear to us in
Pennsylvania and New Jersey; nearly all were born in
Pennsylvania. It is probable, for reasons that will not be here
suggested, that hereditary tendencies to epilepsy, paralysis
and nervous disorders exist to a larger extent with us,
than west of the mountains, and more than in New York
and New England; this primary fact, if it be such, will
just so much modify the conclusions of this paper, as
applied to the communities represented by you.
The symptomatology of epilepsy is known to all of
you; perhaps you have not all thought of the superficiality
of the disease as it appears in the great majority of
imbecile children from five to fifteen years of age. This
characteristic, I am aware, may class it in your thought
as not epilepsy at all, but as eclampsia or as symptomatic


The Epileptic Change in Imbecility.
331
convulsions. Leading authorities, however, are coming to
the position of a common identity or relationship in all
convulsive phenomena, and as it suits my purpose to
accept this view, I leave this discussion to your own
pleasure. I am sure that in a large proportion of the
cases received into our Pennsylvania Institution, in which
epilepsy is a complication, its superficial and its subjective
nature will impress any observer.
Paroxysms are aborted by psychical impressions of the
simplest character; as, for example, epileptic children
yielding for years to the prohibition, never to have a
convulsion in “praise meeting,” “ dance hall” or other
assembly room, from which, if interdicted, they would
lose many a good time; so also paroxysms are induced
as readily as they are controlled; for example, a pencil
grasped by the fingers of an epileptic child was found to
be the factor of his school-room convulsions, displaying
how delicate was the reflex irritability, which could not
tolerate a certain continuous cramping or tension of the
muscles and nerves of the fingers without general spasm.
An aların of fire produced a convulsion in a nervous boy
who had never been known to be so affected; while the
promise of a carriage drive exploded another lad in the
same way. The distention of the great intestine by an
enema, in a case familiar enough with the remedy not to
fear it, was the event of one of the most alarning con-
vulsions I ever saw; the lad was believed to be non-epi-
leptic. The administration of chloroform to a girl whom
we were preparing for the removal of a supernumerary
toe, was attended with a well-marked epileptic fit; she had
not had a convulsion since her infancy.
Again, some of our feeble-minded children live so near
the boundary of unconsciousness and convulsion that
they may pass by self-induction beyond it; there are
muscular tremors; there are ecstacies under the influence
of harmony, of a good meal, or of any other sensuous or
sensual gratification; there are meaningless terrors ending
in partial unconsciousness, as in the case of a little girl


332
Isaac N. Kerlin.
who screams at the sight of a Swiss clock, and sits
crouched together, a mass of trembling terror, when it
begins striking; it would seem that the cuckoo stepping
out at the last stroke would change terror into convul-
sion.
M. F., æt. eighteen, weak-minded from infancy, member
of a church, and in attendance on its worship, indulged
his emotional fondness for sacred music to the extent of
ecstasia, thence to pass into epileptic insensibility, with
its stertor, cut tongue, cyanosis and deep sleep. This he
had continued for two years, until a confirmed epileptic-
his life was consumed with his bible, religious tracts and
convulsions. The Wednesday evening prayer meeting and
the Sabbath service became field occasions, so that after
nearly ruining, financially, his church, the trustees placed
him at our institution, as none but a few heroic members
and the preacher maintained a regular attendance. This
poor fellow, removed to an institution, became useful, and
for years almost free from day-convulsions ; his indulg-
ence limited to nocturnal explosions of the disease
at long intervals. The relief was simple; while the usual
medicinal treatment was not neglected, perhaps it was
mainly through the interdiction of religious books and
music for several months, with the substitution of duties
and general reading, that he outgrew much of this
epileptic habit, bringing him, finally, to the normal enjoy-
ment of religious means without the accompaniment of
his alarming tableaux.
I think we all have in our institutions, not a few
instances of those irregular forms of epilepsy which
writers are now recognizing and describing, where its
general features are wanting, and the paroxysms are dis-
played in periodical attacks of some special eccentricity
or automatism. One of our boys has recently taken to
running without a purpose, which is done with desperate
haste, coming to as sudden an arrest, and going back to
his place, muttering some semi-conscious gibberish — this
may be his form of epilepsy. Another, a non-epileptic


The Epileptic Change in Imbecility.
333
lad of much amiability, of some precocity in a few things,
but of insane heredity, has occasional attacks of down-
right obstinacy and viciousness; the face is Alushed and
the eyes unnatural; he cries easily and copiously, aban-
dons his fellows, hiding in odd places, and is completely
unstrung; there is a suggestion of the epileptic condition
in his case, and I should at no time be surprised by a
convulsion.
Julia — This little girl was brought to my atten-
tion fourteen years ago, then four years of age ; she had
a choreic habit of biting, but had manifested no other
special eccentricity that is now recalled; her speech was
quick and child-like, but in her eye there was at all times
an unnatural glitter; she has been under charge ever
since, ranking high in our school department and becom-
ing somewhat useful in light domestic duties; in the
interval of fourteen years, she has had two grave attacks
of mania, following the active symptoms of meningitis.
Although completely recovered from these with no loss
of intelligence_indeed she is more and more competent-
her paroxysms of biting have never really ceased; they
are unannounced by any visible prodroma, they are
directed against the loved and the unloved, and she is
as irresponsible and helpless when snapping at her victim
as is the typical epileptic when he falls to the ground;
her face is flushed after the act, while there is a wild, lost
look in it; or sometimes it is the face of the swimmer
rising from the water more chilly than was anticipated
when plunging into it — cold, cramped and surprised.
There have been long suspensions of these attacks:
bright, lovable spots in Julia's history, like the hopeful
rests of epilepsy, to be followed, like them, with dis-
appointment, in a fresh outbreak of her irresponsible
ferocities.
I have now a case of paroxysmal pain in the stomach
accompanied with vomiting—a girl who has all her life
been a peculiarly interesting study, as tangled conditions
are likely to be to any of us; these attacks have taken


334
Isaac N. Kerlin.
the place of the temper displays of her earlier years,
accompanied then with the most profane language and
the grossest actions; the poor girl now, after weeks of
orderly and complacent behavior, industriously engaged
in the laundry, comes to me with a scared look and a
bewildered “O, doctor, I am going to be sick!” The
next few days she is a picture of misery; the stomach
refuses nourishment; quantities of bile are vomited with
the ice-water which she eagerly seizes; she rapidly wastes
in flesh. We sometimes question whether these parox-
ysms are epileptoid.
J. H., a child taken into care at five years of age,
so pretty, so perfectly formed, so exact in his movements,
that all visitors exclaimed at the cruelty of “having such
a child in such an institution ;” but his mental outfit was
limited and deranged; at home he had been kept tied
for fear he would fall from the window sills, the boy
having absolutely no knowledge of height; the cerebral
center ruling this dimension was educated at last - or
another acted vicariously — whatever the physiological
transposition, height seemed to be a devil, which once
admitted to his comprehension, “ brought other seven
devils with it.” The sweet-faced boy bent his new acquire-
ment to the injury of his play fellows, whom he maliciously
pushed from ladders, or over window sills, or from the
top of embankments, with a persistency and devilishness
in the act, and yet with an innocency of after-manner
that beggars description. The various freaks of this pro-
pensity have been protean as the forms of epilepsy itself,
and cannot be detailed. A few months ago it was noticed
that John had frequent falls; they were instantaneous,
like the tricks of a clown, and the composure and imme-
diacy with which he regained his chair, and the willful
smile at the nearest, impressed the attendant that this
was another of his freaks ; but a special and more intel-
ligent watch being kept of these phenomena, proves now
the pallor, the momentary unconsciousness, the staring
pupils, the slight spasm of the facial muscles-indications


The Epileptic Change in Imbecility.
335
of the epileptic change which has gradually but surely
developed through the five years of this boy's life in our
institution.
We are helped in our understanding and treatment of
the above cases, when regarding them as the irregular
manifestations of that epileptic change which has been
described as the precursor of, and as underlying all
epileptoid states.
I may be inclined to overestimate the identity of
temper displays, paroxysmal thievings, violence, etc., with
the epileptic change; but this is better, if it will foster
among our teachers and attendants two practical and
much needed lessons : first, kindly tolerance and ingenious
management of these peculiar cases; second, the appre-
hension that the outcome may be true epilepsy, and,
hence, our duty to use all possible vigilance and meas-
ures to avert the calamity.
As medical superintendents, we should make it a
fundamental rule to know these children from their birth;
also their antecedents, remote as we may; the history of
their infancy helps to an understanding of their pupilage;
the convulsions of teething, those of their exanthemata,
or the temper cries and night scares of their babyhood
interpret the eccentricities of to-day, and will become
our danger signals for the successful management of their
lives.
As great an author as Nothnagel says:
“ Often children suffer with eclampsia in early denti-
tion, to be followed by healthy lives up to the outbreak
of epilepsy” (Ziemssen, vol. xvi., p. 202) “and again,
there are cases of which several pronounced ones have
occurred in my practice, where absolutely no etiological
influences mentioned, nor any of the determining causes
yet to be mentioned can be found, and yet where a
blooming child of from five to fifteen years is suddenly
overwhelmed by a seizure, which is then repeated in the
ordinary way. Now, in some of these patients it can be
proved with certainty that they had suffered from
eclamptic convulsions during the first dentition. I cannot
get rid of the idea that here the process, at first purely


336
Isaac N. Kerlin.
functional, which was set up in the central parts at the
time of the teething convulsions, may have furnished the
impetus for the development of the epileptic change
(16., 206).
Our records supply many illustrations to prove the
epileptic change as developing slowly and surely from
causes acute and transient in their action, and operating
at long intervals—worms in the alimentary canal, excite-
ment with the Fourth of July, an indigestible supper
after fatigue—any one of many such causes, may give
the first impulse to the development of an epileptic cen-
ter; repititional impulses through the unrestrained life of
the child finally add to the sum total, to create a chronic
epilepsy for which we have no radical cure. These last
cases I would not knowingly admit to our institutions, as
at present organized; yet no mistake was made when
the following case was received, improbable as it seemed
for favorable treatment.
N. H., age 14, fine physique, ruddy complexion, in
short, an elegant boy. Mentality fair, as compared with
imbecile children of the school department; he was only
backward in his studies and simple in his nature; perhaps
a simpleton, of indolent attention, feeble memory, given
to flimsy deceptions, and of general instability. He had
attended an English-German school, and had had school
training from his third year.
His first convulsions were at teething, and as informed
by the family, not again till ten years of age; but the
lad remembers to have had them slightly when going to
his German-English school. In 1878 the convulsions
becoming frequent and fixed, he was placed under the
medical care of a distinguished physician, who thoroughly
bromidized him. The parents state that “there was a
respite of the convulsions for one month, when they
recurred with greater severity than ever; if spared during
the day, he would have them at night, and they had
counted as many as seventy convulsions within twenty-
four hours. They were accompanied with a desire to


The Epileptic Change in Imbecility.
337
run; he happily directed his running toward some place of
security, but had been known once to fall over the uncov-
ered joists of a building; he never bit his tongue, and
never screamed, yet he turned purple, and often foamed
at the mouth. A box or crib had been built for him,
into which he would beg to be fastened, when anticipat-
ing either his convulsions or when seized with his temper
fits of violence.”
In January, 1879, six months prior to his admission,
he had been circumcised under a guarantee of cure, but the
disease had continued with such severity, and his dan-
gerous temper remained so uncontrollable, that he was
placed in our custody, June 15th, 1879. With the
removal from home there was an absolute cessation of
convulsions until August, 1879, when he had a mild
seizure of petit mal, preceded and followed by a few
temper explosions, caused by trilling interference with
his movements; but from August 1879 to this date,
there has been no return and hardly a threatening of an
epileptic seizure. His intelligence is sufficient to make
him mindful of caution, and he has come to dread the
disease so much that his life conforms very closely to the
restraints of institution living, in which he believes consists
his cure. He has, within the past year, been among his
friends for two months, returning with no relapse.
The neuropathic state of most idiotic children is cer-
tainly on the near confines of spasm. The convulsibility
of infancy (so termed I think by Griesinger), is retained
into the later life of the imbecile; perhaps the explanation
of the inhibitory power of an undeveloped cerebrum over
reflex action in infancy, may apply to the poorly organ-
ized cerebrum of the idiot in its failures to control the
automatism, jactitations and other nervous tricks of our
school rooms; habits which foster the development of the
epileptic change until a special excitement over-rides all
restraint, and the disease is established.
Among the earliest observations under this latter head,
were those made of Morton F., a stout, strong boy of fourteen,


338
Isaac N. Kerlin.
with an ataxic shambling walk, stiff, incorrigible hair, a
great jaw and a very peculiar right eye, which would be
dismissed, unprofessionally, as a “cock-eye,” and nothing
more, but which was in reality very interesting with its
specific history, going back to his paternal ancestor. This
boy illustrated in himself two unusual features; first, an
emotional automatism approaching catalepsy; and second,
a singular muscular rigidity into which he instantly threw
himself when it was desired to move him in any given
direction contrary to his wish or understanding. I need
not describe this last; you have all encountered it in a
few individual cases in your schools; a “muscular obsti-
nacy,” carried to almost tonic spasm: influenced at first
by hesitancy to do what is required, and setting the
fibrillæ like rods of iron; it may be a general resistance
of the whole body, which, the moment the child is
touched, is felt to be an obstruction altogether out of
proportion to his size; the rigidity may be localized in
sets of muscles, or in individual muscles. The lad Morton
F. is a typical representative of this condition; many
hours have been spent, and much exertion (with some
things said to be forgiven), over Morton, to limber the
various portions of his anatomy. Long before massage
was popular, this boy underwent an amount of muscular
persuasion, kneading and counter-action for the flexure of
his set joints, that would put to shame the present appli-
ance of that art. His emotional automatism and muscular
obstinacy were displayed in finest action on the afternoons
for bathing; having an inveterate hatred of water, soon
after dinner he would be missing, to be discovered after
long search, in some out of the way place, like the middle
of a clover field just before harvest; when found he would
be lying on his left side, the right eye quite misdirected,
the left thumb and fore finger nervously and rapidly
stroking his cheek or jaw on that side, and his whole
body rigid; or sometimes the right leg and foot working
into a hole in the ground without power apparently to
arrest the movement; he would neither answer when


The Epileptic Change in Imbecility.
339
called, rise when addressed, nor show any symptoms of
coming when waited for; the only alternative being to
lift and carry him to the bath-tub, the rigidity retained
to the last. The bath over, Morton dressed, would go
with a smiling face and elastic step to the kitchen,
where his faithfulness as a “boy of all work” is quoted
to this day. He lived and died on our premises, and to
the last gave these periodical displays of muscular
rigidity and emotional automatism. He had convulsions
in infancy, and he died of an acute meningeal disease in
which severe convulsions occurred.
In forming a judgment as to the propriety of admit-
ting an epileptic child, a consideration of reputed causes
is in place. Reynolds presents them as, Ist, psychical
influences; 2d, physical influences; 3d, eccentric irritation;
4th, general organic changes. Those induced by
psychical influences and those from eccentric irritations
are favorable for our treatment, especially if there be no
family history of alcoholism or epilepsy.
The girl (probably feeble-minded) who is quoted as
having had a first seizure when obliged to eat the flesh
of a cow which she had taken care of and had been
attached to, might hopefully be admitted to your school-
rooms if her case needed the training of an institu-
tion. The boy described as having had a first con-
vulsion, excited by the preparation for a Fourth of
July parade, with its noise and heat, and the second
upon seeing a man crushed to death beneath railway cars,
will be admitted, much as we desire to curtail the number
of epileptics in our institution, because we hope for a
complete immunity hereafter froin convulsions, and an
outgrowth or overgrowth of any epileptic change.
We made no mistake in admitting C. C., a pale-faced,
nervous boy suffering with chorea and innutrition. He
had a convulson the summer before, when trying to
rescue a drowning brother from the Delaware River; this
had left him in an unstrung and shattered state, when,
a year after, the explosion of the boiler of a factory


· 340
Isaac N. Kerlin.
where he had worked with his father, and the sight of
his father's mangled remains drove him again into a fearful
convulsion, from which time he lost all boyish ambition
and all the knowledge he had gained in the schools.
He was presented to us a poor, illy fed, trembling, per-
spiring, choreic boy. Admitted to the amusements and
duties of an institution, he rapidly grew strong, became
re-educated in the schools, and after two years was dis-
charged, cured of his malady, and is now a valuable
member of the community.
Surely, among these cases of child convulsions induced
by psychical causes, acting upon a feeble and highly
nervous organization, there are many in which the epileptic
change has not occurred, or, if it has, so slightly as to
yield to the family life or methods of cure, such as our
institutions, and ours only at present offer; if we do not
discriminate in favor of these, we may doom to epileptic
idiocy some of the most interesting children of the land.
The changes due to dentition, to convulsion, to gross
food, worms, etc., may be unappreciable, or so slight as
to amount only to that albuminous, intercellular exuda-
tion, pointed out by Schroeder van der Kolk, as existing
among the nerve fibres of the medulla, to undergo, if
conditious continue, induration, fatty degeneration and
softening. Many of these cases may be saved by treat-
ment, while a few only escape by the hap-hazzard,
do-nothing policy of letting them “outgrow” their dis-
ease.
But this paper already exceeds the prescribed limit
and I conclude it with the following epitome:
I. The knowledge gained through careful inquiry
proves that early in their lives a very large proportion
of feeble-minded or idiotic children presents a history
either of epilepsy or other neurosis associated with and
suggestive always of that disease.
II. The so-called epileptic change is not necessarily
accompanied in the present history of any individual case,
with convulsions and insensibility, for these may be
a few these cason, fatty


The Epileptic Change in Imbecility.
341
transmuted into emotional automatism, eccentricities of
behavior or morals, etc., lesser indications of the concealed
malady.
III. As a rule, our feeble-minded children manifest
their epilepsies in superficial and subjective ways which
make them peculiarly admissible of psycho-medical and
physiological treatment.
IV. By refusing admission for all feeble-minded children
who may be epileptic, without discrimination of the
essential characteristics and varieties of the disease, we
shall surely bar many curable cases of epilepsy whose
mental enfeeblement equally requires our skill; also when
admitting any feeble-minded child, without the open
complication of epilepsy as usually described, not unfre-
quently it is discovered that latent epilepsy came with
the child; hence the unwisdom in the first instance, of a
course absolutely proscriptive of this unfortunate class of
idiocy, and hence, also, the impossibility in the second
instance, of keeping our institutions entirely free from
patients who may exhibit at any time this prominent
complication of child insanity.


Art. III.-Progressive Paralysis of the
Insane-Paresis. *
BY PROF. LOGGIA, OF PALERMO, ITALY.
Translated by JOSEPH WORKMAN, M. D., Toronto, Canada.
VERY numerous, indeed, as far as I have seen, are
the anatomico-pathological alterations met with in
those who die of general paralysis; but among these
alterations it is necessary, with the aid of prudent criti-
cism and those lights which are furnished to us by
pathological and experimental physiology, to distinguish
in these alterations those which really appertain to the
disease, and to regard the rest as foreign to it, or as
common to other psycho-pathias.
Indelible imprints of periencephalitis are met with in
the bodies of the unfortunate victims of general progressive
paralysis, whether they chance to have suffered under an
obstinate delirium up to the last moments of life or have
labored under chronic dementia. Opacity, adhesions,
thickening and an excessive quantity of serum, now in
the ventricles or again between the dura-mater and the
arachnoid, never fail; the lesions most frequent are
adhesions of the cortex to the pia-mater, in consequence
of which these have been regarded as pathognomonic of
general paralysis inasmuch as they interest the surface of
the brain or the entire thickness of the cortical substance;
but granulations, osteomata, atrophy of the anterior lobes,
softening, whether of the superior stratum of the cerebral
convolutions or of the medullary substance, atrophy of
the anterior lobes, together with alterations of color, are
not so common or constant as the preceding conditions.
*Translated from II Pisani Gazetta Sicula, September to December, 1880.


Progressive Paralysis of the Insane-Paresis.
343
This is as much as we can discover from macroscopic
inspection. But the scene changes when we bring to our
aid the microscope; then we begin to see and to under-
stand the intimate fibro-cellular and interstitial alterations;
it is by this means we succeed in determining the
vascular and perivascular lesions of the cerebral substance,
the colloid and cistoid degenerations, as well as the
lesions of the nervous element-cells, tubes and neuroglio,
which have, according to the most accurate investigations,
undergone great transformation in this disease.
Some believe that the lesions of the spinal dura-mater,
arachnoid and pia-mater, almost constantly found in the
posterior half of the spinal cord, may have a great influ-
ence in the production of the characteristic symptoms,
particularly the ataxic, which are not rarely observed in
general paralysis. A great influence in the development
of this disease has been attributed to the inequality of
weight of the two hemispheres, by Bucknill and Tuke,
who believe that the cause has not its seat in this or
that part of the cerebro-spinal centers, but that it depends
rather on a morbid state invading all the nervous system,
and consisting in a diminution of the neurine, and the
modifications which this may undergo, both in quantity
and quality.
In truth it must be admitted that, with the sole aid
of microscopic anatomy, and much less with the macro-
scopic, it is not possible to solve the difficult question of
the seat and the nature of the lesion of the cerebral
substance and its envelopes, which gives place to that
series of symptoms proceeding from the disordered
functions, which constitute the dowry, or better, the
physiognomy peculiar to the terrible cerebro-pathia which
has been called progressive general paralysis of the insane.
In order, therefore, to solve this difficult and intricate
question, it is necessary to call in the assistance of
experimental physiology and pathology, from whose
responses, alone, I believe we can be enlightened as to
which of the divers parts constituting the cerebro-spinal


344
Prof. Loggia.
axis, should be found preferentially and constantly affected
in the disease, and in what manner.
The brain, to-day, after the researches of Broca on
the seat of language, and those of Hitzig and Ferrier on
the motor centers of the cortex, can no longer be regarded,
as Flourens would have it, as an organ physiologically
and automatically one ; with all its diverse parts concurring
to the fulfillment of the same functions, but much rather
should it be held with Gall, as an assemblage of congen-
erous organs, adapted to special psychic operations.
Casting a retrospective glance over the experiments
made by Hitzig, Ferrier, Maccagni and Lusanna, and
confirmed by Charcot in his work on cerebral localizations,
it may be summarily said, that these centers, in the
several cerebral types (feline, canine and simmian),
although in all they had their seats in the posterior
parietal and in the posterior frontal convolutions, yet
some very important topographic differences in the above
noted cerebro-cortical centers were observed, and these
differences were much oftener observed in the hemispheres
of monkeys, whose position in the scale may guide us in
recognizing the differences in the human brain.
The motor region, determined by experiments on
monkeys, says Ferrier, in his last work“ On the Localization
of Cerebral Diseases," includes the base of three convolu-
tions, coasting the fissure of Rolando; that is to say, the
ascending frontal, the ascending parietal and its superior
extremity or posterior parietal lobule, with its interior
face, generally designated by the French as the paracentral
lobule. In this region certain definite zones are situated,
whose electric excitation provokes definite movements on
the opposite side of the body; for example, of the leg,
the hand, or the muscles of the face, mouth and tongue,
and whose destruction entirely paralyzes such movements,
when this region has been all destroyed, but in part only
when but a portion is destroyed, the paralysis being
limited to those movements which are provoked by irrita-
tion of the parts which have been destroyed. This region


Progressive Paralysis of the Insane—Paresis. 345
is fed by the middle cerebral, or Sylvian, artery, by means
of four or five branches, each of which nourishes a deter-
minate portion; the artery may then be obstructed in its
principal trunk, or in its branches, and the anatomical
disposition of these vessels is such, according to the
researches of Duret and of Hubner, that the arteries of
the ganglia of the base may remain permeable, whilst
those of the cortex are obstructed by an embolism; from
which it results, that softening may be limited to the
gray substance of the cortex, and to the madulla beneath,
without the least lesion of the ganglia at the base. This
frequently happens.
After this exposition it must be held, first, that in
various brains, centers of various movements are found to
be developed on different convolutions; second, that in
the same convolutions, centers of various movements are
found located, which clearly shows that we are not dealing
with special motor functions of special organs, but rather
with the various influence of voluntary psychical organs
over determinate acts of special motor innervations. As
regards, then, the anterior lobes of the human brain, it may
with probability be held, that in their cortical convolutions
reside the psycho-motor centers of the neck (the breg-
matic portion), of the face (the coronal portion), of the
mouth and the tongue (the opercular portion), that is
the convolution of Broca, which would constitute the
seat of the voluntary movements for articulate language.
Furthermore some pathological observations concur in
corroborating the above-named localizations of the cortico-
cerebral centers in man.
And here it gratifies me to repeat the words of
Lusanna, that it is certainly of cardinal importance to
understand the nature of the movements provoked by
electrization of those particular areas of the cerebral
cortex (the excitable cerebral zone of Hitzig) movements
which not at all depend on electric diffusion into the
deeper motor parts, since the currents adapted to produce
them are the lightest directed to these parts, and never


346
Prof. Loggia.
those directed into the other parts unless they should be
too strong. It is also important to know that the electric
currents prove ineffective on the surface left by the section
of the removed part, shortly after the operation. It is not
sustainable, as some experimenters would have it, “that
those cortico-cerebral centers are truly motor centers, merely
on a par with the peduncular system and the anterior roots,
since the following facts are opposed to this doctrine :
First, the cortico-cerebral centers do not respond to
mechanical irritations; second, they are inexcitable in the
recently dead body, and also in the asphytic degree of
anæsthesia; and third, their removal is followed by only a
transient and insignificant paresis; furthermore, it is to be
held that the movements induced by excitation of the
centers mentioned are neither sensitive nor reflex,
inasmuch as in order to obtain them it is necessary to
suppress sensibility by electrization, and, with this, reflex
phenomena also; besides, complete demolition of the
cerebral hemispheres neither abolishes sensibility nor reflex
movements; and as we have before said, the paretic
symptoms determined by the excision of the cortico-cere-
bral centers are transient and light, whilst the ataxy from
lesion of the sensitive centers is permanent and grave;
and in very young animals, in which the sensibility and
the excito-motor phenomena are yet more pronounced,
on the contrary, the movements of Hitzig take place;
therefore, it is necessary to agree with Lusanna that,
considering the offices to which the cerebral hemispheres
are destined, it appears that the above-named movements,
provoked by galvanization of certain tracts of their cortex
or of certain convolutions, represent only an artificial
substitution of the exercise of the will in the habitual acts
of diverse instincts which predominate in the psychical
life of the animals. In the new-born they are, in fact,
wanting, because their brains have not yet begun to
exercise them. In adults they indicate a functional habi-
tude; they are both by their number and their nature
in a ratio with the importance of the psychical-functional


Progressive Paralysis of the Insane-Paresis.
347
exercise of the zoological series, corresponding to the
degree of cerebral activity and the customs of the
animals; therefore, they are wanting in the ovipara and
in very young animals, and are limited to the motions of
the mandible and the neck, and in rabbits to the lower
articulations—to the jaw and the tongue in cats—and
also to the eyes in dogs, and to almost the whole of the
groups of movements in monkeys. But we are concerned
here, not with merely simple muscular acts, but with
movements very associate and complex, designed for
determinate purposes, such as attack, seizure, striking and
eating, which have much resemblance to movements made
in sleep. But if, from the experiments of Hitzig, I
conclude with Lusanna that the parietal convolutions
alone preferentially respond, this signifies that these are
exactly the most exercised in the psychical life of diverse
animals. However it may be, there can be no doubt
that the results of experiments on the cortico-cerebral
centers, have re-enforced the principle of cerebral local-
izations, from the important fact that some points, and
not others, produce certain special movements; and hence,
that the doctrine of “the functional unity of the brain”
has been put hors du combat. Granting the specialty of
certain movements in correlation with certain groups of
convolutions, the analogy of motor innervation of the
cortico-cerebral centers of Hitzig, to the cerebral organology
of Gall, becomes sufficiently interesting; for galvanization
of the region over the posterior part of the orbit causes
motions of the mouth and the tongue in monkeys, cats,
dogs and sheep (the organ of language); galvanization of
the posterior frontal parts puts into action the mimic
innervation of the facial nerve (imitation); on the inferior
parietal it moves the eyes; on the superior Rolandic
margins, it animates attack and capture; on the upper
fronto-parietal, it moves the neck and head; and on the
temporal, the ear.
Language came to be considered in the beginning of
this century as a functional attribute of the anterior


348
Prof. Loggia.
cerebral lobes, and paralysis of language (aphasia) as a
symptom of lesion of these parts. Language being the
expression of sentiments and ideas, this function cannot
obtain without ideas and sentiments, but sentiments and
ideas may exist without language; that is, without their
expression. Now, for the expression of these ideas and
sentiments, it is necessary to have special signs of them,
to understand these and to adopt and manifest them; and
these signs may be expressed in sounds to be heard
(vocal or phonetic language), or this may be expressed
by signs visible (written or symbolic language); or by
motions (emotional or mimic language).
Animals have, as has also man, emotional or inter-
jectional language, as ah, oh, ha, etc., etc. The cry
emitted under pain does not appertain to language, since
it is involuntary, and is, as Brown-Séquard has well
designated it, a reflex movement. Animals speaking, as
the parrot, learn articulate sounds, but they do not use
them as the special signs of ideas or of special attributes;
they pronounce them, without conception of their meaning,
by mere phonetic imitation.
· In the faculty of language, as in any other psychical
faculty, we must recognize various degrees and modes of
manifestation in perception, memory, intelligence, judg-
ment and volition. The most simple degree and mode
is that of perceiving the signs of ideas; next, that of
recording them by receptivity and memory; a higher
degree of the faculty of language is the conception of
words, as the signs of ideas; and next is the power of
expressing them by voluntary movements; whence, in
language, as in the other psychical faculties, there arises
passive and perceptive, and active or voluntary manifesta-
tion. The loss, more or less complete, of language in
man is called aphasia or aphemia. Paralysis and ataxy
of the tongue are not symptoms of lesion of the true
faculty of language ; since this faculty may show itself in
full integrity by other means, as by writing, gesticulation
or mimicing without any lingual movements. There are


Progressive Paralysis of the Insane-Paresis.
349
varieties of paralysis of speech corresponding to the
degrees and modes of this faculty, from the least to the
greatest; in the first place, we have the impossibility of
uttering words, with the possibility of understanding them,
which is paralysis of the volitive activity of language;
in the second place, there is impossibility of recording or
remembering them (amnesia); in the third, impossibility
of conceiving and comprehending them (aphasia complete)
or paralysis of the perceptivity of language; hence, as
I have said, the glosso-ataxia of Jacoud cannot, properly
speaking, constitute a modality of aphasia.
It was Gall who first not only regarded language as
a special faculty, but also fixed its seat in the posterior
supra-orbital convolutions; Bouillaud afterwards supported
this doctrine by pathological facts, holding that aphemia
is allied to a material lesion of the anterior cerebral
lobes. In 1861, Broca, after the study of various necros-
copic results, limited the seat of it to the third frontal
convolution of the left side, holding as exceptional the
fact of the seat of this faculty in the homologous convo-
lution of the right side. But other pathological facts
induced Recamier to localize language in the centrum
ovale; Foville, in the cornu ammonis; Owen, in the
little foot of the hippocampus; Schroeder Van der Kolk,
in the corpus olivare; and Vernicke and Meynert, in the
insula. It is, however, incumbent on us to admit, after
the facts pro and con collected with unparalleled diligence
by Lusanna in his very learned memoir (delle funzioni dei
lobi anteriori del cervelloumano, tenuto particolare conto delle
opinioni dei modern sulla origine e sulla sede della parola),
that as to the faculty of language it should with great
probability be localized in the third convolution, and
mostly on the left, as the autonomous faculty of a
special cerebral organ.
I do not incline to extend the ideation of language
to the cortex of various convolutions, as Tamburini pro-
poses; nor do I understand how to make of verbal
ideation an operation of the intellect, as Jacoud proposes,


350
Prof. Loggia.
for in almost all of the many cases collected the intellect
was conserved; whilst it is the order of every day to
meet with cases of altered intellect, as in the infinite
series of mental alienations, with alterations in the whole
or in parts of the cerebral hemispheres, but with speech
remaining perfect. An idea is then a thing different
from its sign Ideas are formed in the whole brain ;
language and the other signs are, with much probability,
determined by the third frontal convolution only; the
facts of lesions of other parts of the brain, with language
conserved, are abundant; and assuredly the facts of
lesions of the third frontal convolution, with lamed speech,
are not deficient. A single unexceptional fact against the
doctrine cannot yet be said to have been offered.
As regards sensibility, it must be said that all experi-
menters, from Rolando tò Magendie, and down to Schiff,
Lusanna and Lemorgue, agree that the proofs obtained
from animals excervellated, show us that these animals
preserve all the sensations excepting that of smell; as
with the demolition of the cerebral hemispheres the
olfactory rays are carried away. Flourens, on the contrary,
holds that animals, with the loss of the two hemispheres,
lose all their senses. This opinion finds some support in
the physio-pathological researches of Charcot, Neyssiere
and others, respecting the hemi-anästhesia produced in
dogs by lesioning of the posterior-peduncular radiations
of the corona of Reil. Psychiatrists, however, have never
been able to surrender to the belief that sensibility has
its seat outside the cerebral hemispheres. But things do
not move in the same way when we would determine the
influence of the hemispheres over movements. The con-
victions which may be held as to the motor innervation
of the cerebral hemispheres, principally differ according
to their being based on vivisections of birds, or of
mammifers, or upon pathological observations. Physiolo-
gists have, in fact, been able to see that in all birds the
corporeal movements are still possible, as Lusanna has
stated, after the complete demolition of both their cerebral


Progressive Paralysis of the Insane-Paresis.
351
hemispheres, from which they have been obliged to believe
that corporeal motor innervation has its anatomico-physi-
ological seat outside of these hemispheres. But analogous
experiments on mammifers have, as their consequence,
phenomena more or less marked of paralysis in the
limbs; and hemorrhages and compression of the hemi-
spheres in man are wont to be followed by hemiplegia.
It might then appear that the previous facts stand in
contradiction of the latter; but not so; the difference
proceeds principally from accessory circumstances, inas-
much as in birds their survival with complete excervellation
is possible, but in animals this cannot take place
without seriously injuring neighboring organs; whilst the
two cerebral hemispheres in birds are found almost quite
distinct and isolated, mammifers, on the contrary inevitably
succumb in a few days after abstraction of the brain; and
in these few days present grave phenomena of compli-
cations in neighboring organs. It is impossible, in such
experiments, to avoid injuring profoundly the circulation
in the neighboring organs, and thus compromising them
in common, since the cerebral hemispheres are too closely
connected at every part with the peduncular system and
the thalamic optici (organs of motor innervation), a final
anatomical part which is still more complex in man in
pathological cases.
To render the problem more complicate there have
been added, in these late times, the results obtained by
the above-named Hitzig and Ferreir — movements of
certain parts of the body by galvanization of the cerebral
cortex, and transitory pareses by ablation of cortico-
cerebral centers. Prevising a certain reserve, I conclude
with Lusanna, that it seems we may hold that the reflex
and sensitivo-motor movements may be affected outside
the cerebral hemispheres, whilst only in the hemispheres
themselves the ideo-motor and psychic movements are
accomplished; that is, those which proceed from the
functional intervention of the intellect, the will, or the
memory, and represent the customs and natural life
proceed to
the intelle
I represent


352
Prof. Loggia.
of the animals, the social and moral history of man,
comprising the motions of expression, of spoken and
written speech in man, and down to the cackle of the
hen, the cooing of the dove, and the nodding of the
owl. All the motions which still continue after the
demolition of both hemispheres must have their initiative
in a sensation. The intellect sleeps, the instincts sleep,
the senses are awake, but objectless; motor innervation
subsists, but without will; consequently will, instinct and
intelligence reside in the hemispheres; motor innervation
resides in the thalamo-peduncular system; and the senses
in the encephalic organs. With the loss of the cerebrum
only the motions directed to a given object of the intel-
ligence and the instincts are lost; as would be, for
example, all that series of co-ordinate movements adapted
to take food, to eat it, to escape from danger, and to
pursue prey; but it is not correct to say, as Flourens has
done, that in losing the cerebrum voluntary motions also
are lost; it is certain the will for moving is lost, but the
motions are not lost, and it is therefore very inexact to
pretend, with Müller, Gerdy, Lunget and Bouillaud, that
the will resides outside the cerebral hemispheres, because
with the losing of the hemispheres the motions influenced
by the will are not lost.
Though there are in the cortex of the brains some
parts, the lesion of which does not give place to any
motor phenomena, on the contrary there exists a region
which cannot be acted on by any destructive alteration,
a little extended, without the supervention of profound and
often permanent disorders of voluntary motility. This
region, which has been called the motor zone, comprehends
in man, according to Charcot and Pitties, the ascending
frontal and parietal convolutions, the paracental lobule,
and perhaps also those portions of the cortex which are
found in immediate contact with those parts, as the feet
of the frontal convolutions and of the superior and inferior
parietal lobules.
The motor zone is not gifted, in its whole extent, with
frontaperhaps mediate


Progressive Paralysis of the Insane-Paresis.
353
identical functional attributes, or, in other words, all its
parts are not functionally homogeneous; its territory may
therefore be divided into so many compartments, each of
which, on its own part, and independently of its neighbors,
presides over the motility of a limited portion of the
opposite side of the body; from which it happens in
pathology, that the extent and seat of paralysis of cortical
origin are in direct relation with the seat and extent of
the alterations of the motor zone, and that whenever this
zone is destroyed wholly, or in a large portion of its
extent, there takes place a total hemiplegia of the opposite
side of the body, or better to say, a hemiplegia which
strikes at once the upper and the lower limbs, and the
muscles of the lower part of the face. If, however, the
lesion be more limited, the hemiplegia is no longer entire,
but accords to the seat of the lesion; the paralysis at
one time occupies both limbs, excluding the face; at other
times the face and the upper limb, excluding the lower.
These incomplete hemiplegias of cortical origin might be
distinguished by the name of associate monoplegias.
Finally, when the lesions of the motor zone are still more
limited, and are circumscribed within certain regions of
it, they give place to monoplegias, or better, to paralyses,
which, according to the seat of the cortical lesion, are
limited now to one limb, now to one side of the face, or
again, to an isolated muscular group.
The most general fact, then, is that every destructive
lesion interesting the cortical motor zone, ought to pro-
duce a corresponding disorder of motility; so that,
recalling in a few words the principal phases through
which the experimental excitation of the motor centers
is seen to pass, under application of galvanism, up to
a certain point, according to Ferrier, there are observed
successively in animals, first a simple movement, next
contractions, and afterward spasms, which end by taking
on the character of general epileptiform, if the irritation
be prolonged.
The pathological facts show us only incompletely the


354
Prof. Loggia.
two first grades of this excitation of the motor nervous
centers. Up to this time, observations are wanting
in response, with respect to the production of simple,
disordinate movements, but as regards contractures they
seem to have a different sense. Without going into
details of such questions, it is necessary to recall the
fact that Boudet and Durant Fardel, to whom, next to
the works of Vulpian and Charcot, we are indebted for
the greater part of our knowledge of contractures, have
confirmed and made much more precise the value of this
symptom, which, slowly developing itself, is due not to
a localized cerebral lesion, but rather to a secondary
degeneration of the cord; in the outset it gives no clear
indication, but it may lead us to suppose that the lesion
(an aneurismal focus or a tumor) has its seat in the
vicinity of the convolutions and meninges, or, at the
most, in the vicinity of the ventricular ependyma. What
follows from the analysis of pathological facts is, that it
seems well demonstrated that a contracture requires not
for its establishment any particular irritation of the
frontal meninges nor any irritation of the ependyma of
the corpus striatum; the same lesion, whether it has
its seat on the meninges of the occipital or of the
sphenoidal lobe, brings with it rigidity of the limb;
hence, from the point of view of the cortical motor
centers of the encephalon, a contracture has not the same
value in pathology as it has in physiology. Things,
however, do not stand on the same ground as regards
epileptiform spasms, and convulsions localized in members;
here there exists a brilliant concordance between experi-
mental data and pathological observations, which, notwith-
standing the researches of Todd and Brown-Séquard on
the same subject, and the determinations of Hughlings
Jackson on the special motor centers, established with
the sole aid of clinical observations, have now received
ample confirmation from the researches of Hitzig and
Ferrier. And, in reality, though the enquiry may be, so
to speak, recent, already a certain number of clinical


Progressive Paralysis of the Insane—Paresis.
355
observations have appeared in support of the results
obtained by these physiologists. A prime, general and
more important fact is that in all the cases of partial
convulsions, with organic lesion of the brain, this has its
seat constantly in the anterior regions of the convolutions
at the level of the frontal lobe, sometimes the parietal,
but never the occipital; and what amounts to yet
more is that such convolutions seem specially destined
to movements of the limbs, which has been confirmed
by numerous pathological observations; so that it may
be said that although we have not, in regard to this
subject, arrived at mathematical precision, we may yet
conclude from the observations published, that epilepsy
commencing in the face is due to a lesion near the
fissure of Sylvius, and that it occupies either the ascend-
ing frontal convolution or, perhaps, the ascending parietal
convolution towards its middle part, and that epilepsy
in the superior limbs is the consequence of a lesion
in the upper and posterior ends of the first frontal
convolution, in the neighborhood of the ascending frontal,
and finally, that as regards epilepsy and the convulsive
movements of the lower parts, it seems that this also
depends upon a lesion of the upper part of the ascending
parietal convolution, and of the middle and superior
frontal convolutions, up to the sulcus of Rolando.
What, now, ought we to conclude from all these
examinations of pathological localizations ? Merely this:
That there remain some obscure points to be elucidated,
but that, withal, certain data have to-day become
acquired by science, which leave no doubt that con-
vulsions are linked to lesions which are located in the
vicinity of the sulcus of Rolando, and, in particular, in
the ascending frontal and parietal convolutions, and,
better still, at the points in which experiment has fixed
the seat of the motor centers in the higher animals.
Now, under the clinical point of view, what concerns
us to know, and what seems demonstrated, is that partial
epilepsy recognizes as its cause some organic lesion of


356
Prof. Loggia.
the frontal region, as from a hemorrhagic focus, recent
softening, yellow patches, cerebral tumor or aneurism of
the anterior cerebral artery; hence, it inay be said without
fear of error, that it is enough to follow up the progress
of the patients, and to observe the clinical evolution of
the symptoms in order to comprehend that between
convulsions and hemiplegia there is not a fundamental
difference, the lesions being the same but differing in
degree; a localized irritation in the region of the sulcus
of Rolando may serve to indicate a partial epilepsy, so
long as the convolutions remain excitable, but once the
nervous substance is destroyed paralysis will happen;
hence, the frequent'association of these two phenomena,
readily seen in the course of tuberculous meningitis and
cerebral tumors. It is truly rare that paralytic accidents
are developed all at once; they are almost always
preceded by a period of irritation which mutely progresses
and becomes characterized by partial contractions of
certain muscular groups; hence, like partial epilepsy,
hemiplegia from a cortical lesion of the brain comes in
to add fresh proofs to the theory of peripheral motor
centers. But here arises the question: Will it be possible
to distinguish, clinically, a hemiplegia consecutive to a
cortical alteration from one which is the result of
destruction, more or less complete, or of the corpus
striatum? According to Charcot, this is easily decided
by means of a due valuation of certain signs.*
Without recounting the numerous labors which are
connected with this question, suffice it to say, that from
the time when attention was fixed on the subject, the
majority of the facts observed confirm the views emitted
A prime symptom, which, without being absolutely special to cortical homi-
plegia. 'but which is met with most frequently in this order of lesions, is the
tendency of the paralysis to continue localized. As the phenomena of excitements
consecutive to the experimental or pathological irritation of cer ain groups of con-
volutions give place to partial epilepsy, in the same manner hemiplegia, dependent
on this is for the most part a monoplegia, which affects almost the whole tipper
limb, or the face ; whilst it is known, on the contrary, that in a paralysis from
limited lesion of the corpus striatum, it is the lower limb that is preferentially
affected. Behold here a differential sign very important, since when we meet with a
paresis of an upper limb, supervening without appreciable cause, and without the
Initial phenomena of apoplexy, we may, almost with clear decision, afirm that the
lesion has its seat in the cortex, and, with inach probability, in the vicinity of the
ascending frontal or parietal convolution.
A second characteristic is the trivial intensity of the paralytic phenomena, or


Progressive Paralysis of the Insane-Paresis.
357
by Dax and Broca. The center of coördination of articulate
language, or better, the motor center for the movements
of the tongue, corresponds, like the other motor centers,
to the frontal region, but it is more towards the base
and below those we have previously studied. As we have
said, it is known that the third frontal convolution, and
particularly that of the left side, is destined to this
function. According to the researches of Meynert, con-
firmed in part by certain facts collected by Lepine, it
would be necessary to extend this localization to the
island of Reil, or, at the least, to the anterior part of this
region. But, in whatever way once established, aphasia
may be affirmed to have a cortical lesion at the base of
the frontal region, and that when symptoms of paralysis
are conjoined with it we may be certain that it depends
not at all on lesion limited to the opto-striate centers.
From this discussion, attained from published facts,
we may couclude that the pathology of the nervous system
has begun to enter on a new path, which promises
to be fruitful. Resting, hence, on the results which seem
to be secured to science, there can be no doubt that the
cortical motor centers are really analogous to those de-
monstrated by experiments on the brains of various species
of the higher animals; an analogy which, resting on the
identity of symptoms and lesions in man and in the
monkeys, becomes constantly more confirmed. It is in
the superior frontal region, in the neighborhood of the
inter-hemispheric fissure on one part and the sulcus of
Rolando on the other, that the greater part of the motor
centers for movement of the limbs are grouped; on a
plane a little below this region are those destined for the
their transiency: phenemenu which, to say the truth, are not observed in cases of
circumscribed and little profound alteration of the corpora striata, where it would be
an exception, whilst in cortical hemiplegia it is the rule. The paralysis is so super-
ficial and transient that it may disappear from one day to another, withont apparent
reagon, just as it frequently comes on without being preceded by any percnsory
phenomenon. This irregular course is very rarely observed in cases of paralysis
with central lesion. In fine, the concomitant phenomena usually best define the
cortical origin of hemiplegia; indeed, we not rarely see it followed by unilateral
convulsions; tubercular meningitis offers examples of this at every instant; in
other instances the paralysis may have been established for some time, when new
convulsive phenomena shall arise, which are no other than spasms localized in the
sphere of the member struck with inertia. The demonstration will be more com-
plete should aphasia appear.


358
Prof. Loggia.
movements of the face; where, also, is met with the
territory which clinical observation had for a long time
regarded as the legislative organ of speech.
It cannot, withal, be said that in every case of paral-
ysis, purely cortical, anatomical lesions of the correspond-
ing centers can be demonstrated; nevertheless, despite all
the researches executed, it is, as Ferrier has well said,
impossible to cite one case in which it has been satisfac-
torily proved that the destructive lesion of this region
has been unaccompanied by motor paralysis.
Nor has the case related by Samt, who says that he
found a cyst in the motor zone without any symptoms
having been manifested on the part of motility, nor the
ideas evolved by Brown-Séquard as to the existence of
an intervening tertium quid, between the antecedent and
consequent, or a sort of restricting influence exercised
by the lesion over one or more centers to which the lost
functions are attributed, brought the least modification to
the doctrine of Ferrier.
Such are the approximative data which seem to
emerge from the published facts, and no doubt can be
entertained that, since attention has been turned to this
subject, observations have gained in precision and certainty.
All, then, that has relation to the interpretation of these
facts, and to the necessity of deciding the part which
each hemisphere takes in the motor phenomena above
described, we pass over, since it is not our purpose to
abandon the field of observation in order to enter on
the domain of hypotheses; and much the more so, that
these hypotheses have littte or no influence on the
matter under discussion.
In like manner, there can be no doubt, after the
results of physiological and clinical observance, that the
cerebral hemispheres are, further, the seat of the sensa-
tions, or better, of the perception of sensation, to use the
language of Ferrier, as especially the occipital and tem-
poro-parietal lobes, and both anatomical considerations,
and those of another order, lead to this conclusion.


Progressive Paralysis of the Insane-Paresis. 359
It has been established, as I think, beyond doubt that
the posterior tracts of the peduncles, and their prolonga-
tions into the cerebrum and the medulla, are the particu-
lar paths through which the centripetal or sensitive
impressions pass. The researches of Meynert and others
seem to establish that these tracts are united to the
parts of the cerebral cortex above indicated. But we
have, besides the general anatomical indications, some
experimental and pathological facts relative to the exact
seat of the paths which sensitive impressions take to
reach the cortical strata. The first, that is the experi-
mental, have been furnished to us by the researches of
Veyssierex, repeated and verified by Carville, Duset,
Raymond and others, who have demonstrated that the
anterior part of the internal capsule, that part of the
system of perception which extends to the caudate and
the lenticular nuclei of the corpora striata, be cut, there
constantly succeeds motor paralysis without paralysis of
sensibility, and if the latter be manifested, it is always
only functional and transient; other clinical facts marvel-
lously accord with this.
A motor hemiplegia invariably follows destructive
lesions of the anterior two thirds of the internal capsule,
not disjoined occasionally from concomitant hemianæs-
thesia of a passing character, if such lesion be of a nature
to provoke compression or functional disorder of the pos-
terior third; whilst we have numerous facts showing that
destructive lesions of the internal capsule provoke hemi-
anæsthesia of the opposite side of the body. The first
observations relative to this localization were made by
Turck, in 1859, and were confirmed by those of Charcot,
Magnan, Bourneville, Randu, Raymond, Pierret, Decandin,
Pitres and Rayer, who have by their observations and
researches established the pathology and symptomatology
of this affection in a manner unassailable; hence, Ferrier
concludes that the lesion which provokes a hemianæs-
thesia seated in the medullary fasces produces this effect,
not by destroying the center or centers of sensitive


360
Prof. Loggia.
perception, but by interrupting the paths through which
the centripetal impressions pass in.
Now, after the observations collected by Ferrier, and
those made by himself, it remains demonstrated, that the
facts do not permit the certain establishment of general
ities relative to the positive functional role of the
encephalic occipital lobes; it rather clearly emerges, from
negative effects determined by extirpation and by diseases,
that we cannot localize in the occipital lobes the central
terminations of the fibres of the internal capsule, which
are destined to transmit the impressions of the special
senses to the cerebral cortex; whilst, on the contrary,
there remains a region situate between the occipital lobes
and the motor region which may be called the temporo-
parietal region, in which everything indicates to us that
the central terminations of these tracts are to be found,
and that hence it has been demonstrated in a convenient
manner, that experimental lesions of the cortical strata in
this region, on the inferior animals (the region in which
Ferrier assumes to have demonstrated the existence of
the individual centers of the special senses), are capable
of provoking a diminution, or a paralysis, of sensation, on
the opposite side of the body.
Now, what bearing can all these studies have on pro-
gressive general paralysis of the insane? It has this
bearing—to establish the seats and nature of this cerebro-
pathia, so much controverted and not yet well deter-
mined, notwithstanding studies, on a vast scale, by the
most able alienists, therefore, there is no doubt that one
of the obscure points to be elucidated on the part of
pathological localizations is Progressive Paralysis of the
Insane, of which, as I have a little before said, the part
of the cerebro-spinal axis which should be found preferen-
tially affected in the disease, has as yet not only been
unprecisely determined, but has not been even approx-
imately decided on.
Who does not know that, up to the present day, after
so many researches and studies, writers are not in accord


Progressive Paralysis of the Insane- Paresis.
361
in establishing, from the outset, the part which may be
the seat of the disease? This was what Christian wrote
in his “Memoir on the New Researches on the Nature of
General Paralysis” (vide Medico-Psychologic Annals, edited
by Baillarger and Lunier-1879); and this is what I am
obliged to repeat. In truth, the seat ascribed by one
party (as Westphal) is the medulla spinalis; by another,
(as Bonnet, Poincare and Labanoff,) it is the great sym-
pathetic; by the greater number, the brain, (as Rokitansky,
Luys, Magnan, Voisin and Livi.)
It is, in reality, only necessary never to have seen
dissections of insane persons, in order to fail to be con-
vinced that in ninety-nine per cent. of them, the most
explicit, and more or less extensive, traces of meningitis
are met with, not excluding those affected with progress-
ive general paralysis. Without denying to Bayle the
morbid participation which the meninges may take on, in
the patho-genesis of progressive paralysis, no one will yet
desire to attribute to it the principal role, (Livi, 1875,) as
likewise, no one would avail of similar language to explain
the generation of the psychical and muscular phenomena.
“The secretion,” says Bayle, “ of ideas so absurd, desires
so disordinate, sentiments so disjointed, and of an ataxia
or muscular paresis which proceeds to adynamic degene-
ration, cannot be effected unless in that part of the brain
in which intellectual functionality is substantiated, that is
to say, in the gray cortical substance.”
[Note.—The author here severely rebukes Bayle for
the above materialistic explanation of the genesis of the
morbid psychical phenomena of general pareties. He says
it “was Cabanis who first gave expression to this bassis-
sima idea of the cerebral functions, regarding them as the
product of a secretion of the brain, whilst so noble a
function can have nothing in common with those of
organic life.” Had the Professor been content with this
general protest, he might have better served the cause of
rational psychology. He, however, enters into explanations
which seem to me only to remove the problem a step or


362
Prof. Loggia.
two higher, if not indeed to render yet more obscure that
which we all find sufficiently so already. He says:
“Among the hypotheses emitted, by which to prove that
the brain is the organ of the soul (spirito), and the nerve
cells the agents of the mental functions, the process can
not be comprehended without admitting the concourse of
the ether with the transforming substance." We should
certainly feel indebted to Professor Loggia for a satis-
factory definition of this ether, which he styles the “most
subtile and imponderable substance in all nature, main-
taining, so to speak, the grand masses and their molecules
at due distances; whence attraction, affinities, and all the
forces ideated by physicists in explanation of the grand
concept of creation.” Is this ether, which I take to mean
the universal ether of some astronomers, a material, or a
non-material, entity; or is it a quasi-pantheistic repre-
sentative of the Divine Being? Reasoning of this sort, to
me, looks very like relieving the elephant of the burden
of the earth by giving him a tortoise to stand on.]
It cannot be denied, however, that the congestive
movement may sometimes be initiated in the meninges.
Then, the quality of the phenomena, pertaining rather to
sense and motion than to the intellect, might go to
indicate that the congestion had set out from the meninges
(of these phenomena would be cephalalgia, certain tonic
contractions of the muscles of the eye and the face, the
greater proclivity to febrile disturbance). We may,
however, agree (proceeds Livi) that this question has no
great clinical importance, since, whether the congestive
process proceeds from the meninges or originates in the
gray substance itself, the principal ultimate anatomical
seat of progressive paralysis will always be found in the
latter. This idea has been corroborated by physiology
and pathological anatomy, which show us that the most
grave and constant lesions found in the dead subject,
whether they appertain to the congestive period or to
that of organic dissolution, have their seat in the periphery
of the brain.-[Livi, pp. 33-34.]


Progressive Paralysis of the Insane—Paresis. 363
Westphal has not been the first, as we have before
said, who sought to transfer the capital seat of progress-
ive paralysis from the brain to the spinal cord, for Robert
Boyd, in 1871, had asserted in his first report of the
Asylum of the County of Somerset, that in cases of
paralysis of the insane terminating fatally, the affection
had been accompanied by inflammation of the medulla
spinalis, or had depended on it. The same results, he
says, were realized by him in 1849; for the cases which
ended in death were accompanied by, and were probably
dependent on, inflammation of this organ, frequently com-
bined with that of the envelopes of the brain, and with
effusion of fluid into the ventricles. “No mental affection,"
he adds, "presents morbid alterations so constant and so
marked in the medulla spinalis, although the brain and
its membranes almost always participate in them. These
lesions, which point to a meningeal myelitis, are shown
in thickenings, abnormal adhesions of the arachnoid,
softening, induration, increase of volume and atrophy of
the medulla itself, etc. According to this author it is
probable that when the paralytic accidents precede the
mental disorder, the medulla spinalis is the first to be
compromised, and the brain is so only secondarily; and
it is then, according to him, that the affection may be
arrested by a rational treatment, provided it has been
recognized in the outset. When," proceeds this writer,
"the disease had progressed rapidly, softening of the
cord was found, and, in one case, increase of its volume.
In another case, in which death was almost instantaneous,
after a crisis there was found, besides softening of the
medulla spinalis, an abundant effusion of serum in the
ventricles of the brain. In some cases in which death
did not take place till after some months, induration was
found, and sometimes atrophy of the medulla, and
thickening of its membranes.
"Finally, Boyd, in his complimentary notes, annexed, in
support of his work presented in 1871, on the alterations
of the medulla spinalis in general paralysis, presents to


364
Prof. Loggia.
us a summary of the lesions found in one hundred and
twenty-four men and thirty-one women, who died in the
period of twenty years, in the Somerset Asylum. In
these, only in five men and one woman did the medulla
spinalis appear unaltered.
“I omit reporting the ideas of Westphal as they have
met with a detailed exposition and a brilliant confutation,
in the very learned memoir of Prof. Carlo Livi, in his
journal, “La Rivista Sperimentale di Freniatria e Medicina
Legale, 1875. But I feel it proper to admit that the
work which seems to me to annihilate the existence of
Westphal's doctrine, is the very able memoir of Dr. T.
Christian, on the ‘Nature of the Muscular Disturbances in
General Paralysis of the Insane.'”-[Annals of Med. Psychol.
Jan. and May, 1879.]
Christian, conformably to my ideas above expressed,
says: “The disease which was called general paralysis
of the insane, first described fifty years ago, was consid-
ered by the first observers as an affection of paralytic
nature; hence its baptismal name which is still applied to
it. But I must say that we may be speedily convinced
that this paralysis is truly of a nature altogether special,
being general, incomplete and progressive; yet in the most
recent works no question is made of the nature of the
malady, each writer repeating that it is a paralysis, without
questioning whether the elements constitutive of paralysis
are really seen.
“Now," proceeds this writer, “it is easy for me to show
that these constitutive elements do not exist, and that in
general paralysis of the insane, whatever may be its duration,
at no time are the phenomena of true paralysis observed,
unless as defects from purely accidental complications."
Marcé opposed the designation, when he said that this par-
alysis resembled no other, inasmuch as true abolition of
contractility was not present, the patients being able, when
not seated or lying in bed, to move quite well the arms and
legs, and in moments of agitation to exert surprising force,
conjoined frequently, however, with defective co-ordination.


Progressive Paralysis of the Insane-Paresis.
365
I am further constrained to agree with Christian, that
these movements are perfectly voluntary, as the patient is
conscious of what he is doing, and so conserves his ideas of
force and power, and is pleased to give proofs of them;
nothing equals his satisfaction when he imagines that he has
succeeded. These facts are very common, and they suf-
fice to prove that the muscular force persists even up to
the close of the disease, together with voluntary trans-
mission.
In proof of this, Christian decided to measure accu-
rately the force presented by the dynamometer, and by it
he found that the means were in general less than in the
normal state; only five times in forty-four did the mean
pass fifty, therefore it ought to be concluded : First, that
in general paralysis there is a real weakening of the mus-
cular force, such as is observed in all chronic affections,
but that this weakening is not, withal, very pronounced, since
seven times only the dynamometric force was below twenty ;
second, that there does not exist any constant relation
between the diminution of muscular force and the advance-
ments of marasmus, as after several months' interval, and
in cases in which the marasmus was highly accentuated,
the dynamometer gave sensibly the same results; and third,
that the disease called general paralysis of the insane, is
not, in any period of its evolution, an affection of paralytic
nature, for up to the last the patient conserves the voli-
tional power of contracting his muscles, and the capability
of doing so forcibly. Further he found that the muscles
neither atrophy nor become fatty in general paralysis of
the insane as in other paralysis, a fact which Marcé had
before pointed out. Neither contractibility nor electric
sensibility is found defective, nor does it appear that
either is sensibly diminished. The same may be said of
the muscular sense and tactile sensibility. The dolorific
sensibility, however, on the contrary, appears generally
diminished. It is indisputable that with regard to this,
all paralytics are not alike, since in one cutaneous anæs-
thesia will be found, and in another muscular; hence it


366
Prof. Loggia.
is evident that these symptoms, which exist only in certain
cases, are almost always accidental, and that they make
no integrant or essential part of the disease we are
considering, nor are they destined to characterize it. The
reflex sensibility may be said to persist in certain cases.
In resumption, analysis, the most minute, shows that in
general paralysis the muscles submissive to the will con-
serve their structure, and the greater part of their intrinsic
properties, and also that their power of contraction remains
almost intact.
“Though this may be tested by experiment on the
voluntary muscles,” proceeds the writer, “it is very
difficult to do so on those of organic life. What can
there be more simple and more convenient than to explain
paralysis of the sphincter, the incontinence of urine
and fæces, and the difficulty or impossibility of deglutition
by paralysis of the pharynx? It cannot, in truth, be
denied that these paralytics are very dirty, and that they
pass their urine and fæces without any precaution or
care for keeping themselves clean, thus befouling their
clothing and their beds every time they have an evacua-
tion. But it is very well seen that in the filthy of this
class, just as with children and idiots, the urinary appar-
atus is in an absolutely normal state, and the brain alone
is responsible, as it fails in its function of moderator or
regulator, and, hence, such patients offend only in ignor-
ance. The paralytic is then dirty only from mental
distraction or forgetfulness; and even when paralysis of the
sphincter is present it is only an accident. The same is
to be held for the expulsion of fæces. As regards the
difficulty of deglutition, it ought to be attributed, not to
paralysis of the muscle of the pharynx, which does not exist,
but to the simple circumstance that the patient forgets to
swallow; for, besides being very voracious and gluttonous,
he often so crams his mouth with food that he cannot
swallow it, thus exposing himself to suffocation in a
manner quite mechanical; there happens, therefore, as to
the need of swallowing, the same as we have seen for


Progressive Paralysis of the Insane-Paresis.
367
the need of urinating; either it is not perceived or, if it
is, it is not understood. Reasoning thus, and analyzing
the facts, we should hold that in general paralysis the
entire muscular apparatus, as well the voluntary as
that of organic life, perfectly preserves its intrinsic
qualities; and this is what clinical observance proves in a
manner indisputable. This also shows us, on the contrary,
that the intelligence is progressively destroyed, in conse-
quence of which the patient falls into a state of complete
dementia. It is, therefore, undeniable that the organs of
the intellect are by little and little destroyed, but that
the supposition is impossible, that the motor centers are
the seat of the same destructive process, since if the
motor centers were attacked in the same way as the
intellectual centers, the loss of motion would progress
hand in hand with that of the intellect; the same thing
would happen as takes place when the cerebral texture is
destroyed by a hemorrhage.”
The doctrine of Poincare and Bonnet having equally
been combated by Livi in his learned memoir, a little
before noted, I cannot but transcribe his own words, and
thus render to Cæsar that which is Cæsar's, in fulfillment
of the study of this heinous disease, whose seat has been,
and still is, so much controverted, that up to the present
time no sufficiently concrete idea has been obtained on
this most important part of the pathogenesis of the
disease.
Livi writes: “The organ, in fact, to which these
writers would give the supremacy over the brain, in
opposition to all the writers on the pathogenesis of
progressive paralysis, even to the extent of conceding to
this organ merely a secondary part, would be the grand
sympathetic.”—[Livi, p. 41 and following.]
The grand sympathetic, as the great furnisher of vaso-
motor force, is that part which, becoming primarily diseased,
nust carry anarchy throughout the laws of the general
nutrition of the body, and hence disorder into the entire
vital mastery. The authors (it is well from the first to


368
Prof. Loggia.
know it) found the irtheory on only ten cases of progress-
ive paralysis. That which first struck them in their
examination of the great sympathetic, was the rusty color
of the gangliar cells. Conscientiously, however, they hasten
to add that this dark color is found also in old persons,
and in convalescents from typhoid fever. They have
found this color of the cells in persons of sane mind,
struck by diseases the most diverse, and of ages from thirty
to forty years, but in progressive paralysis it would seem to
have been more extensive and intense. They have also
subjected animals to examination, and have concluded
that such as feed on truly natural aliments, have gangliar
cells, whitish or of a pale yellow color. But they believe
that we, civilized men, with our deteriorated manners,
have, from generation to generation, squandered the histo-
logical elements of the nervous system, adapted to the
life of nutrition.
This rustiness of the gangliar cells of the great sympa-
thetic is due to granules of pigment, which now fill their
whole cavities and again are amassed toward their poles.
Even the adjacent adipose cells are more or less embrowned,
and small deposits of pigment are seen in the surrounding
connective tissue. Two other alterations, less apparent,
but more grave, have been found in the great sympathetic
by the two French physicians — that is to say, great
penury of the nerve cells, which have been substituted by
fat cells and an abundance of conneetive tissue. Now,
with this triple degeneration of the great sympathetic, it
is no wonder, according to these gentlemen, that paralysis
of the vaso-motor innervation should occur. In the brain,
also, in the minute vessels, and in the capillaries of the
gray and white substance, they have formed almost
constantly, pigmentary fatty degeneration within the vessels
and outside of them. In the cellulose of the small arteries
they have found brown patches of pigment, mixed with
yellowish crystals and fatty granulations; large adipose
globules in abundance in the stagnant parts of the blood
current, and great granulous masses along the course of


Progressive Paralysis of the Insane ne-
— Paresis. 369
the vessels as well as in the cells of the gray substance.
These alterations spare no part of the brain, but they
specially abound in the frontal lobes, the corpora striata,
and thalami optici.
If the autocracy devolved by these gentlemen on the
great sympathetic rests only on the color of its cells,
that is to say, pigmentary degeneration, “How then,”
proceeds Livi, “come they to say, that this same rusty
color, this same pigmentary degeneration, is found also
in old persons, in the sane in mind, and in persons
who have died of the most different diseases ? Now, if
all those persons who presented such alterations after
death, never showed, in life, either the psychical or the
paretic signs of general progressive paralysis, how could
the alterations mentioned be regarded as the specific
cause of this disease, since various other dead subjects
present them in common of similiar form and nature ?"
Livi, passing learnedly under review the prerogatives
attributed by recent physiologists, as Bernard, Schiff,
Brown-Séquard, Donders, Marcy and others from their
experiments, says, “we know with scientific certainty
that the suspension and paralysis of the functions of the
great sympathetic augments, by dilatation of the blood
channels, the sanguineous current, the color, the sensibility,
the nutrition and the secretions of the parts; but, on the
other hand, we know that the irritation of the ganglia,
and the consequent excitation of their functions, has a
quite opposite effect, that is to say, the convulsive contrac-
tion of the vascular parts, and after this the diminution of the
above named vital acts.” Now, I repeat with Livi, that
the hypothesis of Drs. Poincare and Bonnet wants the
necessary support. In order to explain the inter-cranial
hyperæmia, they suppose paralysis of the vaso-motor
nerves, without telling us what precisely there is in the
progressive paralysis that goes primarily to offend the
cervical ganglia. They, therefore, deduce the cause from
the supposed effect; an easy and brilliant argument, but
equally fallacious in pathology, where the discussion of


370
Prof. Loggia.
simple causes is not to be entertained. And then, as to
a paralyzing cause on the ganglia of the great sympa-
thetic, it is difficult to us to conceive what this may be,
and I believe the inventors themselves of the hypothesis
would be puzzled to name it. Nothing, certainly, is more
easy to the experimenting physiologist than the tying
or cutting of the cervical great sympathetic in order to
obtain paralysis of the vaso-motor nerves of the cerebral
circulation. But in progressive paralysis, what cause is
there so potent as to give the death blow without this
nerve ever being brought to know of it? We would
also add, with Schiff, as regards our case, that paralysis
of a vaso-motor nerve is never sufficient directly to
produce an alteration of the nutrition of the tissues; its
only immediate consequence is to put them into a
hyperamic state. It would be more easy to us to
imagine, for progressive paralysis, an irritant cause, than,
instead, to have sought for irritation of the vital energy
of the great sympathetic; but the primitive phenomena
of progressive paralysis are so dissimilar to those dependent
on irritation of the grand sympathetic; that they spare us
the trouble of saying more.
To pretend, then, to eject the brain, which must
always remain the essential organ of the manifestations
of the ego and the me—the moderator—and the supreme
arbiter of the acts of life, both dynamic and vegetative,
in order to give the primacy to the great sympathetic,
an organ subordinated by intimate ties to the cerebro-
spinal axis, seems not to be logic suited to physiological
or to pathological fact.
Who does not know that the vaso-motor nervous
:system has some important anatomical relations with the
cerebro-spinal system ? The fibres which establish the
connection of the two systems follow two directions; one
set go out from the medulla, the other come in to it.
The vaso-motor nervous system is hierarchically subor-
dinate to the cerebro-spinal system, and is, under a
certain point of view, dependent on it; but it has its own


Progressive Paralysis of the Insane—Paresis.
371
proper sphere, in which its activity may be exercised, as
when, by cutting, it has been disjoined from the medulla.
Besides this, in all probability, there are some vaso-motor
centers in the cord, the medulla oblongata and, perhaps,
the brain, which are connected by means of communi-
cating fibres to the ganglia of the great sympathetic, the
action of which they probably regulate. These spinal
centers are probably in very close relation with the
motor and sensitive nerves which belong to the medulla,
so that the impressions transmitted to this organ by means
of medullary nerves, properly so called, in certain circum-
stances are reflected beyond the medulla, following the
course of the vaso-motor nerves in such a manner as to
modify the circulation in distant parts of the body, when
they reach them. For this reason it is necessary, when
we seek to explain the mechanism of active congestion,
to take into account not only the state and influence of
the vaso-motor nervous system, but truly also that of the
cerebro-spinal system.
From all these reasons, deduced from physiology and
clinical observation, and confirmed also by the discoveries
of pathological anatomy, both macroscopic and micros-
copic, I conclude with Livi, that we may believe we do
not go far from the truth, in maintaining for progressive
paralysis its capital seat in the brain, and especially in the
cortical substance of the hemispheres.
But this is not enough. If we were believers in the
dogma of the functional unity of the brain, then our
investigations would rest satisfied, and the incognita
behind which we move would be resolved; but we, being
proclaimers of the plurality of the organs, or better,
of the areas constituted of determinate groups of cerebral
convolutions, destined to determine functions and move-
ments, it becomes necessary that we should establish what
the parts are, which are preferentially affected in pro-
gressive general paralysis of the insane.
Now, after the facts before exposed, we can not do
less than attribute the seat of this paralysis to that


372
Prof. Loggia.
portion of the brain which constitutes the inferior frontal
region, in the vicinity of the inter-hemispheric fissure on
one part, and the sulcus of Rolando on the other, where
are grouped, as I have before said, not only the greater
part of the motor centers of the limbs, but also, a little
lower down, the territories destined for the movements of
the face, as well as that which clinical observation has,
for a long time, regarded as the organ of speech.
And that it is this part of the brain which should
become affected in the disease in question is not to be
doubted, inasmuch as the other parts being adapted to
other offices, those functions which have been developed
on the so-called motor zone, cannot be disturbed, or if
they are, it is by a reflex action which the occipital, or
better, according to Ferrier, the tempero-parietal, lobes are
able to exercise.
Here I avail of recalling the fact that Crichton Brown
(vide West Riding Reports, Vol. VI., pp. 170 and 223), seeks
to establish, that in general paralysis of the insane, the
first symptoms, and among others the general inquietude
and the mental obstinacy, with enfeeblement of the power
of attention, alternating with apathy and somnolence,
coincide with the morbid changes which take place princi-
pally in this phase of the disease in the frontal region.
This view comports with the idea that the faculty of
attention is devolved on the frontal lobes.
The destruction of the prefrontal lobes is not followed
by any definite physiological result, since the animals
retain their appetites and instincts, and are capable of
giving proofs of the emotions which they feel. “Their
senses," writes Ferrier, “sight and taste, they retain
in their integrity, and there are few symptoms present
which would indicate the existence of a lesion so
grave as the removal of so extensive a portion of the
brain.” We ought therefore to hold that the development
of the principal symptoms that constitute the essence
of progressive general paralysis of the insane, in addition
to those of the intellect, as the tremor of the tongue and


Progressive Paralysis of the Insane-Paresis.
373
the lips, the inequality of the pupils and the strabismus,
the stammering, the difficulty and uncertainty of the
movements of the upper and lower members, are depend-
ent on a phlogosis, and on subsequent alterations in the
so-called motor zone, where are assembled all the convo-
lutions and territories destined to the various movements
of the limbs and the face, as well as that portion on
which is devolved the production of speech. Strabismus
also, so common in this disease, should be atrributed to
an irritant lesion on the opposite side, or to a destructive
lesion on the same side of the medullary fasces under the
region in which these movements are determined. This is
the conclusion to which Hughlings Jackson and Priestley have
been led from observations on some cases watched by them
It is no longer possible, after so many studies and
experiments, to ignore the fact that a cortical paralysis
is often migratory and transient, above all when it depends
on a superficial encephalitis or a meningo-encephalitis, as
in our case; hence, its tendency to appear and disappear
successively, now on one side and again on the other,
and according as the lesion may be superficial or may
invade the whole thickness of the underlying medulla, we
shall have a transient or a permanent paralysis, and the
latter followed by a descending sclerosis, and later, by
contracture.
Pathological anatomy comes into the final analysis to
confirm these views as to the seat of the disease under
consideration, since in all the cases observed by us there
were found, almost always, signs not doubtful of chronic
interstitial inflammation of the gray substance of the brain,
and in particular of those territories destined to the
various movements; and hence, the hypertrophy of the
interstitial substance, obliteration of the capillaries, atrophy
and consecutive destruction of the cellular elements; so
that the following carollaries, deduced from clinical obser-
vation and sanctioned by pathological anatomy, may be
held as certain :
Ist. That the mental changes presented under


374
Prof. Loggia.
the form of acute or chronic delirium is dependent, as
Bayle has well declared, on phlogosis of the meninges;
the cells and fibres of the nervous substance are only
irritated or slightly offended in their texture, the lesion,
for the most part, being reduced to a state of simple
hyperæmia.
2d. When the nervous cells begin to be interested,
which is shown mucus copically in the process of softening
of the cerebral substance itself, we shall then have in the
first instance dementia, and in the second absolute
paralysis of sense or of motion, according to the part of
the brain that has been altered.
3d. When, however, there commences that species
of phlogosis which is called interstitial, and that part of
the brain lying in front of the fissure of Rolando, consti-
tuting the motor zone, becomes preferentially affected,
we shall then have in the scene the phenomena of
progressive general paralysis with delirium every time
there predominates in the other convolutions a state of
excitement or hyperæmia; or those of dementia if this
part has softened.
4th. Finally, when softening or interstitial inflam-
mation extents to the opto-striate centers, the paralysis
becomes permanent, and is followed by all that train of
phenomena which distinguish it from the improperly called
general paralysis of the insane.


Art. IV.-Insanity in Great Britain and
Upon the Continent of Europe.*
ITS DIFFERING PHASES AND MODES OF TREATMENT COM.
PARED WITH THOSE PREVAILING IN TAE
UNITED STATES.
By J. DRAPER, M. D., Brattleboro, Vt.,
SUPERINTENDENT OF THE VERMONT ASYLUM FOR THE INSANE.
THE difference in the mode of treatment of the insane
1 in different countries has been a somewhat prolific
theme for specialists and philanthropists in recent times, and
has often been discussed without a due regard to all the
premises that should enter into its consideration. Perhaps
it is impossible that all these should be comprehended in
their just measure in the mind of any single individual;
and, assuming this, I know no better method of arriving
at definite and just conclusions, respecting doubtful prob-
lems, than by a comparison of the impressions of different
observers, from their somewhat varying standpoints,
throwing quite out of account the impressions of unqual-
ified persons—those not practically engaged in the care
of this class, and whose conclusions are derived mainly
from their “inner consciousness” of what ought to obtain.
In this view, I offer this paper as a coutribution
toward the solution of some vexed practical questions,
basing it upon the impressions derived from a somewhat
more than cursory personal inspection during the summer
of 1881, of twenty-four European asylums, ten upon
the Continent, and fourteen in Great Britain and Ireland.
In the running record I propose to sketch, I shall
have to crave the patience of those to whom my subject
may be already familiar.
"A paper read before the New England Psychological Society, Jan. 17, 1882,
and printed by request of the Society.


376
J. Draper.
I visited the institutions of the old world for the
purpose of seeing whatever was peculiar in their plans
or methods of management, and, so far as I know myself,
without any preconceived opinion that would disqualify
me for giving just weight to the evidence of such facts
as I should find, and in the hope that I might see
something in foreign methods that could be profitably
engrafted upon our own.
The first institutions visited upon the Continent were
the four Parisian asylums, the Bicêtre, Salpêtrière,
Charenton and St. Anne, and the first impression made
upon my mind was that of the meagreness of in-door
provision for the inmates as compared with ours, and the
much more general facilities for out-door recreation and
treatment than are generally found in the asylums of our
own country. At the Bicêtre, the rooms of patients of the
excited class opened directly upon verandas inside the
airing courts, so that practically the inmates lived in the
open air. The same was observed at the Salpêtrière and
at Charenton ; and at St. Anne, where the accommoda-
tions for excited cases are isolated and peculiar, each
patient having a separate open court appended as a door
yard to his individual apartment. Now, it is easy to see,
at a glance, that this open air provision grows out of the
general habit of the country. All Paris, it is said,
lives out of doors. The climate there draws the inhab-
itants out of their tenements, as much as in New England
it drives them in, for recreation and comfort. And yet
this underlying cause is practically ignored by some of
the writers of our time, who argue that what can be
done in one country can be in another, and complain
that in America the patients are kept too much within
doors without acknowledging, or perhaps suspecting, the
reason to be any other than a difference of policy in the
treatment of the insane in the two countries. A large
percentage of the insane observed in the Parisian hospitals
were evidently of the agitated class, and this, considering
the climate of the country and the volatile nature of the


Insanity in Great Britain, etc.
377
French people, was what, on general principles, it seemed
to me might be expected. In the treatment of excited
cases the camisole was freely used, in some divisions as
many as twenty-five per cent. of the inmates being thus
restrained or wearing canvas suits, but I saw few, almost
none, in seclusion, although strong and padded rooms
were provided.
In all these institutions, also, water as a means
of treatment was prominently dwelt upon, and the
arrangements for its use were everywhere exhibited with
evident pride. There were tubs with covers for confining
patients to prolonged baths, together with douches and
showering apparatus, “with which to refresh the head.”
At the Salpêtrière, I saw caps for the protection of the
head during the shower, and a cooler of novel make which
I can conceive might serve an excellent purpose in
certain cases in any country. It is a coil of rubber
tubing joined together so as to form a cap; thus by
connecting one free end of it with a douche pipe, allowing
a circulation of water around the head. But at St.
Anne the appointments are the most nearly perfect of
any that I saw for this means of treatment, including, as
they do, the covered tubs, the douches and the shower-
ing apparatus, elaborated to the last degree, together
with a raised rostrum, like the pulpit of an old fashioned
church, from which the operator can control the water
and graduate the refreshing effects at will. There was
less apparent use of mechanical restraining means here
than in either of the other institutions. There was more
even at Charenton, although the patients there are of a
better class. The same means were used there as in
the public institutions, and, in addition to the camisole,
which was in frequent use and no apology made for
it, there were restraining chairs by the dozen in the sitting
or day rooms of the patients. These are upholstered
with leather, with an opening in the seat, and fur-
nished with straps to go around the body and to secure
the feet. In 'no institutions in America have I ever


378
J. Draper.
seen so large a percentage of patients under restraint as
in those of Paris, nor so great a variety in the means
of restraint.
What might be termed hospital police is in none of
these institutions neglected. Charenton, which, like the Mt.
Hope institution in this country, is under the immediate
care of the Sisters of Charity, left an impression of
scrupulous neatness upon my mind that was almost
painful. Of the medical practice there, I am unable to
speak, as. I did not meet the physicians in charge. The
general superintendence and management appeared to
be in non-medical hands; but I everywhere received
great courtesy and was freely admitted to all classes of
cases as soon as my connection with the specialty was
made known.
The asylum for insane women of the pauper class,
near Venice, afforded me some idea of the treatment of
the insane in Italy, and the prevailing type of insanity in
that kingdom. Here were a thousand patients under the
charge of Dr. Pietro Carlo Brunetta, an elderly gentle-
man, evidently devoted to his work, and with whom I
was most favorably impressed. Here, contrary to what I
had observed in France, the inmates, instead of literally
living in the open' air, were absolutely all mainly
confined within the buildings, the excessive heat as
effectually driving them in, as the extreme rigor of our
New England climate does ours in winter. True, there
were areas between the different sections of the buildings,
which, in the French hospitals, serve for airing courts,
but they were unprovided with seats or shelter of any
kind, and into them the sun, with all its Italian fervor,
poured its rays so mercilessly as to make them anything
but a comfortable resort. I was informed that it was
only in the cool of the evening that the patients could be
allowed out of doors; but the construction of the wards
bears evidence of an appreciation of the fact that they
must be adapted to constant occupancy, and in space
they are ample. The ceilings are from fifteen to twenty


Insanity in Great Britain, etc.
379
.
feet high, the hall from fifteen to thirty feet wide, with
rooms upon only one side, and the floors of stone or
Venetian cement. I nowhere saw worse classes of cases
than were congregated here. A very large proportion of
them were maniacal, and a very large percentage also
suicidal. Patients by the score, if not the hundred, were
confined to their beds, or restrained by camisoles, by
wrist bands and belts, or by leg straps to tables and
chairs. A very large number also were feeble and in bed,
but a commendable degree of cleanliness and attention
to the sick prevailed. Pellagra was a complication in
many cases, and this, it is said, is peculiar to Italy and
the south of France.
I came to the conclusion that the prevailing types of
insanity in France and Italy are of the active forms, and
certainly the care of the patients at Venice must have
severely taxed the resources of those who were respon-
sible for their management. Not only were the cases bad
in their nature, but they seemed most discouragingly
hopeless in prospect.
The transition from Italy to Switzerland was not more
grateful than was the contrast between the asylum last
described and the one next visited, which was at Laus-
anne. This institution, in the midst of the beautiful
scenery about Lake Geneva, left nothing but pleasing
memories upon my mind. In its architecture it has
many American features; and, like the State institutions
of this country, it accommodates the insane of all classes
belonging to the Canton de Vaud. Here I found, for
the first and only time on the Continent of Europe, no
restraint. Particular inquiry in respect to this elicited the
fact that the abolishment of restraining means was com-
paratively recent here. There are no padded rooms at
Lausanne, but those used for excited cases are strong,
and the walls finished with cement and painted. Strong
canvas clothing, each suit being but one garment, is used;
and, on inquiry as to whether even this might not be
torn or taken off, and what was then done, I ascertained


380
J. Draper.
that the patient was then secluded and provided with
loose bedding made of excelsior.
At the next institution visited in Switzerland, I saw
the water treatment in use more extensively even than in
France. At the time of my visit, a dozen female patients
were confined in the bath tubs, and this, the superin-
tendent informed me, was for the purpose of reducing
excitement. In reply to my inquiry as to the use of
the camisole, and which he would regard as the prefer-
able treatment in cases of furious and destructive mania,
he replied by saying that it would depend upon the
individual case, and that he very rarely resorted to the
latter.
The difference between the insanity of this elevated
region and that observed in France and Italy was very
marked. Besides the great modification of the dominant
characteristics of maniacal disease, there seemed much
more ground upon which to build a hope of recovery.
There is evidently more native stamina inherent in the
mental constitutions of the people. Nowhere but in the
Swiss region did I see much either in the customs or the
personal characteristics of the people, akin to those of
New England, but here one felt at home; and, in the
management of their institutions, their republican prin-
ciples were very manifest. To the wide differences in
the constitutions of the people and to climatic in-
fluences, I think may be attributed, to a great extent,
the differences in the type of insanity prevalent as well
as predominant in the different regions of the same
Continent.
At Heidelberg, I visited the new asylum connected
with the University. This is certainly a model establish-
ment in its design and appointments, and, if representa-
tive of the German asylums generally, predisposes one
very much in their favor. This was the only institution
I saw on the Continent that had any system of forced ven-
tilation, or that was heated by indirect radiation as in the
United States. Its architecture embodies many excellent


Insanity in Great Britain, etc.
381
features, and gives evidence in detail of much careful
forethought in the plan. It was designed for one
hundred patients. Its strong rooms are finished with
cement. Their windows are of iron sash with small panes
of very thick glass, and without protecting guards—each
window cost three hundred marks. The doors are of
double thickness, with an elastic filling between the two
to diminish the noise that might be occasioned by blows
upon them.
The system of management was evidently good.
Leather mittens (handschuhe) and the wet pack are the
restraining means employed. I saw both in use; and
canvas suits, made whole, were worn by destructive
patients, the buttons being locked. I was told by the
assistant medical officer that the prevailing sentiment of
Germany was against mechanical restraint.
In striking contrast to this latter institution is the old
asylum at Antwerp, which accommodates about the same
number of patients. The larger part of a century intervened
between their periods of construction. Situated in the
midst of the city, surrounded on three sides by streets,
and abutting on the fourth against other contiguous
buildings, there is but little to distinguish this externally
from a huge warehouse; yet here was much homely
comfort and painstaking within a very circumscribed
area; and, notwithstanding the disadvantages of construc-
tion, and the very limited open air space within the
square, the inmates did not seem unhappy. Many cases
were excited and restrained by wristbands and
belt, by camisoles and by chairs; but others were engaged
in basket work and the manufacture of cigars, while
others still were employed in the kitchen and the laundry.
The institution has no facilities for agricultural labor.
In respect to the labor question, the conclusion
forced upon my mind was that no larger proportion of
the inmates of the European institutions are employed
than in those of America; and, in respect to the use of
restraining means, that more, rather than less, are there


382
J. Draper.
used. But these conclusions are based entirely upon my
personal observations. More extended investigations
might have modified my impressions. As an offset to the
water treatment, I am inclined to believe that we must
charge to our account the more liberal use of sedatives.
As might be supposed, a visit to the Transatlantic
Continent would be incomplete unless it included Gheel.
I arrived at this Mecca of modern philanthropists on
the afternoon of a Saturday, and remained until the
following Monday. Notwithstanding the descriptions I
had read of the place, few of my preconceived impressions
were confirmed. The extent of the colony surprised me.
My supposition was that the patients were quartered
mainly upon the village instead of being scattered over a
territory equivalent in area to a New England township.
The colony is divided into three geographical sections,
each in charge of an assistant medical officer, whose
duty it is to visit every patient once a month, and oftener
if necessary. Books are kept in the homes of the insane,
in which the physicians enter at each visit the date and
the fact, with such observations as may be suggested.
These medical officers reside in the village, Dr. Peeters
alone, the Physician-in-Chief, residing at the hospital or
infirmary. This building, at the time of my visit, had
but thirty-five inmates, although it has beds for fifty.
These were mainly cases of active mania or melancholia.
Sisters of Charity fill the positions of responsibility in the
infirmary. Restraint by camisole, leather mittens and
chairs was seen here, but none is allowed outside the
hospital unless by special order of the physicians. The
number of the insane at the colony at this time was
1,595, of whom 1,447 were natives, and 148 foreigners;
1,438 were paupers, and 157 private patients. The sane
population of the colony was 11,500. Besides the physi-
cians there are supervisors of sections, who have a constant
and more frequent oversight of the insane, and of the
manner in which they are cared for. The rates paid for
the pauper class vary, according to the condition and


Insanity in Great Britain, etc.
383
habits of the patients, from a Yankee shilling to twenty
or twenty-five cents per day; and those for the private
class, from the last named sum to two or three dollars
per day; but those last named apply only to very excep-
tional cases, belonging chiefly to the nobility.
I visited with particular interest many of the dwellings
in which the insane were quartered. The principle of the
distribution of patients among the families comprising the
population seems well devised and practically judicious.
From one to three only are lodged in a family, two being
the rule, and both sexes are not in any case taken in the
same family. With few exceptions, the amount received
for their care is too small to excite cupidity, while it is
sufficient help to the family to become a consideration,
and to reconcile them to the arrangement. My visit was
on a Sunday, so that I could hardly judge of the amount
of labor performed by the insane; but I apprehend it to
have been exaggerated. That there is now an effective
supervision exercised over the insane of the colony, I
believe. I saw none wandering aimlessly about the streets
of the village, and contrary to what I had expected,
nothing to mark it as the home of the hopelessly insane,
In driving about the colony outside the village, it was
not unusual, although hardly common, to see the insane
sitting outside the cottages. In visiting the interior of
their homes I found the garden in the rear of the house
usually the attractive feature of it; and in this the better
class walk and the poorer work.
I did not learn that wandering about the neighborhood
is interdicted, but inferred that practically there is little
license of that kind, and that as a rule it is expected
that the families will always know where the insane
members are. I made notes of many of the houses
visited, but cannot take the space for their reproduction
here. At some of these the patients appeared to be very
comfortably situated and provided for ; at others I thought
they would be better off in an asylum. The better paying
class are mostly in the village; the poorer and more


384
J. Draper.
demented in the surrounding districts. In one house in the
town were two male patients; one quiet and in bed, but
the other—a French captain, who had been eight years
insane, who was uneasy and incessantly walking, with
melancholy and suspicious look, and so wakeful and
noisy at times that it was necessary to keep the front
door constantly locked, and that of his chamber also at
night-it seemed to me would be better off in any well
regulated asylum. In a house almost directly opposite
this, where was a butcher's shop into which the front
door opened, was quartered a single patient, who was
taking breakfast in an adjoining room, but who arose and
left the table in a nervous and hurried manner when we
entered. This man had been five years insane from
epilepsy, and in the shop hung saw, cleaver and all
kinds of instruments used in the business. This was, to
me, the most objectionable arrangement that I saw, but
I was told that no accident had ever occurred, and none
was apprehended. In another domicile were two female
patients, one a non-talkative old lady who kept her room
constantly, and the other a monomaniacal young woman
who walked in the garden with a regal air and a high
head-gear, imagining herself to be the Queen of Holland.
In one of the best houses, with a large garden and
shaded walks in the rear, were two male patients, one of
whom was a young man, the son of a baron, and much
deranged. He was walking rapidly in the garden and
disposed to shun strangers. I understood that he was
brought to Gheel by the advice of the physician of the
Empress Charlotte, and that he was six years insane with
no amendment. His companion, an elderly, plain looking
man, with coarse clothing and wooden shoes, apparently
in a state of chronic delusion or dementia, I under-
stood to be wealthy, and to pay more than the young
baron. The house was kept by two elderly women, with
two female servants. Decidedly the best provision for
the insane to be found in the place is the house kept by
the daughter of the late Dr. Bulckens, in which were


Insanity in Great Britain, etc.
385
three male patients, one a general paretic, another appar-
ently demented, and the third a Polish prince, evidently
in a state of great contentment and self-satisfaction, and
very observant of etiquette, but probably drifting toward
dementia. Both the house and the family seemed devoted
to these inmates, and I understood they enjoyed many
special and outside privileges.
In the houses outside the village were many patients
of uncleanly habits, and some who were more or less
excited. Bundles of straw laid crosswise on a bedstead
and covered with a blanket to sleep upon, appeared to
be the usual arrangement for such cases, and articles of
bedding and wearing apparel were hanging out on the
hedges, during the day, to dry. Bars to the windows of
sleeping rooms, while not universal, were common, and
some decidedly troublesome persons were seen. One
man, a chronic maniac, with religious delusions, followed
us quite a distance shouting and crossing himself and
bowing down before a rude cross which he had erected
by the roadside.
In another cottage, near by, were two male patients,
one a quiet dement, fifty years an insane resident of the
colony; the other a most incoherent chronic maniac was
sitting inside the great fireplace, in the chimney corner,
in a framed chair designed for restraint by means of a
cross bar in front, from arm to arm, from which, as we
entered, he started in his half clad and disorderly condi-
tion to run out of doors. This man was troublesome,
mischievous, not to say vicious, and in my opinion, most
objectionable as a member of a family.
It is not uncommon in the countries of Continental
Europe for the abodes of the peasantry to be in near
proximity to the quarters of the domestic animals, and
not rarely does one roof shelter both man and beast.
Here in one instance we met such an habitation, one-half
upon the ground floor being occupied by the family and
the other by the quadrupeds. Between the two departments
was a large chimney, with fireplace, in which hung a


386
.
J. Draper.
great iron kettle which could be swung around, by means
of a crane or semi-circular arm, from the kitchen fire into
the stable through a communicating door. The conven-
iences of this arrangement, however, to my mind, were
more than counter-balanced by the disagreeable conditions
inseparable from such association.
The cases cited and the accommodations described
represent, I believe, the best and the worst to be seen in
Gheel. Between these are sandwiched the great majority,
who have no sharp characteristics or mental crooks, and
who are in a state of reasonable comfort and contentment;
but it seemed to me that no class of those I saw were
better off than the corresponding ones in other asylums
that I visited, and that no individual case here enjoyed
comforts and social advantages that the same amount of
expenditure would not procure for him in any well con-
ducted asylum.
It is not the policy of the Belgians to provide for
their insane in the manner in which they, by accident, as
it were, came to be provided for here. There are many
establishments for the insane in Belgium, but all, with
this exception, are on the universally established plan.
While Gheel, among the modern humanitarians of other
countries, has risen into prominence deserving considera-
tion, at home it has been regarded as almost a reproach.
“Many physicians,” said Dr. Peeters, “come here from
all parts of the world, but the Belgian physicians coine
not at all."
Gheel, however, has its lessons for those who will
search for them, and we may thank the old world
conservatism that wisely, perhaps, took measures to grad-
ually reform the place, instead of extinguishing it forever, by
gathering its insane residents into a building large enough
for their accommodation. I have reason to believe the
insane much better cared for than in the days of the
Commune, when all the oversight of the residents, sane
and insane, was in the hands of officers corresponding to
the selectmen of towns in New England, and think it


Insanity in Great Britain, etc.
387
probable that continued advantages will accrue to the
insane under the present established governmental control.
The evils of the system are, in my opinion, to be seen in
the families of the present resident sane population. For
more than thirty generations the people of this region have
been accustomed to the presence of the insane in their
homes, and this has been an element operative more or
less upon their daily life.
What more natural than that the children (and this is
a prolific region) should imbibe more or less of the
erratic and degenerate life with which their own was
constantly and inextricably mingled, and that, in the
course of successive generations, a retrogradation or
retardation in respect to human development and progress
should be the consequence? And this retardation has
been more complete by reason of the isolation of this
region from the active world, no railway having until
recently penetrated to it, and no manufacturing industry
ever having been there developed. The whole population,
indeed, has for centuries been occupied only in the routine
of agricultural pursuits, and notwithstanding the establish-
ment of a general over the local government, the building of
a hospital, and the construction of a railway through the
commune, the town is still barren of apparent activity and
thrift, as compared with those in general of like population
The first institution I saw in Great Britain was the
Royal Edinburgh Asylum, at Morningside. This has beds
for two hundred private and six hundred pauper patients.
The two classes occupy separate buildings. The accom-
modation is very excellent and somewhat varied for the
private class, two or three cottages within the grounds
furnishing quarters, each for a small family—and Craig
House, an estate contiguous to the original asylum
premises, being occupied by from twelve to fifteen of the
higher paying boarders. Some of the private class, who
pay rates but slightly above that received for paupers,
are lodged in the buildings for the latter, but have a sep-
arate table and dining room, and a dietary corresponding


388
J. Draper.
with the increased rate; but the diet for the pauper
class was inferior in variety and quality to that which is
universal in our State Asylums. The East house or main
building for patients of the private class, though built in
the early part of this century, has been so greatly
modernized by structural alterations and extensions that
it has few defects, and certainly many excellent and
attractive features. Its dining rooms, in particular, of
elaborate finish and elegant furnishing, are flanked on
both sides by a narrow conservatory filled with plants.
the whole constituting a thing of beauty long to be
remembered. These, with glass corridors around the
building and its extensions for the use of patients in
rainy weather, are features of which Dr. Clouston may
justly be proud. The main buildings for the pauper
class have accommodations not essentially different from
those of the hospitals in the United States, and I could
not see that the arrangements which differed from ours
presented any important advantages. The aggregation of
all the patients in a common dining hall, I do not regard
as a desideratum. Open coal grates in the wards, supple-
menting the general system of heating, were new features
to me, but I found them universal in England. Like
almost every other place, public or private in Great
Britain, this institution is surrounded by a stone wall laid
in cement, and the gates or entrances are guarded or
locked. Still the walls are not high enough to prevent
escapes. I saw few patients within doors, and many
employed in various ways about the grounds. More of
the daily work appeared to be done by manual labor,
and less by mechanical aids than in our asylums, which
I am not sure is any disadvantage. On entering the
grounds I met an attendant with a party of patients, ten
of whom were drawing a lawn mower, though half of
that number could have done it easily. Doubtless, a
larger percentage of the inmates are thus employed than
with us, but I do not think it certain that more productive
labor is performed.


Insanity in Great Britain, etc.
389
A little further on, I met an excited young woman
walking between two attendants. Subsequently, and in com-
pany with Dr. Clouston I met them again, when the Doctor
took occasion to speak of the mode of treating maniacal
cases in this way. He keeps them the whole day in the open
air, and at night gives a warm bath and a large dose of
bromide of potassium, which, continued for a very few
days, usually subdues the excitement, and brings the
patient into a very comfortable and manageable condition
Restraint is furnished by the hands of special attendants,
mechanical means being wholly discarded and seclusion little
resorted to, although there are padded rooms for violent
cases. So large a proportion of the twenty-four hours in
Scotland, and in the warm season of the year is either
sunlight or twilight, that it is practicable for much more
of the time to be spent in labor or exercise in the open
air than with us, and to this fact, rather than to difference
in policy of management should, as I believe, be attrib-
uted the greater amount of out-door treatment in that
country than in ours.
Again, greater risks of accidents are taken than we
feel justified in taking. The difference in practice in
different hospitals in respect to admitted risks, it seems
to me, can only be explained as Dr. Earle, in 1878,
explained the difference in the proportion of cases in
different hospitals discharged as recovered, by attributing
it to “diversity of characteristics in the constitutions and
temperaments of the superintendents;” and Dr. Clouston
and others to whom I may hereafter refer, appear to be
so constituted as to be able to regard probabilities simply
as possibilities, and to lean in doubtful cases to the less
conservative practice.
The old Bethlehem and St. Luke's Hospitals, in
London, were visited with the same interest as the Bicêtre
and the Salpêtrière, in Paris. Historic associations group
themselves around these old establishments as about few
others, and to the specialist from this side of the Atlantic
furnish an antiquarian interest not attached to those of


390
J. Draper.
our own country. But while one here beholds the relics
of the ancient idea in relation to the confinement of the
insane, he likewise sees some of the best modern practice
in caring for them; and in the results of treatment these
old institutions do not suffer in comparison with those
of later build. Renovated and in many respects modern-
ized, though still unmistakably old-fashioned, they are
yet held as suitable places for the purposes for which
they were created. The principles of practice in the
London institutions I found essentially like those at the
Edinburgh Asylum. Mechanical restraint is totally dis-
carded, as well as anything like regular treatment by
sedatives. Padded rooms are sometimes used, and canvas
clothing is worn by destructive patients. Attendants, of
whom there is one to every five or six patients, at Beth-
lehem, are entirely depended upon for the reasonable
care and restraint of the inmates during the day, but at
night the latter are allowed to do much as they please
in their rooms, after all movable and destructible things
have been, as far as possible, removed. In cases of
acute exhaustive mania, the assistant physician said that
hyosciamin is used, but that no continued treatment by
sedatives is ever pursued. The grounds of Bethlehem
permit a wide out-of-door range, so that the open air
treatment can be as successfully carried out as at Edin-
burgh.
At St. Luke's, as at the old Asylum at Antwerp, there
is little opportunity for open air exercise, but I was told
that in-door and out-door entertainments are provided,
and that carriage drives to a considerable extent com-
pensate for the absence of surrounding pleasure grounds.
At Bethlehem only recent cases are taken.
I next visited the three Middlesex Asylums: Hanwell,
Colney Hatch, and Banstead. These mammoth establish-
ments accommodate about 2,000 patients each. Their
architectural plans differ greatly and embody essentially
the ideas of three successive generations.
The site of each is exceedingly well chosen, and each


Insanity in Great Britain, etc.
391
embraces ample grounds for pleasure and for agricultural
employment. There is much in the plans of asylums, both
on the Continent and in Great Britain, that particularly
interested me, but I can only refer to them incidentally,
in a paper which particularly has to do with the manage-
ment and mode of treatment of the inmates of the different
institutions which came under my observation.
At Hanwell most of the cases are of recent origin.
The medical staff consists of a superintendent and four
assistants. The proportion of attendants averages one to
every twelve patients. Dr. Raynor, an active energetic
man, nine years in charge, and thoroughly imbued with
the spirit of his work, most courteously exhibited to me
the interior plan and working of this great hospital. Five-
sevenths of the male patients were in some way and to
some extent employed; but, in this enumeration were
included all who assisted in in-door work of a domestic
character. The mere transportation of food from the
kitchen to the wards, three times a day, which is done by
hand instead of by cars and elevators, as in the United
States, employs a small army of men at the hours for
meals.
The asylum bears evidence of vigilant management.
The pay received for patients is about two dollars and
fifty cents per week. There are many strong and padded
rooms, but no mechanical restraint is used. Many infirm
and paralytic cases are kept in bed. Suits, including shirts
of the strongest canvas are used for the destructively
inclined cases. I asked Dr. Raynor if he did not sometimes
have patients who would destroy even this clothing, or at
least, divest themselves of it; he replied: “Seldom.”
When he has them he employs “special attendants until
the paroxysm subsides, as it usually does in two or three
days.” I asked him further if he did not sometimes have
cases of asthenic mania in which the patients, unless
restrained, would exhaust themselves and die. So far as
I could learn he had no experience of that kind. I
inquired if he had cases of persistent refusal of food; he


392
J. Draper.
answered, “Yes; but such I put to bed and keep there
as sick persons until they come to their appetites.
I very rarely have occasion to resort to the stomach
tube.” He wished, however, to be distinctly understood
as not bigoted in the matter of restraint or non-
restraint. He would not say he should not use restraint
if the exigencies of the case required it, but he did not
have cases that did require it, and that could not be
bridged over in the way mentioned. He also deprecated
the use of sedatives, and said that he seldom gave even
a single dose for the purpose of allaying excitement, but
kept maniacal cases out of doors as much as possible during
their waking hours. The same avoidance of sedatives
prevails in principle as at Bethlehem. The legitimate con-
clusion apparently to be drawn is that mania, in England,
is more paroxysmal and evanescent than in New England.
At Colney Hatch there are two distinct medical
organizations. Mr. Marshall, with two assistants, having
charge of the women's department, and Dr. Shepard,
with one assistant, of that of the men. The medical
assistant, in the absence of Dr. Shepard, accompanied me
through the latter. The day being unpleasant most of the
patients were within doors. This institution draws its
inmates from the East End of London, and it must
be confessed they appeared rather worse than the
average of the same class in Great Britain, and their
general appearance was not improved by what seemed to
me the needless wearing of their hats in the house; but
this practice is not peculiar to Colney Hatch. Many
patients wore strong canvas clothing, and padded and
strong rooms are used, but I saw no form of mechanical
restraint. I asked the assistant physician if they had no
cases requiring special restraint, and received the reply:
“We never use any.” In answer to my farther inquiry,
if they did not have cases of exhaustive type, in which
the patients, if in no way restrained, would wear them-
selves out and die, he said that he “fancied restraint
would only aggravate the case,” and that “most of the


Insanity in Great Britain, etc.
393
cases of acute mania so far subside in three or four days
that they are managed without difficulty. In point of
fact," he added, “if acutely maniacal cases continue so
for ten days, they almost invariably die.” He spoke of
the condition of violence as a transient one, and, as a
rule, of a paroxysmal nature; persistent destructive mania
not being a usual, hardly an exceptional experience.
Here, as at Hanwell and Bethlehem, sedatives are used
only when specially indicated, and not as a course of
treatment in excited cases.
The Banstead Asylum, the last erected of the three
Middlesex institutions, was designed for chronic cases,
and built upon the block plan. Its patients mostly sleep
in large dormitories, but, as it has been decided to receive
recent cases, the new block in process of construction is
largely devoted to single rooms. This institution is
regarded as a model in its way, and is ably managed by
Dr. Claye Shaw, with three medical assistants. To them,
because of the absence of Dr. Shaw at the time of my
visit, I am indebted for much courtesy, as well as for
much information in respect to the principles and details
of management. The corps of attendants here was in the
proportion of one to twenty patients. A good deal of
labor is performed by the inmates, and, in addition to
agriculture, a tailor's shop furnishes some of the men with
in-door work, while many are employed in the domestic
departments. The treatment here, as elsewhere in Eng-
land, is essentially on the principle of non-restraint.
Mittens are sometimes used and padded rooms for special
cases. Cases of typhomania, or acute exhaustive mania,
are rare, and are treated by these means. Neither acute
nor chronic mania of persistent type, nor that which is
exhaustive to the extent of compromising the physical
welfare of the patient, seemed to have come within the
experience of these medical assistants. Medical treatment
is not ignored, and yet not greatly relied upon. Here, as
at Hanwell, the conveyance of food is by hand from
kitchen to wards, and although those who are able go to


394
J. Draper.
the common dining hall, many have to be served sepa-
rately. The kitchen and the laundry are both on a great
scale, and both excellent. Water from a well, three
hundred and sixty feet deep, is softened for washing by
a chemical process.
The proprietary establishment of Dr. Wood, at Roe-
hampton was visited as a representative one of its class.
The estate embraces some fifty acres, with buildings cen-
trally situated, the whole, in fact, a gentleman's homestead
with the residence enlarged by two wings, for male and
female patients, respectively, and containing apartments
for twenty-five of each sex. Some of the arrangements
struck me as peculiar, and, taken altogether, it appeared
to have more architectural provisions for security than
are usually seen at public institutions. On the first
floor are provisions for the most troublesome cases. The
middle story is appropriated to day uses, and the upper
to dormitories. The private parlors and bed-rooms for
patients, instead of being connected in suites, are separate
and upon different floors. The public rooms, the parlors,
the libraries and the billiard rooms are all large and
luxuriously furnished, one of them serving for religious
services on Sunday. Many rare attractions surround the
house. Enclosed gardens afford recreation to special
classes, while a wider range of privilege is extended to
those who are sufficiently trustworthy. Dr. Wood, the
proprietor, with an assistant medical officer and a matron,
constitute the official staff; and everything that can be
required by individual patients can here be commanded.
I understood the range of prices to be from four to ten
guineas per week.
In the treatment of the inmates, everything in the
nature of compulsion is, as it seemed to me, so scrupu-
lously avoided, as to sometimes compromise the welfare
of the patient. The use of the stomach tube in persistent
refusal of food, I was told, is rarely if ever resorted to,
and the only instance mentioned of the employment of
mechanical restraint was that of a young woman who had


Insanity in Great Britain, etc.
395
destroyed one of her eyes. Closed sleeves were used to
save the other from a like fate.
The Northampton County Lunatic Asylum, at Berry-
wood, near Northampton, was spoken of as one of the
best in England, and the latest built of its class. Its
capacity is for six hundred patients. In some respects
it is similar to the Banstead plan, but differs in its
interior arrangements. Its unpretentious center is a notice-
able feature, the adminstrative building being projected
forward and but two-stories high, while the wings are three.
The proportion of single rooms for patients is as one to
five of its full capacity. Dr. Richard Greene, with one
medical assistant, has charge, and the corps of attendants
averages one to fifteen patients. The windows of the
single rooms are provided with close shutters; all the others
are of substantial wooden sash, but so arranged by stops
that they can be raised or lowered only six or eight inches.
Some of the rooms are padded and some have double doors.
Suicidal cases and those requiring personal care are gathered
into a ward by themselves at night, and are under the
oversight of a special attendant. This ward is a large
dormitory, with a range of single rooms on one side, the
doors of which are of open slat work, to facilitate observ-
ation of the occupants—a recent suggestion of the Com-
missioners in Lunacy.
The patients are employed in all practicable ways. In
addition to farm labor, the shoes and clothes of the male
patients are made in the shops by the men. The women
are employed chiefly in sewing, washing and ironing.
Some of each sex work in the kitchen, and, altogether,
the amount of effective work performed seemed to me
greater than at any other place I saw in England. There
were, apparently, but few cases of mania, and I saw no
seclusion or restraint, except by strong clothing. In reply
to my stereotyped inquiries, I was told that cases of acute
mania are usually transient; and that they use sedatives,
and sometimes the wet pack.
St. Andrew's Hospital, at Northampton, for the middle


396
J. Draper.
and upper classes, impressed me in every way most
favorably. Its location, within the city, is upon an original
plant of sixty-four acres, to which additions have been
made by the purchase of contiguous villas until the area
of the premises is about one hundred acres. Upon some
of these recently purchased lots are fine residences, which
are utilized as boarding places for some of the higher
paying patients. An estate of about four hundred and
fifty acres, about two miles distant, has been recently
purchased and is to be made supplementary and tributary
to the main hospital; tributary as a farm, and supple-
mentary as a colony for certain classes of the chronic
insane. The recent cases, and those which are the most
troublesome, are to be kept at the old hospital which
provides in the most ample manner for three hundred
patients. The attractions of this hospital are many, both
within doors and without. Finer lawns and carpet gar-
dening I nowhere saw, and the enclosures for the use of
the more excited classes deserve to be called gardens,
rather than airing courts. Within are large and fine
public rooms, spacious suites of apartments, and, in fact,
every variety of elegant accommodation. This institution,
which is under the efficient management of Mr. Bayley,
with two medical assistants, appeared to me to occupy a
foremost rank among those I saw in England. In the
treatment of excited cases sedatives are used freely, and
sometimes narcotics, but no mechanical restraint unless
for surgical reasons. Seclusion and the padded room are
occasionally resorted to, but the chief dependence is upon
attendants. All indulgences consistent with prudence and
consonant with individual tastes are allowed, even to the
questionable one of smoking in the wards at will.
The Manchester Royal Lunatic Hospital, at Cheedle,
presented some new and interesting features both in plan
and management. There was here less of the aspect of
confinement than is usual about European asylums. It is
the only one I visited at which the avenue of approach
is not guarded by a gateway and a porter's lodge; and


Insanity in Great Britain, etc.
397
hedges instead of walls surround the grounds. The class
of patients here provided for is the same as that at St.
Andrew's—the private and paying; and the style of
accommodation is equal to, and partaking of, some of the
features of St. Andrew's, and of Dr. Wood's establish-
ment at Roehampton—the private parlors of patients
being on a floor below their sleeping rooms. Many were
made very pleasant by the bay windows formed by the
architectural projections of the building. Two hundred
patients are provided for, but of this number one-fourth
are in cottages belonging to the Asylum, or leased by it
for the purpose. These are of the chronic class. The
rates are practically the same as at St. Andrew's; from
one hundred to one thousand guineas per year.
Seclusion to padded or ceiled rooms is resorted to in
cases of acute or paroxysmal mania, the light being
excluded by means of close shutters. This is believed to
shorten essentially a violent paroxysm.
Mania, here as elsewhere, was spoken of as not per-
sistent in its nature, as a rule. In some very bad cases
mittens are used, but no other form of mechanical restraint.
Sedatives are freely employed, and freedom on parole
is a marked feature in the management of this hospital.
This, as was remarked by the assistant physician, who,
in the absence of the superintendent, acted as my cice-
rone, they believed to be more practicable than it would
be in a county asylum ; as the patients of the grade here
provided for are mostly persons accustomed to respect their
word, and pride themselves upon it when in health. It
would be difficult in my judgment to add anything to
either of the asylums last noticed, that would apparently
be material to the welfare of their inmates.
The only institution I saw in Ireland was the Rich-
mond County Lunatic Hospital at Dublin. This had
separate buildings for males and females, as at the Penn-
sylvania Hospital for the Insane in this country, a quarter
of a mile, more or less, apart. The buildings now occupied
by women were opened early in the present century, and


398
J. Draper.
resemble in style the older British and Continental insti-
tutions, while those for men are upon the modern linear
plan and more attractive exteriorly.
Five hundred men and six hundred women are here
cared for by Dr. Lalor, whose reputation is especially
connected with the system of instruction, which is the
marked feature of his management. In no other asylum
that I saw is there so small a proportion of single rooms,
or so little in the way of architectural restraint, but the
boundary wall around the ample premises, sets limits to
individual liberty.
Dr. Lalor believes that single rooms are unnecessary
for a larger proportion than one to twenty of the average
of patients. To such an extent has the associate system
been carried, that where single apartments have not been
thrown into dormitories, the doors in some sections have
have been removed; and in what was regarded as the
best division for females, red woolen curtains are substi-
tuted in their stead. In connection with the large dor-
mitories, there are one or two strong rooms for use in
case of sudden necessity at night. As a part of this
system of management, Dr. Lalor's instruction drill,
deserves to be called a success.
All are here moved in the gross, if not with the regu-
larity of trained soldiery, at least in platoons, for various
drill exercises, more or less automatic in character. A
large proportion, about eighty-seven per cent. of all the
inmates are reported as employed. I did not see those
out of doors at work, but a half-dozen were in the tailor's
shop, the like number, more or less, in the carpenter's
shop, and in the shoemaking department at least a dozen.
One of the last mentioned was pointed out to me as
being suicidal. He was at work upon a bench, with cut-
ting knives and sharp awls at hand, thus incurring a risk
which I regarded as wholly needless and as unwarranted,
as the quartering of the insane epileptic in the butcher's
shop at Gheel.
The service of food in this institution gives employment


Insanity in Great Britain, etc.
399
to many of the inmates, as it is all carried from the
kitchen of the old department to the dining rooms of both
buildings. Acute mania here, as in England, was spoken
of as usually transient. The suicidal class is large, and
these are all lodged in associated dormitories at night,
and watched over by special attendants. Both Protestant
and Catholic clergymen are here employed, and a Protes-
tant chapel and a Catholic church are situated between
the two departments. Dr. Lalor is ably supported by two
enthusiastic assistants, and the school faculty is repre-
sented by six official teachers and by thirteen assistants,
who, in addition to the ordinary duties of the attendants,
aid in carrying out the system of instruction.
The Royal Glasgow Asylum at Gartnavel, under the
charge of Dr. Yellowlees, embodies many excellencies.
Here, as at the Royal Edinburgh Asylum, both public and
private patients are received, but they are placed in separate
buildings. As at Morningside also, a few of the private
class are lodged in the buildings of the paupers, but they
have a separate and improved table. In the buildings of
the private class, the meals are taken in the wards, and
as a rule, in the corridors, at tables which are used for
other purposes between meals; in those of the pauper
class, in a large common dining hall. In the buildings of
the private patients are ward bath rooms; in those for
paupers, except in connection with the infirmary, the bathing
is in one common room. The furnishing of the rooms
and halls of the private class is substantial, even elegant,
but the average price paid is much less than at Cheedle,
or Northampton in England, the minimum at all of them
being a guinea and a-half or two guineas per week. The
parish rates are about twelve shillings weekly. It appeared
to me that both classes are exceedingly well cared for
here, in fact, nowhere better for the same rates. Non-
restraint here, as in England, is the rule. The mittens
are used, if anything. I saw one bad case of paroxysmal
mania, in an airing court, but in charge two attendants who
were actively employed in keeping her within the bounds


400
J. Draper.
of propriety. The general treatment here, as at Morning-
side, is by the open-air system, instead of seclusion. Dr.
Yellowlees uses sedatives in acute cases. His testimony
in respect to the duration of such cases coincided with
that universally given in Great Britain. Patients of chronic
destructive habits are interfered with as little as possible,
but they wear strong clothing secured by locked buttons
or buckles. Dr. Yellowlees believes that restraint in such
cases aggravates them. In typhomania he depends on
supporting and stimulating treatment, and thinks restraint
to the recumbent posture would not materially affect the
result. He uses the padded room and secures the clothing
upon the patient, and believes that cases of ordinary acute
mania might be much prolonged by restraining treatment.
Open fire-places impart a home-like air to the apartments,
and much pains is evidently taken for the amusement and
diversion of the inmates. Two medical assistants and one
attendant to every twelve patients of the pauper class,
(the proportion to private cases depending upon require-
ments) constitute the working force.
The Ayr District Asylum was incidentally visited,
though not upon my programme. This accommodates
about three hundred patients, and was built at a cost of
£30,000. It affords a good illustration of what may be
accomplished by economy in building, and low rates of
support. £25 per year is allowed for each patient, and
certainly they are comfortably provided and cared for.
At the time of my visit, the resident physician, Dr. C.
Holland Skae, was absent, but I was courteously shown
the establishment by the matron and the head male
attendant. No mechanical restraint was seen, but I was
told they sometimes use dresses with closed sleeves, and
padded rooms for destructive and furious cases.
The Barony Parochial Asylum, at Lenzie, near Glasgow,
was the last upon my route, and, in many respects, I
found its plan and its system of management unique and
instructive. This is the latest and most expensively built
of the Scottish asylums, having cost £150,000, or at the


Insanity in Great Britain, etc.
401
rate of £300 per bed, its capacity being for five hundred
patients. The site commands a wide stretch of country
on every side, and allows of almost indefinite ground
extension of the buildings. The plan of the buildings
embraces many excellent features. They are but two
stories in height with lofty ceilings. There is a common
dining hall for all the patients, and a common bath house
for each sex, exclusive of one for each infirmary. The
proportion of single rooms is so large that their use can
be granted as indulgences to many patients whose condi-
tion does not absolutely demand them. In event of
further extensions of capacity, the additions it is believed
might be largely, if not exclusively, of common dormitories.
Only patients supported at public expense are received.
The two notable features of this asylum are the
remarkable absence of provisions for restraint, and the
very large proportion of the inmates who are employed.
A medical superintendent and one medical assistant
constitute the resident staff, and the proportion of attend-
ants is as one to every twelve patients. The attendants,
as a rule, do not carry keys, and the doors, except to
their own apartments, are not locked. The doors between
halls and dormitories and those of ingress and egress,
open with ordinary latches from both sides; and the
assistant medical officer conducted me through the build-
ing without the use of keys. The doors of the rooms of
single patients open in the same way, by knobs outside,
but are to all intents and purposes locked to the occu-
pants when closed, there being no inside knobs or means
of opening them. The windows of these rooms are pro-
vided with shutters; elsewhere they are of stout wooden
sash, but have stops which prevent them from being
raised or dropped but a few inches. Open fire-places
with coal grates are the sole dependence for the heating
of halls, dormitories and single rooms, steam being used
only in the administrative and domestic departments.
There were few male patients in-doors at the time of my
visit, three out of every four attendants being out at work


402
J. Draper.
with their patients; the remaining fourth one being left in
to take care of those who were unable to work, and to
do the work of the ward, with the assistance of three
able-bodied patients who were detailed for that service.
The women are employed in sewing rooms, kitchen and
laundry, from which latter department all machinery had
been removed or left unused for the purpose of giving
manual labor to more of the patients; and the superin-
tendent told me that he contemplated making the laundry
a source of revenue by taking in work from the city.
There are workshops for tailoring, shoemaking, mattress-
making, plumbing, blacksmithing and carpentry, in all of
which I saw patients at work, though few in number. In
most of them, on the day of my visit, the persons usually
in charge were away on a holiday. Three or four
patients were working in the shoe shop, and as many
in the tailoring and mattress shops. Two or three were
in the carpenter's and blacksmith's shops, and one alone
in the plumber's shop-an epileptic whose mania was
suicidal, after every seizure having hallucinations of hear-
ing, in which voices from the other world called him to
come at once. This case, like those at Gheel and Dublin
before referred to, illustrated what seemed to me an
unwarrantable license, considering the risk so frequently
run; but the assistant physician said that premonitory
symptoms always preceded his attacks, which enabled
them to guard against any unpleasant occurrences.
The larger portion of the male patients work on the
farm, which contains about four hundred acres. I saw
groups of from ten to twenty working with attendants at
various employments, one party widening the banks of a
brook, another laying stone wall, another making mortar,
another hoeing in the field, another covering and trim-
ming a hay stack, and another grading. All who are
able physically, are required to go out with some of these
parties, and remain with them during working hours, even
if they do not work; except those detailed, as before
stated, to do housework with the indoor attendants.


Insanity in Great Britain, etc.
403
Escapes, I was told, average two and one-half per month.
There are no enclosed airing courts, and no high wall or
fence surrounds the grounds. In the matter of the most
thorough system of employment as a remedial and moral
treatment, Dr. Rutherford deserves to rank as the most
successful. The secret lies in the fact that he has only
to deal with the class always accustomed to labor, and
that he employs attendants to lead in the work, and to
labor with as well as for the inmates.
Within the year past a colonizing movement has been
begun at Lenzie, similar to that mentioned in connection
with St. Andrew's Hospital at Northampton. An estate
upon the outskirts of the Asylum property, having thereon
farm buildings, has been occupied and organized with
man and wife at the head, in charge of fourteen chronic
male patients of the laboring class, who are to raise
vegetables for the asylum, and take care of a flock of
sheep. It is contemplated still further to develop this
plan, and make it a permanent feature of the institution.
While this method of permanent provision as supple-
mentary to existing institutions may be practicable, and
to a certain extent advantageous, the so-called cottage
system, exclusively, does not apparently gain favor either
at home or abroad, and I nowhere in Scotland heard of
the adoption of the Gheel system of boarding out. In
England it was mentioned in connection with Cheedle ;
Mr. Mould's popularity, as a practitioner, having led to
his having many patients under his care, who board in
families in the neighborhood of the Asylum.
The hobby of unlocked doors has little to recommend
it, in my judgment, and is to a certain extent a fallacy.
In looking over the last report of Dr. Rutherford, I
noticed his reference to an unfortunate accident which
occurred soon after the opening of the Lenzie Asylum,
in consequence of the escape of a patient, and which led
to the removal of the inside knobs of the outer doors.
He states that during the past year the knobs had been
restored, so that there is now free ingress and egress. I


404
J. Draper.
am still, however, in doubt as to whether these doors are
locked or not in the night. It may be pertinently asked,
if there is no need of the restraint of locks, or treatment
by medicine (for medical treatment here, in cases of
mania, unattended by febrile disturbance, is ignored),
where is the need of institutions of this kind? As long
as custody, as well as care and treatment, is a factor in
the case, it seems to me but reasonable that the public,
at least, should be protected against possible nocturnal
visitations from the inmates, even if it has become accus-
tomed to two and one-half escapes per month, in spite of
the customary vigilance of those having them in charge.
The principle of treatment in maniacal cases, at Lenzie,
is essentially by the open air method, as at Gartnavel
and Morningside, and the transient duration of such cases
here, as elsewhere, was confirmed.
Out-door recreations in Great Britain, indeed in all
Europe, are enjoyed, as we must admit, to a much
greater extent than in America; but on the other hand
it is admitted there that we do more than they in the
way of in-door diversions and entertainments. It would
be absurd to claim that the policy of management in the
two countries is thus diverse, for we can all perceive that
the diversity of climate is largely the compelling cause of
the difference noted. I am, however, convinced that in
the treatment of maniacal cases, we might find it advan-
tageous to overcome, to some extent, this difference,
and endeavor to secure in the treatment of our cases
more out-door liberty and less seclusion. For eight
months of the year we would have little difficulty in
following the method of our British brethren, but for the
other four months the rigor of our New England winters,
and the snows, which often bury the ground to the depth
of from two to four feet, forbid such treatment, unless by
some special provision for a partial protection against the
inclemency of the season. In a few instances an approach
to this has been made by some of the institutions of our
country.


Insanity in Great Britain, etc.
405
The verandas of the old Worcester Hospital, to some
extent, meet this want, and it has been to me a matter
of marvel that this most useful architectural hint has not
been developed into a prominent feature in some of the
numerous establishments that have sprung into existence
during the half century since the foundation of that insti-
tution. Something like this, I am aware, does exist in
connection with a few of the later ones, but I believe the
value of it has been quite generally overlooked. In debating
how best to engraft some provision of this kind upon the
institution with which I am connected, the most practicable
method appears to be to surround with a broad veranda a
small airing court upon each side of the house, under which
a sheltered promenade may be secured for all seasons of
the year, and all kinds of weather; and if a really fine
thing could be afforded, the central area of the court
could be covered, like a conservatory, with a glazed roof,
and thus, perhaps, allow to a certain extent the presence
in winter of some of the attractions of the green-house.
This provision for the treatment of excited and irritable
cases, struck me as a feature that might profitably be
adopted here. A second, equally practicable, impressed
me as no less desirable, namely, an isolated house or
cottage, for a summer retreat, to which small parties of
the inmates might repair for a brief season, accompanied
by their attendants, and procure that change from the
fixed routine of asylum life, which all the world at present
recognizes as an essential to the preservation of mental
health. A house of this kind has been within the last
two years connected with the Edingburgh Asylum. It is
four or five miles from the Asylum, and is open only
during the summer months. It is not designed as a fixed
home for any, or even a summer home for a few of a
particular class, but a place of recreation, in turn, for all
who might be benefited by a temporary change. Some
stay a few days, or weeks, according to circumstances or
inclination; others go only for a day, an omnibus load of
them riding out in the forenoon, taking lunch and dinner


406
J. Draper.
there, and returning in the evening twilight. The cottage
has lodgings for twelve patients. While there they have
the entire liberty of the place, and they return refreshed
and satisfied for the time being. Those going out are
accompanied by their attendants.
A summer house, or convalescent establishment, has
for a still longer time been connected with the Bethlehem
Hospital. It is at Witley, in a rural neighborhood, thirty-
eight miles from London. It was built for the purpose,
and affords accommodation for thirty-five patients. These,
or a portion of them, are changed every fortnight, being
accompanied and cared for by their attendants, as at the
Morningside Asylum. Although the building was designed
especially for convalescents, other classes have been found
to be equally benefited by these temporary changes;
especially chronic cases in which the disease appears to
be stationary, while some intermittent cases, when appar-
ently on the verge of an aggravation of their malady,
have been thought to escape a relapse by such removal.
The Hospital at Cheedle has such a retreat in Wales,
and Mr. Mould, at the time of my visit, was there upon
a vacation with seven of his patients.
At Gartnavel no such house is owned, but each season,
for some years past, they have rented one either at the
sea-side or in the mountain region.
These two provisions for the enlargement of our exist-
ing facilities for the cure of the recent and the chronic
cases, which we have ever with us, so impressed themselves
upon my mind, as indispensible. desiderata to the pro-
gressive treatment of the insane, that I felt no hesitation
in presenting them to the consideration of the Trustees of
the Vermont Asylum. The members of the board equally
and unanimously favored these additional advantages, and
immediately negotiated for and purchased an estate
contiguous to the Asylum domain, having upon it buildings
suitable for the use proposed, and which, with some
minor alterations and renovations will be made available
for occupancy the coming season. Some additional


Insanity in Great Britain, etc.
407
facilities for the exercise of excited patients during the
inclement season, are also under consideration, and before
another winter will probably be provided.
In respect to the management of chronic cases of
destructive habits, I think we may also learn something
from Great Britain. It appeared to me that greater pains
are taken there to provide strong and indestructible clothing
for such patients, and to secure it upon them, than with
us. While we restrain the use of the hands, or, more
properly, the abuse of them, they render destructive efforts
futile by the use of more resisting materials for wear.
The best material I anywhere saw for the purpose, was
being made up in the tailor's shop at Lenzie. It is of
much finer and softer texture than canvas or duck, very
durable, and called moleskin. I was informed it is used
as the common clothing of the working people of Scotland.
With all the good things observed, there were others
connected with the management of the British Asylums
that did not commend themselves to my view. One is
the practice, particularly about London, of uniforming the
attendants. It unpleasantly suggested the presence of a
police officer in every little group or gathering of patients,
as if among a party of rioters to preserve order, or to
arrest the conspicuous offender, and the black dress and
white cap of the female attendants was unpleasantly sug-
gestive of the garb of a nun, and of a religious preparation
for the other world, rather than a restoration to this.
Another practice, already referred to, which did not
commend itself to me for adoption, is the indiscriminate
indulgence of smoking in the wards, especially in asylums
for the paying classes. Smoking I do not regard as a
habit so universal as to be equally agreeable to everybody,
and to those who do not enjoy it, it is a discomfort and
annoyance; hence I conceive it incumbent as well to
protect the one class as to indulge the other. And for
everything there is a proper time and place.
The recognition of the varying requirements of differ-
ent social grades, as seen in English or Scottish provision,


408
J. Draper.
commends itself to one's inherent sense of justice, and the
eternal fitness of things, although in opposition to the
democratic ideas of our own country. Upon this point
Dr. Nairne, of the English Board of Lunacy Commission-
ers, expressed his dissent from the general policy of the
State institutions of this country, which provides for all
classes together, and without distinction.
After visiting the London Hospitals I was governed, in
respect to those I subsequently saw in England, by the
suggestions of Dr. D. Hack Tuke, who, with reference to
my proposed route from London, named the private asylum
of Dr. Wood, at Roehampton; the Banstead Asylum for
Incurables ; St. Andrew's Hospital, at Northampton, for the
middle classes; the new County Asylum at Berry Wood,
and the Hospital at Cheedle, which he assured me afforded
as good examples of provision for all the different classes,
as any I could select, and if I saw these I should not
return to America ignorant of the English ideas of the
present time in respect to such provision. I followed his
advice to the letter, and if more time had been at my
disposal, would have added Hayward's Heath, Wakefield,
or Prestwich to the list. Dr. Tuke expressed a lively
interest in the American institutions, and but for the
crossing of the Atlantic, would gladly pay a visit to the
United States.
The April number of the Journal of Mental Science, of
1881, contains some comments upon the management of
American Asylums, which may be briefly noticed. These
do not seem to be made in an unfriendly spirit, and the
writer's disapproval of our greater uniformity of plan in
architecture, and our preference for single rooms over
dormitories, and for ward dining rooms to great refectories,
is but the expression of a personal preference in this
respect, rather than complaint of the faulty character of
these arrangements. In the somewhat caustic review of
Dr. Kirkbride's book in the same journal, this remark is
made by the critic: “We do not believe that the type
of mental disease differs essentially in the two countries,”


Insanity in Great Britain, etc.
409
hence “a good hospital for the insane in the Northern or
Middle States, would be a good one in Great Britain.”
In respect to the prevailing type of mental disease in the
two countries, I should most decidedly take issue with
him. My observations impressed me with a difference,
and inquiries only confirmed them. In the same number
of the English journal, already quoted, is an article on
“The Influence of Democratic Feeling in America on the
Management of Public Institutions,” in which intense
individualism is dwelt upon as a marked American feature.
This same individualism runs through the inmates of the
Asylums, as through the sane population, and it is this in
reality that determines our use of single rooms instead of
the congregate day rooms and dormitories. Necessity is
the governing law everywhere, and if individual provision
were not found absolutely needful, it would not be chosen.
In a recent article from the pen of that indefatigable
champion of British Policy, Dr. Wilbur, the author labors
to show that “Chemical Restraint,” so called, is not
resorted to in the British Asylums for the purpose of
obviating the use of mechanical restraint.
To me this is a labor lost, or rather a needless effort.
I am satisfied, abundantly, that neither drugs nor mechan-
ical restraint, nor seclusion in lieu of either, is resorted
to, or needed as it is here; that the disease there being
of a milder type, calls for neither; and that with the same
phases of insanity we need neither. It is but a com-
paratively small percentage of the whole number treated,
in this country, that are subjected to such restraints, and
these are restrained chiefly by reason of the more persistent
type of maniacal disease, which, instead of subsiding in
a few days, as universal testimony, which I have quoted
in detail, convinced me it does there, continues through
weeks, months, and even years, until dependence upon
the constant watching of attendants must in some measure
be relieved by a resort to other aids; and if the record
of the aggregate of restraint in the hospitals of this
country be carefully analyzed, I venture the opinion that


410
J. Draper.
the amount of it will be found to depend more upon
the continuance of a few cases constantly requiring it,
than upon many temporarily subjected to its use.
I unhesitatingly express my belief in the curative
agency of restraining means in typhomania, and in acute
mania of the exhaustive type, and believe I every year
see recoveries instead of deaths from their use. I recog-
nize them also as preferable to manual restraint in very
irritable patients, and in those laboring under homicidal
and suicidal impulses who are morbidly intolerant of
personal authority; and finally, I regard them as a necessity
in chronic cases of destructive propensities, in which the
special oversight otherwise necessary, cannot be com-
manded; although, as has been already intimated, such
cases ought to be largely saved from restraint by the use
of less destructible clothing. When the alternative is
restraint or seclusion, the former would have my pre-
ference.
While I quite agree with Mr. Dorman B. Eaton when
he says that “the hospital which succeeds in reducing
restraining means to the lowest minimum, other things
being equal, is the best,” I am free to say that the
presence of restraint in the different classes enumerated,
and for the reasons given, does not, in my mind, detract
from the merit of an otherwise well ordered hospital, if
its use is manifestly warranted by the condition of the
cases subjected to it. It is absurd to suppose that its use
in this country would be continued if it were practicable
to abandon it; and having in my mind cases, not a few
in which I believe I have seen the question of life or
death turned in the balance in favor of the former, by
the timely use of restraint, I can no more bring my mind
to its unqualified relinquishment, than could the consci-
entious surgeon, who sees the satisfactory recovery of his
patients from bodily injuries, under the judicious use of
mechanical appliances, be persuaded to abandon the use
of splints in fractures, or to trust to the hands of attendants
in lieu of them.


Insanity in Great Britain, etc.
411
I question, from what I have observed, if our practice
in respect to restraint radically differs from the
English; whether the class of cases to which its use is
mainly confined here, is not there unknown; but be
that as it may, I place on record, in concluding, my
conviction that the insanity of Great Britain, in its pre-
vailing type, differs from that of either continent; and that
the modification of its features is primarily due to climatic
conditions, which in the process of time have modified
the constitutions of the people, and consequently qualified
their manifestations of disease.
Art. 7.-Note on the Essential Psychic
Signs of General Functional Neura-
trophia or Neurasthenia.*
By C. H. Hughes, M. D., St. Louis.
06 THE subject of latent and unrecognized morbid
1 mind,” said Forbes Winslow in his classical and
unequaled treatise on Obscure Diseases of the Brain
and Mind, “is yet in its infancy.”
Much that was unknown to the profession before this
great observer penetrated the then unexplored wilderness
of obscure cerebro-mental pathology, and led others to the
later discovery of new truth, still remained undiscovered
up to the time of his death. Much has since become
familiar ground, but more yet remains to be brought to
light, both within and external to the brain, in connec-
tion with the nervous system and related mind.
Among the subjects of which we have of late years
learned much, and of which we are destined to yet learn
• Read before the Missouri State Medical Association, at Hannibal, Mo., May 18,
1882.


412
C. H. Hughes.
more, is that of general functional neurathrophia or neu-
rasthenia, for which we are so much indebted to Van
Deusen, a Michigan insane asylum superintendent, who,
in 1867, first emphatically differentiated it in this country
as a distinct form of disease.
The Kalamazoo Hospital superintendent had, up to
that time studied and described it as “a form of nervous
exhaustion culminating in insanity,” its usual ending when
not arrested in its course by fortuitous circumstances in the
life and surroundings of the patient, or successful treatment.
Since Van Deusen's concise pioneer description, the
contributions of Beard, Ball and Benedikt, Cordes, Erb,
Gowers, Jewell and the present writer have appeared,
until the few sentences of the past having been extended
to pages and pages have been enlarged to volumes.
But it is still possible to more briefly describe its
distinguishing features than has yet been done, so that
it may be even more generally recognized. This brief
description is possible through its characteristic psychic
symptoms, some of which are never absent when the
disease is present. We draw the picture solely from our
personal observation of the disorder. .
Neurasthenia, differentiated from its complications,
antecedents and gravest sequences, is a more or less
general failure of the normal nutrition appropriating
power in the higher nerve centers, especially the psychical,
leading to consequences short of appreciable structural
change-a pure neuratrophia which is only functional in
its effects and confined, in expression, to an altered and
lowered functionation in the nervous system itself. The
neuratrophia here is solely functional, not at all structural,
so far as can be sensibly appreciated, whatever struc-
tural change may be conceded in neurasthenia being
merely conjectural and undemonstrable, except through
theoretical deduction. Thus we should restrict and
circumscribe the term neurasthenia, were we to use the
term at all, but we prefer in its stead the more definite
term, functional neuratrophia.


Psychic Signs of Neuratrophia.
413
General functional neuratrophia (if you do not cavil at
the term we offer,) is a state of nerve starvation due to
causes inherent in the nervous system itself, having its
appropriate symptomatic expression in nervous exhaustion
and its immediate sequences, the chief and most signifi-
cant of which are psychical. The physical symptoms, how-
ever, are not to be ignored, though we do not intend to
here discuss them. The general tired feeling and sensa-
sation of inadequacy to the demands of duty in the
presence of some accustomed and easily performed
mental work, and the quick break-down which follows
the attempt, even though not forewarned by a sense of
insufficiency and weariness, are significant.
The transitory localizations of symptoms which appear
in the progress of general neurasthenia have led to such
distinctive differentiations as cerebrasthenia and myalas-
thenia, according as the symptoms appear most promi-
inently in the head or spine, and the term gangliasthenia
has been proposed for ganglionic neuratrophia and, con-
sequently, debility; but whether the heart, or the cord,
or the brain functionate abnormally at different times, the
brain always displays, early in the progress of this disease,
evidence of the defective nutrition, and the failure is marked-
ly in the vaso-motor centers, which, being inadequately
nourished permit of secondary morbid vascular states,
which are often mistaken for the primary disease.
Neuratrophia is primary when a precedent anæmia is
not the cause; secondary and symptomatic itself, where
blood defects induce it, but then not strictly entitled to
be called neuratrophia.
General functional neuratrophia being, as we have
said, so seldom entirely dissevered from cerebral debility
from atrophic causes that the psychic symptoms con-
tribute the most important, as they make the distin-
guishing feature, in its symptomatology, the latter are the
special evidences by which we may often differentiate
from graver cerebro-spinal and sympathetic system disor-
ders, and need only now claim our attention.


414
C. H. Hughes.
The panophobia, of Esquirol; the pathophobia or
hypochondriasis, of the old writers; the toxiphobia, of old
alienists; and Hammond's synonym mysophobia (the gravest
of neurasthenic psychic symptoms, by the way); the claustra-
phobia, of Ball; and its antipodal agoraphobia, of Maschede ;
the monophobia, panophobia, phobophobia, astraphobia,
anthropophobia, and topophobia of Beard; the gynephobia,
of Spitzka ; the sideromophobia, of Rigler; the agoraphobia,
of Westphal, with Rosenthal's synonym of platzangst, and
Benedikt's similar platzschwindel; the syphilophobia ;
hydrophobia (dread of large bodies of water, a natual dread
in horses); thanatophobia or necrophobia and necropalo-
phobia (fear of death and grave yards); and the numberless
other fears, needless here to name, not natural to certain
persons, but which come upon them when neuratrophic
ill-health overtakes them, are expressions of a certain
psychical change, not at all limited by the special terms
thus far coined to express them—not to be limited either by
the many words likely to be constructed from Greek, Latin
or Saxon languages by expert philologists amongst us.
It would be an almost endless task to enumerate the
many morbid fears of the neuratrophic. Their name
is legion to a mind fertile in verbal coinage, and
some are even unnameable. For example, such singu-
lar morbid fear as that which takes possession of a
naturally fearless man at the approach of a familiar
face, and causes him to go away and hide himself, as
happened lately with one of my patients; such unfamiliar
fear to a naturally brave men, of taking once delightful
journeys, without rational cause for the newly awakened
fear, save only in the state of the nervous system. The
unusual fear and indecision which sometimes seizes once
bold men without cause external to themselves, and partly
paralyzes their psychic centers in the midst of " enterprises
of great pith and moment,” which, in their best estate
they would, without hesitancy, have carried to successful
issue, delighting in encountering and overcoming the real
obstacles which their present feeble brains build in fancy


Psychic Signs of Neuratrophia.
415
too high to overcome. This is debility of brain, and the
fears, forebodings of evil and morbid unnatural dreads of
adverse consequences of ordinary mental movements are
its characteristics, and associated with these are the
timidity and irresolution or transitory, fleeting, or spas-
modic decision supplementing the former natural firmness
of mind, apparent when the brain was strong.
The mental substratum underlying these unaccustomed
morbid fears and dreads, and morbidly colored percep-
tions, conceptions and misconceptions, is timidity or
irresolution and irritability of manner and speech not
natural to the person, and this state of morbid feeling has
not been reasonably acquired by any rational experience in
the history of the person.* A change less marked, but
none the less real than that which takes place in insanity,
has come over the natural mental character of the
victim of general functional neuratrophia. This character-
istic change in his manner of thought, feeling or move-
ment is noted by his friends, in marked cases, as well by
his physician. A degree of mental and nervous instability
and irritability accompanies this timidity, and is the
essential basis of the morbid fears the victin of functional
neuratrophia feels. He weeps more easily and sleeps more
difficultly than he used to. Nerve instability, mental
timidity, dread and fear and easily hurt feelings, and
later on, illusion and hallucination. Later still, delusions
obtrude, when insanity confronts us, of which general
functional neuratrophia, with special cerebrasthenic expres-
sion, is a most frequent precursor in many organisms.
But timidity underlies the morbid fears, as, later on, the
hallucinations underlie the culminating delusions.
This fact has not been noted by others, and it is the
most important fact to the general practitioner, for the
initial stage of unnatural timidy and irresolution, which
the family physician may discover if he looks for it,
•Some men are naturally superstitious and fearful of evil happenings Some
fear to travel on steamboats, some on cars or to ascend heights, and some by reason
of past experiences have special canse for certain fears. But the fear of the neura-
trophic is causeless and unnatural to him and preceded by an unaccustomed
Irresolution and timidity.


416
C. H. Hughes.
is the time when the impending calamity may be
averted, by counselling the patient to promptly suspend
business, and seek relief and recuperation in restorative
medicine, and rest from mental strain through temporary
change and recreation.
Insanity is closely allied to neuratrophia, and is its
frequent sequence as Van Deusen wrote. The morbid fears
of the neurasthenic are but the shadows of graver coming
mental events cast before. Often the advanced lunatic has
no more of delusion than the trepidation and fear in their
various forms, somewhat aggravated, of the neurasthenic.
As neurasthenia frequently advances to insanity, so positive
and well defined insanity sometimes recedes to simple neu-
rasthenia.
Esquirol has thus painted some of the advanced neuras-
thenic denizens of Salpêtrière and Charenton—"Certain
persons who suffer from panophobia are afraid at the approach
of night and darkness” (Mal, Ment. p. 216). “Lypema-
niacs dread obscurity, solitude, insomnia, the terrors of
sleep; fear, terror, jealousy and hallucinations keep them
awake.” “I once had in charge,” said he, "a lady whom
the slightest noise filled with terror, especially during the
obscurity of the night. The steps of a person walking
lightly caused her to shudder, and the wind caused her
to tremble. The noise which she herself made while in
bed frightened her and obliged her to utter cries of
terror. I enabled this panophobist to sleep at night by
keeping a light in her chamber, and placing a woman
with her who watched during the whole night” (Ib. p.
116).
How like a phase of neurasthenia is this, and what is
mania, often, but intensified, aggravated, cerebral neuras-
thenia-exhaustion of the brain either from sanguineous
impoverishment or blood pressure ? True neurasthenia is
neurotrophasthenia, from failure, from whatever cause on the
part of the involved nerve centers to appropriate the requisite
nutrition for that normal repair of tissue which is essen-
tial to the maintenance of healthy tone and function, and


Psychic Signs of Neuratrophia.
417
like the unstrung lyre, responding “out of tune and
harsh ” to the player.
If our experience did not give us many illustrations
we could readily conjecture what might be its psychic
symptoms. They are the symptoms of inadequate nerve
nutrition, and in the higher centers of the cerebrum there
are instability, irresolution, timidity, dread and fear, morbid
and groundless suspicions, hallucination and delusion,
not natural to the individual in his best estate, positive
hallucinations and delusions, appearing generally when
greater than mere neuratrophic changes are affected in
the cerebrum, and the debility has passed into insanity
and more or less organic change.
This note would be anything but brief were we to
attempt to name all the psychic signs of general functional
neuratrophia. We have not even mentioned all of the
morbid fears of the neurasthenic. No terms have yet
been given to that inexplicable fear of one's own voice
and other familiar sounds once heard with pleasure by
these nerve-weakened miserables, nor for the dread of
certain dreams, of receiving once welcome visits from
friends who have never, offended, nor for the fear of
riding in certain vehicles when no previous experience
foundates the fear, and the numberless other nameless
fears which unnaturally oppress these patients.
The feature of functional neuratrophia to be italicized is
the timidity not natural to the person out of which these
fears grow, and give to the mental character that notable
change in which irresolution replaces former decision of
character, and supplements even natural fearlessness with
fearfulness and dreads innumerable.
Beard's view, that the characteristic of neurasthenic
fear is in the degree rather than in the kind, is only
partly true. Their fears may be common to others, not
neurasthenic, but they are not usual with the person
afflicted with neuratrophia in his healthiest nerve condi-
tion. The mental change of character in general func-
tional neuratrophia is none the less real though far less


418
C. H. Hughes.
in degree than that which attends upon insanity. It is
seen in the mental movements as it is shown in the voice
and walk and in functional nerve irritability and inertia.
This change is a psychical timidity and indecision of mind
and manner, whether it displays itself in monophobia,
deutophobia, tritophobia, panophobia, or whether it has
not taken shape in a single definite fear, or in multiple
fears defined.
The aim of this note is to be practical rather than
learned, and it is hoped that it may be received in the
spirit in which it is prepared. We think too much has been
made of the subject by some writers. Perhaps you may
conclude that we have made too little of it.


Art. VI.-Some Medico-Legal Aspects of
Morphia-Taking.
WITH SPECIAL REFERENCE TO “ THE LAMSON CASE."
By H. H. KANE, M. D.,
SUPERINTENDENT DE QUINCY HOME, FORT WASHINGTON, NEW YORK CITY."
W HILE interested in the case of Dr. Geo. H.
V Lamson, as reports of his arrest, trial, conviction,
reprieves and, finally, execution appeared from time to
time in the papers and journals, the fact of the receipt
of a cablegram from Lamson's counsel, calling upon me
for an opinion as to the part which the habitual use of
morphia hypodermically might have played in the produc-
tion of that form of insanity under which he was said to
have been laboring, before and at the time of the
supposed murder, made it doubly interesting and important
to me. The necessity for supplementing the experience
I had already obtained from treating and seeing in con-
sultation an exceptionally large number of cases of the
opium habit, by that to be found in the medical journals
in works on insanity and those devoted to a study of the
various habits, soon made it evident that upon no subject
equally as important as this, both in its medical and medico-
legal aspects, was there such a poverty of recorded facts.
Indeed, beyond the testimony of Dr. C. H. Hughes
in the “Cowgill Will Case" some years ago in Missouri,*
a few general statements by others and the compara-
tively valueless statistics of Calkins,t there was
really nothing touching upon the conditions of the
mind and morals that results from or occurs in the
course of the long-continued use of narcotics—more
especially opium and chloral. This is the more surprising,
•The question at issue being undue influence of a nurse over and aged opium
Opium and the Opium Appetite, Alonzo Calkins, Philadelphia, 1871.
habituate


420
H. H. Kane.
so far, at least, as our own literature is concerned, when
we considered the fact that no country in the world (save
China, where opium is smoked and the habit is light)
can boast so many habitual users of narcotic agents as
the United States.
This very dearth of facts on so important a subject,
is sufficient to show the necessity for a thorough study
of the matter in all its bearings. Then, too, the plea of
insanity from morphia abuse having been once urged,
will certainly be offered again. Thus far there have been
but few instances where the habitual use of narcotics has
been plead in extenuation of crimes committed or as in
any way affecting ordinary legal proceedings. This seems
strange when we consider the following facts:
(a.) Opium or Morphia-takers are usually of the better
classes, and as a rule have some wealth which must be
managed during life and which will revert, after their
death, to some person, persons, institution, society or
body named in an instrument known as a will.
(6.) In many cases as men having wealth grow old, their
relatives seek to take the management of their property
from them on the ground that they are incapable of
managing it.
(c.) Of late years any eccentricity of character, natural
or acquired, any act in fact that in the slightest degree
points to impairment of the robust mental health seems
to constitute, in the minds of interested relatives, suffi-
cient grounds for seeking by process of law to deprive
the person thus affected of the control of his or her
property, and the same deviations from the normal, much
exaggerated, are often urged after death as evidence that
the testator's mind was not in a fit condition to make a
will. If persons are constantly on the watch for such
trivial actions as are sometimes urged in court as indica-
ting mental aberration, or mental impairment and inca-
pacity, it seems truly surprising that the mental and
moral change resulting from the habitual use of narcotics,
more especially opium and chloral, has not been studied


Morphia-Taking.
421
and the peculiarities of action resulting, been offered to
judge and jury, with a view of gaining the same end. It
is not because all opium takers squander their fortunes
or lose them in reckless speculation and thus leave
nothing to invite the cupidity of others, nor is it because
there are so few devotees to these drugs. While financial
recklessness and spendthrift habits may result from the
habitual use of narcotics in a sufficient number of cases
to prove the connection between the two, they do not
occur in the majority of cases, or, if present, not in a
degree to jeopardize everything. The same may be said
as to the connection between the opium habit and the
proneness to gross and uncalled for untruthfulness.
The recognition of the fact, that the individual using
narcotics may thereby be incapacited from caring for
himself or administering his estate to advantage, was
recognized by the members of the Kentucky Legislature
as early as 18—, and found expression in the passage of
a law taking the control of his property from the hands
of such an individual and committing him to an asylum
until such power was regained. This, too, not upon the
certificates of two physicians, as is customary in cases of
insanity, but simply on the sworn statement of two
citizens. While a step in the right direction, this law
opened up the way to much roguery, if certain persons
wished to injure or control the property of another.
A somewhat similar law was passed in Connecticut
and in New York some years later, but in the case of
the latter State was, I believe, repealed after the
disgraceful failure of the Binghampton Inebriate Asylum.
In these States, however, physicians' certificates were
necessary.
The cases where mental aberration from opium habit-
uation has been urged as a plea for irresponsibility, in the
commission of a crime and in extenuation of incapacity
for performing the ordinary duties of life, that have thus
far come into court are few in number and as follows:
1. The Earl of Mars having had his life insured for


422
H. H. Kane.
a considerable sum of money, died a short time after,
and the Insurance Company finding that he was an
opium habituè, obtained indubitable proofs to that effect,
refused to pay the money to his family and defended
their course when sued by urging that his addiction to
the drug had shortened the natural period of his life, and
advanced considerable proof as to the evil effects of the
practice. They lost the suit and were obliged to pay the
money. The principal testimony against them was that
of Sir Robert Christison, who gave it as his opinion that,
in the majority of instances, life was not shortened by
the use of the drug.
2. In Baltimore, in 1877, one C- , a letter carrier
who had long and faithfully served the Government in
this capacity, who was consequently implicitly trusted,
an ex-soldier, a man of family and member of the
church, was found to have been robbing the mails system-
atically for some time. He was arrested, and in court it
was urged in his behalf that he was a morphia-taker and
that to the effects of the drug upon his mind and morals
was his fall to be ascribed; the exciting cause being
want of money with which to support his family and
obtain the ever increasing quantity of the drug necessary
to satisfy his craving. He was convicted, sentenced and
imprisoned; but owing to his good record in the past, his
conduct during the war, his exemplary behavior while in
prison and the fact that while there he was broken of
the habit by the physician of the jail, he was pardoned
by the President some little time before the term of his
imprisonment expired.
3. Another case, similar in every respect-age, occu-
pation, past record, crime, etc., etc.— occurred in Chicago
a few months ago. He, too, was broken of the habit and
was pardoned by the President.
4. Not long since two professional thieves stole two
valuable opium pipes from a "joint” in Mott Street, New
York, and sold them to the keepers of a rival “joint"
(white men) in 32nd and in Crosby Streets. On being


Morphia-Taking.
423
arrested and brought into court they stated that they
entered the first-named place at the solicitation of a
stranger and smoked considerable opium. As they had
never indulged before they became sick and dazed, and
wanting fresh air, walked out of the place with the pipes
in their hands. On recovering full consciousness they said
that they could not remember where they had got the
pipes and finally, being short of money, parted with them
to the parties mentioned for a small sum. The plea was
a poor one, and both would have been convicted had
not their friends so intimidated the chinaman that he
dared not appear against them. The truth in the matter
was that they had both been hard smokers for over four
years and were not strangers in the city ; nor had they
gone to Mott Street at the solicitation of a stranger, it
being their practice to smoke in this very place several
hours each day.
5. The case of George Henry Lamson, who was
accused of poisoning his cousin, Percy John, a cripple, on
the 3d day of December, 1881, with aconitia. Percy
John had been under Dr. Lamson's treatment, and Lamson,
being, as was afterwards well proven, an enthusiast upon
the subject of the great therapeutic value of aconitia in
neuralgia, had used it freely in his cousin's case. The
motive of the crime was said to have been the fact
that certain monies, otherwise unobtainable, would revert
to Lamson in the event of Percy John's death, and it
was proven that Lamson's affairs were decidedly involved
he being pushed on every side. An analysis of portions
of the body after death revealed the fact that aconitia
was present in abundance enough to prove conclusively
that a fatal dose had been taken.
Dr. Lamson's solicitors, at the trial, seem to have
rested the safety of their client on the weakness of the
evidence obtainable by the prosecution. The plea of
morphia insanity was not urged until after the jury, much
to the astonishment of the defense, had returned a
verdict of “guilty," and the accused had been sentenced


424
H. H. Kane.
to death. The day for execution was twice postponed,
a reprieve being granted to admit of the obtaining and
sending of affidavits from this country to England. The
following summary of affidavits was sent me by J. W.
Barrow, Esq., who worked so continuously and earnestly
in securing evidence in Lamson's favor.
An examination of a small part of the American and
English affidavits in the Lamson case shows that it was
proved :
1. By Dr. Nichols, that there was insanity in two generations imme-
diately preceding, and consequently a presumption of a tendency to
insanity in George Henry Lamson.
2. By Dr. Swinburne, that there were indications of insanity in 1870
and 1871.
3. By Mr. McElroy, that morphia was used by him in 1877.
4. By Dr. Von Klein, that there was unsoundness of mind in 1877 and
1878.
5. By Dr. Caseq, that he had a severe illness at Bucharest in 1878,
arising from exposure in dreadful weather, during a journey through
Bulgaria; that he did not recover his health while in Bucharest, and that
there were many indications of weakness of mind.
6. By Dr. Von Klein, that he used morphia in dangerous excess
during this illness.
7. By Dr. Kane, that morphia has a more than ordinary effect upon
those who have an hereditary tendency to insanity, or whose minds have
been weakened by bodily disease.
8. By many English witnesses, that he was insane during his resi-
dence at Bournemouth, from 1879 to the spring of 1881, and that he was in
the habit of taking morphia during that period.
9. By Mr. McElroy and others, that he used to take morphia in large
quantities in April, May and June, 1881, and that he was then considered
of unsound mind.
10. By his father's letter, dated 14th of July, 1881, attached to Mr.
McElroy's affidavit, that his father considered him of unsound mind at the
time.
11. By Dr. Winston, that he was a victim of the morphia habit, and of
unsound mind in September and October, 1881.
12. By several English witnesses, that he was of unsound mind in
November, 1881.
13. By G. H. Tullock, that his conduct on the 30th of November, and
1st and 2d of December, was that of an inBanc man.
17. By J. L. Tullock, that on the 1st, 2d and 3d of December (the 3d
being the day of the alleged murder), he appeared to be of unsound mind
and irresponsible for his actions.


Morphia-Taking.
425
The following affidavits are so important that I give
them at the risk of monopolizing more than my share of
space :
“INSANE AND IN NO WISE RESPONSIBLE.”
The City of Cincinnati, County of Hamilton, State of Ohio, and United States
of America, 38.:
Charles H. Von Klein, physician and surgeon, resident in the City of
Haruilton, County of Butler, in the State and United States aforesaid, aged
thirty-eight (38) years, being by me first duly admonished, cautioned and
solemnly affirmed to testify to the truth, the whole truth, and nothing but
the truth, concerning all matters known to him relating to or of one George
H. Lamson, lately tried, convicted and sentenced to death for the murder
of his brother-in-law, Percy John, in the City of London, England, Great
Britain, says: That he is an American citizen; that in 1877 and 1878 he
was a surgeon in the Russian army, and for a period of about six (6)
months he was in the line of his duty as such surgeon in Bucharest, in
Roumania, in a hospital which was under the direction and control of said
George H. Lamson, under the auspices of the Red Cross Association of the
City of London; that during said mentioned period he became and was
well acquainted with the said George H. Lamson,who was also a physician
and surgeon, having control of the hospital aforesaid; that by reason of
their connection, as such physicians and surgeons of said hospital, affiant's
knowledge of and concerning the said George H. Lamson W:s most com-
plete. During said period he met and conversed witb said George H.
Lamson almost every day, and frequ'ntly many times during the same
day. During all said time and in almost every cise, and without regard to
the character of the disease or injury of the patient, and in all cases where
there was an increase of the temperature or pulse of the patient, and espe-
cially when the pulse was abnormal, did the said George H. Lamson seem
possessed of a mania for the adm nistration to the sufferer of aconitine.
That the action and conduct of said Lamson, in the administration of said
poisonous drug, was unwarranted and reckless. Affint frequently called
his attention to the great danger to which he subjected patients, and said
Lamson's manner on such occasions was vague, incoherent, and that he
laughed and ridiculed the fears of affiant. Affiant further states that while
he was at said hospital he was and became afflicted with neuralgia, and
called upon said Lamson to treat him in a professional capacity. That he
administered such quantities of aconitine that affi int became alarmed and
spoke to said Lamson about it, who in turn only laughed at him; and upon
affiant's repeating his fears to said Lamson concerning his treatment that
their friendly relations were for a time disturbed. Affiant also states that
said Lamson made habitual and frightful use in his practice of the poison-
ous drug aforesaid. To such an extent did this proceed that it not only
became the hobby of said Lamson's mind, but he used it both in season
and out of season. It seemed to be his favorite and only remedy for all
diseases and injuries, and so continued to be until his recall to England.
Affiant says that he has not met said Lamson since that time, nor did he
know of his whereabouts until a few days ago, when, through the agency


426
H. H. Kane.
of the press of this country, he learned of his conviction and sentence to
death. Affiant says from his knowledge of Lamson, so as aforesaid
acquired, he has ever been apprehensive that some dreadful calamity would
happen in the practice of his profession, like unto that with wbich he now
stands convicted. Affiant says that at the time of and during his acquain-
tance with him, he unhesitatingly concluded that said Lamson was of
unsound mind and wholly irresponsible for his conduct. He further states
that now, when his recollection is refreshed and his attention directed to
his action and conduct during the time he associated with him as aforesaid,
and associating that with the history of the alleged homicide, he entertains
no doubt but what the said Lamson at the time of the commission of said
alleged homicide was insane and in no wise legally responsible for his acts.
CAARLES H. Von KLEIN, M. D.
Signed in my presence by the said Charles H. Von Klein, and affirmed
to before me by him this 27th day of March, A. D. 1882.
H. HOWARD MERRIAM,
Notary Public, Hamilton County, 0.
[Legality of notarial seal attested to by Samuel W. Ramp, Clerk H. C.
C. P., O., and Robert McKnight, British Vice-Consul.]
“A PERSON OF UNSOUND MIND.”
United States of America, State of New York, Saratoga County, 88.:
Florence M. Schuyler, of Saratoga Springs, in said county and State,
being duly sworn, deposes and says: I reside with my father, Oliver M.
Barbour, and am upwards of forty years of age. George H. Lamson, now
under conviction of murder in London, visited my father's house the 22d
of June last. I have known him since his childhood, and seen him at fre-
quent intervals.
While he was here he told me he suffered constant pain in his head from
wounds and in his lungs, and told me he constantly used morphine as the
only relief he could find for this pain. I saw bim almost hourly while he
was here, and bad many long conversations with him, both in the presence
of other members of the family and while we were driving together. At
times bis conversation was perfectly clear and lucid, and then he would
suddenly, in the midst of a rational conversation, start off on an entirely
different topic, mingling truth and romance in a manner which led me to
consider him unsettled in his mind. At times he acted so strangely that I
felt obliged to apologize to friends of the family who met him here. He
told me many things concerning his mother's family which I knew were
untrue, and built upon such statements stories of fiction and fancy. He
told me that his mother's mother was a foreign princess, and expressed
surpise that I did not know it, and appeared from his manner and actions
to believe that his statement was true. During all bis conversations with
me he betrayed that same restless wandering from one topic to another,
dwelling principally upon marvellous exploits and impossible adventures
of his own. At one time, in the midst of a rational conversation concern-
ing his brother Robert, making statements about him which I knew to be
correct, he suddenly broke off, at the mention of Robert's gun, into telling
me the most impossible stories of his own hunting adventures, relating


Morphia-Taking.
427
incidents which I knew to have been impossible from my knowledge of his
former life, after which he suddenly quieted down and became rational
again, recognizing scenes and localities with which he had been familiar in
his childhood. This occurred during a drive. From my general observa-
tion of him, his physical appearance, and from his conversation while he
was here, as above stated, I then considered him to be a person of unsound
mind, and so stated to members of my family.
The said George H. Lamson was my husband's nephew. I have
always considered him affectionate, gentle and warm-hearted, and a high-
toned Christian gentleman, and entirely incapable of committing any such
act as murder when he was himself.
FLORENCE M. SCHUYLER.
Subscribed and sworn to before me this 29th day of March, 1882.
EDMOND STILES, Notary Public.
[Legality of notarial seal attested to by James W. Horton, Clerk of the
County and County Court of Saratoga; also by Edward Mortimer Archi-
bald, Her Britannic Majesty's Consul-General for New York.]
“ A DISORDERED MIND.”—“AN IDIOT OR INSANE.”
Dr. John Swinburne, long Health Officer of this port, has made an
affidavit, in the course of which he says: From September, 1870, to March,
1871, I was Surgeon-in-Chief of the American Ambulance Department at
Paris, France, in the Franco-Prussian war; one of the temporary executive
committee of which was the Rev. Mr. Lamson, father of Dr. George H.
Lamson, now under conviction and sentence of death for murder at London,
England, in the kingdom of Great Britain; the said Dr. George H. Lamson
was one of the volunteer aids of the Ambulance Department; by the
appointment of said George H. Lamson on said medical staff he became
one of my personal aids and was placed directly under my care and notice.
I soon discovered that the conduct of said Lamson was strange and pecu-
liar and that his associate aids, of whom there were men and women in
the neighborhood of forty, complained of his 'wild, erratic and bad conduct
and that they were not prepared to say, as they informed deponent,
whether his behavior was that of an idiot or insane man, or whether it
was the result of special wickedness. I made a careful examination of all
the persons or witnesses making these charges against young Lamson, and
found it difficult to satisfy myself in regard to them or of the exact cause
or causes which led the associate aids to make them, but by a little careful
examination I 8oon discovered that in some way young Lamson had a
disordered mind, and that he could not be trusted to administer medicines
or carry out special instructions; that he had no judgment in the admin-
istration of medicines. He was just as likely to give a large and dangerous
dose as a smaller and safe or proper one, no matter how carefully or par-
ticularly insiructed, and seemed to be utterly reckless of results. This
state of things continuing, I was compelled at length to request the with-
drawal or removal of said Lamson from the ambulance department con-
taining the recently wounded to a place where he would not have any
charge of patients except convalescents, which request was made known
to him through his father. Consequently neither young Lamson nor his
father were on friendly terms with me, s.) that subsequently when young


428
H. H. Kane.
Lamson returned to this country and dwelt in Troy and West Troy, and
at times in Albany, he never called on me, nor I on him, nor have I seen
him since the termination of the Franco-Prussian war. In the intercourse
which I had with young Lamson while at Paris, which at times was inti-
mate, supplemented by a careful watch over bis conduct and actions there,
induced by the reports coming to me from the associate aids of the Medical
Ambulance Department, I was irresistibly led to regard him as a man of
unsound mind, and that his mind was so constituted, or became so diseased
and disordered from some cause or other unknown to and undiscovered
by deponent, as to render him irresponsible for his actions, especially in
the administration of drugs and medicines, wherein he seemed to be wholly
destitute of all judgment and common sense as to their effects."
HE HAS “LOST ALL MORAL RESPONSIBILITY.”
State of New York, City and County of New York, 88.:
Kate P. McElroy, wife of the Reverend Irving McElroy, minister of
the Protestant Episcopal Church at Rouse's Point, New York, being duly
sworn, deposes and says: I am thirty-three years of age; at present visiting
my father, Thomas P. Williams, at Fordham Station, New York. In the
month of April, 1881, I was residing at Rouse's Point, and my sister,
Grace P. Williams, was then on a visit to me. Towards the end of said
month of April, George Henry Lamson, a physician, who is, as I am in-
formed and believe, now under sentence of death in London, arrived at
my house on a visit. I had known him since the autumn of 1871, and was
well acquainted with him, but had not seen him since the year 1877. lm-
mediately on his arrival, in fact as soon as he stepped out of the stage at
the door, I noticed a terrible change in bis personal appearance, and even
in his walk, which had become very peculiar, the left shoulder being
higher than the other and the body stooping and pitching forward as if
about to fall. His carriage in former years was very erect and soldier-like.
On the first afternoon of his stay he fell into a deep sleep on the sofil from
wbich he did not awake for several hours. This surprised me, but I was
not able then to attribute it to any special cause. On Saturday, the 30th
of April, we bad visitors in the afternoon. Dr. Lamson left the room and
remained so long away that I became alarmed at his absence. I went up-
stairs to his room and found him lying on his bed perfectly unconscious.
I made every effort to arouse him, but without success. His breathing
was heavy and labored. He continued in this condition for several hours.
During this period I went up-stairs several times and found each time that
he was breathing rather more easily. Some day in May, after the 1st and
before the 10th, when I was in the sitting-room with my before-named
sister, Dr. Lamson came into the room and he injected a fluid into his arm
with a syringe which he had with him. He filled the syringe from a bottle
which he placed in a lin cup of hot water on the stove. When I noticed
that his face became much flushed and the veins in his forehead swelled,
I went up to him, took the syringe away from him and took the bottle
out of the water. The label remained in the water, and when I took it
out I found that it was marked "morphine.” I said to him: “You look
like a man who is going mad.” A look of terror passed over his face.
He then lay down on the sofa at my suggestion and fell into a deep sleep,


Morphia-Taking.
429
which lasted for five or six hours. I sat by him until he awoke at 1 o'clock
in the morning. I am able to state this date approximately from the fact
that the occurrence took place after the first day of May, and before we
moved from one house to another in the village, wbich was on the 10th of
May. One evening shortly after this I found Dr. Lamson very unwell, and
learned from him th:t he had taken a large dose of laudanum in mistake
for chlorodyne. I then determined, by the advice of my husband, and in
accordance with the wish of Dr. Lamson, to take charge of such micdicines
as might be in his possession, as we did not think he was well enough to
administer remedies safely to himself. I found that his laudanum bottle
was empty. He had, besides this, a bottle of chlorodyne, about three-
quarters full, and an unmarked box of sugar-coated pills. He told me
that these pills were either morphine or quinine, but that he did not know
which they were. I therefore threw the box with the pills into the
lake. On the day we moved from one house to another, he lay down in a
room in the new house on a pallet on the floor, while the laborers who
were moving the furniture were passing from and into the room, and were
inaking a great noise, which did not disturb bis heavy slumber. One
evening we found it quite impossible to arouse him from his heavy
sleep on the sofa, and he lay there until four o'clock the next morning. I
knew the time because I was passing backward and forward through the
sitting-room attending to a sick child. One evening he acted strangely,
talking wildly and attempting to wind his watch with a cigarette. One
afternoon when he was talking very wildly and incoherently, and com-
plaining of his head, I advised him to lie down on the sofa to sleep. While
60 sleeping I noticed that his head was very hot and his face flushed. The
heat of the head was so great that it was plainly noticeable upon holding
my hand two inches above it. He spent most of his time in the house on
the lounge in the sitting-room. Sometimes his conversation was clear
and his memory of past events good. At other times it was so incoherent
and irrational as to be quite unintelligible. I know that while he was
visiting at our house he was very abstemious in the use of liquors. He
took nothing of tbat kind except a small quantity of brandy, perhaps balf
a dozen times during his stay, prescribed for him by my husband or
myself in consequence of some peculiar weakness at the time, and a glass
of lager beer at dinner. During his stay he had several severe hemor-
rhages of the lungs. He spat blood continually, and he complained of the
effect of a wound in the chest which he had received in the war. From the
conduct and conversation of Dr. Lamson at the time of his visit, I was in
continual apprehension lest he might take the life of himself or some one
of the household, being deeply convinced that he had lost all moral respon-
sibility. I ascribed this solely to the use of morphine, which I believed
was making him crazy. 1 his being my belief, at the time, of the condi-
tion of his mind, I took great care, and was likewise so cautioned by my
husband, that he should not administer any medicine to my children or any
member of the household.
KATE P. McELROY.
Subscribed and sworn to before me this 4th day of April, 1832.
JAMES F. THOMSON,
Notary Public (48), County of New York,


430
H. H. Kane.
A careful study of the narrative furnished by his
friends and of the other affidavits must, of necessity,
impress us with the fact that Dr. Lamson had been in a
decidedly abnormal mental and moral condition for some
years prior to the date of Percy John's death, and that
this mental clouding and instability and the state of moral
deterioration had been a growth of some little time, the
various symptoms increasing and intensifying with the
increased amount of the drug used, and the increase in
the length of time it was taken. His course, from the
time he began to use the drug, save the first few months
of his addiction, answers with reinarkable accuracy to the
usual description of moral insanity, with more or less
intellectual involvement. Had the outward expressions of
his moral degeneracy been irregular, had they appeared
in a person previously disposed to be dishonest or crimi-
nal, and had they, invoked by hope of personal gain,
suddenly found expression in a desire to be possessed of
another's money, culminating in the murder of that
person, we could, without a moment's hesitation, ascribe
the line of action pursued by this man to viciousness
alone. This, however, is not the case. I have now in my
desk some fifty letters recently received from asylum
superintendents and physicians, in various parts of this
and other countries, that prove beyond a doubt that both
intellectual and moral insanity may result either from
single doses or the continued use of opium or morphia.
These gentlemen have sent histories of these cases, they
are competent judges, and the reports are full and fair,
and there can be no question but that true insanity, not
acute delirium, not simple mental hebetude, but genuine
insanity of various types can be and has been produced
by the use of these drugs. I hope as soon as all the
answers to my circulars are in, to study this matter of
drug insanity in every detail. Until that time, my simple
statement must be taken.
In every case of morphia habit, where the drug has
been used for a long time or in large amounts, the first


Morphia-Taking.
431
symptoms noticeable are those affecting the moral nature
of the individual. It follows as a logical sequence that
if, in a perfectly healthy individual, with a strong well-
balanced mind and body and pronounced morals, the
continued ingestion of opium or its alkaloid, morphia, can
cause a dazed and dulled condition of the mind, destruc-
tion of the sexual appetite and procreative power, weakness
and irregularity of action in both the voluntary and
involuntary fibres, a very decided perversion of morals,
as made manifest by proneness to lie, even when nothing
is to be gained thereby, loss of affection for both family
and friends, cheating in business matters, theft of small
articles of no value to the person stealing them, the
development of cunning and deceit in hiding his vice from
friends, neglect of all religious duties and weakening of
religious convictions, and a distinct change in the manner
of meeting and treating people. This change in manners,
the first to be apparent in case of commencing moral
degeneration from the use of either stimulants or narcotics,
is very ably expressed and discussed by Dr. Geo. M.
Beard, in an article in the June number of the American
Journal of Stimulants and Narcotics. With this change
in moral tone, we observe some mental aberration : Devel-
opment of low cunning, love of solitude, irritability
from slight causes, incapacity for continued intellectual
effort, a dazed and lost expression of countenance, and,
finally, many of the more prominent symptoms of dementia.
How much more likely would these symptoms be to
occur if the individual using the drug had, instead of
being well and sound, physically and mentally, been
already showing signs of mental and moral weakness ?
With Lamson the great turning point seemed just to
have been reached. The morphia had not caused the
mental and moral change, but it had so firmly joined
itself with the forces already acting to that end as to
greatly aggravate his condition.
That the moral insanity of Lamson, however well proven,
had anything to do with his action in the case of Percy


432
H. H. Kane.
John so far, at least, as suggesting or modifying any
motive I certainly do not believe, for had it been so,
some trace, some remnant of that motive would have
remained after the deed was accomplished. Indeed we
have a so much better explanation of the occurrence
which, though dependant on his mental condition, and
undoubtedly due to the hypodermic use of morphia, places
his act in a much better light than that in which it has
heretofore been viewed. It is a notable fact that physi-
cians in active practice, who become addicted to the
habitual use of morphia develope a certain carelessness
with poisonous drugs. This is true more especially of mor-
phia, which they are themselves using several times daily
in large doses, but also of other drugs such as atropia,
strychnia, and in Lamson's case aconitia. Physicians
whom I have had under treatment for this habit, have
frequently spoken to me of the danger their patients were
constantly in, and two of them told me of instances
where they had actually done harm; the one convulsing
his patient with strychnia, the other killing his patient
with two one-grain injections of morphia.
Thus Lamson, being constantly under the combined
influence of morphia and atropia in large doses, and having
used aconitia upon himself and in his practice in large
doses, might have given his weak and sickly cousin enough
of the latter drug to cause his death without having had
any intention of so doing. The condition of mind des-
cribed by the prisoner just before his death and when he
had been without the drug for some months, would be
such a one as would be favorable to the commission of
such an act unintentionally.
The trance state there referred to, in some degree
like that described by Crothers and others as resulting
from the use of alcohol, I have known to occur in two
instances in morphia-takers, and Christison describes a
like condition from atropa belladonna.*
Amer. Jour, Stimulants and Narcotics, June, 1881; Editorial “The Lamson
Case.')


Morphia-Taking:
433
Aconite has in several instances been used with decided
benefit, appearing to act as a physiological antagonist in
morphia poisoning, and the question naturally arises as
to whether Lamson, thoroughly saturated with morphia for
some years, might not have used uncommonly large doses
of aconitia upon himself without producing any evil
symptoms, and thus be led to use proportionately large
doses of the drug upon others.
Whether Lamson unitentionally killed his cousin while
in a state of moral insanity or did so accidentally through
the same causes matters little, so far as the question of
how to deal with such persons is concerned. That every
habitual user of narcotics should, upon the appearance of
the first symptom of mental or moral aberration, be com-
mitted to some asylum where a cure of the habit would be
accomplinshed, there can be no question.
Such persons, no matter what their motives, are
dangerous to their fellow men and should certainly be
restrained of their liberty; the more so when we know
that such restraint will in ninety per cent. of all cases
effect a restoration to mental and moral health. Laws
should be passed making this possible, and in the case
of harm resulting to individual or property from the
action of such persons, the friends or family knowing of
the person's habit and not taking proper measures to
control them should be held responsible.


Art. VII.-Idiocy and Imbecility-Insan-
ity in an Infant-Moral Insanity.
CLINIC OF M. LE DOCTEUR MAGNAN. REPORTED BY
M. P. LUCAS-CHAMPIONNIERE.
Translated by E. M. NELSON, M. D., St. Louis.
IT is interesting to follow, with reference to the progress-
I ive development of intelligence, the series of morbid
types which extend from the most complete idiocy to an
imbecility which does not exclude a certain degree of
intellect, and to which belongs a whole category of
individuals most dangerous to society.
Among idiots more or less complete we observe most
frequently some modifications of the face, such as altera-
tions of the form of the jaw, strabismus, a coloboma,
pigmentation of the retina, an enormous development of
the ears. Often the development of the hair is very
unequal; the genital apparatus is almost always atrophied ;
in the woman menstruation is almost always retarded.
Idiots also quite frequently present supernumerary fingers
or webbed fingers. In the complete idiot the gaze is
wandering; he sees, but does not regard; attention is
absolutely absent, and this is a fact quite peculiar to this
state, and gives a peculiar appearance to these patients.
When, in growing, idiots gain strength, they exert it
uselessly. Most of them gives themselves up to a sort of
perpetual balancing; an idiot referred to by Griesinger
spent his life in pulling out and pushing in the drawer of
a bureau. We compare this fact with some facts observed
in certain maniacs who invest themselves in some sort
with one idea or one act, and have no other occupation
during all their life.
At a little higher grade, the idiot walks, tramps around
perpetually, and employs his activities in acts more or


Infantile and Moral Insanity, Idiocy, etc. 435
less disgusting, fills his mouth with pebbles or with filth of
all sorts. Here commences the practice of onanism; and
it is at this grade that they may become very dangerous.
But, even at the lowest grade, we may see in them a
certain affectionateness, a sort of gratitude towards those
who nurse them and are continually with them. Thanks
to their aptitude for imitation, they may sometimes be
utilized in certain conditions; as, for example, the idiot
who has for his sole aptitude, to utter a cry which
attracts attention whenever anything unusual occurs in his
presence, like the fall of a patient, or any accident in the
ward of the Bicêtre where he remains. Another child
who was found there had an extraordinary aptitude for
begging. He was even hired out by his relatives to a
family whom he supported in this manner. This was his
only faculty.
But from this spirit of imitation may sometimes result
consequences the most grave; the fact is known of an
idiot who, after having assisted in the killing of a hog,
killed one of his comrades in the same manner. German
authors report a fact which corresponds to this, but in
which a certain amount of reason may be observed : An
idiot reputed as very courageous in the asylum where he
stayed, in order to test his courage, was placed on guard
over a person stretched out, covered with a cloth, simu-
lating one dead; but seeing the cloth move, the idiot took
an axe and crushed the head of the false cadaver.
When reason manifests itself in a certain degree in
subjects which present the characteristics of idiocy, they
can be classed at a higher level in the intellectual scale,
and reach imbecility. The imbecile is generally slow to
walk and to speak; he pronounces the gutturals with
diffculty, while he emits the dentals easily enough. His
general appearance may be absolutely normal; in him the
intellectual and emotional faculties exist to a certain
degree; he brings together and groups ideas, but is inca-
pable of an abstraction; he will count, for example, all
the objects which may be presented to him, even though


436
Magnan.
quite numerous, but will be incapable of telling how many
are two and two. These individuals can invent nothing,
and can only imitate. In this respect it is curious to see
certain subjects learn a trade and gain a living, yet not
susceptible of adding the simplest numbers. A patient in
the service of M. Magnan, aged twenty-three years, has been
at school for eight years, and has never been able to learn
to recognize more than the letter A. His antecedents
are, as they almost always are in such cases, that is to
say, the father and mother were both drunkards; the
latter also frequently gave herself over to gross immorality.
He himself is much addicted to the same practices, and is
dangerous from a sexual standpoint. Nevertheless, he
responds quite well to questions addressed to him ; he
has learned the trade of a blacksmith, and explains quite
clearly the different practices of his trade; but he cannot
tell how much one and two make.
Another example of imbecility compatible with a
certain moral and physical condition of the individual
who is affected, is that of a man of sixty-four years, brought
with the service under peculiar conditions. This man
who has been at school nearly twelve years, applied
himself with difficulty; he has been a baker and has
always been an object of ridicule for his comrades. He
believed absolutely everything that was told him, and so it
was that he was persuaded that he might present himself
at the Elysée, which he did, to marry the widow of the
President. It is to be noted here that ideas of the same
sort, so frequent in ordinary insane patients, are then
spontaneously produced, but that in this patient, incapable
of creating them for himself, all this was inculcated by
others. This extraordinary credulity had moreover already
been the occasion of more serious complications, for he
had been condemned once to ten days, and again to
three months in prison for having stolen vegetables of
which he had been persuaded that he was the legitimate
owner. Now it is evident in the medico-legal point of
view that these facts deserve to be made known, for they


Infantile and Moral Insanity, Idiocy, etc.
437
show how often it happens that the irresponsibility of
such patients may be misunderstood.
INSANITY IN EARLY INFANCY rarely manifests itself. M.
Magnan has, however, an example that is remarkable
both for the precocity of the insanity and for the totality
of the hereditary conditions, which had, so to speak, pre-
pared this ground. This child, who was born in 1870,
during the siege, has a grandmother who suffered from a
mystic delirium which came on at about fifty years of
age; she remained always very reserved and was perfectly
harmless; a grandfather and an uncle died crazy; as to
the father, at this moment confined in the asylum at the
same time as the son, he commenced at the age of
twenty-eight to manifest the delirium of persecution, and
since then to render existence intolerable to all around
him, and has attempted suicide. Born in these extraor-
dinary conditions of heredity, the infant, nursed by his
mother, was, at the age of three years, extremely impres-
sionable, subject to violent fits of passion, striking his
head against the walls. Soon afterwards, at the age of
four years, he presented all the characteristics of veritable
insanity with melancholy ideas and a tendency to suicide.
He had hallucinations of vision, of hearing and of taste.
He saw black men; heard voices crying out to him to
kill himself; felt a disagreeable taste in his mouth. He
voluntarily isolated himself, and retained his melancholy
ideas even when he had no hallucinations.
This child, small, emaciated, slightly developed, des-
cribed calmly all the hallucinations from which he suffers,
all the visions which he sees and which almost always
have for their object to impel him to kill himself. He
said that he could not keep from weeping, because he had
much ennui which he could not explain, having always
the desire to kill himself on account of the ennui.
It is to be noted that in this patient there are, at the
same time with the hallunciations, a depth of melancholy
such that the impulses to suicide exist entirely apart from
these last. An insanity so complete and so precocious,
ul.


438
Magnan.
since it is manifest in a fashion clearly defined at the
age of four years, could only be met as the result of
heredity, which in this case had its most unfavorable
action.
MORAL INSANITY.-Facts designated under this name
count among them those which have the most importance
in a medico-legal point of view, because, of all insane
people, those who are affected with this form of insanity
are frequently those who appear to preserve the most
complete integrity of their intelligence, and because the
impulses to which they yield may have all the character-
istics of common misdemeanors. M. Magnan had in his
service a man of thirty-seven years, a veritable type of
this form of insanity, and whose observation deserves to
be reported with some detail. As always in these cases,
the hereditary antecedents are defective; the father was
a drunkard, an uncle died insane, the mother and sister
are eccentric and nervous, a brother is weak. The first
insane act committed by this patient, an act which will
be reproduced always hereafter with the same character-
istics, and in analogous conditions, occurred at the age
of fifteen years. One day, seeing a white apron hanging
upon a cord, he felt a veritable impulse which impelled
him toward it. He took the apron and carried it out into
the fields, where he gave himself up to the practice of
masturbation. From that moment he has not ceased to
be affected with a besetting passion for an apron. He
must have it at any price; he would buy them; he has
sometimes stolen them; in the street he followed men and
women who wore them. In Paris, where he came later,
he chose places where he could have them at his dis-
posal. His dreams had for their object only these aprons.
Never did money or other effects tempt him. In this
situation his family made him enter the navy. Here the
absence of the object of his besetment, determined an
amelioration, but at the end of several years, having
obtained a furlough to come home, the next day he stole
an apron, and was condemned for this deed to eight days


Infantile and Moral Insanity, Idiocy, etc.
439
in prison, in spite of what he could say to defend himself.
On a new voyage a new amelioration was produced, but
four years later, during a leave of twenty-four hours
obtained at Cherburg, he took an apron and did not
reappear for eight days, which condemned him to prison
for a month. Three years later, again on leave for twen-
four hours, passing before the shop of a pastry-cook, he
perceived white aprons in an open closet. He controlled
himself, however, but was troubled and sad all day, and
kept wandering around that shop; evening coming on, he
forced an entrance, and was arrested at the moment when
he was escaping with the aprons. Condemned for a year
to prison, he formed then the project of secluding him-
self entirely, and afterwards entered La Trappe, where he
remained several years, disciplining himself almost with
frenzy. He came out at the end of the time ameliorated,
but he was arrested again in 1880, for a new assault, and
it was then only that making a search of his house, there
was found a great quantity of white aprons, all spotted
with sperm. Shut up then in an asylum, he has since
come out, and has been able to secure employment. His
besetment has much diminished. This man, of perfect
clearness of mind, relates his history very completely,
recognizing well the gravity of the acts which he has
committed, but obedient to an irresistible impulse.
It is seen that in this case several condemnations have
been pronounced against this individual, who, however,
far from being responsible for his acts, struggled with
energy against the impulse which forced him to act.-
Jour. de Méd. et de Chirurg. Prat., Apr., '82.


Art. VIII.-A Case of Multiple Abscesses
of the Brain. Slight Epileptiform Con-
vulsions-Absence of Other Cerebral
Symptoms.
ARD
By EDWARD C. Mann, M. D., New York.
To observe the clinical manifestations of diseases
1 of the brain, and from the symptomatology according
to the different parts of the brain affected to deduce
rules for diagnosis of the exact seat of cerebral
disease, is the special study of the neurologist of our day.
There is no more facinating study than that of the brain
in health and disease, and none which requires more close
and careful attention. The principle of cerebral localiza-
tion is correct, although, of course, we may find occasional
exceptions to this as to any other law. We may find at
an autopsy an old lesion of the brain, which nothing in
the clinical history of the patient would have caused us
to suspect. Owing to the clinical and experimental work
of Charcot, Ferrier, Meynert, Wernicke, Delasiauve, Pie-
ger, Pitres, Maragliano and Tamburini, we may regard it as
settled that the psycho-motor centers for the upper and
lower limbs are situated in the innermost and superior part
of the ascending parietal convolution ; for the forearm
and head, in the middle part of the ascending parietal
convolution; and for the facial muscles, in the external or
inferior part of the ascending parietal convolution.
The psycho-motor centers for the muscles of the lips
and the tongue—those muscles principally destined for
the pronunciation of words—are situated in the ascending
frontal convolution, in the inost external or inferior part,
where the third frontal has its origin; so that we naturally
look for a parallelism between the intensity of the lesion
of movements and the gravity of the lesion in the motor
zone. We also look for the access of convulsive
movements in cerebral disease, in the limb whose cortical
center is most affected by the disease, and from the


Multiple Abscesses of the Brain.
441
region of the body where the convulsive movements
commence, which open either the epileptic access, or
which are indicative of tumor, or which result in sequence
to a hemorrhage, or a softening or an abscess. We may,
as a rule, diagnosticate with certainty the cortical center
primitively and principally affected. Respecting aphasia,
while there is a functional pre-eminence of the left hemi-
sphere of the brain, lesions of the center of language in
the right side also are capable of producing it. The
motor or excitable zone of the brain includes the median
region of each hemisphere, particularly the posterior
extremity of the third frontal convolution, the upper half
of the second and first frontal, the ascending frontal and
ascending parietal convolution, the anterior gyri of the
island of Reil, the paracentral lobule on the inner surface
of the hemispheres, and, perhaps, a back part of the
upper set of parietal convolutions. This has been clearly
shown by Seguin, who also mentions those fasciculi of
white substance which connect the above mentioned gyri
with the crura cerebri, constituting the anterior half, or
less, of the internal capsule as it passes between the
nucleus lenticularis on the outer side and the nucleus
caudatas and thalamus opticus on the inner side. A tumor
in this motor zone we should expect to find characterized,
clinically, by localized convulsions in peripheral muscles,
by neuro-retinitis and localized headache. The existence
of chronic localized convulsions are the most important
diagnostic mark of a localized lesion in the opposite
cerebral motor zone. The island of Reil bears this rela-
tion to language: that its convolutions are “the path of
transition of motor impulse awakened in the cortical centers
of language, in the lenticulata-striate region, from which
they are transmitted to the apparatus of execution.” It has
been said by Sir Wm. Gull, of England, that there are no
pathognomic symptoms of cerebral abscess or of tumor.
Respecting tumors, we entirely disagree with this
author, as the existence of localized convulsions in peri-
pheral muscles, neuro-retinitis or choked disc, and localized


442
Edward C. Mann.
headache would lead the writer to diagnose with secu-
rity the existence of a localized lesion—in all human
probability a cerebral tumor-in the opposite cerebral
motor zone.
Respecting abscess of the brain, as the following case
clearly shows, there is the greatest difficulty sometimes
in making an exact diagnosis, as cerebral abscess usually
forms in the white substance of the brain, and not in the
cortical motor zone.
In the case about to be related, the first indication of
cerebral mischief was a sudden and unexpected epilepti-
form seizure, commencing in the right forearm and hand,
leaving that arm and hand partially paralyzed. The leg
of the same side was not affected. At no time during
the sickness of thirteen days was there complete hemi-
plegia. The tongue, when protruded, did not deviate to
the partially paralyzed side in the least. At no period in
the disease was there pain in the head or vomiting; there
was no vertigo ; there was no disturbance in sensibility;
there was neither defective articulation nor defective sight;
no incontinuance of urine or fæces until two days before
death.
The history of the case is as follows: A man of about
fifty years of age, a gardener by occupation, who had been in
the late war, and had suffered from a chronic dysentery,
and who had two or three slight hemorrhages of the lungs,
was suddenly attacked, thirteen days before death, by a
sudden and unexpected epileptiform seizure, commencing
in the right hand and arm, leaving, as I have said, the
right arm partially paralyzed. There was and had been
no previous cerebral symptoms whatever; neither pain,
nausea, vomiting; no heaviness, stupor or drowsiness; no
rigors and no vertigo. The patient had suffered some
loss of appetite and had suffered from pain in the stom-
ach after eating, for some months. Such was his history,
as I obtained it of him at my first interview with him.
There was slight delirium, after the first epileptiform
seizure, lasting for about an hour. He had never received


Multiple Abscesses of the Brain.
443
any injury to the head or brain, and there was no dis-
ease of the internal ear, both of which are frequent
causes of abscess of the brain. There was no history of
any recognized cause to account for the multiple abscesses
which were found after death, save the slight hemorrhages
which may have indicated acute , changes in the lungs.
Auscultation and percussion revealed very little abnor-
mal, however. In a few days after the first attack there
was a second slight attack, described by the patient as a
"working of the right hand and arm," and also a third,
followed by a hot skin, quick pulse and a somewhat dry
tongue; temperature 101°. These symptoms were fol-
lowed by great prostration, and the patient was removed
to the City Hospital in Brooklyn. He gradually sank,
and died on the thirteenth day after the first symptoms
appeared. Previous to the first epileptiform seizure, the
patient had suffered from very slight localized convulsions
of the right hand and arm. These were, however, not
chronic, but they led me to suspect a localized lesion in
the opposite cerebral motor zone. There was a tempo-
rary paralysis of the left leg, which lasted twenty-four
hours and then passed away, and which did not reappear
again. If I had had any reason to suppose that there
were vegetations on the heart's valves, I should have
suspected cerebral aneurism and local embolism of a
small branch of the left middle cerebral artery. The
convulsions, as I have said, began in the right hand, and
consciousness seemed partially lost when the spasm had
extended to and involved the face. I gave an unfavor-
able prognosis in this case, stating as my reason, that I
feared the existence of gross organic lesion as the cause
of the convulsions, which made me certain that more
convulsions would follow, and that the patient would
eventually die, although I did not expect death to ensue
so rapidly as it did. The absence of rigors made me
doubt the existence of cerebral abscess. The peculiar
type of convulsions were to me the indication of the
result of direct irritation of the brain by some gross


444
Edward C. Mann.
organic lesion, but the exact nature of the lesion, I frankly
confess, I was somewhat in doubt about. We know that
gross organic lesions may destroy large parts of the brain,
without the production of any special symptoms, the
patient only beginning to suffer when a local encephalitis
is set up by the gross organic disease. I could exclude
syphilis in my case as the patient had never had a sign
of it.
Owing to the politeness of the resident physician of
the Brooklyn City Hospital, I am enabled to append the
official record of his symptoms after admission to the
hospital, and the record of the post-mortem examination :
BROOKLYN City HOSPITAL,
July 28th, 1881.
Dear Doctor :- * * * He was admitted
to hospital on June 20th. Died, June 27th. He then had
paralysis of right arm only. He was stupid and sluggish,
but could be easily aroused, and was in no wise uncon-
scious. He became progressively more stupified, but it
was not till within a few hours of death that he was truly
comatose. During the last two days, he passed urine
and pus involuntarily. Urine throughout was ammoniacal
(alkaline) loaded with urates, phosphates and sediment.
His breathing was emphysematous, and there were some
coarse râles but no ædema. Following is a record of
pulse, respiration and temperature :
Jano
21st
220
220
230
24th
25th
26th
A.M.P. M A M.P. M.A.M.P. M. A.M P.M.A.M.P. W.A.M.P v.
Pulso - 108 100 | 118 100 100 104 105 104 | 120 100 | 120
Respiration | 50 | 50 48 60 50 52 54 60 40 50 64
Temporatare,8 100.5 99 100.5 99 98.5 101 101.5 99
10
40
At the autopsy five abscesses were found in brain, as
follows:
Left Hemisphere.- Two in anterior lobe-about size of
hazel-nut-in first and second frontal convolutions; one
in middle lobe, near cortex, just behind fissure of Sylvius.
Right Hemisphere-Very small abscess (size of pea) in
first frontal convolution.


Multiple Abscesses of the Brain.
445
One, much the largest abscess, size of large hen's egg
-stretching from near periphery of post lobe into right
lateral ventricle. All of these contained greenish and very
foul smelling pus. Rest of brain slightly congested, but
otherwise healthy
I have forgotten the condition of the other internal
organs, but my impression is they were found fairly
healthy, excepting some ,old pneumonic deposit in one
lung. Trusting the above may be of some interest,
I am,
Sincerely yours,
To Edward C. Mann, M. D. William M. THALLOW.
Art. IX.-Some Peculiar Effects of Cin-
chonia.
By Jos. G. Rogers, M. D.,
SUPERINTENDENT INDIANA HOSPITAL FOR THE INSANE.
W ITHOUT special ambition to claim originality, I
V wish to call the attention of the association to
certain important, but hitherto unnoted, effects of the
alkaloid cinchonia, which I deem valuable to the specialty.
This agent has always occupied a modest place in the
array of cinchona products, on account, especially, of its
assumed inferiority, as a febrifuge, to quinia, but it has
certain remarkable qualities not possessed by those alkaloids
to any noticeable extent, which seemed to have escaped
general observation completely. Its tasteless quality,
where unsalified, led me some years since to use it as an
antiperiodic among children. Noticing certain peculiar
effects, I made a study of its action on my own person.
The observations then made I have since repeated many
hundred times during a period of two years, and the
effect referred to I have found to be constant. They
may be detailed in a few words: An hour after the
ingestion of twenty grains, more or less, is made manifest
a decided disturbance of the sympathetic system, as


446
Jos. G. Rogers.
shown by cardiac weakness and irregularity, and a gen-
eral sense of muscular debility with tremor, because quite
marked; nausea is not infrequent. These effects may
arise from any of the bark alkaloids, and are not peculiar.
At the same time paresis of visual accommodation appears,
and progresses to such an extent as to be almost com-
plete, in many instances, at the end of the second hour;
at this stage, even the emmetropic eye will require the
aid of a number ten convex glass to properly distinguish
objects at the normal near point. The paresis lasts eight
or ten hours. It is not associated with any mydriatic
effect in adults, but sometimes this condition is noticeable
in children of delicate nervous organization.
With these phenomena are associated primarily slight
mental excitation, a sense of heat and blood-fulness in
the head and upper parts of the body and some flushing
of the skin. Later a relative pallor involves the entire
surface; the mucous membrane of the eyes, nose, mouth
and throat becomes very dry and so continues for several
hours. At the same time there is very decided obtusion
of tactile sensibility. Stimulants, food and rest readily
overcome the cardiac and muscular disturbance, but have
no influence on the other named conditions. The fore-
going observations refer to effects upon adults. In young
children within an hour after administration, a most
decided erythema suddenly appears, notably about the
head, but involving the entire surface. This appearance
is exactly as in the third day of scarlet fever and just as
then, the skin can be legibly written upon with a blunt
point. This state of cutaneous vaso-motor paresis is
temporary and usually disappears within two hours, and
is followed by a paleness more noticeable than in the
adult, which is prolonged for several hours.
The deduction from these observations is that cin-
chonia, in addition to its tonic and antiperiodic effects,
exerts special influences on the nervous apparatus cognate
to those belonging to the alkaloid of belladonna, hyoscia-
mus and stramonium, and should be correspondingly useful


Some Peculiar Effects of Cinchonia.
447
in those conditions in which this class of agents is
indicated.
Practically, I have found it éminently serviceable in
febrile conditions associated with cerebro-spinal congestion
and in the more sthenic types of acute mania. The
ordinary sedative effects of the bark alkaloids have super-
added to them most marked vaso-motor influences, which
result secondarily and permanently in an increase of
tension and consecutive reduction of congestion.
With these suggestions, I delegate to the physiologists
further study of the modus operandi of this neglected but
important agent.
Art. X.-Remarks upon Megalomania or
Partial Lypemania, with a Predomin-
ance of “Delirium of Greatness."*
By Achilles Foville, M. D.,
INSPECTOR GENERAL OF INSANE ASYL UMS AND ELEEMOSYNARY INSTITU.
TIONS OF FRANCE
DAVING the honor to address the London Congress
11 upon a form of mental disease in which predominate
the delirious ideas of riches and greatness, it is pleasant
to remember that this form of disease was first described
just a century ago by an English physician. Several
physicians of ancient times, as well as of the middle ages,
have chronicled their observations of a few cases, but no
one had given a theoretical description of this kind of
intellectual deviation previous to the publication at London,
in 1782, of Dr. Arnold's work entitled, “Observations on
the Nature, Cause and Prevention of Insanity.” Arnold
refers to a particular kind of mania, which he designates
under the title of “Mania of Vanity or Self-Importance.”
*Delivered before the section of Mental Medicine of the International Congress, at
London. Angust, 1881. Presented by the author, through Dr. A. Witmar, of Wash-
ington, D. C., for publication in this JOURNAL.


448
Ach. Foville.
“Those who are attacked in this manner,” he remarks
(Vol. I., p. 171,) “have a very exaggerated opinion of
their proper dignity, of their importance, of their fortune,
of the price of their clothes, of their personal charms, of
their manners, talents, knowledge and of all the excel-
lencies with which they imagine themselves endowed.”
Notwithstanding the truths contained in this description,
it seems to have attracted but little notice, and it was
not until the era of the discovery of “general paralysis,"
from 1820 to 1825, that the clinical value of the “delirium
of greatness ” took its place as a matter of considerable
importance in mental pathology. This was due, in a
great measure, no one will fail to recognize, to the works
of French physicians of the Esquirol school. I will first
mention the absolute theory of Bayle, who did not hesi-
tate to consider delusions of greatness a necessary and
characteristic feature of general paralysis ; necessary, for it
existed, according to him, in all cases of this malady;
characteristic, for it did not exist in any other form of
mania. This opinion was immediately attacked as entirely
too arbitrary by Georget and by Calmeil, and it has never
been accepted by alienists. All recognize the frequency
of a certain kind of ambitious mania in general paralysis,
but all agree in declaring on the one hand that there
are cases of general paralysis without ambitious delirium;
and, on the other hand, that ambitious delirium is found
in numerous cases of mania other than general paralysis.
The relative place to be assigned to each of these groups
has been the object of numerous researches. The most
prominent and successful investigators of the subject have
been M. M. Baillarger, Jules Falret and Linas. In 1869,
the Academy of Medicine deemed the subject of sufficient
importance for discussion at the meeting of Civrieux.
Upon that occasion I presented a work for which the
Academy did me the honor to award me a prize. In a
portion of this work, I believe myself to have introduced
into science certain new and original data, which I to-day
beg leave to briefly review. The lapse of a dozen years


Megalomania or Partial Lypemania.
449
since then having enabled me to confirm, in my own mind,
and to elaborate the views then expressed. Delusions of
ambition, every one knows, are very frequent among the
insane, and it can even be said that there are few forms
of insanity in which it may not be recognized as an
accessory feature; but, if leaving aside all cases in which
it has no specific significance, we are satisfied to take into
consideration those in which delusions of grandeur are
manifest, with a predominance sufficiently marked to
impress upon the affection a truly pathognomic character,
we find that these cases constitute two very distinct
groups; one belongs to general paralysis, the other to
partial insanity, which was called, thirty or forty years
ago, monomania. To distinguish between these two classes
is ordinarily very easy. In general paralysis the delusions
of ambition are diffused, unstable, incoherent, generalized,
absurd; in partial delirium, on the contrary, they are
steady, precise and systematized in a logical and progress-
ive manner. Messrs. J. Falret and Delasiauve, among
others, have very distinctly described the pathognomic
symptoms of these two classes, and pointed out the
characteristics by which they can be distinguished one
from the other. It is not, however, sufficient to recog-
nize that a case of mental aberration, in which ambitious
ideas predominate, belongs to this large class of partial
insanity; but, in order to properly understand the nature
of the case, and that of those cases which belong to the
same classification, the precise method of inception must
be determined with the causes, the mode of evolution
and the results. It is only by bringing together all these
data that an exact idea can be formed of the partial
insanity having a predominance of delusions of greatness
and pride, for which Mr. Dagonet proposed the name of
"megalomania,” which, in my opinion, is very appropriate,
and which I have adopted. Without proper consideration,
one might suppose that insane persons affected with
megalomania, and having, as already mentioned by
Arnold, a very exaggerated opinion of their rank, of


450
Ach. Foville.
their wealth, their ability, ought to feel very happy
and take pleasure in the enjoyment of these imaginary
advantages. Nothing could conform less to the result of
observation. Some years ago, Calmeil made a very just
remark: “It is a mistake to think that those affected in
this manner enjoy perfect happiness. The sovereigns of
Les Petites Maisons often deplore with bitterness the
injustice of their supposed subjects” (Dictionary, in thirty
volumes, article “Monomania,” Volume XX., page 139),
clearly showing that the delusions of greatness may be
found in cases of melancholia.
I have found by collecting in a manner as detailed as
possible the observations of quite a number of megalo-
maniacs, that this mixture, this association of delusions of
ambition with melancholia, so far from being an accidental
and casual coincidence, is on the contrary constant, and
constitutes a nosological law. It is known that the usual
form of partial insanity is that which is now designated
under the name of delusions of persecution, and that this
kind of delusion is almost invariably connected with
sensorial trouble, more particularly those hallucinations of
hearing which sometimes precede and induce delusions, and
sometimes follow and are the cause of the same. Not
having the leisure to dilate upon this subject, I am content
with referring to the works of Messrs. Morel, Jules Falret,
Lasigne, Delasiauve, Legrande du Saule, etc. If a megalo-
maniac is examined with patience and accuracy you will
rarely fail—I was about to say never fail—to discover,
associated with the delusions of ambition and pride, hal-
lucinations and delusions of persecution. The origin of
the co-existence of these intellectual troubles, apparently
differing so much, and their manner of association, is often
the result of a mental process quite interesting to analyze
and follow. Let us take the case most frequently met
with: that of a chronic lunatic, whose trouble manifests
itself by hallucinations of hearing, and in whom these
hallucinations have given birth to delusions of persecution.
Every one understands the psychological process by


Megalomania or Partial Lypemania.
451
which these delusions have been generated. After long
continued researches attended with anxiety as to the
cause of phenomena, strange, and apparently devoid of
all natural means of explanation, the patient concludes to
attribute them to some powerful and mysterious influence,
which he recognizes without being able to explain, and
which he dignifies with a name implying mystery ; elec-
tricity, magnetism, physics, police, league, secret society,
Jesuits or Freemasons. Most frequently the ideas of per-
secution stop here, or rather it is from these subjects that
the patients weave variations more or less complicated
according to their degree of knowledge or imaginations.
They compose a novel in which they represent themselves
to be the hero without their real social position suffering
in their eyes any appreciable modification, without their
individuality being changed thereby. But frequently
matters do not rest at this point and the delusions reach
in a class of insane persons, on the subject of persecution,
a degree of systematization more complicated. It is not
sufficient that they should have convinced themselves that
they are followed by inveterate enemies; they wish to go
further and learn the cause of this occult persecution,
They ask themselves what umbrage they can have given
personages who must be great, wielding powerful influ-
ences, judging from the means which they employ. What
motive can there be for such desperate oppression and
the perpetration of such long continued abuse upon
persons unknown to the world and of modest condition ?
After much perplexity and incessant introspection, a solu-
tion to this strange problem dawns upon them. Is it
quite true that they are personages of so little importance ?
Is their social status really so humble? This train of
thought having once been established they are supplied
by the most frivolous incidents with new lights which at
last reveals to them the truth hidden until now. They
are persecuted by the rich and powerful for the reason
that they are rich and powerful themselves, and are
purposely kept in obscurity because they occupy a high


452
Ach. Foville.
social position when free to enjoy their rights. Odious
usurpers have the greatest interest in allowing them to
remain in ignorance of their true origin; they are not by
birth of that obscure class to which they appear to
belong; they in truth are members of a noble, princely
race, not unfrequently of a royal family; it is by reason
of a most infamous conspiracy, a criminal substitution
effected at their birth, that they are deprived of their
rank, their power and their wealth.
Such, in a general way, is the manner by which men-
tal disorder is manifest in those whom Calmeil called,
fifty years ago, “the sovereigns of the Little Houses."
Was he mistaken in saying that they do not always enjoy
perfect happiness; and are there, in fact, many conditions
less calculated to produce happiness than that of an
imaginary sovereign, who, instead of ascending the throne,
rarely fails to spend a sad life within the confines of a
lunatic asylum ? Lack of time deters me from introduc-
ing here much interesting matter. I will only present the
following, written by a megalomaniac, and addressed, in
1846, to Mr. Guizot, the prime minister: “I have been
transferred to the house of Charenton on account of a
memorial, in which I expressed conviction that I am the
son of the Emperor Napoleon I., and of the Empress
Marie Louise, retained in France for extraordinary reasons
in 1814. At this time, more than ever, I believe in this
hypothesis regarding my origin, because it is the only one
which can explain to me the outrageous and incessant
persecutions to which the government of the King of
France has subjected me since 1840. It alone can
explain for what motive the son of the Emperor Napoleon
I., and of the Empress Maria Louise, whose existence
was recognized under the name of Duke of Parma, in
the treaties of 1814, disappeared suddenly and was
replaced under the title of Duke of Reichstadt, whose
name does not appear in any treaty.” It is needless to
add that the alleged persecutions by Louis Philippe were
nothing but extremely varied and intense hallucinations.


Megalomania or Partial Lypemania.
453
Are not a few lines like these, written by an intelligent
and educated patient, worth as much as a lengthy theo-
retical description, and cannot one readily understand the
chain of intellectual researches and fallacious reasonings
by which an imaginative individual becomes insane on
the subject of persecution associated with systematized
delusions of greatness ? Does it not demonstrate that
this megalomania, instead of finding joy and happiness in
the illustrious birth with which he prides himself, is filled
with sadness and righteous indignation, believing that his
rights are withheld, and his well-founded claims disallowed
by his enemies ? This case, in its origin and development,
is by no means an isolated one. The histories of all
megalomaniacs present intimate points of resemblance,
and among all those which I have studied in detail at a
stage sufficiently remote from the origin for the disease
to have become fully established and the delusions fixed,
I have found the same combinations of chronic hallucina-
tions, of fixed ideas, of persecution, and the delusions of
pride well marked. With these three elements of insanity,
the insane never fail to create for themselves a patho-
gnomonic romance, naturally varying in its details according
to their degree of intelligence, culture and ability to
invent and elaborate new theories, but in which will
invariably be found the same principal ideas; substitution
at birth to serve family interests and political purposes ;
childhood spent in obscurity; first signs of an illustrious
origin; a period more or less prolonged in searching for
a solution of the mystery; desperate and secret persecu-
tions by adversaries; finally revelation, often by accident,
of their true origin, efforts to effect reinstatement to rank
and honors, and restoration of the wealth to which they
are entitled, then follows increased persecutions, and that
which crowns the whole, the accusation of lunacy and
confinement in a lunatic asylum. It is my opinion that
illegitimacy is the principal predisposing cause of this
form of insanity. The secrecy and uncertainty usually
associated with these children, the moral and physical


454
Ach. Foville.
suffering to which they are often subjected stimulates them
to make inquiry concerning their birth, which probably
serves to prepare the way for the ultimate development
of megalomania. Of the twelve cases referred to in my
first work, five were of illegitimate origin; since then,
without keeping an accurate account, I have observed
that a large proportion of megalomaniacs were persons
who were unlawfully begotten. * * * * *
The following history of cases are given illustrative of
the entire subject :
M. L. - insane and persecuted for more than
twenty years. Knows that he is not the son of a provin-
cial lawyer, his father was Louis XVI., escaped from the
scaffold, his mother, Queen Hortense ; imprinted on his
body is the fleurs de lis mingled with the imperial arms.
Political intriguers wish him dead, not knowing that he,
by his combined imperial and royal extraction, could
conciliate all political parties. Not satisfied with conspir-
ing against his person, his enemies wish to put an end
to his dynasty, and every night he hears above him the
cries of his children who are being murdered in the garret
of the asylum where he is held a prisoner of State.
Mlle. X— of illegitimate Spanish extraction, has
been for many years pursued by the police, who wished
to cause her death by poison, she being unable to divine
the reason for such continued persecutions. In 1856, at
the time of the Congress of Paris, she discovered that
she was Archduchess of Austria, Sovereign Queen of
Italy. She is sure of it because she read the resolutions
of the Congress, whose sessions were held in a room
adjoining hers. The height of her destinies were almost
attained when the ambition of Victor Emanuel caused him
to interpose, he would not permit her to ascend the
throne of Italy, but caused her to be confined at great
expense in a fictitious asylum, the officers and patients of
which are police agents in disguise. Persecutions like
these cannot last forever, she will eventually achieve her
rights and ascend the throne.
Mme. 2.- after years of persecution by the League
and the Society of Propagandists, discovered that she was
not the daughter of an honest country physician by whom
she was brought up. Her enemies have assassinated this
to cause her
such continued perishe discovered that


Megalomania or Partial Lypemania.
455
ant.co He understa heir of the ngland, and this, he is
excellent man in order to abstract an ebony casket in
which was enclosed the documents and titles by the aid
of which she might some day have established her rights
to the Spanish throne; in fact, her true father is Don
Carlos; she professes for him the greatest filial affection,
and she preserves a pious admiration for her adopted
father, but she has not words to express her hatred for
the political schemers who cause her to be held captive
in an asylum.
B- , an ordinary peasant, occupation, commercial
traveler; in pursuit of his vocation has traveled in dis-
tant countries; everywhere he was the subject of persecu-
tions. He understands it all, now that he has learned
that he is the sole heir of the Plantagenets. He is the
rightful heir to the throne of England, and Queen Victoria
should abdicate in his favor. Instead of this, he is per-
secuted, adjudged insane and sequestered in an asylum.
M. M.— , of illegitimate English extraction, a profi-
cient engraver, whose life is rendered miserable by his
persecutors, who deprive him of his rights, and withhold
his great destiny. He creates for himself a double
personality; as an artist, he is the son of Raphael; as a
man, he combines the rights of the Bourbons with those
of Louis Philippe. During the last months of a life
shortened by a mental anxiety and pulmonary phthisis, he
declares himself to be Jesus Christ himself, returned to
earth to save the world, and until his death, he emulates
the Saviour.
The description given of the pathogeny and symptoms
of megalomania, although greatly curtailed, permits one,
it seems to me, to appreciate its character, and to deter-
mine its exact place in the list of mental diseases.
Thirty or forty years ago it was considered a distinct
species of monomania—the monomania of ambition and
pride. To-day it is not looked upon as a monomania, for
the delusions are complex and varied. It is not a dis-
tinct mental disorder—a separate pathological entity-for
it is a part of another malady, of which it presents but
a phase, or an advanced stage of development.
Megalomania belongs exclusively to that group of
maladies classified under the head of partial lypemania,
with a predominance of hallucinations and delusions of


456
Ach. Foville.
persecution. It presents the most complete systematiza-
tion of delusions of persecution.
This nosological theory, indicated in part by Morel
and by myself, formulated twelve years ago, has been
formally received by many French authors, who have
since that time given the subject their studious attention,
and if I presume in reproducing it before this Congress,
I do so because I consider it a demonstrated fact and
deserving of a place in medico-psychological science.
SELECTIONS.
CLINICAL NEUROLOGY.
LOCALIZATION OF THE VISUAL CENTERS.—Wm. Julius
Mickle, M. D., M. R. C. P., Medical Superintendent Grove
Asylum, London, reports in the Medical Times and
Gazette, the case of a blind bible-reader, aged sixty-five
years, who was admitted in February, and died in May,
1881. Three weeks before his admission he suffered the
first attack of mental disease, the symptoms consisting of
“maniacal excitement, delusions as to being starved and
ill-treated, incoherence, etc.” Further reference to his
mental condition must be withheld, as we wish to restrict
inquiry to the subject indicated in the caption.
“ This patient had, for more than twenty years, been
totally blind; the anterior segment of the globes was
opacified and cicatrized by disease, resulting from injuries
received by being kicked by a horse. Among other
symptoms immediately preceding death are enumerated,
albuminuria, bronchitis, attacks of pulmonary congestion,
slight pneumonia and dysphagia developed from time to
time, and persistent looseness of the bowels; right pleurisy
supervened, and finally, erysipelas of the face, and with
this the patient became dull, stupid and inattentive;
the legs appeared mottled with purple patches, septicæmia
appeared present and death soon followed.”
At the necropsy, the vertebral arteries were found to
be highly atheromatous, the basilar and inferior cerebellar
slightly so. Atheromatous patches in all the vessels and
slighighly atheropsy, the vert soon follo Patches, se


Selections.
457
Slitesting the uposting was presenons. * * Coin in parts
their branches entering into the formation of the circle of
Willis, particularly in the posterior and middle cerebral
arteries, the anterior cerebrals being almost free from this
change. * * The optic nerves, bound by slight adhesions
to surrounding tissues, were somewhat atrophied, but
of a softened yet stringy feel; and a section of the same
presented a dull, dirty whitish appearance, so often seen
in the optic nerve supplying long blind eyes ; optic tracts
wasted and soft. The gray cortex was very thin in parts
of the parietal and occipital regions. * * Considerable
convolutional wasting was present on both sides, mainly
affecting the upper part of the supra marginal gyrus, and
slightly that of the angular. In the occipital lobes were
almost symmetrically disposed patches of red softening of
the cortex, to which the elsewhere easily separable men-
inges appeared somewhat adherent. That on the right
side was about an inch from the great longitudinal fissure
and affected part of the second occipital gyrus, extending
through the intervening sulcus to the outer part of the
first occipital. On the left side, the patch of softening
had almost exactly the same position, but invaded the
third occipital slightly. Slight wasting of the left corpus
striatum, very slight wasting of both optic thalami, which
were pale and flabby. The geniculate bodies were not
well marked on the right side.
Microscopically, in the right supra-marginal gyrus,
the branching nuclear (neurogliar) filaments gave a some-
what lace-work appearance. The nerve cells were granular.
In the red and softened portions of the right second
occipital gyrus were atheromatous changes in the vessels.
Here, with long continued blindness, was symmetrically
disposed atrophy in the parietal regions of the cerebral
cortex on each side, mainly affecting the upper portion
of the supra-marginal convolution, and that of the angular
in much less degree. The microscopical changes in the
mninute vessels were well marked. There was also another
symmetrically disposed change in the red softening,
affecting parts of the second and first occipital convolu-
tions of both hemispheres.
This functional disease of both optic nerves for many
years seems to have brought about (a) symmetrical atrophy
and slight interstitial changes of portions of both supra-
marginal gyri, (and apparently slight, similar affection of
part of the angular also,) and (6) symmetrical vascular and
interstitial changes in the occipital lobes predisposing to
symmetrically were well markeroscopical chants


458
Selections.
local infarction; the starting point of these trophic and
atrophic local changes, being, of course, the cutting off of
the natural stimulus of the part by ophthalmic disease,
and, so far, consequent cessation of activity of the corres-
ponding centers. * * Evidence is afforded that what-
ever connections (if any) the optic nerve may have, it has
intimate functional and anatomical relationship with certain
cortical foci, in this case, symmetrically affected, certainly
with the supra-marginal gyri and, perhaps, also with the
second and first ɔccipital.
Though it be the special prerogative of science
to generalize, it yet differentiates and defines. Crude
cerebral anatomy first gave us the apparent and ap-
proximate sources of origin of the nerves of special
sense. The logic of this demonstration doubtless instigated
the hypothesis that sources of origin of psychical opera-
tions and their associate phenomena were also subject to
localization. When once the medical world was emanci-
pated from the thraldom of the dogma that the brain
acts as a whole in the determination of these, a mighty
deliverance for science was achieved, a notable era estab-
lished, for then was laid the corner-stone of the modern
doctrine of cerebral localization. Long before the time of
Bouillaud, the coexistence of aphasia, with certain forms
of paralysis, had been often observed, but he, in the year
1825, was the first to note and distinctly to proclaim its
intrinsic complication with pathological conditions affecting
circumscribed portions of the anterior lobes of the brain,
and thus demonstrated the seat of articulate language.
Broca, the contemporary of Bouillaud, elaborating the
doctrine by subsequent experiments, was enabled to locate
this faculty, save in exceptional cases, in the third convo-
lution of the left frontal lobe. (Ferrier has deemed aphasia
due also to embolism or thrombosis of the left middle
cerebral artery.) Thus, a well defined eminent entity in
cerebral pathology was established; a lodgment in the
wide domain of the unknown of cerebral physiology
achieved, a factor indispensable, and, if maintained, omnipo-
tent in the successful conduct of military campaigns.
From this demonstration the deduction is easy and
natural, that what is true of one faculty may be true of
all; for the Creator works according to general laws and
one scheme in the genesis and development of the species.
Convolutions and lobes immediately assumed unwonted
importance and significance, since discoveries in rapid
cerebral pain of indispensconduct eduction may be


Selections.
459
etallo Junction to also foungular
succession ascribed to each the residence of specific
endowments. Meynert, in 1866, demonstrated that to the
cortical substance of the fossa of Sylvius belongs the
function of receiving the impression of sound. The angular
gyri and portions of the occipital lobes are also found to
sustain important relations to the function of vision; while
inherent in the superior parietal lobe and superior portions
of both the ascending frontal and ascending parietal con-
volutions are the centers for movements of the upper and
lower extremities, respectively. This but very imperfectly
represents the present stage of the doctrine of cerebral
localization; and the time is not far distant when the
entire cerebral cortex will submit to a topographical survey,
at once, intelligible, philosophical and scientific, and made
with a precision transcending that assumed by the modern
phrenologists for the cranial configuration, because more
in harmony with reason and fact.
The case narrated presents most remarkable aggre-
gation of diseases, as diverse in character as in seat, viz :
air-passages, substance of the lungs, pleura, kidneys and
skin, from which latter septicæmia seems to have super-
vened, and to which, by the author, is apparently ascribed
the immediate cause of death. Notable pathological condi-
tions were present in different parts of the brain, cortex, ves-
sels, etc., incapable of intelligent detection, ante-mortem, to
which must be assigned the occasion of the mental dis-
orders manifested during life. Repressing a disposition to
review this interesting case in all its aspects, we must
confine ourselves to the ophthalmological phenomena and
these in relation to the sources or origin of the optic
nerve.
In this case, we find an observation of the fact long
since observed and recorded, that the destruction or pre-
vention of function is followed by atrophy or other form
of degeneration of the nerve by which such function is
determined. In reference to the optic nerves (the globes
having become incapacitated twenty years before), it is
stated “they were atrophied, softened, and of a dull, dirty
whitish appearance, and the optic tracts were wasted and
soft.” The supra-marginal and angular gyri did not escape
the general atrophy, in which condition the occipital lobes
were also involved, besides the more obvious sources of
origin of the optic tracts, viz.: the geniculate bodies,
especially of the right side, and the optic thalami. In
respect to their cortical origin, our author refrains from


460
Selections.
of these
guage
of function the resulter
the oracular reasoning, ergo hoc, propter hoc, for he employs
with some degree of ambiguity the word “seems;" e.g.,
“ functional disease seems to have brought about
symmetrical atrophy, etc.” This may have been the fact,
but such a deduction, to us, seems by no means impera-
tive, since portions of the cerebral cortex participated in
the general wasting, doubtless due to the atheromatous
condition of the vascular system of these several parts,
and not necessarily the result of trophic changes induced
by loss of function; and Charcot says, in forceful lan-
guage: “In the encephalon, the vascular systen commands
the situation.” We acknowledge loyal allegiance to the
doctrine of cerebral localization; but, in respect to the
optic tract, we are disposed to accord to it a much wider
extent of domain of origin than is ordinarily accepted.
Far behind those assigned in text books, its sources must
be; beyond even the cerebral depths of Charcot, the
angular gyrus of Ferrier, or the occipital lobe of Hitzig
and Munk. Each and all of these are but tributary
sources to a greater or less degree. The spinal cord
furnishes its contribution, as demonstrated by Stilling ;
and hence may be found a solution of some of the unex-
plained phenomena of amblyopia associated with affections
of the medulla. Clinical experience compels the belief
that the cerebellum sustains intimate and important rela-
tions to the optic apparatus. Stilling, indeed, has traced
bundles of the optic tract into the crus cerebelli and corpus
quadrigeminum, and from thence into the cerebellum.
Andral relates a case in which blindness was occasioned
in consequence of the development of tuberculous matter
in one of the lateral lobes of the cerebellum; and another
case from softening of the right lobe of the cerebellum,
in which blindness existed on the side of the body
opposite to that of the lesion. Amaurosis may ensue in
consequence of a tumor existing in the brain, and not
directly affecting the optic tract; it may occur also in
disease of the anterior, middle or posterior lobes. Beside
the sources of origin long acknowledged, Meynert asserts,
‘the optic tract extends to the arm of the inferior
bigeminum, which is essentially nothing but a fasciculus
of the corona radiata, whose origin is in the cortex cerebri;
and by its outer margin it is in connection with the crura
cerebri, and thus in connection with the olivary bodies,
and inferiorly with the anterior columns of the spinal cord.”
Is there no significance in the fact confirmatory of the
quadrigerelates a cashe developmen cerebellumies


Selections.
461
pat shall dene entire and thirty-s in the com
doctrine of the unknown multiple sources of origin, that
amaurosis occurs concurrently with hemiplegia, epileptiform
convulsions, paraplegia, locomotor ataxia, hydrocephalus,
etc.; and who shall deny that these sources may not
be co-extensive with the entire cerebral cortex, when
it is remembered that four hundred and thirty-eight thousand
represents the approximate number of fibres in the optic
nerve and tract, and that to each one of these is com-
mitted the prerogative of conveying to the optic ganglion
cells the luminous and chromatic impulses impinging upon
the three and a-half million rods and cones constituting
Jacobson's membrane, with which they are in communica-
tion? Who will deny the probability that the Creator has
subordinated the remotest masses of cineritious substance
for the perfection of the function of vision ?
Pertinent to this inquiry is the scheme enunciated by
Griesinger, as follows: “A fan-formed expansion can be
distinguished within the hemisphere, passing from the
optic tract to the summit of the posterior lobe; other
such radiations pass forward in all the anterior convolu-
tions, the high development of which is characteristic of
the human brain. The optic nerve and its roots are, in
the human species, relatively small, but the expression of
the nerve in the brain assumes an extraordinary devel-
opment. This expansion is not to be considered through-
out as a simple continuance of the fibres of the nerve
itself, but rather as a multiplication of these, or of the
addition of a new system of fibres of the optic nerve.”
The demonstration of the author, of “Subject and
Object," corroborates the views above expressed, respecting
the means by which the varying states of expression and
character are given to the eyes. The anatomical provision
for this purpose is found in connection with the optic
nerves, and the several cerebral masses subserving our
mental and emotional systems. On a careful section of
the brain, below the corpus callosum, we see a general
convergence of lines and bands of communication to-
wards the commissure of the optic nerves. The pillars of the
fornix come downwards to this very spot and blend with
the corpora albicantia ; and the fornix itself sends branches
into the cornua of the lateral ventricles, thus putting the
eyes into direct communication with the posterior and
middle lobes. The tenia semi-circularis of Haller extends
itself to and from the same localities. The same must be
said of the prolongations of the septum lucidum and the


462
Selections.
anterior folds of the callosum, which are reflected down-
wards, adhering to the optic commissure and becoming
continuous with the tuber cinereum, which is embedded
within the commissure itself. The albicantia and the
tuber are thus ganglia of expression and intermediate
organs of communication between the interior of the
brain and the retina.—Dickinson.
SENATOR ON BULBAR PARALYSIS.—Recently Senator
has reported a case (see Archiv. f. Psych. Bd. xi. p. 713)
which shows that hemianæsthesia alternans may be present
though the lesion is confined to the medulla oblongata.
A man, aged fifty-six, without losing consciousness
was seized with vertigo. He had the greatest difficulty
in swallowing, had a tendency to fall to the left side, had
a feeling of cold in the left half of his face, and had an
affection of speech which gave one the impression that
he was suffering from some obstruction in the pharynx
or larynx. There were no symptoms of motor paralysis,
except that the tongue was protruded a little to the left,
and the left eye appeared somewhat smaller than the
right. The temperature was normal, but the pulse beat
120 per minute. Five days later he was seen by Senator.
He was then complaining of difficulty in swallowing, of
hunger, and of want of breath. Sensibility was almost
completely lost in the left half of the face, and in the
whole right half of the body, as well as in the right arm
and leg. Attempts to swallow either liquids or solids
caused hawking and choking, and the substance was
returned, sometimes through the nostrils. The voice,
once powerful and clear, had become a whisper, and
there was still the inclination to fall to the left. The
patellar tendon-reflex was absent on both sides.
For a week there was little change in his condition.
Examination with the laryngoscope showed partial par-
alysis of the vocal cords. The electro-cutaneous sensi-
bility was either lost or very much diminished in the left
face and in the right half of the body. The patient died
of putrid bronchitis and broncho-pneumonia, after an illness
of fourteen days in all.
The post-mortem revealed a small focus of softening in
the outer portion of the left half of the medulla oblon-
gata, and thrombosis of the left vertebral and posterior
inferior cerebellar arteries. The greatest length of the
focus was attained a little below the middle of the oliv-
ary body; here the restiform body and the contiguous


Selections.
463
portions of Burdach's column and of the lateral column,
the ascending root of the fifth nerve, the motor nucleus
of the vagus and a portion of the fibre of the vagus were
all implicated. The olivary body, the root of the hypo-
glossus, and the nuclei of the hypoglossus and vagus' were
quite intact.
Senator remarks that the difficulty in swallowing, the
snuffling speech (due to paralysis of the pharyngeal
muscles), the altered voice, the rapid pulse, the hunger
and the feeling of want of breath were all symptoms
indicative in this case of lesion of the vagus nerve. The
absence of vaso-motor disturbances (with the exception
of a slight and transient lividity of the right arm), of
polyuria and glycosuria, is worthy of note; as also the
fact that there was no marked defect in the knowledge
of the position of the right extremities, notwithstanding
the loss of ordinary sensibility in them.—Brain, April,
1882.
A CASE OF EPILEPSIA FROM SCALP CICATRICES (?) is
also reported by Dr. Tuttle (same source) cured (?) by
subcutaneous section of the circatrices. The convulsions
did not re-appear during the life of the patient after
the operation, but he died suddenly in his bath, no one
being with him, some three weeks after; the attendants
and his physician, who saw him shortly after, found no
evidence of convulsions. He probably had an attack of
petit mal and was drowned.
The following interesting case is also reported from
the same source. Paralysis due to softening of lenticular
body :-
M. J., colored female domestic, felt a slight pain in
her head, and lost power and control of her left arm and
leg; drew mouth to left; never unconscious; sensation
normal; no power of motion in left side. Patellar tendon-
reflex was exaggerated on left side, normal on right; no
ankle clonus; area of cardiac dullness was slightly
enlarged; strong mitral murmur of the heart stroke.
Died, Feb. 23, 1882.
Post-mortem revealed the following conditions: Slight
pericardial effusion; ante-mortem “chicken-fat” clots in
the heart, one of which extended from ten to twelve inches
into the pulmonary arteries ; large organized clot in the
left side of the heart; great thickening of mitral valves ;
small cavity in the apex of the right lung; arteries at
the base of the brain bleached, numerous points of


464
Selections.
yellowish thickening, one of which amounted to almost
occlusion of the right middle cerebral artery just before
its entrance and division in the fissure of Sylvius; upon
the right side of the brain a cavity formed by softening
of nervous substance in posterior portion of the internal
capsule and lenticular body, about one and one-half inches
back of the anterior border of the caudate nucleus and
and one-quarter inch below the floor of the lateral ventri-
cle, was about the size of a hazel-nut, and circumscribed
by a center of softening involving the entire length of the
capsule and lenticular body, and also the posterior portion
of the crus cerebri of that side. The mode of occurence
and the nodular, atheromatous condition of the cerebral
vessels render it more than probable that the lesion was
embolic. There was no atheroma of the aorta or other
vessels in the thorax.
CHARCOT ON THE GALVANIZATION OF THE BRAIN OF
HYPNOTIZED HYSTERICAL PATIENTS.-(Progres Medical, Nos.
2 and 3.) Professor Charcot relates some curious experi-
ments showing that the cerebral centers apparently share
in the general hyperexcitability observed in certain hypno-
tized subjects. Makes and breaks, more especially voltaic
alternatives of a current from four to ten Leclanché cells
applied to one hemisphere, gave rise in several cases to
muscular contractions on the opposite side of the body.
In the waking condition no such effects were ever pro-
duced. In other cases, the muscular contractions occurred
on the same side of the body. Finally, in cases where
peripheral hyperexcitability was not well marked, the
effects of cerebral galvanization were but slight. Prof.
Charcot expresses himself with great reserve on this subject,
full of interest, but requiring careful investigation.—Ibid.
GoWERS ON A CASE OF Loss of TASTE FROM DISEASE
OF THE FIFTH NERVE. (Journal of Physiology, Vol. III., p.
229.)--A female, aged thirty-two, after certain premonitory
symptoms, was seized with sudden anæsthesia and paralysis
of the parts innervated by the right trigeminus. No
history of syphilis. On the whole right side of the tongue
the sense of taste had disappeared. The lesion probably
involved the fifth nerve near the pons; and though the
glosso-pharyngeal nerve was intact, yet the nerve of taste
had disappeared from those regions usually believed to
be innervated by it. The author concludes that in this
patient all the gustatory fibres arose from the fifth nerve.
-Ibid.
had didharyngeal nerve reappeared. She side of the


Selections.
465
RENAL CENTERS AND THE CORD.-Sachs (Pfluegers
Archives, book xxv.) finds from experiments on dogs and
rabbits that no direct nervous influence is exerted by the
cord on the kidneys. No direct effect over urinary
secretion produced by section. If there are centers for
the kidneys in the cord, they are not in its cervical
portion.- Ibid.
RELATION OF ANTERIOR CORNUA OF THE CORD TO
CERTAIN NERVOUS DISEASES FOUND DISEASED by Jarisch,
Vienna Centralblatt f. Nerven., No. 27, 1881), in chronic
herpes iris, psoriasis and lupus erythematosus. — Brain
October, 1881.
NEURO-THERAPY.
othe often veprary effecat
ather therake the view to the ne Brown-
MUELLER AND EBNER (ON NERVE-STRETCHING, Wiener
Klinik, vii., 1881), describe very minutely two cases in
which the operation relieved ataxy and anæsthesia, and
removed agonizing pains the patients had had twenty-two
and fourteen years, respectively. They look upon the
remedy as a symptomatic mode of treatment, with (prob-
ably) temporary effects only. Nevertheless, its results
are often very striking, and unapproached by those of any
other therapeutic measure.
They take the view that it acts by its finer molecular
effects, which spread to the nerve endings of the spinal
centers. The experiments of Brown-Séquard, Scheving,
Debove, Quinquad and others on animals, prove an altera-
tion in the spinal functions consecutive on stretching the
sciatic.
The result of nerve-stretching in affections of the
sensibility will depend upon the possibility of influencing
the spot of the irritative lesion by means of the mechanical
stimulus. Hence, the doubtful value of the operation
when the seat of morbid action is in the brain. In cases
of motor hyperexcitability, it is indicated when the lesion
is spinal (facial and accessory spasm, disseminated sclerosis,
late rigidity, etc.). It is useless in paralysis agitans,
athetosis and the like. In traumatic tetanus it ought to
be resorted to without delay. It may be of use in cer-
tain tropho-neuroses.- Ibid.
A CASE OF HYDROPHOBIA Cured.-M. Dennis-Dumont,
Surgeon-in-Chief of the “Hotel Dieu," of Caen, comuni-
cates to the Academy of Medicine, seance of June 13th,


466
Selections.
the case of a man aged thirty-eight years, who, attacked
with hydrophobia, was brought to the hospital at Caen, on
the 23d of last May, the man having been bitten on the
16th of the same month, also a woman and a little child,
by a vagrant mad dog.
The treatment consisted of bromide of potassium, four
to eight grammes a day; syrup of codeine and chloral,
internally, and of subcataneous injections of pilocarpin,
repeated at first three times a day, afterwards twice daily.
Under this medication, the crises were diminished
more and more, the disphagia lessened and finally ceased;
the agitation disappeared, the appetite revived, and in
about five days the cure was considered to have been
complete.- [Gazette des Hopitaux.
From what we know of the tranquilizing power of
chloral over the cerebro-spinal centers and of its antisep-
tic properties, it would seem that chloral in large dozes
ought to be our best remedy for hydrophobia and the
broinide ought to be of value. But why not use hydro-
bromic acid or Bibrons' bromine mixture, remembering the
efficacy of the latter in venomous snake bite ?
AMMONIA AND CAPsicum ENEMATA IN OPIUM AND Chlo-
RAL NARCOSIS.-Five years ago the editor of this JOURNAL
successfully employed enemata of one drachm of aqua
ammonia and tincture of capsicum in coffee, in a case
of profound opium poisoning with suicidal intent, to
which he had been summoned by Drs. Roemer, Hypes
and other physicians, after the employment of atropia.
The same remedy has proven efficacious in profound
chloral narcosis in our hands, hypodermic injections of
strychnia being added
[We take this occasion to note that in the printed
proceedings of the St. Louis Medical Society, for Novem-
ber, 1878, we are incorrectly reported as having employed
two drachms of each of the first named every fifteen
minutes. The quantity named by us in the remarks
reported was one drachm in fifteen minutes, till two
doses had been given, when the patient was on his feet
though his respiration had previously been four a minute
and gasping.–Ed.]
RELATION OF ACCESSION OF ACUTE DISEASE TO THE
RECOVERIES FROM INSANITY.–Acute diseases have long
been regarded by alienists as exerting, at times, a bene-
ficial effect, sometimes temporary, sometimes permanent,


Selections.
467
on the psychosis. The cases reported by Fritsch (Jahr-
bucher fuer Psychiatrie, Band III., Heft 3) are in full
accord with previous observations. Two cases of melan-
cholia were attacked by erysipelas. They became delirious.
On recovery from the delirium, they were found to be,
and remained, mentally sound. A case of progressive
paresis was temporarily improved. Similar cases have
been reported by Esquirol (Maladies Mentale), Sponholz
(Allgemeine Zeitschrift fuer Psychiatrie, Band XXX), Nasse
(Ibed., Band XXI.), and Macleod (Journal of Mental
Sciences, 1879).
A vaso-motor influence, modifying pre-existing morbid
vascular states is probably induced by these morbid
vascular accessions, and persisted in where recovery
follows.
A MENSTRUUM FOR ERGOT that shall render it palatable
and acceptable to the stomach is desirable, and we should
be obliged to the readers of the ALIENIST AND NEUROL-
OGIST for formulas. We usually combine each drachm
of the fluid extract with five or ten grains of the extract
of taraxacum, a fluid drachm of syrup of wild cherry and
a few drops of essence of peppermint, but this does not
always make the ergot agreeable, and it doubles the size
of the dose. Uncombined ergot is one of the most disa-
greeable of medicines to most patients who need it,
greatly disturbing the gastric functions. To overcome
this objectionable feature is to add fully one hundred
per cent. to its therapeutic value.
THE CURE OF EPILEPSY BY LIGATURE OF THE VER-
TEBRAL ARTERIES.—Dr. William Alexander, Liverpool,
reports in Medical Times and Gazette five apparently
hopeless cases of epilepsy cured by ligature of the ver-
tebral arteries. In three of the cases only one artery
was tied. In the other two cases, by tying one artery,
the symptoms were ameliorated, but the fits did not cease
until the other artery was tied at a subsequent vper-
ation. He has ten more patients under treatment with
apparently satisfactory results in every case. In three of
these he tied both vertebrals simultaneously without any
bad effects.—North Carolina Medical Journal.
A CASE OF CONTRACTION OF A SINGLE MUSCLE FROM
SPINAL INJURY relieved after six years, is reported by Dr.
James P. Tuttle, in Phila. Med. Times, service of Dr. H.
C. Wood, Philadelphia Hospital. The man was struck by
until these has ten moresults in everned


468
Selections.
a stone in the region of the sixth and seventh cervical
vertebræ, the immediate effect being paralysis from
shoulders down. But at the end of two years, nothing of
the injury remained but the contracted hand, which
almost entirely regained its functions under persevering
Faradism.
HyosciAMINE.—Dr. J. C. Shaw, Med. Sup't King's Co.
Lunatic Asylum, N. Y., has instituted a series of experi-
ments with this agent on frogs and albino rabbits (jour.
Nerv. and Ment. Dis., Jan., 1882), reaching conclusions not
greatly at variance with the experimental results obtained
by his predecessors on man. Physiological experimenta-
tion on inferior animals, however, will always be less
satisfactory than clinical experience with its administra-
tion to the human subject, not only on account of differ-
ences in nervous imppressibility and resistance, but because
the human subject may be more favorably placed for the
prompt reception of its proper therapeutic influence.
and Ment..ce with the expehysiological ways be less
THE AUTOPSY OF GUITEAU.
THE OFFICIAL REPORT by D. S. Lamb, M. D., Army
Medical Museum, Washington.-The following autopsy of
the President's assassin is all that has thus far been given
to the public:
The examination was begun at 2:30 P. M., one hour and a-half after
death. The body, was of a faint yellowish tint, that of a man five
feet seven inches in height, and weighed 145 pounds. (Eyes examined
by Dr. Loring, the pupils slightly and equally dilated ; vitrious cloudy
and fundus indistinguishable; conjunctiva of the left eye was con-
gested. He repeated the examination two hours later, and noted the
appearance as of a transverse fracture of the lenses.) A small white scar,
directed obliquely downwards, forward and to the left, and confined to the
scalp was observed and midway between the top of the left ear and median
line of the head (skull). The right parietal bone was slightly flattened
over the space about two inches juist back of the frontal parietal suture
and to the right of the interparietal. There was a slight flattened eleva-
tion in the corresponding internal surface of the calvaria. The frontal
suture was obliterated; others quite distinct. A number of pacchionian
depressions were observed near groove for longitudinal sinus. In thick-
ness the skull presented nothing remarkable. The membranes of the brain
the dura mater, was firmly adherent to the interior portion of the calvaria
in the vincinity of the longitudinal sinus. There were adhesions of the
dura also to the base of the skull. They were quite firm and, situated in


Selections.
469
the serveral fussæ, and most marked in the deeper parts of the fossæ,
where also there were small patches abruptly limited, of immoveable
arborescent congestion, with, however, no attendant thickening or pigmen-
tation. This stagnation was again most marked in the left anterior and
middle fossæ. There was no congestion of dura except at the points just
noted. The dura and pia matter were adherent to each other, and to
the brain on both sides along a limited portion of longitudinal fissure in
the vincinity of the pacchionian granulations. The dura was slightly thick-
ened along the longitudinal sinus. It was also slightly thickened and opa-
que along a portion of the line of the middle meningeal artery on each side.
The arachnoid of the upper convincity of the brain presented in many places,
where it covered the sulci, small patches of thickening and opacity; else-
were it was normal. The pia mater was anæmic anteriorly. Posteriorly
there was slight hipostases. The cerebral vessels appeared to be normal
in all respects. The obitual plates were well arched, and presented many
conical eminences of large size. There was no roughening anywhere of
the inner surface of the skull. The brain was firm. Its weight, including
cerebrum, cerebellum, pons and medulla and a portion of the dura, was
494 ounces. It was slightly flattened in the region corresponding to the
flattening of the parietal bone above mentioned. On the section of the
cer-brum there was an appearance as of slight thinning of the gray cortex.
Measurements gave depths of one-sixteenth to one eight inch in close
proximity to each other. The white substance was almost absolutely anæ-
mic. The cerebellum and isl ind of Reil were both covered on each side
the fissures. The fissures generally presented considerable depth, in
many places, as in the right fissure of Rolando, amounting to seven-eights
of an inch. The right of Sylvius was typical; the left was separated from
first temporal fissure by a slight bridge deeply situated; the right fissure
of Rolindo did not connect with the fissure of Sylvius; the left was sepa-
rated only by a small bridge deeply situaded. Both were separated from
the longitudinal fissure. The first frontal fissure on the right side was
not connected with that of Rolando, but at the posterior, part was crossed
by the secondary fissure. The same on the left side, except that the
fissure was crossed by a small bridge near the center. The second and
third frontal fissures presented nothing remarkable. There were numer-
ous secondary fissures.
The præcentral and retrocentred fissures on each side were well
defined, and were unconnected with other fissures. The interparietal
fissure on each side terminated in transverse occipital, separated only by a
slight bridge. The parieto occipital was well marked on each side. The
transverse occipital fissure on the right side was ill defined. It began on
the median surface and extended well outwards. The first temporal fissure
was well developed on the right side. On the left it was not of the usual
length. The Wernickes fissure was well marked on the left side, but not
confluent. The calloso marginal fissure was double on each side, the
upper of the two being properly the true one. On the right, the upper
one extended back to the anterior margin of the paricentral lobule on the
left, not quite so far. The lower one extended on the right side to a line
about half an inch in front of the parieto-occipital fissure, from wbich it


470
Selections.
was separated by a small bridge on the left side, also by a bridge of large
size, orbital surface. On the right side were seven tissures radiating from
a circular fissure surrounding small isolated convolution. On the left
side were five fissures radiating from a small shallow depression The
left collateral fissure was well defined, extending to the anterior extremity
of the temporal lobe. The right was also well marked, but did not
extend so far back as the other, and there was attempt at confluence
anteriorily with temporo-occipital, a small bridge intervening. The left
temporo-occipital fissure was well defined.
The Convolutions.—The following alone calls for remark: The ascend-
ing frontal was well defined on each side. The ascending parietal on the
right side was well developed in its lower three-fourths, but narrowed in
the upper fourth. On the left side, the narrowing was less marked. The
island of Reil presented on the right side five fissures and six straight
gyri; on the left side, reveral fissures and eight straight gyri. The para-
central lobule was well marked on the right side, small on the left.
Thorax and Abdomen. The usual median incision was made, and the
abdomen opened. There was extravasation of blood into the right pector-
alis major muscle near the second rib. The adipose layer of the abdom-
inal section was one inch in thickness. The dome of the diaphragm
extended up to the fourth rib on each side. There were old pleuritic
adhesions at the apex of the right lung ; upper and middle lobes were
congenitally united by connective tissue. The lung was normal throughout.
There was also old pleuritic adhesions of the left lung to the diaphragm,
and between its lobes three small tubercle-like pigmented patches were
observed in the upper lobe. The heart weigbed ten and three-quarter
ounces. Its muscular substance was apparently normal. There was
abundance of fat upon its anterior surface, and a villious patch of old peri-
carditis near the apex of the left ventricle. The right ventricle contained
little blood, just forming a clot. The valves were normal. The aorta was
slightly atheromatous for a short distance above the valves. All of the
abdominal viscera presented large accumulations of fat; they were normal.
The liver was congested. The gall bladder contained a little bile. The
spleen was lobulated and enlarged; it weighed eighteen ounces; capsule
was bluish, substance brown; malpighian bodies hypertrophied. The
pancreas was normal. The stomach contained food. The intestines
appeared normal, they were not opened. The kidneys were congested;
there was a small superficial serous cyst on the right one.
Notes.-1. A considerable quantity of dark blood ran out of the
heart in separation of the heart and lungs. 2. Dr. Young states that the
man was subject to malarial attacks wbile in jail. 3. He had eaten dinner
an hour and a-half before the execution.


Selections.
471
Report of Drs. Sowers and Hartigan, at Washington,
D. C., July 13th:
“So much contention has grown out of the making of this autopsy,
and recently there has been so much controversy made public through the
press concerning it, tbat we are constrained to give a brief history of the
case.
“ Brain Membranes.—The dura mater was quite strongly adhering in
places to the inner surface of the skull; viz.: near the trunks of the middle
meningeal arteries; also near the longitudinal sinus in front, but could be
stripped clearly from the bone at all these points of attachment, as there
was no roughening of the skull bere or elsewhere. There was no exuda-
tion on any part of the inner surface of the dura mater, Quite a number
of pacchionian granulations were distributed along the course of the
sinus. The cerebro sinuses contained but little if any blood. The dura
mater, pia mater and brain were adherent to each other on both sides and
along a limited portion of the longitudinal fissure adjacent to the pacchi-
onian granulations of the arachnoid. There were very well marked milky
opacities of the arachnoid, but no apparent thickening, extending over the
upper portion of the convex surface of the hemispheres only. As else-
where the membrane was perfectly normal. These opacities were confined
to the upper portion of the sulci in this vicinity exclusively, and were such
as are often found without previous history of disease. The sub-arachnoid
space contained very little fluid; pia mater was easily stripped from all
parts of the brain. The blood-vessels of the membranes and brain were
empty, and the general appearance of the brain was anæmic.
Both these conditions can be readily accounted for by the unfortunate
removal of the lungs and heart, and the severing of large blood-vessels by
Dr. Lamb before the brain or its membranes were exposed or examined
and on this account nothing of importance was attached to this condition,
as the blood that was in the brain at the time the autopsy commenced had
opportunity at least of making its exit into the chest cavity. Sufficient
examination was made of the large blood-vessels of the brain to determine
that they were in a healthy condition.
“Brain.-The brain entire, with a portion of the dura mater attached,
weighed 494 ounces, about the average weight for an adult male. Just
how much more it would have weighed had it not been drained of its blood,
and had the scales been more delicate, we are unable to say, but certainly
it is safe to assert that it would have been considerably more. The consist
ence of the brain was normal; its specific gravity and measurements of its
cortex areas could not be obtained, owing to lack of facilities. There
was no apparent asymmetry of the two hemispheres. As regards contour
and shape, exact studies were not made, and comparative weights of
different parts were not obtained. The cerebellum was well covered.
The occipital lobes were not noticeably blunt or sharp.
“ We desire to state that we were not in accord with Dr. Lamb in the
order adopted by him in making the autopsy. We did not object at the
moment for the reason that it had been agreed that he (Lamb) should do the
cutting, and after this agreement we did not feel at liberty to interpose an


472
Selections.
objection at the very instant of the beginning of work, with a number of
genilemen present by invitation to witness the operation. We thought
then, and think now, that the brain should first have been opened and ex-
amined, ir stead of which the first incision made by Lanıb was in the
region of the beart, and wben the iboracic cavity was laid open we had no
idea that it was the intention of the operator to sever the large vessels
which must necessarily be cut in the removal of the heart before an exam-
ination of the brain was had. The cutting of these vessels was the work
of an instant, and was done before objection could be interposed. That the
brain had been cut in pieces and the parts distributed, and tbis before its
examination under microsc pe, is true, It was done without consultation
with, or authority from us, and furnishes another instance of what has
been apparent all through this proceeding-unwarranted assumption of
authority and responsibility by Dr. Lamb."
[The lamb and the lion did not lie down together in the Guiteau
autopsy matter. The result is neither luminous nor brilliant.–Ed.]
AUTOPSY of a Chronic Lunatic, twenty-nine hours
after death, who died of fæcal accumulation and its con-
sequences, after a residence of thirty years in the Royal
Edinburg Asylum. Reported by Dr. Carlyle Johnstone,
M. B., Senior Assistant Physician. Abstract from Journal
of Mental Science for July:
Mrs. T., admitted May 10th; 1852. Age 34; married. Died February
1882. Aged 64. Body poorly nourished; abdomen measured 3 feet 7
inches in circumference at umbillicus; percussion note generally clear.
Brain. Membranes normal. Considerable escape of cerebro-spinal
fluid on removing organ. Frontal convolutions small. Floor of fourth
ventricle granular. Organ otherwise fairly normal.
Heart healthy. Lungs compressed and of doughy consistence; firm
adhesions at both apices posteriorly; in each apex a small cicatrix and
limited area of caseous and granular degeneration. Liver slightly mottled
on section; consistence normal; gall bladder empty; no gall stone.
Kidneys, capsule very firmly adherent to cortex; cortex pale and granular
in appearance and much diminished in size.
Intestines.—The intestines are enormously distended with flatus and
fæces. The ascending colon measures 2 feet 24 inches in circumferences;
the remainder of the large intestine is distended to a somewhat less
extent. The rectum completely fills the pelvic cavity, the bladder being
pushed upwards, and the uterus compressed and flattened, and increased
in its transverse diameter. The small intestine is fairly normal in size
and contents. There is no abnormality at the ileo-cæcal valve, and there
is no stricture or other organic obstruction in the course of the large intes-
tine. The large intestine is crammed with soft fæces, while the rectum is
tighly and closely packed with fæces of hard consistence. Section of the
intestine shows great hypertrophy, the walls being about twice the nor-
mal thickness. The increase is chiefly due to the excessive development of
muscular fibre. The mucuous membrane is considerably congested in
patches, and there are numerous snall superficial erosions.


EDITORIAL
ental status unprejudicial psychoand trial were
e sus the countrunited vode
GUITEAU'S TRIAL—The time and place, and all the
circumstances attendant on the tragedy and trial were
not conducive to an unprejudicial psychological inquiry
into the mental status of Guiteau, or calculated to lead
to such a cool conclusion as might commend itself to
the calmer judgment of the unbiased future.
The "stalwart” press, representing a wing of the Repub-
lican party, at once suspected of collusion with the crime,
wishing to show to the country their innocence and
execration of the murder, with united voice and intense
vehemence, demanded the criminal's blood. The “half-
breeds," chagrined, mortified, thwarted and stricken with
grief and horror at the tragic and sudden death of their
lamented leader, most righteously demanded vengeance,
and the lately estranged South, wishing to demonstrate
the sincerity of its professions of renewed fealty to the
Government, and wipe out the stain of the martyred
Lincoln's death, vociferously joined in the general cry for
Guiteau's execution. Added to this, the frenzied mob, seek-
ing and almost accomplishing the prisoner's assassination,
and threatening death to counsel, judge and jury, if, by any
chance, any other verdict than death might be reached,
and to this add still the rulings of the court at variance
with many phases of morbid mental function, “that knowl-
edge of right and wrong is always evidence of responsible
sanity," and the yet stronger influence than all others, exist-
ing in the overwhelming demand of public polity, that
where a criminal is arraigned for a capital crime, having in
it the essence of treason, and the guilt of the deed is proven,
it is extremely doubtful if any consideration ought to acquit.
Under all of these circumstances, what reasonable
chance was there for the life of the maddest man in Bedlam,
much less for the calm conduct of a psychological inquiry
into the mental status of a psychical anomaly, a mental
phenomenon, undeniably unique in so many marked fea-
tures ? So singular in his mental make-up that, while no
one doubts his unsoundness, the expert opinion of the day
is divided as to the condition of his mind with reference to
responsibility to law and that technical mental state
bis always evidnction, “thatvariance


474
Editorial.
satisfactwithstanding thed the display lish trial of Bellindisse
termed insanity, itself so variable and indefinitely under-
stood in its obscurer phases as never yet to have been
satisfactorily or, at least, unobjectionably defined.
Notwithstanding the semblance of a fair trial, conforming
to the forms of law, and the display of less indecent haste
than characterized the historical English trial of Bellingham,
whose arrest, conviction, sentence, execution and dissec-
tion occupied less than ten days of public attention,
Guiteau's trial was conducted in the same spirit. Public
opinion ruled the judge and jury, and largely determined
the character of the testimony. Its blighting bias even
influenced the medical expert opinion, unconsciously, no
doubt, but none the less effectually, as no solitary con-
cession was made of the misguided wretch's most
apparent mental weakness, to say nothing of his possible
insanity. The explanation of purposive simulation was
made for acts and speech plainly the promptings of a
mental character either morbid or naturally unsound.
Few of the government experts dared to say, what is
most clearly apparent, that though we should concede
his insanity not proven, many of Guiteau's acts and
words, before, at the time and since the tragedy, were
strangely inconsistent with normal mental balance, uncom-
plicated by immediate or remote disease.
The poor wretch whose crime is now expiated to the
satisfaction of the clamorous crowd, was pronounced a
consistently immoral character in defiance of his vacillating
life history of mingled good and bad acts and impulses.
Limited definitions of insanity were given, as if they compre-
hended the whole subject, which has never been defined.
The existence of forms of insanity most clearly demonstrable
were declared non-existent, and the physical factors in
mental disease were declared to be the significant elements,
despite the fact that in many phases the psychical signs
alone reveal the aberrant mental movements, and by
inference only the morbid somatic substratum.
Opinions equally positive came from the other side.
The uncertain physical evidences of his insanity were
undoubted. His cranial atypy marked him as a moral
monstrosity, and only a fool could see signs of sanity in
him. Yet the signs of his sanity, as well as of his insanity,
hole subje insanity moshe physical
evealach that in lated to be the physical mom
were here have bee countries, ha vout in the pa
There have been times when medical experts in
psychiatry, in other countries, have dared to say they did
not know things not fully proven, but in the presence of the


Editorial.
475
late phenomenal, foolish and insane criminal at Washington,
the most complex psychical problem of the century
becomes as plain as the determination of a plain case of
dementia, acute mania or perfect sanity.
We make no harsh criticisms on the medical experts.
They formed their conclusions, pro and con, the best they
could in such an atmosphere of prejudice, fury and
passion and in the light of the testimony; and he was
badly defended. No mighty Erskine stood by him to
stay the waves of popular indignation and fury, and bring
out all the facts in their fullest force touching upon the
question of insanity. But undoubtedly there was something
mentally wrong with Guiteau, and the country is not
yet satisfied that he was not insane, nor will it be con-
vinced of his real mental condition till after the sober
second-thought of posterity pronounces a calmer verdict
than has been rendered at Washington.
How different had been the result had the govern-
ment displayed less haste and postponed the trial, with its
undignified, mad and indecorous incidents and final insane
displays on the scaffold, until after a calm medical
inquiry had pronounced upon the prisoner's mental
status, and then, having ascertained his sanity, if that
could have been thus established, proceeded with solem-
nity and decorum to pronounce his guilt or innocence. How
absurd for an ordinary jury to decide the existence or
non-existence of disease from a detail of the presence or
absence of symptoms conforming or not conforming to
certain defective definitions, and often first filtered through
the sieve of judicial opinion.
In matters of disease, before courts, medical testimony
should be final and founded on all the facts attainable,
not merely such as, in times of great excitement and
prejudice, it is possible to get before the experts, or such
as the courts may regard as essential symptoms. If
disease or defective mental organism excuses crime before
the law, nothing should be permitted to stand in the
way of its discovery in the arraigned one's behalf, when
it is pleaded, and any legal proceedure that cripples or
embarrasses effort in the direction of the discovery of the
existence or non-existence of disease under such circum-
stances is violative of the rights of the afflicted before
the law, and ought to give way to medical methods for
the determination of medical questions.
As matters now are, if the angered god of public
um to learn
it on a


476
Editorial.
opinion demands the sacrifice of any madman, it must be
made, and, per contra, if the same diety looks with
complacency on certain forms of homicide, the plea of
insanity finds acceptance in the most doubtful cases.
The murderer whom this god 'would save he first makes
mad.
The evidence of his insanity, aside from his own
conduct, was not made indubitable by the bungling
presentation of his attorneys, and his conduct, though
insane enough, neither excited sympathy nor established
irresponsibility to the minds of most of those who saw
and heard him at the trial. But he was his own best witness
on the scaffold, and that was the place from whence the
public were most willing to receive evidence of his insanity.
THE NATURE AND DEFINITION OF INSANITY.—It is more
easy to recognize the nature of this disease than to
so comprehensively define it as to leave no room for
exceptions. It has from time immemorial been regarded
as a mental disharmony of the individual with his sur-
roundings, and various causes for this disharmony have
been assigned and coupled with its definitions. Thus, the
ancients regarded this disharmony as the result of deities
offended; later, satanic possession and witchcraft were
suggested, and a very respectable modern medical writer,
Dr. Burrows, regarded it as a penalty for sin.
The latest and now generally recognized definitions
always include disease implicating the brain as one of
the factors to be coupled with the maladjustment to
environments. Of late several notable descriptions have
appeared which serve to show the harmonious concep
tions of the disorder existing in the minds of those who
study it well, though they express no feature really
newly observed. These attempts to formulate its distin-
guishing features will, in time, ultimate in a satisfactory
definition.
Dr. J. G. Kiernan (Gaillard's Medical Monthly, Nov.,
1880) defined it to be “a morbid condition produced by
disease or malformation of the brain which perverts the
mental relations of an individual to his surroundings, or
to what, from his birth, education and circumstances,
might be expected to be such surroundings.” Dr. Chas.
Mercier (Journal of Mental Science, Jan., 1882) says:
“ Insanity is a failure in the process of adjustment of the
organism to its environments ;” and Hughlings Jackson
(cited by Ringrose Atkins, Dublin Journal of the Medical
arded Satanic spectab
ancieded; Tated a very it as a pily reco brain ast
st and new implicating the maladi


Editorial.
477
the sized
Maudsley n d. 1867), page 9Organism-hat
? his son to the
Sciences, May, 1882) says: “Insanity is the loss of the
acquired relation of man to his surroundings."
But these descriptions are not essentially different from
the old definition of Dr. Gooche, adopted by Andrew
Combe, and accepted and italicized by Ray in his
unequaled jurisprudence of insanity, namely : a “prolonged
departure, without adequate external cause, from the state
of feeling and modes of thought usual to the individual."
Maudsley recognized it in his first edition (Phys. &
Path. of Mind, 1867), page 199, as “a disturbance of the
harmonious relation of the organism and the external
world, by a concurrence of cau es both within and exter-
nal to the organism. Blandford, Bucknill and Tuke, and all
the French, German and Italian writers, have discussed
insanity on the basis of a conception which recognized it
as a mental maladjustment to environment, though they
have not precisely so expressed.
For fifteen years we have so regarded and defined it
before Courts, and with such qualification as we give
below, it is the best discriptive formula in which to
aggregate its various and varying phenomena. We quote:
“ Insanity, therefore, whether acute or chronic, and howsoever acute or
howsoever chronic, is such a mental change in the individual resultiny from
cerebral disease, as causes him to act not in hırmony with his natural self and
surroundings.
In a state of mental health the mental faculties appear to act as a
whole. There is a peculiar harmony in their action, and in their relation
to each other in action, giving to each person a distinct mentality, and con-
stituting the individual's natural character.
In insanity this natural, harmonious action is disturbed, and the
lunatic is neither in harmony with himself, as he has appeared naturally
or with his surroundings. He is deranged iu regard to both.
If no change in the habits of thought, feeling or action of the individual
takes place then it is not insanity. The true test of insanity, therefore, is the
comparison of the individual with his former self taken in connection with
disease of the brain.
There are but few objections to this definition that I know of; the
principal one being aphasia, where no mental aberration of necessity really
co-exists, for a man may be both aphasic and insane.
Here then is a disease of the brain which always produces, to some
extent, a change in the manner, if not in the babit of thought of the amicted
individual, and in some of his feel ngs and modes of action, and yet there
need be no insanity in consequence of it.
Thus you see how difficult it is to find an absolutely unerring definitivn
of this disease.
But if the aphasic person, or the individual suffering from cerebral


478
Editorial.
traumatism, especially of the anterior lobes of one hemisphere (as some-
times happens, without delirium or other mental disturbance), recognizes
in a rational manner, that his brain is injured, and appreciates the extent
of his disability and the necessity for modified mental and physical active-
ity and comports himself inentally in accordance with the facts; he is not
insane and it is here that the qualifying clause, in harmony with one's
natural self and surroundings becomes the saving clause that establishes one's
sanity, even though he have disease of the brain, while our inability to truth-
fully affirm the existence of this harmony, establishes the presence of mental
disease.
The brain may either be primarily or secondarily involved in disease.
The principal cause of the insanity may be mainly in the sympathetic
nervous system and largely dependent on disease of the uterus, tbe genitals
or the liver.
As the cerebro-spinal centers may morbidly influence through motor,
sensory and sympathetic nerve channels, the tissues and organs with which
they are in communication, so may morbid states at the periphery of
nerves, reciprocally affect the brain, as is illustrated in epilepsia, convul-
sions and neuralgia; and, as other diseases are occasionally devoid of their
usual characteristics, 80 may we sometimes fail to find any physical sign
of insanity.
In those exceedingly rare instances, where the subtile morbid pio-
cesses still escape our search for them, we need not therefore conclude
that there is no disease, if we but remember how far more subtle then the
inost penetrating research, are the processes of disease in the human organ-
ism elsewere; as in the insidious morbid changes which first follow the
imperceptible, imponderable, intangible virus, or germ, or malaria, of an
atmospheric infection, the unseen and unknown contagia of the exanthe-
mata, the quick and certain work of some of the more tangible but infini-
tesimal poisons, or the structural causes of such undoubtedly physical
diseases as hysteria, tetanus or chorea. I need not illustrate further.
It must be borne in mind that every definition of this disorder is an
attempt to aggregate many morbid conditions into one comprehensive
and brief description—to so unify all the neuro-psychic disorders b. ginning
or ending in the brain and disordering the mind, as to make any and every
form of insanity readily recognizable by applying to it the test of a single
comprehensive definition, yet we succeed better in grouping together all
the diseases of the brain affecting the mind, then if we were to attempt to
comprehensively define all the diseases of the spinal cord or nervous
system elsewere, effecting sensation and motion.
The beginning of all disease is altered molecular action, either in the
blood, which nourishes a part or organ and which is its life, or in the
nerves, which constitute the soul, so to speak, of organic function. Next
follows more profound changes, which we recognize as structural and
marked derangement of organic functions; we then have recognizable and
appreciable disease. When there is either a functional or structural dis-
ease of a whole organ, we have change in its natural manner of acting,
whether it be in the heart, the lungs, the liver, the abdominal or thoracic
viscera, or in the cerebro-spinal axis.


Editorial.
479
Wherever it may be the natural manner of action is changed, and the
organ or part involved is neither in harmony with itself naturally nor with
its surroundings in the organism.
So it is with the lower and higher centers of the brain; if the former
are effected, paralysis results; if the latter, psychical disturbance.
So that insanity conforms to the law of all other diseases in being a
departure from natural function due to morbid invasion, and differs from
them only in the fact that the invaded territory is that which is occupied
especially by the mind."— Extracted from an address by the Editor, on
the nature and definition of insanity, read before South'n Ills. Med. Ass., at
Sparta, Ill., June 20, '79, and published in the St. Louis Med. and Surg. Jour.]
The mere maladjustment to one's environments does
not make insanity in every instance. There must, in
addition, be a departure in the ordinary harmonious con-
formity of the individual with his natural mental char-
acter. The idiot, the imbecile, the genius, the eccentric
and the enthusiast is out of harmony often, with his
environments, but when, in addition, a mental maladjust-
ment to his natural self is brought about by disease,
either hereditarily transmitted or acquired, we recognize
the insanity as begun.
The best distinction possible to make between idiocy,
imbecility and allied congenital or co-natal mental condi-
tions is on the basis of maladjustment to environments.
While the phrase embraces congenital forms of insanity,
the qualifying clause, out of harmony with the natural
self includes all lunatics and excludes the insanity of
imbecility, idiocy and allied hereditary cerebral conditions.
Yet there will probably be found objections to our defini-
tions, just as we, before framing our own, found objections in
every other. The more we study insanity, the more our
conceptions of it widen, and the broader our views of its
nature and varieties become, the more narrow and inade-
quate appears the average definition. We think we have
struck a comprehensive definition, but others, and perhaps
we ourself in after years, may find that we have missed
it and only made an approximative description as those
have done before us.
the the best i allied Coof mala
THE LATE Meeting OF THE AMERICAN MEDICAL
Association, at St. Paul was one of profitable recreation,
agreeable reunion, harmonious understanding of some
essential matters and some valuable work.
The attendance was unusually large, and under this
circumstance the unanimous action of the Association in
excluding the New York delegation was quite significant.


480
Editorial.
such upon at St. an associ
The difficult undertaking of an association medical
journal was determined upon at St. Paul and we are soon
to know whether such a desireable feature (if properly
managed), can succeed in this peculiar country of intensely
rival local medical interests, so different from England
with its one London, or France which is Paris, or Ger-
many which is Vienna, in all that concerns medical
instruction.
Many of the shining lights of the profession were
conspicuously absent at St. Paul, as usual, but the vener-
able Atlee was there and was made president.
In connection with his name an occurrence took place
which indicates how easily the Association may be mis-
lead through its influential members. Some one moved
that this veteran physician of two centuries who was then
sitting in the audience, be invited to take a seat on
the platform, this was duly seconded, when the “father
of the Association," punctilliously perceptive of the pro-
prieties, remarked that there was a time for Dr. Atlee to
be asked upon the platform, which was sufficient with
the unthinking, to kill the proposition to justly honor
the oldest physician in the assemblage, who had come
into it from the eighteenth century and who, president
or not president elect, was entitled to a place of honor
on the platform even though he had not been vice-
president, and could as well have been presented from there
as from the "ground floor,” as was subsequently done.
The proposition to allow permanent members the right
to vote, was killed in the same way by a specious
suggestion that the proposition might annul the right of
States on the floor, as if the States have any special
rights except such as appertain to physicians in general
in good standing in the profession, and as if it might not
be a possible necessity at some time to exercise just
such a right in behalf of individuals against States; a
contingency which has already come in regard to the
New York members. Under this absurd ruling, the New
York society disfranchises, in the National body, all of
the physicians of New York. Venerable and influential
men in this body are under a double obligation to speak
with prudence, because their errors of judgment are
weighty. The American Medical Association is not solely
a confederation of representative medical bodies politic,
but it is a national organization of medical men, in which
all regularly entered members are entitled to equal floor
into it president even tho have been pequently dothe right
presiom the position to in the sa might anave any get


Editorial.
481
favorite in Medicineded with digs satisfactory: filled the
privileges. What is the value or honor of permanent
membership if it entails the discrimination and degrada-
tion of disfranchisement ?
The work of the sections went on fairly well. Marcy's
address in the Section on Medicine, Byrd's address on
Surgery, Porter's on Laryngology, Gihon's on State Medi-
cine, and Battey's, in the Obstetrical Section, on his
favorite operation, were well received, and Octerlony's
address .in Medicine was masterly and classical. Presi-
dent Hooper presided with dignity and decorum, his
address being excellent, and rulings satisfactory. Atkinson,
the secretary, and Dunglison, the treasurer, filled their
positions with accustomed fidelity and efficacy and all
the standing committees faultlessly filled their several
functions,
Dr. Stone and his collaborators on the Committee of
Arrangements and the Reception Committee discharged
their onerous duties beyond expectation and the possi-
bility of cavil.
The receptions at St. Paul and Stillwater were excep-
tionably hospitable, eliciting universal commendation for
their completeness, and the grandly magnificent hospitality
of the Northern Pacific; St. Paul and Duluth; St. Paul,
Minneapolis and Manitoba Railroads, added to that of
the citizens and profession, made the late meeting of the
medical profession at St. Paul, one of the most meinor-
able for the substantial entertainment, recreation and recu-
peration of its members, in its history.
What matters it that little professional work was done?
What was done was good work and well done, and all
have returned home better fitted for the arduous life
labor they left unfinished, better qualified by their visit
to St. Paul, the north lands of Manitoba and the western
empire that skirts the northern Pacific, to fittingly take
up and complete their work resumed.
In the State Medicine Section, expert medical testi-
mony was discussed, and it was resolved that subpoenas
for medical men called as expert witnesses should be so
worded as that they should appear as summoned to
advise the court and not to testify for a side. In this
section, for the first time in the history of the Associa-
tion, a plea for the rights of the insane was read, in
which it was maintained that the insane are entitled to
medical inquiry by medical methods; to judicial rulings
in accordance with the nature of their disease, and that
mile for the substantiars in its history. I work was do
tiestion, for court andey shouxpert wifolved


482.
Editorial.
the claim made by courts, that a knowledge of right
and wrong is always evidence of sanity, is incorrect;
and that the criminal insane should be confined for life,
and be prevented from transmitting the disease to posterity.
: GENERAL PARALYSIS.—What Crichton Browne said
in his excellent monograph on general paralysis (in West
Riding Asylum Reports, 1876) with reference to the
reports of cases, then available, viz: “that they are to
brief and general, the best of them being wanting in detail,
the most of them being vague and valueless," can not so
truthfully be said since the appearance of the treatises of
Voisin, Mendel and Mickle; nevertheless the records are still
defective in many cases, as Browne has observed; "in some
records of cases” it is still quite curious to notice (now and
then) " with what perverse consistency all that is iniportant
is left out of the history of cases of general paralysis,
while all that which is irrelevant and trivial is inserted.”
There is one obstacle that yet seriously interferes
with the acquisition of such full trustworthy histories of
cases of this disease, “and that is the non-recognition of
the disease in its earliest and probably most instructive
stage. It is generally well advanced before it is identi-
fied. It has often existed for many months before asylum
treatment is resorted to, and thus but few opportunities
are afforded of noting its beginning and primal growth.”
Bayle, Calmiel and Delaye have left us clearly enough
defined clinical descriptions of its advanced stages; what
we yet need are delineations so numerous and confirma-
tory of its initial or prodromal stages as to leave no room
for doubt as to whether the psychical symptoms, as J.
Crichton Browne asserts, appear first in order of time
(West Riding Reports, 1875, p. 223), or whether the dis-
ease “does not necessarily begin in the head," as asserted
by Dixon (Insanity, p. 245), or that "it has not been
proved to be essentially a disease of insanity," as the
latter asserts (Ibid., p. 234).
“The subjects of progressive paralysis are not all
insane,” said Dixon, p. 235. “Insanity may precede,
accompany or be superinduced upon progressive paraly-
sis," said the same writer (p. 247), and Aitken asserted
that there are on record cases where it existed without
mental symptoms; that it is a distinct species of paraly-
sis rather than a mere variety of disorder of the intellect
(p. 356).
But, thanks to such recent contributions as the book


Editorial.
483
of Dr. W. Julius Mickle, we are receiving clearer light than
formerly, and we shall likely be able to say with some-
thing like unanimity of opinion based on common and
amply confirmatory observation, that there is, from the
beginning, an essential psychical factor in the causation of
the early paretic phenomena however obscure. Its incep-
tion is in the brain, and its chief cause over-mental strain
and consequent exhaustion, whatever other causes may
coöperate or precede.
The determination of the question beyond dispute has
an obvious medico-legal significance.
THE KNOWLEDGE OF Right AND WRONG Test in MEN-
TAL ABERRATION, when applied by courts of justice without
qualification as a criterion of responsibility, regardless of
all other mental perversions possible, where mind is involved
in disease, is a disregard of the facts of medical observa-
tion and a wrong against the helpless insane in certain
instances.
Judicial instructions cannot make that true which is
false in fact and contradicted by science. Law may define
the boundaries of States and quarantine disease, but it
cannot restrict the invasion of mental disorder to the
knowing faculties, for insanity is a law unto itself, just as
convulsion is. It is itself often a psychical convulsion, in
which knowledge yields to morbid impulse. Courts should
not instruct on the subject of mental disease unless they
will instruct truly. Juries had better have no instructions,
than be misled by the Bench. It is not uncommon to
hear during a trial the statement made and reiterated by
experienced medical witnesses, that in certain forms of
insanity the abstract knowledge of right and wrong may
exist, while the will, by reason of disease, is in certain
cases absolutely powerless to resist the over-mastering
influence, and at the conclusion of the testimony to
hear the solemn judicial mockery of justice, outraging the
rights of some poor helpless lunatic, as helpless as if a
tornado had moved him bodily, in such words as these :
“If you believe that the prisoner knew what he was doing
at the time the act was committed, you will find for the
State," etc.
As well hold a judge responsible for abruptly and
indecorously leaving his seat on the Bench before the
resistless vis a tergo of a cyclone, as insist on this criterion
as a true test of responsibility in certain forms of mental
convulsion caused by uncontrollable cerebral disease.


484
Editorial.
In most forms of insanity before courts the victim does
not know right from wrong, especially with reference to
the particular act committed. In such forms the right
and wrong criterion is a good one, but the varieties of
insanity — the insanities rather — are many. It would be
just as rational to apply a uniform test to all bodily dis-
eases as but one criterion to responsibility in all the forms
of insanity. Mental disease has a way of its own of
dealing with human minds not subject to judicial regulation.
THE ASSOCIATION OF MEDICAL SUPERINTENDENTS OF
AMERICAN INSTITUTIONS FOR THE INSANE held its thirty-
sixth annual meeting in Cincinnati, from May 30th to
June 2d, 1882, and about forty members were present.
The medical profession of Cincinnati gave a very
courteous and generous reception to the members on
Tuesday evening, and visits were made on other days to
the Longview Asylum, Cincinnati Sanitarium, the Asylum
for the Insane at Dayton, and also the Soldiers' Home at
Dayton.
Dr. C. A. Walker resigned the office of President, and
Dr. J. H. Callender was elected President, and Dr. J. P.
Gray, Vice-President.
It was resolved that in the future the election of
president should be annual, and that he should deliver
an address at the opening of each meeting.
Dr. Hughes read a paper containing the relation of a
case of Moral Insanity. Dr. Bucke, on the Development
of the Intellect. Dr. Hurd, on Periodic Insanity. Dr.
Dewey, on the Differentiation and Segregation of Certain
Classes of the Insane. Dr. Rogers, on certain Effects of
the Alkaloid Cinchonia, particularly as a Paretic to the
Powers of Accommodation of the Eye; and Dr. Fisher,
on the Mental Status of Guiteau.
Conformatory of a resolution of Dr. Rogers, of Indian-
apolis, the president appointed committees to report at the
next meeting on the following subjects:
1. Annual Necrology of the Association.--Drs. Gris-
som, of North Carolina; Wallace, of Ontario, and Stearns,
of Connecticut.
2. Cerebro-Spinal Physiology.-Drs. Gundry, of Mary-
land; Chapin, of New York, and Kilbourne, of Illinois.
3. Cerebro-Spinal Pathology.-Drs. Clark, of Ontario;
Kempster, of Wisconsin, and Mitchell, of Mississippi.
4. Therapeutics of Insanity and New Remedies.—Drs.
Rogers, of Indiana ; Strong, of Ohio, and Gale, of Kentucky.
on the Mentacommodation particularly on certain de certain


Editorial.
485
5. Bibliography of Insanity:-Drs. Hughes, of Missouri;
Godding, of the District of Columbia, and Graham, of
Texas.
6. Relation of Eccentric Diseases to Insanity.-Drs. A.
E. Macdonald, of New York; Goldsmith, of Massachusetts,
and Powell, of Georgia.
y Asylum Location, Construction and Sanitation.-
Drs. Reed, of Pennsylvania ; Dewey, of Illinois, and Wilkins,
of California.
8. Criminal Responsibility of the Insane.-Drs. Everts,
of Ohio; Andrews, of New York, and Fisher, of Massa-
chusetts.
It was agreed that the Chairman would be held respon-
sible for the report to be prepared by himself or some
member of the Committee.
The Association decided to hold the next annual
meeting at Newport, R. I., in June, 1883.
THE DIFFERENCE BETWEEN VOLUNTARY DRUNKARDS
AND DIPSOMANIACS consists not only in the inherited neu.
ropathic condition of the latter, but in prolonged vaso-
motor disturbance, which often persists after a spree in the
latter, whereas in the former the normal vaso-motor con-
dition affecting the cerebral circulation and cell activity
is soon regained, enabling the one to abandon drink, if
he will, while the other is still irresolute and unstable.
Cardiac gangliopathic states, too, are often persistent, in
our experience of dipsomaniacs, so that an increased
heart activity and more than naturally rapid pulse are
second nature to these unfortunates.
Dipsomaniacs are accordingly not safe against repeated
sprees, notwithstanding their promises of reform, for many
months after the liquor of the last indulgence is entirely
out of them, whereas the common drinking man, without
the fatal heritage, who indulges from appetite alone, may
be, if the incentive to self-restraint be strong.
It is therefore only folly to create and endow reform-
atory hospitals for dipsomaniacs without legal provision
for prolonged detention which cannot be evaded — not
less than a year in all cases, often longer. The links of
the chain of heredity are generally too strongly forged to
be broken so easily as some imagine.
It is an organic slavery that the State undertakes to
free these unfortunates from when it organizes hospitals
for inebriates, and it should take care of the slave till
the master relinquishes his hold, and then guard the


486
Editorial.
asian in the proach hislator. avty to disti
slave in his freedom ever after, even though the right of
habeas corpus be permitted only such a conditional hold
as will not re-enslave whom the State proposes to make
free, that he may enjoy the benefits of true life, liberty
and the pursuit of happiness, and bless and care for those
whom he may be bound in law to care for and support,
but whom he does not, and cannot take care of and main-
tain in his pathological thraldom.
INSANITY AND SANITY ARE SO EASILY DIFFERENTIATED
by casual observers that any tyro-alienist or layman
may distinguish them at a glance, e. g., if he is not told
better after he has made his self-satisfactory diagnosis.
See that honorable expert legislator as he strides grandly
through the corridors of the State Hospital he is commis-
sioned to inspect. He is on the Asylum Committee. He
has learned by long familiarity to distinguish a lunatic
from the average legislator. Of course he must be expert!
See him approach that nice, intelligent and sedate young
man in the hall, who is the "proprietor of the asylum," and
ask him what misfortune brought that other mild-looking
young man, his attendant, to the hospital and how long
he has been afflicted ? He can distinguish insanity at a
glance !
See those other visitors. How intelligent some of them
are! They are educated people. They read regularly the
almanac and the science column of their daily paper.
They can tell a lunatic at a glance, and wonder why so
many intelligent, harmless persons are confined in the
hospital when they might be so useful at home. Some
of these harmless ones have just come from home where
they made themselves very lively and useful — too lively
and useful, in fact.
See that young medical man. He is historical. He
was a pupil of the great Esquirol. He is introduced to
two of his master's friends. One of them is reserved,
sedate, silent; his words few and timely and not over-
many, befitting his grand station, he never perpetrates
a pun. The other is loquacious, funny, hopeful, opin-
ionated, and discourses prophetically of the future.
The young medico has not studied medicine in vain!
He knows the sane man from the mad man at a glance.
“The distinguished well-informed, quiet man is he.” The
other “chatterer and fool” is fit for an asylum. But M.
Esquirol has had so much to do with the insane “that his
judgment is weakened," and the Master makes the mistake
they made, in facta medical marrol. He then is te


Editorial.
487
of insanity hem changas no pific ar
because he knows the wise, reserved and dignified man
is one of his patients at Charenton, having gone there
in consequence of a mere mistake of judgment in regard
to his being “God the Father.” This little incident
biases the Master's judgment. It was the other man
who ought to have been in the asylum. The other is
only poor Balzac. The world in his case has made a
grand mistake in counting him great, when minds so
much more illustrious are confined in the asylum!
THE DIAGNOSIS OF INSANITY should be made on its
symptoms not post-mortem. The relation of coarse cere-
bral lesion, or of microscopic structural lesion of the
gray matter to insanity, has not been so well established
that where no post-mortem change of brain-structure is
found it can safely be said there was no previous insanity.
Such a declaration would be as unscientific and unmedi-
cal as to deny the pre-existence of epilepsy, with which
insanity is so often associated in its most violent and
destructive forms, because the post-mortem revelations
might show, as they often do, no appreciable cerebral
lesion. The same is true of other forms of insanity; of
hysteria, which is so closely allied to it; of catalepsy,
not far removed, which sometimes kills; of tetanus,
chorea, etc. The gravest mental states are connected
with ante-mortem vascular conditions, which do not issue at
once in structural lesions, and sometimes never do, and
which especially do not show when intercurrent disease,
as the judicial accident of hanging, intercepts the morbid
processes. Diseases are diagnosed by their symptoms.
Post-mortem appearances of a spent disease are its results,
not its causes.
If ante-mortem morbid vascular activities, meningeal
changes and reflex circulatory disturbances are to be
excluded as causes of insanity, because they are not so
perceptible in structural change after death, cerebral path-
ology must henceforth become very simple. But mental
pathology has not yet become so somatic. The texture
of the cortex need not be broken in order that its
molecular or vascular movements may be morbid and
aberrant.
GUITEAU'S INSANITY. - In the light reflected from the
scaffold the psychological import of the tragedy of last
July is so plain that it can neither be further illumined
nor obscured by post-mortem examination.
Insanity is revealed in its symptoms during life regardless


488
Editorial.
of the clearness or obscurity of its effects upon the
cadaver. Guiteau died insane. A psychological analysis
of the assassin maintaining this view of his mental condi-
tion, by the editor, is crowded out from the present but
will appear in the next number.
While the slayer of the President lived there were
two sides to the question of his insanity, and the demands
of public policy and the exigencies of time and occasion
have balanced probabilities against the assassin. But now
that the murderer has gone the way of his victim, we
may dispassionately, and without incurring suspicion of
seeking to thwart justice by scientific refinement, inquire
into his mental status.
There are public exigencies when, perhaps, even a
lunatic ought to be executed, and forms of insanity with
so much of sanity in them that it would seem not wise
to exempt them from legal penalty when forms of law
are complied with and juries cannot discern the existence
of irresponsibility, but questions of doubtful mental dis-
ease should not go before ordinary non-professional juries.
MUNDINUS AS A NEUROLOGIST. — Dr. George Jackson
Fisher, in the seventeenth of his interesting series of his-
torical and biographical sketch papers, in the Annals of
Anatomy and Surgery, for July, thus refers to the neuro-
logical knowledge of Mundinus in the early part of the
fourteenth century:
" It is quite evident that he devoted himself also to experiments upon
living animals; thus he says, that when the recurrent nerves of the larynx
are cut, the voice of the animal is lost. It is quite remarkable to find the
rudiments of phrenology in the work of Mundinus. He tells us that the
brain is divided into different cells or compartments, each of which
contains one of the faculties of the intellect. Thus it is shown that
the doctrines of Gall are not as entirely new and original as is generally
believed.”
Yet this celebrated anatomist, the first to dissect a
human subject since the dark ages, and that subject a
dead woman, was unwilling to open the head, in order to
demonstrate the brain, for fear of committing a mortal
sin.
To Whom IT MAY CONCERN. — The ALIENIST AND
NEUROLOGIST will not exchange with druggists' journals,
whose chief feature is the art of counter prescribing, and
whose pages are filled with recipes and treatments of
diseases whose symptomatology are as familiar to the
average druggist as the principles of astronomy are to a
native African.


Editorial.
489
the mai controveists.cers us good
mindody and somlich patience wuiry: “Wheriting in the
The reverend gentleman who sends 11s a sectarian reli-
gious journal, with request for exchange, probably mistakes
the meaning of our name. We have nothing to do with
biblical controversies, though we sometimes take care of
the controversialists.
The lawyer who offers us good security for a loan is
also mistaken. We do not publish “A Leinist's Journal.”
GUITEAU'S SANITY AND RESPONSIBILITY AND HIS INSANITY
AND IRRESPONSIBILITY are the subjects of two recent papers
in the January number of the Journal of Nervous and
Mental Diseases, respectively by Wm. H. Hammond and
Geo. M. Beard, the former insisting that the mentally
unbalanced assassin of the President should be executed
notwithstanding his insanity; the latter, writing in the
charitable spirit of Pascal's inquiry : “Whence comes it
that we have so much patience with those who are maimed
in body and so little with those who are defective in
mind?" asserts both his irresponsibility and insanity.
This view of the case is also maintained by Dr. Charles
Folsom, in the Boston Medical and Surgical Journal, Feb.
16th, and by Dr. Walter Channing in the same journal,
March 30th; and Dr. W. A. F. Brown, late Commis-
sioner in Lunacy for Scotland, in the last number of the
Journal of Psychological Medicine, takes a similar view.
Dr. Stearnes, Sup't and Phys. of Hartford Retreat, and
the editors of the Journal of Mental Science, hold to his
sanity on the testimony. These, with the Government
experts on the same side, and Dr. Godding and the other
experts for the defence holding the opposite view, show
plainly that the extinction of Guiteau has not settled his
mental status. A great many pages of the medical journals
of the day are thus filled with psychological coup and counter
coup. Dr. John P. Gray, also in the Journal of Insanity,
for April, stoutly maintains the sanity and guilt of Guiteau.
GREAT SARTORIAL skill is not required to make medical
breeches. The scalpel and shears both make misfits.
Neither the autopsy of the late President nor that of his
assassin settle everything. Brains, like breeches, may be
wrong in warp and woof, and wear badly though looking
fairly well. We call the one inherently neuropathic; the
other we call shoddy. The true way to have got at
Guiteau's true neuropathic inwardness would have been to
have made a post-mortem on the whole Guiteau family. It
would have been better to have made such an examina-
tion on the assassin's father before the latter was born.
ors of the found Phys. of Hakes a simila


Editorial.
THE CURE OF THE OPIUM HABIT.—The special sur-
veillance and constant attention required by opium eaters
during the withdrawal of the drug and cure of the habit
are so urgent, that a number of institutions, conducted by
reputable medical men, have, of late, been established in
this country, which greatly relieve the active practitioner,
who cannot well divide his time with these troublesome
patients. Readers of this Journal will find among our
advertisements several institutions where these cases can
be cared for. Among the latest claimants in our columns
for professional confidence, and which we deem worthy,
is the place of Dr. J. B. Mattison, 185 Livington Street,
Brooklyn, N. Y.
BROmidia is a reliable compound of well known and
favorite medicines in the management of insomnia, and as
such we commend it to those of our subscribers, hospital
physicians and others, when occasion requires the employ-
ment of this combination of the potassic bromide, canna-
bis indica and chloral hydrat. We have always found the
compound uniform in composition, the mixture well made
and the therapeutic effect what ought to be expected
from its ingredients.
APROPOS of the autopsy of Guiteau, Dr. J. Carlyle
Johnstone, Senior Assistant of the Royal Edinburg Asylum,
reports, in the July number of the Journal of Mental
Science, the death of a patient from fæcal impaction and
its consequences: thirty-eight years insane, the autopsy of
whose brain revealed “Membranes normal, considerable
escape of cerebro-spinal fluid on removing organ; frontal
convolutions small ; Aoor of fourth ventricle granular, organ
otherwise fairly normal.
PAPERS ACCEPTED FOK Next NUMBER : -“Katatony,"
by Kiernan; “The Asylums in Great Britain,” by Rice;
“The Mental Status of Guiteau,” by Hughes; “A Case
of Moral Insanity,” by the same ; "A Medico-Legal Record,”
by Comegys; A Posthumous Paper, by Isaac Ray, “On
Testamentary Capacity;" "A Contribution on Atrophy of
all of the Cranial Nerves,” by the late Jno. T. Hodgen.
“Address on Progress in Neurology,” by Thombs. The
other papers received have not been examined, but authors
will be notified in a few days.
Dr. W. W. GODDING, Superintendent and Physician of
the Government Hospital for the Insane, at Washington,


Editorial
491
D. C., is writing a book in which he will maintain the
insanity of Guiteau.
Dr. Godding expresses himself as satisfied with the
post-mortem appearances—the thickening of the arachnoid
membrane and thinning of the anterior cortex-as confir-
matory of his view.
NOTES FROM THE HOSPITALS.
BIENNIAL REPORT OF THE INSANE ASYLUM AT ST. JOSEPH,
MISSOURI.-Admitted during year ending December 31st,
1880, 138; males 73, females 65. Total number of cases
under treatment, 354; males 186, females 168. Dis-
charged, 159; males 84, females 75, as follows: Recov-
ered, 42; males 26, female 16. Improved, 80; males 39,
females 41. Unimproved, 21; males II, females 10.
Escaped, 5 males. Died, il; males 3, females 8. Re-
maining under treatment January 1st, 1881, 195 ; males
102, females 93.
Without the sad experience the trying circumstances,
the urgent necessities which followed the destruction, by
fire, of the State Lunatic Asylum No. 2, it is not likely
that the people of the commonwealth would ever have
had it demonstrated to them that one hundred excitable
and violent insane persons could be sheltered, clothed,
fed and medically treated in cottages, farm houses and
ordinary dwellings with as much satisfaction, as they
undoubtedly were, by Dr. Catlett during the fourteen
months that followed the conflagration, and before the
rebuilt asylum was in a condition to be occupied. It is
difficult to do the Doctor justice in our brief space, and
we cannot refrain from publishing his closing remarks:
“In consequence of the crowded conditions of these
temporary buildings, both the male and female patients
were kept out doors under the shade trees of the grassy
yard and lawns, engaged in swinging, playing foot ball
and other extemporized amusements, from early morning
until late in the evening, whenever the weather would
admit of it; and often inclement weather was not an
obstacle to out-door life, which had become a most desir-
able and coveted manner of spending their days. Never,
in a somewhat extended experience, both in civil and
army hospital life, have I seen such marked beneficial
effects, both physically and mentally, as was manifested


492
Hospital Notes.
ical, aextract fromnd provisioodel asylun
, and manyrom this valusions for the edifice of thi
in these irritable, enfeebled, excitable insane. A few
months of this life enabled them to enjoy a healthful
physical, and many of them improved intellectual, existence.
Again, I extract from this valuable crucible of experience,
lessons in therapy and provisions for the insane which
tend to convince me that the model asylum edifice of this
era of psychological activity is, perhaps, erected at too
great expense of the humane public, as well as opposed
to the best hygienic and curative interest of the improved
and chronic insane; or, in other words, I am almost per-
suaded to assert my belief that less expensive segregated
cottages, erected on asylum farms, for the treatment of
the improved and chronic insane, sufficiently near the
main edifice, where all can be under the one supervision,
and where exchange of patients may readily be made
when the condition of the patient requires it, would be a
very great improvement in the present mode of provision
and treatment of the insane.”
May the Doctor's recommendations receive from the
people the attention they deserve, and may all his efforts
be as successful as those he narrates in his last report.
OBITUARY.
The death of Dr. John T. Hodgen is an irreparable loss
to the profession of St. Louis and the Mississippi Valley,
Over his bier the profession paid him the tribute of their
tears. At the St. Louis Medical Society rooms in Poly-
technic Hall when his demise was announced the voice of
eulogium, in the vast concourse that crowded the rooms,
was stified by grief. It was a touching sight to see one
after another of his professional brethren, as they arose on
that occasion, to recount his professional merits and per-
sonal virtues, overcome with emotion, and sit down
unable to say what they intended on rising.
The same profound appreciation of the greatest loss
the profession of St. Louis has ever sustained, was appar-
ent, too, at the church and cemetery, where the last sad
rites were performed. Eyes of strong men all over the
house, in the crowded doorways and out on the paves,
unused to weeping, were wet with tears.


Obituary.
493
Patients, friends and physicians joined in the common
sorrow, scarcely distinguishable from that of the great and
good man's bereaved family. Even the few foes he had,
conceded his capabilities and the community's loss.
Dr. Hodgen's medical judgment was skilled and
cautious, his acquisitions were profound. He had worked
all his life without ceasing, and with a remarkable stead-
iness of purpose. His surgical judgment was conservative
and safe, and he operated with a quick, sure and steady
hand. He appeared to possess remarkable intuitions,
so quick and satisfactory were his conclusions in grave
surgical emergencies. His general knowledge of physi-
ology, anatomy and surgical pathology, were such as made
his counsel much valued and sought by the profession
all over the Valley of the Mississippi. Like all progressive
men of the day, he had latterly paid much attention to neural
pathology. The nervous system, in his mind, held no
insignificant place in the solution of pathological problems.
He had not time for extensive literary work, but contrib-
uted liberally in short papers to current medical journals,
some of them having appeared in these pages, and it was
his intention to have soon presented to the profession a
work on “Fractures and Dislocations,” which would have
been an honor to surgery. Up to the time of his death,
Dr. Hodgen had filled successively the chairs of anatomy,
physiology and surgical anatomy and pathology. His
lectures were always clear, concise and comprehen-
sive, forcibly delivered, and leaving little, if anything,
of his subject unsaid. His personal character was plain,
positive and honest. He abhorred shams in every form,
and won his way to fame and fortune solely by his
meritorious industry and talents; he had no other help.
It will be long before St. Louis will see his like again,
When he died the general expression was," there's none
to fill his place; its hard to have to lose Hodgen.”
Dr. Hodgen was born in Hodgenville, Kentucky, and,
at the time of his death, May 20th, 1882, he was in the
fifty-seventh year of his age. A wife and a family of
three children, among them a grown son, who is a physi-
cian, survive him.
been on "Fract have sopeared in Current me
d surgical a
concise
ante if anything,


REVIEWS.
THE DIAGNOSIS AND PROGNOSIS OF IDIOCY AND IMBECILITY certainly
claim the vigilant and earnest attention of the physician in ordinary prac-
tice, and he will appreciate such valuable help in this direction as Dr. Ire-
land gives in this interesting and observant contribution to the subject.
Dr. Ireland presents bis subject in a manner that makes it no less attractive
to the family physician than the exceedingly important contribution of
Dr. J. W. Kerlin, in the original department of this ALIENIST. Dr. Ireland,
like Dr. Kerlin, is specially well fitted, by reason of practical familiarity
with large numbers of idiots and feeble-minded, to speak on his subject in
such manner as to entitle him to confidence.
Referring to the disinclination and slowness of parents to recognize
these defects in their children, Dr. Ireland enjoins cautious deliberation and
prudence in prematurely disclosing the fact.
The difference between early deaf mutism and idiocy next engages his
attention.
On being consulted about a possible case of idiocy, careful inquiry, he
says, should be made into family neuroscs, insanity, idiocy, epilepsy or
other pervous diseases or constitutional maladies, and states that “idiocy
is most frequently propagated by heredity.” Not only grand-parents but
collateral relations should be inquired into.
Drs. Kerlin's and Grabham's views as to the extensive ancestral reli-
tionship of consumption, froun 56 to 22 per cent., and Shuttleworth's con-
clusions as to the hereditary factor of inebriety, in comparison with those
of Dr. Howe and Fletcher Beach, are referred to, and the conclusion
drawn that when intemperance causes hereditary tendencies to transmis-
sion of idiocy, it does so by exciting other nervous diseases in the grand-
parents or parents.
He finds the most distinctive accompaniment of genetous idiocy and
imbecility to be deformity of the palate and irregularity of teeth. The
distance between molars and bicuspids is narrow, and the roof of the palate
is high and invades the nasal cavity-V-shaped generally, though not
always. “A good set of teeth is rare in idiots.” Dr. Ireland makes alto-
gether an interesting study of the palate of imbeciles and idiots, which we
have not space to dwell upon, as he likewise gives due importance to other
physical abnormalities of fingers, ears, eyes, etc. The sum of his views as
to congenital idiocy are embraced in the following:
With the characteristic deformity of the palate and teeth, there would
be strong probability (increased by a history of hereditary neurosis), and
the rarer concomitant of deformities and the absence in early life of those
diseases that destroy mind, of congenital idiocy. We do not give his exact
words.
He does not attach great importance to cranial asymmetry, except
acephaly.
His prognosis is better when the deficiency is congenital than when


Reviews.
495
due to disease in childhood, though epileptic imbecility is the most hopeful
of all forms.
He takes a hopeful view of training and treatment in many cases.
The paper, in the main, is confirmatory of the observation of others in
the same field of research, and of the author's former views.
The deficiency in the thermogenic mechanism of idiots finds in Dr.
Ireland another affirmative observer, and many other facts of value but
which we have passed over, from lack of space, have been confirmed by
Dr. Ireland's observation.
THE Neurologisches Centralblatt, devoted to the study of the anatomy,
physiology, pathology and therapeutics of the nei vous system and mental
diseases, and edited by the distinguished and accomplished Dr. E. Mendel,
Privatdocent of the University of Berlin, by an unavoidable inadvertence
has not before received the notice its meritorious and capable management
deserve for it.
Only the January number is before us. The contents of this excellent
number mark this journal as entitled to a distinguished place among the
best of its kind in any country. The initial original article is by Dr. A.
Eulenberg, already too well known to fame to require more than the
mention of his name. He writes on the duration and the pseudo-retlex
character of the knee phenomenon. Dr. Th. Rumpf also contributes a
valuable paper on the treatment of tabes dorsalis with the Faradic Brush,
The contributions to forensic psychiatry of Legrand du Saulle, Rousseau
and Despin find in this journal, as they do in every other of its kind, a
distinguished place among the selections.
The other selections are made from the contributions of C. Kupffer,
F. Bessel, v. Gudden, Th. Rumpf, Forel, Lesser, Th. Petrina, Nothnagel,
Seelig muller, R. Schulz, Fr. Schultze, J. Comby, E. Bloch, Friedreich
Buccola, B. Ball, Luys, Magnan, Mickle, Turnbull, Ferrand, Fusier, Lere-
boullet, and the bibliographical department is conducted by F. Scholz.
We most heartily commend the new journal to our readers, and tender
to Dr. Mendel our apologies for neglecting to sooner note the meritorious
character of this excellent journal. We place the Neurologisches Central-
blatt on our exchange list, and shall in the next number give our patrons
some translations from its valuable pages.
THE PHYSICIAN HIMSELF AND WHAT HE SHOULD ADD TO THE STRICTLY
SCIENTIFIC is a b..ok filled with good suggestions, concerning the personal,
as distinguished from the strictly professional conduct of the physician.
The book abounds in practical precepts, many of which are quite fami-
lar to the middle-ag d practitioner, some of which are new and all of
which are of more or less value to the physician who hopes to made a
success of the profession.
The tenor of ibe book is ethical and honest, and its pages are profit-
able and contain good reading for the physician's hours of leisure. It
abounds in common sense and is well written in an unpretentious, but easy
and entertaining strle. Edited by D. W. Cathell, M. D., of Baltimore.
Published by Cnshings & Bailey, 262 W. Baltimore street, Baltimore.


496
Reviews.
GENERAL PARALYSIS OF THE INSANE:* — During a brief period three
extended treatises on progressive paresis have appeared. Of these that of
Voisin is the most voluminous, and deals largely with the pathological
physiology of the disease; Mendel's is medium in size and the most statis-
tical, while the present volume is by far the best in its relations to, and
descriptions of the Clinical phenomena of the disease. The author has
been for a long time collecting material for the present volume, which in
its next edition will be much more complete, to judge from Dr. Mickle's
communications, published since its issue, in the Journal of Mental Science.
It is to be regretted that Dr. Mickle has chosen the somewhat lengthy
and awkward term of general paralysis of the insane,” in lieu of the much
more correct" progressive paresis." The term used, however, is for many
reasons preferable to the one which is such a favorite with certain tentono-
pbiles in the United States, “ Dementia paralytica.” As Dr. Mickle says,
this last term should be avoided in practice, as it has been used in at least
four senses, and is consequently ambiguous. Dr. Mickle is an adherent of
the doctrine of unity-that is, he believes progressive paresis to be a symp-
tom, complex, properly so-cal'ed, and not a fortuitous union of paresis and
insanity. It is curious to note that in his enumeration of the authorities
who adhere to the doctrine of duality he omits Dickson, although the latter
expresses very decided opinions on the subject.
Dr. Mickle says, and the opinion is in accord with the experience of
the reviewer, that in progressive paresis any one of the so-called stages
may be absent. He uses the somewhat objectionable Gallicism“ pro-
dromes" in lieu of prodromata. The resume given under this head is con-
cise and comprehensive. In contrast with the absurd resolution recently
passed by the New York State Medical Society, Dr. Mickle lays great
stress on the perversion of the moral sense as a prodromus of progressive
paresis, and says: “Often, therefore, is this disease to be feared when sud-
den unforeseen moral falls, of which theft is one of the most frequent,
occur to those hitherto without reproach.
The second chapter, on the symptoms of the disease, is decidedly well
condensed as regards the authorities cited. Dr. Mickle leans largely to the
opinions of Guislain. He does not, however, agree with the latter, that
depression necessarily precedes progressive paresis. In healthy contrast
with the dilettante alienists of the London Lancet, he alludes to the occa-
sional importance of bad orthography as a symptom. The experience of
Dr. Mickle and that of the reviewer correspond in respect to the rarity of
hallucinations of the sense of smell.
The observations of Dr. Batty Tuke. respecting the existence of color
blindness in paretics is alluded to briefly. Dr. Mickle calls attention to the
fact that the paretic's delusions are not always grandiose, but are at times
depressing. He agrees with Baillarger that a hypochondriacal form
exists. The cases cited by Dr. Mickle correspond with those coming under
the observation of the reviewer. There is possibility, however, that some
of the so-called hypochondriacal cases of progressive paresis are really
cases of other forms of insanity, complicated by progressive paresis.
* By W. Julius Mickle, M. D. London: H. K. Lewis. 1880.


Reviews.
497
The doctor cites the following divisions: the expansive form, the
hypochondriacal form, the melancholic form, the demented form, the form
with stupor and the “circular” form. Dr. Mickle does not appear to have
noticed that the temperature is asymmetrical, and as a rule below 980 F.
He comes to the following conclusions: “A risc in the temperature often
accompanies a maniacal paroxysm. A rise in the temperature often pre-
cedes and announces the approaching congestive or convulsive seizures,
nearly always accompanies them. When these states (congestive or
maniacal) are prolonged, the associated elevation of temperature is
prolonged also. Defervescence of temperature after its rise with excite-
ment or with apoplectiform atticks often precedes the other indications of
toning down to the usual state. Moderate apoplectitorm attacks or mod-
erate maniacal exacerbations are, however, not associated with increased
heat of body. A transitory rise of temperature may occur without
any apparent change in the mental or physical state to account for it.
The evening temperature is usually higher than the morning temper-
ature in general paralysis, and an absolutely high evening temperature
occurs in cases rapidly progressing toward death. A relatively high even-
ing temperature seems to be of evil omen. Rapidly progressing cases may
show temperatures above the average, both in morning and evening for a
long time before any complications exist. Gradual exhaustion may pass
on to death in general paralysis, with au average morning temperature
normal, or nearly so throughout, except when raised temporarily by the
special attack, to which general paralytics are subjected. Some of the
cases cited are rather impose, being complicated by secondary pulmonary
and decubitic phenomena.
Sphygmographic results in progressive paresis have been recently
shown by Dr. Turnbull (Boston Medical and Surgical Journal, May 20th,
1882) to be negative. The results of Austin as regards the relation of the
pupils to depressed and exalted states which Dr. Mickly says have not
been confirmed by any one, have been claimed by Macdonald (Journal of
Insanity, April, 1877), as correct. The latter's observations, which were
made by the reviewer, however, directly contradicted Austin. Dr. Mickle
agrees with Spitzka (Journal of Nervous and Mental Diseases, April, 1877), in
believing that changes in the optic papilla are by no means constant.
In the third chapter, Dr, Mickle is inclined to believe that no positive
statements can be made respecting the precedence of mental and physical
symptoms. He also leans to the belief that progressive par-sis does not
exist independently of insanity, but leaves the question somewhat 86
judice. He is inclined to the opinion that the remission in progressive
paresis is not a perfect one.
He has had under observation cases of progressive paresis of ten
years' duration. The reviewer has seen cases of six, seven and eight years'
duration.
The chapter on Diagnosis does not deal at sufficient length with the
differential diagnosis, between the hypomania of Mendel, the sub-acute
mania of asylum reports and progessive paresis. The statements respect-
ing the differential diagnosis between intra-cranial syphilis and progressive
paresis are somewhat too positive. The reviewer has seen cases in which


498
Reviews.
ane
syphiloma of the cortex produced symptoms undistinguishable from
those of progressive paresis.
There is nothing said as to the difference in character between the
systematized delusions of monomania and the unsystematized delusione
of progressive paresis. Dr. Mickle seems inclined to believe that locomo-
tor ataxia does not pass into progressive paresis which bas been the case
in the reviewer's experience. The chapter on Diagnosis is certainly a
valuable one.
In the chapter On Causation, the author very appropriately coinciding
with Crichton Browne (W. A. R. '76, p. 189), lays great stress on the influ-
ence of mental strain in the production of progressive paresis. He does
not believe that sexual excess plays the part that has been claimed for it
in the ætiology of progressive paresis. He alludes only incidently to the
influence of lead poisoning, heat and traumatism.
The chapter on morbid anatomy is excellent, which may also be said
of the chapter on pathological physiology. Dr. Mickle is somewhat
inclined to agree with Spitzka, that the rapid flight of ideas is due to
hyperæmia of the cerebral capillaries; the incoherence to patches of the
hyperæmic engorgement passing over into stasis; attacks of stupor to
more extreme and general stosis, and subsequent lucidity to the breaking
up of the opalescent hyaline cylinder into which the blood corpuscles had
coalesced during stosis.
Dr. Mickle makes no allusion to the peculiar tendency of paretics to
accept each other's ideas. He makes the following positive statements
respecting prognosis: “It is the duty of the physician to say at once that
the case (progressive paresis) is without hope.” The reviewer has seen
one or two cases where the patient has not displayed any symptoms,
mental or physical, of the disease for seven years, but defpise these he fully
agrees with Dr. Mickle.
The chapter on treatment is valuable, and the author states that in the
epileptiform seizures of the disease witrite of amyl has been of no value-
he might have added, is very dangerous. He says nothing of the hæma-
toma of the stomach and intestines, to which atter tion bas been called by
Krueg (Archiv. feur Psychiatrie, No. 10), and the reviewer (Journal of Nervous
and Mental Disease, April, 1877).
Dr. Mickle concludes by an analysis of the varieties of progressive
paresis. Taken as a whole the book is a store-house of clinical observa-
tion; some portions, however, not so exbaustive or thoroughly well
digested as they might be, and bearing evidence of basty writing. The
index is also faulty. But, despite these defects, the reviewer is inclined to
believe it the most valuable volume issued of late on progressive paresis,
and one well worthy perusal by every one interested in psychiatry.
JAMES G. KIERNAN.
MENTAL DISEASES.*—This work can be regarded as complementary to
the works on neuro-anatomy and neuro-physiology already published by
Dr. Luys. Although a careful description of the anatomy and pbysiology
of an organ whose pathology is about to be considered, is not out of place
in any work, yet it would seem that Dr. Luys has given by far too much
*By Dr. J. Luys, Paris Adriese, de la Maye, 1881.


Reviews.
499
space to cerebral anatomy and physiology. This is a fault which is so rarely
committed by writers on psychiatry, that one may well condone it more
especially as the views of the writer are so original and so facinatingly
presented that the portions of the work devoted to them may well be read
with interest. According to Luys, it is the blood which gives life to the
nerve cell and centrals, and regulates its various activities. Dr. Luys
adopts the well-knowo theories of mania being due to hyperæmia and
melancholia to anæmia , folie circulaire having its pathological basis in
alternate changes. The portion of the work devoted to mental diseases
cannot be said to be entirely satisfactory. Dr. Luys seems not to have
recognized the difference between systematized and unsystematized
delusions; a difference which is patent to every thinking student of
peychiatry. Which has been lately very carefully analyzed by Spitzka
and Foville. The difference between an initial and a consecutive
hallucination, so carefully pointed out by Loseque, seemns to have
passed unnoticed by Dr. Luys. He fails totally to distinguish between
melancholia properly so-called and the depressing state 80 often
found in monomania (the primire verrucktheit of the Germans). The
sadness tbat pervades the patient's mental being in these cases is totally
distinct. In the one case it is at heart partially objective, in the other it is
totally subjective. Dennis Mahoney, the monomaniac, is sad because he,
being King Brian Boru, is called by the opprobrious name of Dennis
Mahony, and incarcerated among lunatics; a condition of things that, were
he really a king, might reasonably be expected to produce sadness. Karl
Dummkopf, on the other hand weeps and cries, he can't tell wby; and,
later, develops delusions which are the effect and not the cause of this sad-
nens. Such a striking distinction should have impressed itself on such an
observer as Dr. Luys. The classification adopted by Dr. Luys is as might
be expected from the foregoing remarks, not up to the times. The first
class are those in which the brain is hyperemic, the maniacs, etc Second,
those in which it is anæinic Third, those in which it is alternately anæmic
and hyperamic. The fourth class are those in which the circulation is
subordinated to acquired or inherited cortical defect. It must be evident
that such a classification is totally worthless, from any standpoint, whether
criminal or pathological, and the divisions made by the author under it
are absurd. He places some varieties of mania raesonnante (the primare
verrucktheit of the Germans, the imbecility of the first grade, of Ray; the
monomania of Spitzka) under the conditions produced by hyperæmia, a
classification not to be qualified from either a clinical or a pathological
standpoint. Luys endeavors to trace hallucinations to disorders of the
circulation to occurring in the region of the optic thalamus; a theory that
neither his own cases nor observations, nor those of other observers sup.
port. The pathological disturbances found by him in the region of the
optic thalamus, in hallucinated lunatics, can only be regarded, in the light
of the researches of Spitzka, Monaton and others, as secondary to cortical
changes. The book is well issued, and comparatively well illustrated,
though some of the plates are not by any means too clear.
K.
STRATEGEMS AND CONSPIRACIES TO DEFRAUD LIFE INSURANCE COM-
PANIES, has been made the subject of an interesting and instructive


500
Reviews.
volume, by Dr. J. B. Lewis, Consulting Surgeon and Adjuster, Travelers'
Insurance Company, and C. C. Rombough, A. M., M. D., Editor of the
Baltimore Underwriter.
The book is an authentic record of surprising attempts to defraud
insurance companies," beginning with an account of the first fraud in life
insurance, and ending with a discussion of a Hungarian nobleman's strata-
gem. The intervening histories are of “Jacob Wallace,” “the Monroe-
Snyder Case," "The Captain Colvernesses Case," "The Hartung Crime,"
"The Wichita Monsters," “ The Prof. West Infamy,” “The Brantley-
Erkridge Romance,” Angie Stewart the Murdered Child,” “ The Goss-
Udderzook Tradegy," and many other reinarkable cases, which we bave
not space to refer to.
The book is as interesting as a romance, and as instructive as history.
We should have noticed it long ago, but confided its review to an insurance
friend, who simply neglected to attend to it.
THE CASE OF GUITEAU is the subject of an article by Allan McLane
Hamilton, one of the Government's expert witnesses, in the Boston Medical
and Surgicul Journal, for March 9th, a reprint of which is before us.
This monograph is a reply to Dr. Folsom, whose article appeared in
the same journal for February 19th.
Dr. Hamilton controverts the view that Guiteau bad symptoms of
general paralysis, or that his cranium was markedly asymmetrical, pre
senting diagrams and asserting the other proofs. He concedes that Guiteau
was eccentric, that he was " badly nourished and anæmic,” with a depraved
physical condition and “a pulse of 88 on two occasions,” but insists that he
was a criminal; "a shrewd scamp," “ playing a part,” with “the plausi-
bility of an Alfred Jingle," the enthusiasm of Micawber or Colonel
Sellers, the cant and hypocrisy of Aminidab Sleek or Uriah Heap, the
ambition of Erostratus, and the murderous manner of Felton, the slayer
of Buckingham."
From the number of antagonistic and discordant opinions given upon
Guiteau it is evident that more than one has blundered, and we are inclined
to the opinion that the error of opinion is not wholly on either of the two
sides. In seeking to find a well known and well defined mental disease
or none at all, the experts for the prosecution and for the defence have
failed to elicit as much light as might have been gleaned from the study of
this remarkable psychical compound.
The GuITEAU CASE. A Physiological Study. By Geo. M. Beard,
M. D., New York.
This paper strongly maintains the insanity of Guiteau as remotely as
at the age of eighteen years, and that he has been insane ever since, with
religious monomania. The paper combats many errors on the subject of
insanity and the misconceptions of courts as to its nature, but makes his
argument by betraying a singular lack of practical familiarity with certain
well known phases of the disease, in the erroneous assertions that the
essence of insanity is immorality," "the insane are always immoral,"
which is not true, even of the majority of religious monomaniacs, in which
class the author places Guiteau. "The moral impairment of the insane


Reviews.
501
is not in knowledge, but in the power to abstain from wrong,” the author
says. Whereas they are often impaired in both knowledge and power,
but sometimes in the latter and not in the former.
THE PAPERS AND PROCEEDIXGs of the National Association for the
Protection of the Insane and the Prevention of Insanity, at the stated
meeting held in New York City, January 20th, 1882, state the Objects of the
Association ; Constitution and By-Laws; Officers; Proceeding of the Coun-
cil; the Discussion of Insanity in Relation to the Medical Profession and
Lunatic Asylums, by Nathan Allen, of Lonell, Massachusette; the Asylum
Superintendents on the Needs of the Insane, with Statistics of Insanity in
the United States, by C. L. Dana, New York City; the Function of a
Consulting Staff to Lunatic Asylums, by E. C. Seguin, New York City;
a Second Year's Experience with Non-Restraint in the Treatment of the
Insane, by J. C. Shaw, Brooklyn.
The Association invites all persons desirous of becoming members to
remit two dollars to Geo. M. Beard. the treasurer, with name and address,
52 W. Thirty-Fourth Street, New York; and states that all documents
issued by the Association will be sent to the members.
Such an association is much needed in this and every other country,
and will flourish if it seeks only the real protection of the insane. The
Association gives evidence of its earnestness and sincerity of purpose in
inviting all interested in the welfare of the insane to join in its work.
It has made some blunders, but if it rectifies its errors as it grows
older, we shall wish it success. It should attack asylum superintendents
less, and the real abuses of the insane more, and should have an eye to the
protection of the sane as well.
THE American Journal of Stimulants and Narcotics: A Monthly
Magazine devoted to a Scientific Study of Acute and Chronic Poisoning by
Alcoholic and Narcotic Agents. H. H. Kane, M. D, Editor, Vol. I., No. 1,
June, 1882. New York: Pusey and Rooney.
A journal of thirty-two pages. The present number contains an
original article on the Relation of Inebriety to Other Nervous Diseases, by
Geo. M. Beard, M. D., and one on Habit by Wm, A. Hammond, M. D;
editorials on Suicide from Alcohol, and the Lamson Case.
Dr. Kane Realizes the necessities of the times in specialization of
journalistic labor. The new journal promises to be especially valuable to
students of neurological toxicology, and the ability of its editor com-
mends it.


Books, Monographs, Etc., Received.
The Effect of Genital (rritation in the Production of Nervous Disor.
ders. By Landon Carter Gray, M. D., of Brooklyn. Reprinted from the
Annals of Anatomy and Surgery, Jan. and Feb., 1882.
The Evidences of Insanity Discoverable in the Brains of Criminals and
Others whose Mental States have been Questioned; with Some Remarks on
Expert Testimony and the Grapotte Case. By Edward C. Spitzka, M. D.
Read before the New York Medico-Legal Society, May 3, 1882.
Chapters in the History of the Insane in the British Isles. By Daniel
Hack Tuke, M. D., F. R. C. P., London.
A Further Contribution to the Local Treatment of Pulmonary Cavities.
By Wm. Pepper, A, M., M. D. Extracted from the Transactions of the
American Medical Association.
Address in Medicine. On Some of the Relations of Catarrhal Affec-
tions. By Wm. Pepper, M. D., LL. D., Pennsylvania. Extracted from
the Transactions of the American Medical Association, 1891.
Addresses at the Inauguration of William Pepper, m. D., as Provost
of the University of Pennsylvania, February 224, 1881.
Note sur la Mégalomanie ou Lypémania Partielle avec Prédominance
du Délire des Grandeurs. Par M. le Dr. Ach. Foville. Extrait des Annales
Medico-Psychologiques, t. VII., Janvier, 1882.
Annual Address. A Short Study of Some of the Phenomena of Mind.
By Peter Bryce, M. D. Before the Medical Association of Alabama.
Hodgen Memorial, Under the Auspices of the Alumni Association of
the St. Louis Medical College.
A Contribution to the Study of Nerve-Stretching. By William J.
Morton, M, D., New York. Reprinted from the Journal of Nervous and
Mental Diseases, Vol. IX., No. 1, January, 1882.
Meningeal Tuberculosis of the Cerebral Convexity. By Wm. Julius
Mickle, M. D., M. R. C. P., London, Medical Superintendent Grove Hall
Asylum, London.
Observations on Surgery in Children. By Edward Borck, M. D., St.
l.ouis, Mo., Professor of Surgical Diseases of Children, and Abdominal and
Clinical Surgery in the College for Medical Practitioners, St. Louis. Read
before the St. Louis Medical Society, April 1st, 1882. Reprinted from the
St. Louis Medical and Surgical Journal.
Qvariotomy: Difficulties Diagnostic and Operative; Continued Men-
struation After Double Ovariotomy. By J. Engelmann, M. D., Prof. of
Obstetrics in the Post Graduate School of the Missouri Medical College.
Extracted from the American Journal of the Medical Sciences.
Are Uterine Displacements Curable by Position, Reposition, Electricity,
Therapeutic Means, Pregnancy, Surgical Operations or Pessaries? By
Eugene C. Gehrung, M. D. Read before the St. Louis Obstetrical and
Gynecological Society, Jan. 19, 1832. Reprinted from the St. Louis Courier
of Medicine, March, 1882.


Books, Monographs, Etc., Received.
503
Annual Address Before the Society of the Alumni of the Medical
Department of tne University of Pennsylvania. By G. Comegys, M. D.
With the Proceedings of the Alumni Meeting of 1875.
Our Thirtieth Year. Annual Address Before the Kentucky State
Medical Society. Delivered April 5th, 1882, by J. W. Holland, M.D., Presi-
ident.
On Reflexes and Pseudo-leflexes. By A. De Watteville. Reprinted
from the British Medical Journal, May 20th, 1882.
'The Opium Habit; Its Successful Treatment by the Avena Sativa. A
paper read before the New York State Medical Society, February 9th,
1882. By E. H. M. Sell, A. M., M. D. Reprint from the Medical Gazette,
April 22d, 1882.
The Asylum Superintendents on the Needs of the Insane, with Sta-
tistics of Insanity in the United States. By C. L. Dana, A. M., M. D.
Reprinted from the Journal of Nervous and Mental Disease, Vol ix., No. 2,
April, 1882.
· A Clinical Study of the Disease and Curability of Inebrity. By T. D.
Crothers, in the American Journal of the Medical Sciences for July, 1882
The Diagnosis and Prognosis of imbecility. By Wm. W. Ireland,
M. D., Reprinted from the Edinburgh Medical Journal, June, 1882.
Bibliothéque Diabolique Le Sabbat des Sorciers. Par Bourneville et
E. Teinturier, Paris.
Ingersoll Unmasked. A Scathing and Fearless Exposé of His Life and
Real Character. By Clark Braden, No. 315 East 65th Street, New York.
The Prevention of Venereal Disease by Legislation. By Albert L.
Gihon, A. M., M. D. Read Before the New York Medico-Legal Society,
April 5th, 1882.
Sixth Annual Meeting of the American Medical College Association.
Held at Cincinnati, Ohio, May 16th, 1882.
Annual Address Before the Alumni Society of the Medical Department
of the University of Pennsylvania. By John Curwen, M. D. Delivered
January 19th, 1882.
Papers and Proceedings of the National Association for the Protection
of the Insane and Prevention of Insanity at the Stated Meeting held in
New York City, January 20, 1882.
Sixteenth Report of the Connecticut Hospital for the Insane of the
State of Connecticut.
Microscopical Examination of the Water Supplied by the City of
Hartford. A Report to the Board of Water Commissioners. By Wm. J.
Lewis, M. D.
Sixteenth Biennial Report of the Private Institution for the Education
of the Feeble Minded Youth, Barre, Massachusetts.
Annual Reports of the New flampshire Asylum for the Insane, June,
1882.
Report of the Quebec Lunatic Asylum for the years 1878, 1879, 1880
and 1881.
Report on Surgery. By W. 0. Roberts, M. D. Reprinted from the
American Practitioner, June, 1882.


504
Books, Monographs, Etc., Received.
Announcement of the Woman's Medical College of Baltimore, Balti-
more, Md.
Thirty-Third Annual Announcement of the Women's Medical College
of Pennsylvania, Philadelphia.
Forty-First Annual Announcement of the St. Louis Medical College,
Session 1882-'83.
Annual Announcement of Lectures and Catalogue of the University of
the City of New York, Session 1982–83.
Annual Announcement of Trinity Medical School, Session 1882-'83.
Fort Wayne Journal of the Medical Sciences. A Quarterly Journal of
the Medical with a Summary of the Allied Sciences.
Asylum Index and Review. Published in the Interests of Feeble-
Minded Children.
American Journal of Stimulants and Narcotics. A Monthly Magazine
Devoted to a Scientific Study of Acute and Chronic Poisoning by Alco-
holic and Narcotic Agents. H. H. Kane, M. D., Editor.
New England Medical Monthly. William C. Wile, M. D., Editor.
“Canada First," a paper published in the interests of Canadian Inde
pendence.
THE TRI-STATE MEDICAL SOCIETY, of Indiana, Kentucky and Illinois.-
The eighth annual meeting of this flourishing association will be held at
Terre Haute, Ind., September 26th, 27th and 29th. A large programme and
attendance are assured; the former so arranged that several papers upon
similar topics may be discussed jointly.
The society is second to none in the enthusiasm and honest work of
its members.
Inserted out of place, owing to lateness of arrvial of notice.


THE
ALIENIST NEUROLOGIST.
Vol. III.
OCTOBER, 1882.
No. 4.
ORIGINAL CONTRIBUTIONS AND PREFERRED TRANSLATIONS.
Art. 1.-Asylums in Great Britain; Notes
of a Visitor.
By P. M. WISE, M. D., Willard, New York.
THE published impressions of foreign asylums upon
1 American visitors have differed in so great a degree,
that a general skepticism appears to prevail among
American alienists regarding the distinctive methods of
asylums abroad, and especially those of Great Britain.
A visitation of eighteen asylums in England and
Scotland during the Spring and Summer of 1882, thirteen
of which were asylums for the care of pauper insane, forms
the basis of the following notes :
To an impartial observer, the chief differences existing
between the asylums on either side of the Atlantic, in
the features favorable to British asylums, are: In the
uniformity and thoroughness of surveillance; in methods
of construction, with a view of grouping patients for
sleeping and dining purposes in large associate dormi-
tories and halls; in the removal of patients from the
apartments occupied at night to others specially designed
for day uses; in an efficient night service; in the develop-
ment of the industrial system; in the absence of mechanical
restraint and the greater degree of personal liberty
allowed.


506
· P. M. Wise.
The immediate supervision and management of public
asylums in England is in the hands of the county magis-
trates, of which a committee of visitors have functions
closely corresponding to the boards of managers of
American asylums. In addition, all the insane have the
visitation of officers in lunacy who are paid members of
a board of commissioners. The active members are six
in number, three barristers at law and three medical men
skilled in the treatment of the insane. They are ap-
pointed by the Lord Chancellor for life, unless disqualified
by misbehavior or inability.
They are required to visit all receptacles for lunatics
at least once annually and to make a detailed report of
their observations to the Lord Chancellor. They are
empowered to govern asylum construction conjointly with
a secretary of state; to prosecute any asylum employe
for violence or neglect and to grant licenses to private
asylums. Retention of lunatics in workhouses is subject
to their approval. Abstracts of asylum accounts and all
commitments of lunatics to asylums must be submitted
to them. They exercise no judicial functions and their
arbitrary powers are very limited, but their corrective
suggestions, from the publicity given them, are seldom
disregarded. The lunacy board of Scotland differs in no
essential feature from the English.
The influence of the commissioners in regulating the
care of the insane is apparent in the uniform system
prevailing throughout the kingdom. Their relations to
the medical officers of asylums do not appear unpleasant;
they are, on the contrary, appreciated as a protective
power, a bulwark of safety against indiscriminate and
unfair public attacks and the pet reforms of emotional
enthusiasts. In practice they tend to restrain unwise
economy of asylum managers. Their published reports
contain in full their memoranda at the various asylums
and tend to promote a healthy spirit of rivalry. In
marked contrast to asylum reports in our own country,
they contain a full list of asylum casualties and abuses


Asylums in Great Britain.
507
and a statement of their investigations and conclusions.
The independence of the lunacy commissioners in the
performance of their various functions is assured by the
nature of their appointment. The permanency of office
and the liberal emoluments the position secures attract
the best quality of men to their ranks.
The special feature in the plans of construction that
is universal in structures less than thirty years old, is the
arrangement for removing patients from wards occupied
at night to others designed for day use. This is effected
in two-story buildings by having the day rooms on the
ground floor and dormitories above; or by transferring
the patients in the morning to adjoining wards on the
same floor. In several old asylums having antiquated gal-
leries—long corridors with sleeping rooms on either side-
changes are being made that will effect the same object.
In this connection I cannot refrain from mentioning
the admirable changes that have been made in an old
asylum at Prestwich, near Manchester, under the superin-
tendency of Mr. Ley. This building has been so recon-
structed, at comparatively small cost, as to provide light
and airy day rooms dissociated from the sleeping apart-
ments. Through the labor of patients Mr. Ley has
furnished his wards with homely comforts and artistic
decorations to a degree that cannot fail to elicit admira-
tion.
Single room accommodation rarely exceeds twenty
per cent, of the whole in county and borough asylums.
The associated dormitories are large, frequently containing
fifty beds or more, with a few single rooms attached for
exigencies. In many asylums a low partition separates
the beds and prevents altercations between patients. It
also allows a personal privacy without obstructing the
view of night attendants. Homely lavatory arrangements
are furnished the sleeping rooms in sufficient abundance
to make the morning ablutions inviting. By the removal
of the sick to infirmary wards the dormitories are deserted
for the day, and thorough ventilation is rendered possible.


508
P. M. Wise.
As a consequence the institutional odor that is so difficult
to avoid in wards that are continuously occupied by
patients is nowhere distinguishable. The largest dormi-
tories are provided for epileptic and suicidal cases who
receive continuous night watching. The dining halls are
usually large. Instead of distributing food to the different
wards, they have the less expensive method of bringing
their patients to common halls adjoining the kitchen,
where food can be served more expeditiously and in
better condition. The writer was enabled to witness, on
various occasions, from three to five hundred patients
dining in a common hall where the greatest decorum
prevailed.
The absence of window guards, especially in day rooms
and watched dormitories, is notable in all their asylums
and the sash are provided with lights frequently of large
size. Single rooms are very generally constructed with
close shutters and it is the usual practice to lock them
at night-a surprising fact when one considers the freedom
from other forms of restraint.
Open fire places are the ordinary means of heating
the wards and are consequently seen both in day and
sleeping rooms. They are furnished with locked guards
when required, but it is seldom this security is applied,
except in epileptic wards. It is not uncommon to see an
unguarded fire in the most refractory wards. An open
fire may not be as suggestive to a British lunatic for the
reason that it is the ordinary method of heating in private
houses. The bright open fire certainly adds very much
to the cheerful appearance of their day rooms and aids
entilation.
The night service in their asylums is a feature that
must meet the approval of every person who has had
the care of the troublesome insane. This service is rend-
ered by a force of attendants in a ratio equal to from
one to two per cent. of the lunatic population. Their
duties are distributed to provide stationary watches with
epileptic and suicidal patients in the large dormitories,


Asylums in Great Britain.
509
patrols and supervisors. The patrolling nurses are required
to raise all patients with untidy habits at fixed intervals
and to provide clean linen, of which they have an unlim-
ited supply, whenever a patient becomes soiled.
The night attendants in charge make a detailed report
to the medical officers in the morning, and are required
to deliver their patients to the care of the day attendant
in a cleanly condition. The fixed watch in the large
dormitories occupy prominent seats from where they can
observe each patient. By a system of bells they can call
assistance when required. They are visited periodically
by the patrol and charge-attendant and are further stim-
ulated to wakefulness by tell-tale clocks. An electric clock
I witnessed in several asylums, registered the location
of attendants, throughout the night, in the office of the sup-
erintendent.
. Thus watchful care of that class of the insane actuated
by disease to destroy themselves, is efficiently provided
and the result is seen in the rarity of night suicides. With
the same object of preventing untimely death epileptics
are placed under constant observation. In all the asylums
visited the night service is quite uniform in practice, and
is considered essential for the welfare of the patients,
whatever their quality.
There is a settled conviction that the industrial occu-
pation of the insane is a necessary adjunct to successful
asylum treatment, especially that kind of occupation that
calls for muscular activity. It is upon the assumption
that the motorial centers in turbulent cases need a mus-
cular outlet that they are given opportunities for active
employment and thus are diverted from violent and
destructive activity. That occupation tends to make the
insane tractable and composed is evident from the fact,
that where the industrial system is the farthest advanced
there will be found the least turbulence and excitement.
The industrial question still involves problems in regard
to the kind of occupation for the mass of those principally
able to work, and especially how to provide active employ-


510
P. M. Wise.
ment for women, except that required in kitchens and
laundries. In rural districts where the asylums have the
advantage of large farms, agricultural pursuits furnish male
patients employment for a large portion of the year. In
several asylums having small farms it is common to employ
male patients in spading the ground instead of plowing,
thus increasing the amount of labor and giving occupa-
tion to a larger number. In marked contrast to the
general approval of the industrial methods described, is a
late indication of public sentiment in our own country,
where an attempt to employ male patients in grading a
short railroad for the use of an asylum, raised a howl
from the local press about the abuses of the insane. It
does not appear that the physical condition of patients
is overlooked in their selection for labor. I saw no
patient employed that I could regard as physically unable
to work.
Artisan attendants have the charge of patients working
at trades, and skilled occupation is provided for artisan
patients. It has been found impracticable to teach the
insane mechanical employment except the simplest—such
as mat or basket making. As a rule all the clothing
for patients and the uniforms for attendants are made in
the asylums. In exceptional instances clothing and shoes
have been manufactured for sale. The labor saving
machinery that furnishes our laundries is there used to a
very limited extent. The laundry affords them active
occupation for women, and it is not rare to see maniacal
females working off their excitement at the wash-boards.
Perhaps a few statistics will best illustrate the extent
to which useful employment is carried in several repre-
sentative asylums. At the Barony Asylum near Glasgow,
with a register of 245 men and 204 women, on an ordi-
nary day there were industrially occupied 196 men and
145 women. Of the men employed, 104 were engaged
upon the farm, 48 in polishing floors and assisting in
house-work, 12 at mason work, 10 as quarriers, 3 as
stokers and 17 as artisans. Of the women, 16 were


Asylums in Great Britain.
511
attendant's assistants, 13 working in kitchen, 29 in the
laundry, 2 as housemaids, 59 at needle work, and 26 at
knitting. Of the 108 who were not employed, 61 were
physically unable to labor and the rest, with few excep-
tions, were incapacitated by mental feebleness. In the
Surrey Asylum at Brookwood, with 1,049 patients of both
sexes, 710 are usefully employed in some way, and of
this number 48 men labor at their trades. In the Lan-
cashire Asylum at Prestwich, with 1181 patients on the
register, 885 or seventy-five per cent. are industriously
employed.
The same class of difficulties are experienced in engaging
patients in employment that we meet in America; prob-
ably not in the same degree for the reason that in the
asylums of Great Britain the classes are more strictly
defined. County, borough and parochial asylums receive
none but pauper patients, whereas in America our asy-
lums contain all qualities. The refusal of private patients
to engage in manual labor acts largely as a disaffecting
element among the dependent class. In the asylums of
England receiving private patients, active amusements are
employed in lieu of the industries, but not with the same
effectiveness.
It naturally follows that where mechanical restrictions
on liberty are in a great degree withdrawn, it becomes
expedient to engage the attention of patients in some
way, either by amusements or in useful occupation.
Accordingly there is an effort on the part of attendants
to increase the number of those employed, as the easiest
way of caring for them. Industries are not pushed to
the exclusion of diverting recreation. Weekly half-
holidays afford occasion for cricket matches—the national
British game-and other out-door amusements. Their
wards are furnished with means for recreation and evening
entertainments are liberally provided.
The use of restraining apparatus appears to be entirely
abandoned. Although visiting asylums with an aggre-
gate register of 13,000 patients, I failed to see a single


512
P. M. Wise.
instance of mechanical restraint and but two cases of
seclusion. There is no reason to believe its use would
anywhere have been concealed to create a favorable
impression, for the subject is not one of great delicacy
with them. It is a question that has been settled in
Great Britain for many years and is now chiefly referred
to historically. The medical officers express themselves
as entirely free to use it and would do so if they con-
sidered it necessary for the well being of their patients.
There were several occasions witnessed, however, where
the use of a mild form of restraint appeared preferable to
the practice in vogue. Whether it is better to place a
patient with an active and persistent tendency to personal
injury in the grasp of two to four attendants who are
apt to become fatigued and irritated, or to use instead
a more comfortable form of restraint that is mechanical,
is certainly not an unfair topic for discussion. That the
occasion for the use of restraint sometimes exists is not
denied by British asylum officers; but it is argued that
the difficulty of limiting its application to the proper cases
and the danger of teaching attendants its labor-saving
qualities, more than counterbalance any advantage to be
derived from its use.
It is a matter of fact that the present generation of
attendants know nothing of mechanical restraint. Several
intelligent attendants questioned upon this subject appeared
entirely ignorant of the specific meaning of the term; and
they could not see the necessity for its use under any
circumstance. They are taught from the inception of
their asylum service other methods of treatment, and,
consequently, never appreciate the occasion for its employe
ment.
Active exercise, either by voluntary occupation or by
forced walking, is the usual device for calming boisterous
excitement; and strong dresses and bedding are furnished
those with destructive habits. Seclusion is practiced to a
limited extent and the padded room is a distinctive
feature of British asylums. Panels well padded and


Asylums in Great Britain.
513
protected by strong macintosh or painted canvas cover the
floor and the sides of the room to a height of six or
seven feet. They can be easily removed for cleansing and
are almost indestructible. It is noticeable, however, in
the statistics of the most progressive asylums, that the
seclusion of the insane is being gradually abandoned and
the disuse of this form of restraint is regarded as a future
probability.
Whatever may be the influences that impel asylum
superintendents to avoid so many restrictions on the
personal liberty of their patients, it is not unjust to infer
that the publicity of the lunacy reports create a spirit of
emulation and stimulate efforts to gain the public approval
of the commissioners. That the results obtained are
worthy of admiration must be honestly admitted. No one
accustomed to the wards of American asylums, who visits
the busy and decorous scenes to be witnessed in the
asylums there, can avoid comparisons and conclusions
favorable to the British system.
It would appear at first sight that the insanity of
Great Britain assumes milder forms, or that the class of
insane composing their asylum population is quite different
from that to be found in ours. The older superintendents
can recall a period when many of their asylum wards and
airing courts were scenes of confusion and turbulent excite-
ment; but, through the agency of active occupation and the
other features of their present system, the character of
their asylums has changed. It is claimed that with the
present methods they have improved insane conduct,
modified the intensity of motor disturbances, and, as it
appears, have made the British lunatic a reputation
abroad for subordination to authority. It is true the
foreign element is not large; although about the great
seaports—Liverpool and Glasgow—the asylums have quite
a mixed nationality, without presenting any difference in
the results of practice from those in the interior.
The confidence with which medical officers regard the
efficiency of their methods is well illustrated by the


514
P. M. Wise.
statement of a medical superintendent in Scotland, that he
could take the most turbulent insane from any American
asylum and under their system they would assume the same
quality and require no more restrictions than their own
patients. Such a statement would appear humorous were
it not for the honest sincerity of its author.
The open door system of which so much has been
written strikes one as being more apparent than real.
In Scotland, where this practice has been most fully
developed, the greatest amount of employment consistent
with the physical condition of patients is urged. At
Lenzie, particularly, where the doors are all unlocked
during the day, patients live out of doors so much that
the necessity for locks does not appear to exist; and
where the wards are occupied the liberty of patients is
as much restricted by the watchful care of attendants as
if the doors were locked. In some English asylum wards,
the doors leading into airing courts are opened during
the day and patients can go out and in doors at will,
although limited to the courts. There is not an unanimity
of opinion among asylum officers on the subject of open
doors. Many of them maintain that the risks entailed by
the open door practice outweighed any advantage to be
gained from it. The system has enthusiastic advocates,
however, who claim that their method produces a content-
ment and tranquility of patients not to be obtained other-
wise and indirectly results in a larger recovery rate.
The greatest factor contributing to the successful
abandonment of restraint is evidently the increased personal
care provided for patients. This factor is not represented
in numbers as well as in the quality of the service rendered
by attendants. In several county asylums, where the
inquiry was made, it was ascertained that the ratio of
attendants to patients including those on night service
was not greater than one to eleven. Their average length
of service is comparatively long and where it exceeds
fifteen years they become eligible to a life pension in case
of disability.


Asylums in Great Britain.
515
The initial lessons of new attendants are made as
impressive as possible. At Morningside there is what can
be called a training school for attendants that deserves
mention. Dr. Clouston has furnished several infirmary
wards with appliances for the treatment of a few acute cases.
He stations there an attendant in charge who is experi-
enced, intelligent and capable of teaching. He keeps
his new attendants in these wards a sufficient length of
time to teach them their various duties in the care of the
insane and to fully impress them with the fact that
insanity is a sickness; this, he reasons, is best accom-
plished by first placing them where they can observe the
bodily sick with those acutely maniacal.
The medical organization of asylums does not differ
materially from ours. The superintendent has all apart-
ments under his control and supervision, except in the
metropolitan district where the general hospital system is
adopted. The asylums are not supplied to the same
extent with assistant physicians, and their emoluments are
not proportionately as large as in the average American
institution, but promotion is more certainly assured.
Vacancies in the office of medical superintendent are
invariably supplied from the ranks of assistant medical
officers. The appointment of a superintendent without
previous asylum experience would be regarded in much
the same light as the installation of a Frenchman in the
office of Prime Minister. The security of position and
freedom from political and partisan considerations, permit
a liberty of action and license of opinion on the part of
medical officers that is truly refreshing.
How far the admirable results obtained in British asy-
lums can be realized here, it is not the purpose of this
paper to discuss, but merely to attest a belief in the
sincerity of their practice and briefly to record its leading
features. The charge made by a celebrated English writer
on American asylums, that ignorance of our superintend-
ents was the only explanation of their course, cannot be
applied with equal force at the present time. The number


516
P. M. Wise.
of asylum visitors abroad has been annually increasing
and their testimony is occasionally offered to the public.
It is incomprehensible then that expert alienists consulted
in questions of asylum construction should advocate
antique plans; and that efforts to infuse progression in
our representative society should be frowned down as
recusant to time-honored principles.
We must come to realize that our asylums are not
the best in the world if they have cost the most money.
And that our country, although leading others in the arts
and sciences, in social and political organization, has been
wofully laggard in respect of the care of the insane.
Certainly, no pride of opinion or personal prejudice should
blind our teachers to existing defects in our system. It
must be, and in charity we call it so, a failure to unite
effort in breaking away from old usages and fears of legis-
lative opposition.
It would be much better that progressive changes in
asylum practice, which must inevitably come, should be
led by asylum men, rather than emanate from organized
elements that gain notoriety and morbid applause to the
extent of their power in creating public suspicion of
asylums and asylum management.


Art. II.-A Case of Moral Insanity.
Described by a mother and reported by
C. H. HUGHES, M. D., St. Louis, Mo.
COMY daughter E. was twenty-seven years of age in
11 September, 1880. When she was about sixteen
months old she was severely poisoned; she had
been suffering from a severe cold, and my family physician,
Dr. L., had given a prescription for her; the druggist made
a mistake, and sent her a prescription prepared for a labor-
ing man; both prescriptions having come at the same
time, I forget the ingredients, but remember two of them,
morphine and calomel. The doctor, having discovered
the mistake, despaired of saving my child's life, but by
immediate attention and constant working with her for
the space of about twenty-four hours her life was saved.
I always considered this poisoning to have had some effect
on her subsequent mental trouble. She was extremely deli-
cate after it until she was four years old. Her disposition
appeared always afterward very peculiar.
“ Although very talented she entirely lacked persever-
ance; even as a child, she exhibited a jealous nature
and an extremely self-willed one. When the time for her
periods arrived (much earlier than I expected), she went
six months before I discovered she had changed, and she
had not told me, and all the while had constantly bathed
in cold water. At each period her ill temper would
increase, and as she grew older she would give way to
the most violent spells. She always suffered great pain
at the time of her periods, too. One instance I recollect,
when she was about twenty years of age, small pox was
then an epidemic, her brother having been seized with a
severe attack, the physician advised all the family to
leave the house. My husband, children and one of the
servants went to a hotel, whilst I remained to take
charge of my son. A day or two later, E. left the hotel,
returned home, and, despite all protestations, tried to
effect an entrance in the house. I considered it an insane
freak on her part; she could give no reason for her
desire to come home, except that she wished to stay there.
I refused her admittance and she was obliged to return
to the hotel. A little while after, her sister was seized
the tire was nic, her hysicianand, chill rema left theried to


518
C. H. Hughes.
people.com. Since the man who camease; but went always
with small-pox, too, and was sent home. E. always
declared her sister never had the disease; but went home
merely because a clergyman who came to see my brother
was there. Since that time, her mania for slandering
people commenced. Nothing was vile enough to say of
her sister of whom she was jealous. Her moods were
various. After the most violent scenes and having been
most abusive, she would, probably in a short while,
expect people to converse with her and treat her as kindly
as though she had never acted otherwise than amiable.
From the age of twenty or thereabouts, her thoughts
would assume the most vile channel in accusing people
who displeased her of being all of degraded characters.
Her father's heart she almost broke by her disposition,
at times loveable, at others, unbearable. Finally, her
abuse of her eldest sister was almost continual; the most
frightful accusations she would make against her and a
prominent clergyman here, both of whose characters were
irreproachable. After her father's death, she grew worse,
and the loss of our fortune apparently increased her
mental trouble. She separated from me and went to live
with her aunt. After a short while she took a dislike to
her uncle, and refused for the years she lived there even
to come to the table with him. She would come out to
visit our house, I and my younger children were then
boarding with my married daughter, and often would the
violent scenes again occur; she would destroy property,
etc. One time she took a knife and cut her dead father's
portrait, merely because it was in the house of her
sister.
Then came her brother's death; he was away and
met a terrible death by the cars crushing him. My poor
daughter E. unfortunately picked up the paper and read
an account of the accident, although it did not announce
that he had yet died. I think from that time she has
been much worse. For days she screamed and was hys-
terical. First, however, on the day we received informa-
tion of his death, she came over to our house, and,
instead of sorrowing with each other and trying to bear
the sorrow, she began the most violent abuse; threw
open the hall door, and loudly spoke of my having murdered
her brother by sending him away (he had gone expressly
by his own wish), and giving their money away, etc.
We lost our estate through the mismanagement of the
administrator. Her father had left everything to me;


A Case of Moral Insanity.
519
I had to bear the loss as best I could, though almost
distracted, as I had besides E. and my son, then
not more than eighteen, three younger children, all
girls. Finally, as a last resort, I took a house to
take boarders, and have my daughter E. with me
(as before she could not live at her sister's owing to
her intense hatred of her), but I found, too soon, it was
a failure. I forgot to mention that shortly after her
father's death her actions were so violent, her language
so abusive, and her destruction of property so great that
we sent for Dr. B. and Dr. G. Dr. G. said it was her temper.
Dr. B., on the contrary, declared her insane and recom-
mended her committal to an asylum that very night.
However she being so young and our dread of putting
her in an asylum made us neglect his advice, and so
we have continued to bear with her until this year. One
peculiarity is her readiness for giving presents to people,
and when they to whom she would give did not please
her, she would deamnd her gifts back. Last Summer, in
in one of her frenzies, she became provoked at her youngest
sister, who was only fourteen; she got down on her
knees and cursed the little one, wished her to die a most
miserable death, and used the vile language to which she
is accustomed to use when angry. Now, about these
curses and the low language and vile thought she gives
utterance to, this is, I think, a most striking sign of
insanity. All her life she has been surrounded by the most
pure and lovely influences; she has, like all my children,
received every advantage that education and travel could
give her. I have been unusually careful about bringing
my children up to be good women. E. has always been
either at a convent or a school where religion was instilled
with other lessons. She had a brilliant intellect and has
read a great deal, but I was careful to let her have only
good works, and if she read others she did so without
my consent or knowledge. She must have gotten from
books or newspapers the language she uses, for nowhere
could she have heard it. Another thing that is noticeable
is her spells which almost invariably come on towards night;
she very seldom has one in the morning. When I first
took boarders, she behaved quietly at first, and even took
freaks to assist me at times; in a short time, however,
the trouble recommenced with more violence than ever.
She abused me (always without cause, or one which
existed solely in her imagination, as people are witnesses


520
C. H. Hughes.
to the fact), beat me and cursed me; then, her married
sister not being here, she centered her hatred on the one
next to herself, seven years her junior. She not only slan-
dered me, but the sister of whom I spoke; she invented the
most scandalous and outrageous stories, although everyone
who knew my other daughter knew how false E.'s asser-
tions were, still strangers might not understand and the
poor child's name would be ruined. When she attempted
violence, the gentlemen (there were five boarding with me)
interfered, and her dislike turned on them. She has kept
not only all in the house, but the neighbors awake nearly
all night. On one occasion, when she tried to get into her
sister's room after she had abused her so that she fainted,
we tried to prevent her froni entering, and she became
more violent; the police finally came, whilst her sister
was in such a deep swoon they did not think she would
recover. E., having gotten into the room, during the con-
fusion, would pull her sister's hair when she got the chance,
and otherwise annoy her; finally, the disturbance became
unbearable. She would spend (hours at one time) time
at the boarders' doors abusing them.
“She was so violent, and her sister was so ill from
nervous prostration, that I sent for Drs. P. and S. to come
and see her; they both gave their certificates as to her
insanity, and she was removed to an asylum. They kept
her there only two weeks, the physician in charge saying
her conduct was so unexceptionable that it could not be
insanity. For a few days after her return, her conduct
was very quiet, her sister had spoken to her, and E. was
apparently friendly with her. One day, I had gone out
with my other daughter and when we returned we found the
mirror in our room broken in pieces. When I questioned
E. about it, she said it was broken by her walking across
the room; as the pieces were lying around the broken
mirror, of course, her story was untrue; I believe she
broke it out of spite to her sister, and to cause her
inconvenience the same evening.
“A gentleman called to see her sister, it was one to
whom E. had taken a great dislike, she came down stairs,
ordered him out of the house, and when her sister remon-
strated she threw her down, pulled her across the room
and beat her on the head, she then went for a knife to
compel the gentleman to leave; we had to have assist-
ance to prevent a tragedy, possibly. So it went on, all
the gentlemen boarding with me left, they could not


A Case of Moral Insanity.
521
also dish of mine poor having" tan her
stand my daughter's conduct. She would threaten my
life and my daughter's life, so her sister would have to
remain shut up in her room. At one time, I think it
was almost two months, she was afraid to leave her room
at all.
“I could not begin to tell the violent and insane way
in which E. acted. When she was in one of her spells
she would throw buckets of ashes down the front hall,
ruining my carpets, and throw water over the carpets, too;
destroy pictures, frames, etc., etc. Finally, I got Dr. H.
and Dr. S. to see her. Dr. S. witnessed one of her spells,
Dr. H. one also, though not nearly as bad as usual, he
saw the insanity immediately, they both gave certificates,
and again I had her removed to an asylum. They say
the first night she was boisterous, but afterwards behaved
as lady-like as possible. After three months, they sent
her home again; she had not been home a day when her
violence recommenced; she abused me, and having taken a
dislike to the cook, she insulted the poor girl, and threw
a very handsome table dish of mine at her, breaking it in
pieces, she threw also a goblet at her, finally a china
pitcher, which struck the girl in the face and broke a
tooth; the girl was frightened and called a policeman,
the officer, through respect for my family and saying he
saw my daughter was insane, of course, did not arrest her.
“E. continually talks of my taking her money and
giving it away. As I have said, she never had any money ;
it was left entirely to me; if she were not insane she
would try to help me bear my misfortune.
“Another of her peculiarities is her taking great likings
to people, and if they happen not to reciprocate or dis-
please her she will hate them intensely. She has showed
this trait in innumerable instances. Again, after some of
her spells, when her abuse of me has been greatest, she
will expect me (and I do) to speak to her, and she will
converse in the most quiet manner; all must be forgotten
when she is ready to have it so. Just before she left for
the asylum the last time, she had a softened mood, and
told me how she loved me and loved her sister, and
talked to me very affectionately. She will sometimes
talk to me quietly, but with the same strain of how I
gave her money away, the abuse she has received, etc.;
instead of her ever being ill treated, she was petted, even
when her father was living and I could have had protec-
tion, gave up to her for peace sake. She cannot reconcile
oth; " which is
sane, of my familied a po


522
C. H. Hughes.
herself to the fact of not having all to which she has been
accustomed; she rings her bell every morning, desires her
breakfast to be brought to her, requires every attention,
and as I have but one servant, and several boarding with
me now, it is impossible, I have to do it myself for her,
just to prevent those scenes, which, however, does not
prevent them.
"Another mania is her suing everybody; she threatens
to sue the doctors who gave their certificates; my lawyer,
for her money, as she says, and for bribing the doctor as
she says; also, myself for having her put in an insane
asylum and taking her money-of course, they are all
insane threats—even the policeman she says she will have
punished for not arresting the cook (when she could bring
no charge against her). She talks in such a plausible
manner that I think she would convince anyone, who did
not know, that her story was correct and she had been
ill treated. I am convinced she frightened the doctors at
the asylum by saying she would prosecute them. Lately,
however, she is changing somewhat; her eyes have a
peculiar expession, and her conversation at times discon-
nected. I am fearful of having a tragedy, as she has
frequently threatened my life, my daughter's life and lately
the cook's.
“I have not told you one-third, and have left many things
unsaid which I would like to say. The greatest trouble
is her continually accusing everyone she dislikes of being
without reputation, etc., her thoughts seem to dwell so
much in that direction. She has also a perfect mania
for clothes, and when she has new clothes she is like a
child with playthings—happy for the time.”
Such, I may add, are the skeletons in many closets
that cannot be kept hidden or silent. They make home
an inferno and are not devils either or devil-possessed,
though they so appear. Their insanity is sometimes shown
in their decadence into dementia. The mother's simple
concluding comments are in these words:
“Were she not insane she would confine her
temper to her own home and not have these dreadful
scenes to be witnessed by outsiders. Again, she would
have too much respect for herself. It is absurd to think
a lady brought up as she has been and in her social
position would act in that manner were she not insane,
and if such were not the case, on her return from the
V


A Case of Moral Insanity.
523
asylum she would act quietly and feel too mortified to
act in the way she does. She seems to covet notoriety,
and to forget her position entirely. Were she not men-
tally afflicted, knowing our circumstances and that I am
trying to keep a home for my children, she would try
to help me keep that home instead of destroying its
peace and happiness and disgracing her family, for if she
were not insane it would be disgraceful. She has almost
broken our hearts."
Art. III. – Inebriety from a Medical
Standpoint-The Study of a Case.
By T. D. Crothers, M. D.,
SUPERINTENDENT OF WALNUT LODGE, HARTFORD, CONN.
THE following case is presented as a psychological
1 study, illustrating the physical causation of inebriety
and some of the mental defects and perversions associated
with it, that at present are overlooked and not so well
understood, perhaps, by the profession at large as they
should be. This case, like all others, was considered a
type of depravity and vicious impulse which could only
be reached by severe punishment in prison and the
power of conversion. This case was very kindly referred
to me by the editor of this Journal, Dr. C. H. Hughes,
accompanied with a brief history, which was of great
value in the further study of the case.
Z., a strong, healthy looking man, was admitted; said
to be both a constant and periodic inebriate. From the
statement of his friends and relatives the following facts
relative to heredity were elicited: His grandfather on his
mother's side was a moderate drinker for a lifetime. One
of his sons died from excess in drink, another one died
from consumption, and two daughters have been nervous
invalids for many years. On his father's side, two uncles
and several cousins have been moderate and excessive


524
T. D. Crothers.
drinkers. His father drank occasionally to excess up to
thirty years of age, then became an occasional and mod-
erate drinker of wine and beer, generally away from
home. His mother was a nervous invalid from her
marriage, suffering from various functional disturbances
and severe neuralgias requiring medical care, and for
which, at times, she found great relief in beer and wine.
His father was an active business man of wealth; hence,
his family had ail the comforts and luxuries of a country
residence in the summer and the city in the winter.
The early history of this patient was noted by a severe
attack of scarlatina with very slow recovery, and broken
restless sleep for a year or more after. At ten years of age
he was sent to school and was either at the head or foot of
the class. At times he made rapid progress in his studies,
then would be indifferent and careless. In play and physical
sports he was the leader, and grew to be a very active,
stout boy. When thirteen years of age while out gun-
ning with some playmates, his gun accidently went off
killing an intimate friend instantly. He started to run
away and fell down in a faint, which was followed by a
period of unconsciousness, in which he was carried home.
He remained in bed a week under the care of a physi-
cian. From the statements of his friends, he was prostrated,
could not eat, and when asleep would mutter and start
up suddenly calling out for help; had some fever ; ice was
placed to his head and mustard along the spine, etc.
He recovered, but a few months after a change in dispo-
sition was noticed ; at times he was silent and depressed
and would go away by himself. The noise of a gun
would cause him to start up and turn pale. His sleep
was broken at night and he would call out in some
agonizing dream, etc. From his own statements, the
memory of this event always caused a shadow of sadness,
and he frequently dreamed of seeing his dead schoolmate,
and would wake up all excited and in perspiration. He
from this time complained of frequent headaches, and
would have to go to bed from the extreme exhaustion


Inebriety from a Medical Standpoint. 525
which followed any excitement or alarm. At sixteen
years of age he entered college, and two years late: left
to take a position in a bank. During college life, he at
times drank beer when exhausted at night. The taste
was not pleasant but the effects were satisfactory and
brought marked relief. A few months after going to work
in the bank he had sexual intercourse for the first time,
followed by intoxication from wine, and suffered from
headache and exhaustion for two weeks and more. He
lived at home, and after the first year grew more and
more irregular in his habits; would come home late at
night under the influence of spirits; then for a week or
longer would seem to be using spirits regularly, then change
and be as before. From his own statement he was intox-
icated several times while at the bank, and generally
following sexual intercourse, or any great excitement.
Two years later he left the bank for a position of greater
responsibility and trust. From this time he gradually
grew worse. At first he performed all his duties correctly,
then he neglected them and spent much time in beer
saloons, and was intoxicated at times. A marked moral
lapse began in which his word was unreliable, and all
respect for the outward conventionalities grew less and
less.
He listened to all remonstrances and advice of
friends, promised sincerely to follow it, but always failed.
He affirmed that spirits were essential to his health, and
had other excuses for taking it. Finally his father gave
him a place under him where he could have more direct
personal care, but all seemed useless—the use of spirits
increased. At times he would reform and remain sober
for weeks; then he would drink strong spirits in his
room at night and beer in the day time. He claimed that
spirits were essential to make him sleep; also, was under
the care of physicians for many disorders following excess
in drink. His mind was cloudy and full of fears of death
and permanent injury from unknown causes at times, and
this would always be followed by an increased desire for


526
T. D. Crothers.
drink. By the advice of the family physician he was
sent on a voyage about the world in a sailing ship.
Somewhere in the East he was driven from the ship and
forced to work his passage home as a common sailor.
The next four years was spent on the frontier as a miner,
teamster, stock-hand and trader. He seems to have
drank periodically during this time, and to have improved
in physical appearance and apparent energy. Coming
East he drank to great excess and was sent to an asylum.
Here his symptoms were noted for the first time with
accuracy. He was at times full of confidence and pre-
tense that he would not drink again, and then he would
manifest the most extraordinary cunning and intrigue to
procure spirits, both for himself and others. He would
place spirits in the rooms of those whom he knew were weak
and would use it, and seem to enjoy the suspicion
and trouble which followed. When under the influence
of spirits he was irritable and quarrelsome. A few months
of treatment was without results and he was sent to
another institution; here the sharp discipline of restraint
improved him greatly and he was permitted to go home.
The next year was spent out on the frontier and at home,
drinking severely at times.
Finally he was placed under my care, having been
sober six days before admission. His physical symptoms
on admission were not indicative of any particular form
of disease. The liver was enlarged and the digestion was
irregular. The pulse and temperature were both normal.
The urine contained phosphates, and his sleep was trou-
bled and broken. Mentally he was clear, and talked with
regret of the past, saying he did not know why he drank, that
the impulse came over him like a flash of lightning and could
not be resisted. He complained of periods of depression
and extreme nervousness, which lasted from one to two
hours; also, at night of dreams that were distressing but
not clearly defined in character. A few days after admis-
sion one of these periods of depression came on, and was
relieved by a brisk cathartic. A few days later he


Inebriety from a Medical Standpoint.
527
violated an important rule of the institution, with deliber-
ation and audacity, and was expelled, but at the request
of friends permitted to remain sub judice. For the next
four months he was careful and attentive to all the rules,
and entirely free from stimulants. His resolution to
abstain grew stronger, and he evinced a clearness and
caution to avoid all sources of temptation. At times he
would go to bed, take cathartics, and complain of trem-
bling and thirst, which he knew was the fore-runner of a
paroxism for drink. This would go away in half a day
and be followed by a great appetite. His mind seemed
always busy in formenting trouble, in starting prejudices
against any one who happened to be in his company.
Stories that had no foundation would be told to those
who were most likely to believe them; intrigues to
• make trouble, and aimless slander and gossip in which he
was involved seemed to fill all his thoughts and give
keen pleasure. When remonstrated with, he either denied
it earnestly or gave some frivolous reason for this course.
At times this line of conduct seemed malicious, but
when analyzed, proved to be childish and weak, and
more the whimsical impulses of a mind that reveled in
intrigue. It seemed to spring from sensational novel
reading, where the plots and counterplots were studied
with pleasure and keen interest. He is now doing very
well, and has been away from the asylum some time.
This is a general outline of a case that is not extra-
ordinary in any way, but is rarely understood, one always
supposed to represent a criminally wicked man, who drinks
for the pleasure of being an outlaw to society and him-
:self. In a review of the facts it is clear that he inherited
a special nerve diathesis or tendency to inebriety. Under
all circumstances, there was a strong probability that
inebriety would appear, or some allied nerve disease,
£omewhere during his lifetime. The injury he received
at thirteen from the shock of killing his schoolmate was
a well-marked cerebral traumatism, which produced a
permanent injury of the nerve centers, manifest in the


528
T. D. Crothers.
depression and exhaustion which continued ever after,
The first intoxication following sexual depression seemed
to fix the diseased tendencies and explode the inherited
inebriety. From this time the disease grew progressively
from stage to stage. All appeals to his will power to
stop, were worse than useless, because the failures that
followed lowered all faith and confidence in the future
so essential in permanent restoration. As in all cther
cases, every movement he made brought him into worse
temptation, and more intense conditions of exhaustion,
All the rules of health and hygiene were set at
defiance; overwork and underwork, in the worst mental
surroundings, still further increased the disorder. To have
locked him up as a criminal for sixty or ninety days,
would have not only educated him as a criminal, by
contact and acquaintance with this class, but would have
built up social barriers over which he would have with
difficulty crossed in the future. Both mentally and phys-
ically he would be worse for this course.
As his mind grew weaker, all the influence of sensa-
tional stories became more impressed on his brain. His
character, disposition, habits and temper changed, and he
became a mere mental waife, subject to all influences
of an intriguer of low cunning, slander and gossip.
The drinking was the result of exhaustion and injuries
following the excess of alcohol, and the mental perver-
sions noted were hints of the failure of the mental pro-
cesses. To the general observer he seemed intelligent
and clear, talked well about himself; but a closer obser-
vation showed that he could not concentrate his mind
long on any snbject, and was very free to discuss the
folly and weakness of others, giving reasons and motives
without any foundation. He still suffers from depression
at times, and has a capricious, changeable appetite. In
love matters he has been disappointed several times, and
suffered keenly, always drinking to excess after.
The prognosis of this case is very uncertain. A resi-
dence of three years in an institution where restraint and


Inebriety from a Medical Standpoint.
529
occupation are combined, with freedom from spirits and
all exciting causes, would give more positive promise of
cure than elsewhere. The next best course would be resi-
dence on a farm, removed from all great centers of excite-
ment, with active work for a length of time. Had this case
been understood and placed under care and medical
treatment soon after the first appearance of intoxica-
tion while in the bank, recovery would nave followed.
The only hope now is that he may be able to live
removed from temptation, free from stimulants, and in
surroundings that will help him to grow stronger.
The practical facts appearing from this case are many
and suggestive. The physical origin of inebriety can be
traced in all cases more or less clearly, and points to
the necessity of positive physical remedies. This man
was incapable of bearing the wear and tear of an active
city life. He should have been sent to the country,
Here, actively employed, he might have resisted the
diseased tendency to inebriety for a lifetime. Society and
church are responsible for the neglect in properly treating
and quarantining these cases promptly on the appearance
of excess from alcohol. Physicians owe a duty to parents
to warn them against exposing weak, nervous, exhausted
boys to the bad surrounding and mental strain that
follows all business activity in the city. Inebriety must
be recognized as a disease, requiring change of surround-
ing, rest, restraint, removal from all temptation and
exciting causes, building up of body and mind. Each
case must be judged from its own history, and the rem-
edy or means of relief will be suggested from such study.
All these cases must be studied from a physical stand-
point, and the moral or criminal phases considered as
hints or symptoms of the degeneration going on in the
higher nerve centers.


Art, Iy.-Case of X.- Apoplexy, Aphasia;
Absolute Loss of Speech, but Conserv-
ation of Intelligence and Ability for
Writing. Interdiction Demanded;
Judicial Counsel Granted.*
By LEGRAND DU SAULLE.
TOHN X., æt. fifty, ex-cashier, Paris, had slight conges-
J tion of the brain in August, 1873; in the course of a
week recovered and resumed his duties. On July 23d,
1874, had a stroke of apoplexy with right hemiplegia and
aphasia ; the paralysis lasted but two months, but the
aphasia remained complete. In 1875 he had another
apoplectic attack with right hemiplegia, but at this time
there are only slight remains of it.
From these serious physical disorders X. is nearly
restored, and his intelligence is, I may say, about perfect;
his reason, memory, voluntary power and judgment are
intact; nor is there any perversion of his sentiments
(feelings), yet a great defect exists—he cannot speak.
Thus, while X. sees, hears and understands everything,
he finds an insurmountable difficulty in the function of
speech. He constantly attempts to talk, but can only
employ one or two syllables, and invariably the same, e. g.,
“ni,” “eni,” “ni,” then he resorts to gestures, which are
very animated, significant and expressive. When the
patient finds that he cannot, by his mimicry, make himself
understood, he takes his note-book and rapidly writes his
answers.
Veritable tantalus of the speech, but privileged aphasic;
he has lost, indeed, the articulative faculty, but retains
its co-ordinate-writing. If, then, he does not speak, it
is not because he has lost the ability to express himself
in words. His affliction, then, is not characterized by the
•Translated from Gazette dos Hôpitaux, Paris, June 13, 1882.


Case of 8.- Apoplexy, Aphasia, etc.
531
beclouding of his reason, but a torpor of his speech. For
the rest, aphasia is not a particular form of mental alien-
ation, but a symptom connected with divers affections of
the brain.
Here is an account of the examination of Mr. X. :
Question. Give your full name, age, profession and
residence.
He made signs that he could not speak.
l. Please write your reply.
Answer. (In writing.) John X., age fifty, Paris, etc.
e. Your children demand your deprivation of civil
rights.
A. (By signs.) Yes.
. Do you think this measure is to your interest;
and why does your daughter solicit it?
A. · (By writing.) No, she only wishes to manage my
affairs.
l. In what does your fortune consist.
A. · Three thousand francs of rente, and my pension
of two thousand, nine hundred francs.
l. The family council is unanimous in the opinion
that the appeal of your daughter is for your benefit.
A. But I do not know them.
e. Do you mean to say that you do not know the
persons who compose the family council ?
A. Yes.
(We then gave him the names of the persons who had
participated in the family council and he gave us, by
gestures, to understand that he knew them only enough
to exchange solicitations; but they knew nothing of his
business affairs, had no knowledge of his condition.)
e. Are you now in good health ?
A. Yes. I was sick in 1874 and very ill in 1875.
e. You calculate well, having been a cashier?
A. Yes.
Q. It is said you cannot do so now?
A. Yes.
(He then, as requested, added 497 to 379 correctly; but


532
Legrand du Saulle.
in multiplying 498 by 769 he made a mistake. This was
found to be owing to a defect in one of the figures given
to him.)
l. Do you live with your daughter?
A. Yes.
Q. Have you a purpose to remove to Batignolles ?
A. Yes,
Q. Why do you not continue to live with your
daughter?
A. Because I am pleased with them.
Q. That is a reason for not quitting them?
A. I retire at half-past eight.
l. It is feared that you will be subjected to the
influence of strangers; that you will waste your fortune.
A. The influence of strangers? Why, I know no one
but Mr. and Mrs. T., Mr. F. and Josephine P.
Q. Have your son-in-law and your daughter the best
feelings for you?
A. My daughter may have, but not my son-in-law.
Q. Do you believe yourself competent to manage your
affairs ?
A. Yes.
Mr. X. can write, and to a certain point is comparable
to an educated deaf-mute, who expresses himself by signs,
and who is possessed of all his civil privileges.
In the infirmary of Bicètre during thirteen years con-
secutive residence, I observed a certain number of aphasics.
In some the intelligence remained in as good condition
as it is with Mr. X. to-day; but at length I observed in
them a vulnerable point, that is there were times when
they were disposed to yield to covetous suggestions of
others, and in that state would make testamentary dispo-
sitions outside of the family lines, of a questionable
character too, which without the condition of aphasia under
which they suffered would not have been consented to so
readily. Save this weakness on this single point, save this
questionable testamentary disposition, the varied and
diverse operations of the understanding were exhibited in


Case of X.- Apoplexy, Aphasia, etc. 533
this
x. beimbecil
all other respects without a suspicion of mental disease.
I am aware that the absence of speech is one cause
of weakness and relative inferiority, but on the other hand
I maintain that the defendant is possessed of sufficient
intelligence to direct his own affairs. A tribunal would
not be able to interdict Mr. X. because he is an aphasic
merely, but because he was an imbecile, demented or
furious; now he is intelligent, therefore he cannot be inter-
dicted.
“The causes of incapacity," says the Court of Cassation,
“should be treated as real exceptions, and never reach by
implication from a case clearly established to one purely
hypothetical."
Must it be said that Mr. X. has had no need of a
protector or guardian? Though he should not be deprived
of his civil rights because of the existence of his intelli-
gence, and because the motives for interdiction are limited
to mental diseases and do not extend to lesions purely
physical, still would it not be equitable that some one
should aid him as occasion may require ? Not being able
to speak and discuss his business, I am apprehensive that
the default of this principal mode of communication of
his ideas would lead to complications in his business
transactions, and Mr. X. may become a victim of delusive
maneuvers. In such a case, it seems to me the appoint-
ment of a guardian would not only place him under
serious control, proper to prevent all errors, all surprise
in his transactions, but would also have for an object to
furnish him an interpreter, a sort of spokesman that would
facilitate singularly his social relations.
To sum up:
1. Mr. X. is an apoplectic suffering with aphasia,
but he remains intelligent and rational.
2. He expresses himself by interpretable gestures and
also by writing.
3. There is no reason why he should be interdicted.
4. However, as he has need to be assisted in his
business by a devoted person, both firm and enlightened,


534
Legrand du Saulle.
I am of the opinion that a judicial counsel should be
appointed for his benefit.
The following is the order of the Court:
“In consideration (without it being necessary to
grant the application of his daughter and his son-in-law,)
of the collateral circumstances as exhibited by the docu-
ments submitted, and more especially from the examination
of Mr. X., that he is not in a condition of imbecility,
dementia or delirium, the demand for an interdiction
of his civil rights is, therefore, not granted. For the
reason, nevertheless, that X. has suffered in health from
two grave attacks of disease, which have resulted in com-
plete aphasia, and which have reacted on his intellectual
faculties in a way to render their actions less free and
certain, it will be necessary for the safety of his interests
hereafter to grant a measure of protection to him, recog-
nized in Article 499 of the Civil Code, by appointing for
him a judicial counsel.
By these motives, and without pausing to consider the
subsidiary conclusions of the plaintiff, for the purpose of
obtaining an inquest by medical experts, the Court
declares the principal specification of the applicants
unfounded and dismisses it. Nevertheless Mr. X. in the
future shall not be able to litigate, make contracts, bor-
row, receive personal property nor dispose of it; to sell or
hypothecate, or mortgage his effects, without the aid and
consent of Mr. O., whom the Court appoints as his judicial
counsel.
The applicants are to pay costs in order to obtain by
other modes of expression as much information as is
possible to procure in regard to his capacity.”
It is plain that if a patient can give proof of his
capacity by writing, he comes under the head of educated
deaf mutes; but if it is found that his ability to write is
impaired (not uncommon in aphasia with right hemiplegia
-TR.] account should be made of it, while, at the
same time, the most thorough examination should be
made in order to ascertain, by other modes of expres-


Case of X.-Apoplexy, Aphasia, etc.
535
sion, as many facts as it is possible to procure of his
capacity.
[With such undoubted intelligence as is displayed in
the examination and history of Mr. X., it is doubtful if
in this country anything more than monitory guardianship
could have been secured for Mr. X.-Ed.]
Art. 7.-History of the 0. z. Family;
an Illustration of Rapid Neuropathic
Degeneracy.
Reported by C. H. Hughes, M. D., St. Louis.
M R. O. Z. is now seventy-six years old, in full possession
W of his faculties; sight, hearing and taste are good. He
still walks quite erect and attends to his own affairs,
writing his own letters and providing for the care of his
afflicted children. He is a great reader, possessed of
good intelligence, and a conservative, prudent and
cautious judgment respecting the care of his estate, which
he has most judiciously put into securities. There are
remarkable peculiarities in his mental “make-up" that
attract one's attention, especially when the moral, mental
and physical infirmities of his children try him and deci-
sions of importance are to be made. These peculiarities
display themselves in irresolution inconsistent with his
judgment and their welfare. He vacillates regarding
them in a manner not approved by his physician, friends
or wife. He is of nervous and sanguine temperament,
and spare build, and carries the burden of his family's
troubles ; while his wife, in contrast, is phlegmatic, fleshy
and greatly indifferent. Mr. O. Z. is otherwise eccentric,
but is in no sense insane.
Mr. O. Z. was extremely intemperate and irregular in
his habits in his youth and early manhood, drinking to
excess in a warm climate-one of the colonies of Great


536
C. H. Hughes.
Britain. Having seen most of his companions ruined by
drink, he suddenly reformed, changed his name and left
the country.
On the paternal side, the grand parents died at upwards
of fifty years ; cause of death could not be ascertained
by me. The great grandmother died at above eighty
years. The grandfather of Mr. O. 2. lived to beyond sev-
enty-nine years; his grandmother to over sixty years.
Mr. O. Zi's father died of paralysis; his brother of apo-
plexy, at sixty-two years. Both died suddenly, and with but
little previous warning—the latter while at prayers, the
former after being ill sixteen hours.
Mrs. O. Z.'s great grandmother and great grandfather
were very old people, dying at about eighty years of age.
Her grandfather died at sixty, after the amputation of a
limb; her grandmother at over eighty years. She is now
over sixty-five years of age, of a phlegmatic temperament
and full habit; ordinarily even-tempered, but unreasonable
when excited by anger, and displays less anxiety for her af-
flicted children than any mother I ever saw; showing
no emotional perturbation whatever at what may justly be
regarded as a most remarkable neuropathic family fatality.
She had one aunt insane and three inebriate brothers out
of a family of four.
In the remote ancestry of the O. Z. family for three
hundred years back, on both the paternal and maternal
side, all lived to beyond middle life who passed beyond
infancy and early childhood. There are no instances of
insanity recorded among them, so that the suggestion of
atavic descent is out of the question.
Mr. and Mrs. O. Z. have had nine children, three of
whom died in infancy and childhood. One child died at
seven years of age of croup, the others of convulsive affec-
tions incident to teething. The remaining six children
have reached maturity and are now living, with the
following history:
Two of the daughters have recurrent forms of positive
insanity; one having been in four asylums in three different


Illustration of Rapid Neuropathic Degeneracy.
537
States, displaying the forms of violent mania, acute neuras-
thenic dementia, nympho-mania and hysterical insanity.
She was treated by me for the three latter forms in which
the recurrence of her insanity was manifested after having
been for about a year out of the asylum. The other had
been in two asylums with melancholia atonica, followed
by destructive delusional insanity. Both have received
treatment for insomnia and neuropathic states bordering
on insanity.
The remaining daughter is married and has two
children, both having neuropathetic tendencies, as displayed
in a preponderance of nervous symptoms when they are
sick with any slight trouble, and in positive convulsion
and choreaic disease. The mother is markedly neurotic
when fatigued or worried, has constant spinal tenderness,
frequent ovarian and cardiac ganglionic irritation, emo-
tional and one-sided in her mental nature, and has
profound attacks of obstinate hysteria and fainting spells.
One of the sons was treated by me in 1875 and 1876
for epileptiform seizures of a persistent and troublesome
character, but under more or less constant treatment they
are kept in abeyance so that he attends to business. He
has slight exophthalmos. He has no children, and by my
advice will have none.
Another son is and has been extremely erratic, prodigal
and given to periodic drinking. Has actual dipsomania.
Has wandered about all over the world, and though con-
stantly assisted by his father in his extremity, he engages
in no steady employment. Makes repeated good resolu-
tions but invariably breaks them. He is not vicious,
but unstable in mind, constantly raising the expectations
of his friends to disappoint them in results. Has never
left a situation of any kind except abruptly. Has been in
numberless needless affrays; takes up and champions
causes in which he has no interest from mere love of
excitement, and always ends in the hands of the law.
Once shot and dangerously wounded his lawyer on
account of a trivial difference of opinion. His general


538
C. H. Hughes.
appearance is that of a handsome, well-formed man phys-
ically, tall and erect of statue, but habitually restless and
ill at ease. He has had syphilis, but has been well-treated
for it and is of sufficient intelligence to keep up the
treatment himself; whenever any suspicious pains or
aches have appeared, promptly suppressing them. He is
not an habitual drunkard, but takes to drinking at the
most ill opportune times and never terminates his drinking
voluntarily, but his sprees are ended for him through his
arrest for the trouble he gets into. Some years ago he
received an injury to his head which was followed by
brain fever and delirium, but from which ke recovered.
The remaining son is quite exemplary, mprally, and is
engaged in regular business; but, though scarcely mature,
he has fallen into phthisis.
The insane members of this family group are known
to several of my brethren in charge of asylums, and they
will doubtless recognize the picture though too briefly
and imperfectly painted. The decline of this family. may be
attributed to ancestral intemperance and conjugal, physical
and psychical incompatibility, the latter factors being more
appreciable to personal observation than discernable from
description
:
Morel has given us no example of neurotic degen-
eracy so typical or rapid as this family history illustrates.
The fatal heritage is painted on the mental phosiognomy
of all of its members in neuropathic and psychopathic char-
acters unmistakable to the observant alienist. The
diathesis of mental degeneracy has reached so advanced
a degree in the progress of descent, that the 0. Z. family
may be regarded as practically extinct even in the present
generation. No regenerative influence can properly revital-
ize the dying, mentally, nor ought the attempt by inter-
mingling even with the best of blood in marriage be made
to accomplish its regeneracy.


Art. VI. - Personal Experience with
Hyosciamine as a Hypnotic.
By H. A. HUTCHINSON, M. D., Pittsburgh, Pa.
L AVING read in the journal of Mental Science for
11 July, 1881, the remarks of Dr. Bacon on the use
of hyosciamine as a hypnotic, in which he recommends
Merck's “extractive alkaloid” dissolved in spirit of the
strength of one grain to the drachm of spirit, giving, as
he says, “never more than one and one-quarter grain, and
usually one or two-thirds of a grain as a dose. “I was
induced to try the effects of a quarter grain dose upon
myself before giving it to patients, who could not express
their sensations nor describe to me any poisonous effects
the alkaloid might produce.
My experience you will see was very much like that
of the medical gentleman to whom Dr. Bacon gave it to
relieve pain resulting from locomotor ataxy. The results
were, in the words of the latter, “ disastrous, it acted
upon him as an irritant poison, producing a great flush
over the face and body, increasing the ataxy pains,
destroying the appetite and causing a tendency to vom-
iting; along with this were dilated pupils, cheeks puffed
out, and his brain was full of delusions." I agree with
him in saying it is a most dangerous medicine, and should
be used with caution.
Just here I am reminded of an answer I received
from a medical gentleman who is connected with one of
those institutions for the insane that claims to have
entirely abandoned the use of “mechanical restraint."
When asked what substitute was used for restraining
apparatus, he said that “hyosciamine is used invariably
for the purpose of quieting excited patients.”
After the experience I have had in its use, I do not
hesitate to say that if I were a patient in an insane
asylum, and had any choice in the matter, I would, by


540
H. A. Hutchinson,
all means, prefer the camisole, or even the “crib,” to the
tranquilizing and insidious restraint of hyosciamine.
On the evening of September 5th, 1881, after prepar-
ing a solution of Merck's hyosciamine, containing one-fourth
of a grain to the fluid drachm, as remarked above, I took
one dose to test the efficacy of the drug, with the follow-
ing results : Immediately I noticed a decided dryness of
the mouth and throat, and almost a total absence of
saliva, and difficulty of deglutition. Looking in a mirror,
I noticed an intense congestion of my head and face, the
carotids throbbing violently with every impulse of the
heart. Along with this, there was acceleration of the
pulse and respiration, accompanied by a feeling of numb-
ness extending over the entire body, with loss of power
in producing the ordinary movements of co-ordination.
I made an effort to "walk it off,” but soon found my feet
becoming so enfeebled that I could only walk by fixing
my eyes intently upon the ground. Had anyone noticed
me at this time, I should have had some difficulty in
establishing the fact that I was not deeply intoxicated.
Finding that exercise would not relieve me from the poison-
ous effects of the drug, I, with much exertion, ascended
the stairs to my room for the purpose of retiring to bed.
My mental faculties up to this point were intact, and
I fully realized my unpleasant position, but had no fear
of any fatal result. Indeed, I was entirely oblivious to
everything, past, present or future, and cared little for
anything except sleep. So imperative and overwhelming
was this demand, and the general helplessness of my
limbs so rapidly increased that I was only able to throw
myself upon the bed without undressing, and was soon in
a deep slumber or coma, which lasted eleven hours.
During this period, I have no recollection of anything.
I was not disturbed by any delusion or dream, or con-
scious of the presence of anyone, or of my own existence.
Medical friends who were present with me during
those eleven hours, alarmed at the profound stupor in
which they found me, and not knowing I had been


Hyosciamine as a Hypnotic.
541
experimenting with hyoscyamine, resorted to every expe-
dient to bring me out of what they supposed an apo-
plectic coma. Resort was had to sinapisms, dry cupping,
application of cold to the head, flagellation by wet towels,
etc., but all efforts were unavailing to awaken me, or
produce any evidence of consciousness.
I am told that during this prolonged sleep there was
entire relaxation of all the voluntary muscles, except
occasionally some spasmodic movements of the arms and
legs; the pulse ranging during the first few hours at 138
full and hard; respirations numbered thirty-four to forty,
and temperature 106° F.
As the narcotic effects of the alkaloid passed away
the pulse rapidly fell to 106; temperature declined to
99', and the respirations were reduced in frequency, but
consciousness did not return for several hours after this.
When I did regain consciousness I had great difficulty
in collecting my thoughts or concentrating my mind on
any particular subject. There were no hallucinations,
delusions or illusions, but for twenty-four hours or more,
every object on which I looked was tinged with yellow.
It seems that during the period of sleep I suffered
more or less from nausea, and at one time vomited,
although I had not the slightest recollection of having
done so.
For several days after my recovery the pupils were
very considerably dilated, and I was annoyed with double
vision, and a general arrest of the various secretions of
the body, as well as the excretions from the skin.
In conclusion, I may repeat that the alkaloid is a
dangerous hypnotic, and should not be used except with
great care and in very moderate doses. If the unpleasant
experience which I have had with the drug will prove a
“cautionary signal” to other medical gentlemen, I shall
be well repaid, not only for the article I have written,
but for the experiment which came well nigh costing me
my life.


Art. VII.-The Physical Basis of Moral
Insanity Viewed in Relation to Alco-
holic Impressions.
By T. L. Wright, M. D., Bellefontaine, Ohio.
INTELLECTUAL aberration is assumed by very great
1 authority to be, if not the only kind of insanity that
is possible, at least, the foundation and basis of all
varieties of mental deterioration.
There are certain physical effects of alcohol upon the
constitution and structure of the essential tissue of the
brain, which seem to me to form a sensible and substan-
tial basis of moral insanity, without of necessity involving
the true ideational centers. These are at times so obvious,
and even obtrusive, that a brief notice of them may be
profitable:
First. It is well known that a very common effect
of the constant use of alcohol, even if not carried to
intoxication, is to invite a proliferation or increase of the
connective tissue within the proper brain area. This
hypertrophy encroaches upon the rightful domain of the
fibres and cells of the proper brain structure. Such
encroachment is, of course, a cause of trouble in the
nerve cells and in the functions of the nerve fibres, both
interfering with the receiving of perceptions, and the
projecting of motor and ideational impulses-a trouble
depending simply upon intrusion and pressure.
But the difficulties are only beginning at this stage
of change. The increased tissue subsequently undergoes
contraction; just as the apparently redundant tissue of a
scar after a burn undergoes contraction. This carries
with it the phenomena of strangulated capillary vessels
and displaced nerve cells; besides, several forms and
modes of stretching and strangling, and even disruption
of nerve fibres, follow in regular course. Add to this


The Physical Basis of Moral Insanity, &c.
543
general wreck and misery, the various forms of cell degen-
eration; as of the fatty, with subsequent absorption, and
the substitution of mere cellular tissue; also the pigment-
ary degeneration of nerve cells in the gray matter, not
omitting the calcareous or bone-like degeneration of the
same class of cells—and we have some idea of the physical
wreckage possible in the brain from the toxic power of
alcohol.
It is not necessary to enter into the minutiæ of chronic
alcoholism just now.* The power of alcohol for the
injury of the brain in general—the injury of the physical
basis of reason and of morality—is all that we desire to
point out in this place.
We will now turn our attention to one particular
portion of the brain, in order to see what will be the
probable effects of the toxic power of alcohol upon it and,
of course, its functions.
Spitzka says:
“Meynert many years ago called attention to the presumptive physio-
logical role of certain arched fibres which are known to unite adjoining as
well as distint cortical areas with each other. * * * I should,
if asked to point to the chief factor on which the higher powers of the
human brain depend, lay less stress on the cortical development than on
the immense preponderance of the white substance due to the massive
associating tracts. Both projecting and associating fibre masses increase
in a nearly geometrical ratio as we pass from the lower animals to man.
But the ratio of progression of the associating fibre masses exceeds that of the
projecting tracts. There are certain convolutions which are almost exclu-
sively connected with the associating tracts, and which enjoy but little
direct communication with the bodily periphera. Such cortical areas and
their subsidiary association tracts, bound into the higher unity of the entire
hemispbere, constitute the substance of the metaphysician's ego. A
disturbance of the material basis of the ego may render an ego an impos-
sibility."
Maudsley says:
" The habitual co-ordination of thoughts and feelings is the basis of
consciousness and personality. * * * When the co-ordination
of function in the brain is overthrown, the consciousness of personal
identity and responsibility is also lost.”
•See Journal of Inebriety, for July, 1882.
+Journal of Nervous and Mental Diseases, January, 1881.


544
T. L. Wright.
When the interchange of nerve influence is unre-
strained and unembarrassed by disease of the brain, there
is present in every individual an impregnable sense of
personal importance and individuality. It is the true,
responsible ego on the one hand, and the universe on the
other. The feelings of rights, duties, cares and responsi-
bilities spring to the front. The theologian insists, with
good reason, that this ever present sense of personal
importance implies the feelings and assertions of respon-
sibility, and invites, in the magnitude of its independent
and free nature, all the alternatives of retribution.
But in chronic alcoholism the interchange and equilib-
rium of nerve association is overcome by the intrusion of
hypertrophied interstitial tissue' upon the nerves of
Meynert; and particularly are these nerves injured in
structure and function by the final contraction of this
connective substance, which, by process of strangulation,
annihilates their function. If it is true that the fibres of
association contribute so greatly to the establishment of
the feeling denominated the ego, it follows that the destruc-
tion of those fibres must be attended by a destruction of
the sense of the ego, together with its inseparable con-
comitants—the senses of responsibility, rights and duties.
An early mark of the mental deterioration connected
with the toxic impression of alcohol on the human struc-
ture is a change in the disposition; that is, a change in
the moral nature; and this is what we might expect from
the facts already stated.
We have seen that the true moral sense is, in all
probability, dependent upon the integrity of the fibres of
Meynert; that responsibility, the ego, the individuality of
the person, is derived from the healthful structure and
function of those nerves. Hence, it follows that a serious
impairment of those functions must be associated with a
disturbance or decay of the moral attributes of the mind.
We have also seen that the proportion of the brain
mass comprising the association fibres is greater than that
of the brain mass connected with any of the other


The Physical Basis of Moral Insanity, &c. 545
functions of the mind. Hence, a morbid process extending
pari passu through all the brain structures, would operate
proportionally with greater force upon the preponderating
associating mass of the brain, or, in other words, upon
the physical basis of the moral nature, than it would upon
the physical basis of the ideational nature. Therefore,
we would expect to see first and most prominently, a
change in the disposition, or in the moral nature, in cases
of alcoholic insanity.
Some apparent exceptions might arise in certain cases,
as, for instance, where the brain trouble would partake
to some extent of the nature of syphilis, in which disease
the general malady is often accompanied by severe local
and circumscribed lesions. But it will be remembered
that we now treat only of the toxic power of alcohol as
it is displayed upon the neural basis of the moral faculties.
Second. We will next consider briefly the probable
effects of alcohol upon the moral nature of man, when it
operates through another of its toxic qualities upon the
nerves of common sensation. Anästhesia, in a degree more
or less complete is a general, if not universal, accompani-
ment of intoxication. The anesthesia of alcoholic influence
is of course not, as a rule, complete ; although Dr. L. D.
Mason* has reported some cases where even the major
surgical operations were performed without the knowledge
of the patient while under the influence of anæsthesia
from alcohol only. We will confine ourselves in these
brief notes to the general principles involved, and not
descend to the particular forms and favorite localities of
anästhesia that have been recognized as characteristic of
alcohol.
There is no principle more thoroughly established and
recognized than that sensation is the basis of the percep-
tions. When sensation is abolished there is no true
perception. At most, there are only dreams, and the
unsubstantial and inconsequent mental wanderings grow-
ing out of organic associations, and it might be memory
*Quarterly Journal of Inebriety, p. 154, July, 1882.


546
T. L. Wright.
—and in every instance without relation to passing facts
and present surroundings. And when sensation is
impaired or perverted, the perceptive faculty is likewise
impaired or perverted. Conceptions are correspondingly
modified, and, of course, the whole train of mental func-
tion is dwarfed in dignity and is unreliable. Upon the
hypothesis that the co-ordination structure of the brain,
the centers and fibres of Meynert, do not participate in
the disabilities of anæsthesia, it is still true that such
co-ordination as might be accomplished from such mental
material as has been described, must fail wholly to bring
together that unison of healthy and normal mental traits
which harmonize into a physiological ego. Hence, there
must be a failure in the establishment of the healthy
concomitants of the ego—in the establishment, in fact, of
the ideas of responsibility, duty and obligation. Here is
wreck of the moral powers, and a beginning or ground-
work for affective insanity. But there are surely no facts
which warrant the assumption that the anæsthetic proper-
ties of alcohol do not affect the co-ordination centers and
associating fibres, as well, and as much, as the sensitive
and ideational centers.
We are, therefore, justified in expecting anæthesia or
absence of sensibility in the function of the association
fibres, when under the influence of alcohol, as much as
we are, in looking for depravity of function in the same
fibres, in consequence of interstitial hyperplasia or other
physical injury.
Considering the fact that absent or impaired sensibility
may continue with little change for years in anyone
addicted to habitual drinking, it is not difficult to conceive
that, sooner or later, this imperfection of sensibility, and
the perverted mental activity associated with the abased
perceptive faculties, may become constitutional. They
become constant, and are no longer evanescent and
changing. But it must not be forgotten that this process
of establishing a new and impaired constitution, implies
what, indeed, is commonly observed a radical change in


The Physical Basis of Moral Insanity, &c.
547
the disposition of the person who is the subject of it. The
kind man, difficult and ugly only while under the influence
of alcohol, becomes, at last, unkind and ugly in his disposi-
tion at all times. The sympathetic man becomes hard in
his feelings, talks much of “business” and its rights.
His disposition most likely goes to his progeny, and is
perchance there re-enforced by alcoholic habits until, at
length, morality and “business” become divorced.
It is a favorite notion with many that the moral
nature is subservient to the reasoning faculties; that, in
fact, it is an idea worthy of toleration as a useful fiction,
as churches and religion are, in the minds of some pow-
erful thinkers, tolerated for the conjoined amusement and
admonition of the female sex. The fact is, that in the
highest civilization, the moral nature is the greatest and
best of all mental principles. It originates thought; it
guides, and is the subject of, reason and activity. Motive
is of the moral nature; it inaugurates reasoning and
incites will ; it is the incipient impulse to reason, and
while it employs will, it is not itself the object of will,
but the objective point of will, is the satisfaction of motive.
What, then, is motive? “That which incites to action;
anything prompting or inciting to choice, or moving the
will.”
“By motive,” says Edwards, “I mean the whole of
that which moves, or incites or invites the mind to voli-
tion.”
When a man of bad motives wishes to injure the
feelings or reputation of another, he employs his reason
and his physical capacities to invent and disseminate
slanders concerning him. Slander is not the motive; hate
and revenge are the motives sought to be gratified by
the injury of another. He who would enjoy property not
his own, blows open a safe. Robbery is not the motive,
it is simply a means and way to the fulfillment of the
vicious promptings of a selfish heart-of a bad moral
nature. “Teach me to feel another's woe" is the expres-
sion of a moral principle incomprehensible to such men.


548
T. L. Wright
Motive, therefore, the spring of all voluntary activity,
mental and physical, good and bad, is a principle of the
moral nature, and it depends for its finest and highest
qualities upon the integrity of the physical structure of
certain portions of the brain. Alcohol, by permanently
changing the physical basis of the moral nature, renders
that nature inoperative. Sad as the consummation undoubt-
edly is, it is the more deplorable from the obvious fact
that a reconstruction of a moral nature thus destroyed is
impossible ; for it is certain that the activity of the mere
rational faculties is inadequate to the production of a
permanent alteration in morals.
Therefore, we conclude that the anæsthesia of alcohol,
by greatly interfering with the functions of the physio-
logical basis of the moral faculties, interferes with a
fundamental factor of right mental activity, and contributes
to deflect mental effort towards selfish and sensual and
morbid courses.
Third. There is a disastrous outcome of all this
functional aberration; the sins of the fathers are visited
upon their children. Heredity is a strong and, indeed, an
irresistible force. The finer and more delicate moral
sensibilities necessarily suffer first, and, in fact, the suffer-
ing may reach no farther. The reasoning faculties may
preserve, at the same time, at least the appearance of a
good deal of capacity. Indeed, a certain craft and cun-
ning, which is very deceptive, may take the place of the
better reason, and the spectacle of the criminal character
now appears. We perceive the character of one who
knows well “the difference between right and wrong,"
but who, by reason of disturbance in the physical basis
of his moral nature, cannot rightfully feel that difference.
Such men may reason correctly upon the questions of
right and wrong. They may write and talk pathetically
upon that subject; but this is merely habit, a parrot-like,
daily routine practice. When an individual, no matter
what his attainments may be, is physically deprived of
the capacity for moral feeling, then, what the nature


The Physical Basis of Moral Insanity, &c.
549
of his conduct would be under temptation, is a question
that must "give us pause.” We are now in the presence
of the criminal nature. It is, in such circumstances, vain
to hunt for evidence of a change in the disposition in order
to establish mental defect. This change has occurred, it
is true, but it was in ancestry, and to search for it in the
criminal—as in the case of the assassin of the President
-is useless. The nature was born in him, and the
changes in the disposition, which were birth-marks on him,
should be sought in the history of his progenitors. It
was when the wreck of brain cells and brain tubes was
progressing in some ancestor that the change in disposi-
tion took place; and when also, consequent delusions
and hallucinations would surely be heard of, if the testi-
mony was all given.
In the new adjustment of structure which heredity
imposes in response to ancestral disease of the brain, the
delusions and hallucinations of progressing changes in the
neural tissue are not to be expected. That stage has
passed in the personations of ancestry. Now, such adapt-
ations are to be expected, as will represent only the
functional deficiencies imposed by progressive disease in
the parent, without any sensible co-existent morbid
changes, or any of the active indices of such ultimate
molecular morbid processes.
Sometimes the moral deficiencies of criminals are
brought in view through the impulses of sensation* and
selfishness. The criminal may not be an alcoholic inebriate;
he may avoid liquor altogether. The alcoholic neurosis
of the parent may seem to have been eliminated, or has
probably become the subject of transformation. Amongst
this class will be found the forger, the counterfeiter, the
embezzler, the gambler and all kinds of professional
criminals. A little further on, where the intellect is low,
and the legal consequences are not perceived, and when
cunning fails to give adequate prudence, we find the
•A class of motiveless acte, characteristic of moral insanity, is here liable to
come into notice, as kleptomania, etc Tbis point is illustrated somewhat at large
in Quarterly Journal of Inebriety. July, 1882, pp. 146, 147, 148.


550
T. L. Wright.
grosser criminal, the highway robber, and sometimes the
murderer.
Thus alcohol, by destroying the symmetry of the
physical basis of morality in the human brain, delivers an
insidious but dreadful blow to the happiness of man and
the welfare of society.
Art. VIII.—The Last Chapter in the Life
of Guiteau.
By W. W. GODDING, M. D.,
SUPERINTENDENT AND PHYSICIAN OF THE GOVERNMENT HOSPITAL FOR THE
INSANE, WASHINGTON, D. C.; AUTHOR OF "TWO HARD CASES.”
66 TINIS coronat opus,” says the old Latin. The Sab-
1 bath school books of the last fifty years have
made us familiar with the contrasted ends of the truly
good and the horribly wicked, the dime novel portrays the
calm indifference of the hardened criminal face to face
with his doom, but since Bellingham held out his hand
under the clear sky that canopied his scaffold, remarking,
“I think we shall have rain,” we have had but few
eminent examples to teach us how a lunatic meets the
extreme penalty of the law.
Whatever we may individually believe in regard to the
mental responsibility of the great State criminal of our
time, the closing acts of his life were, to use the psycho-
logical phraseology just now in vogue, sufficiently “out of
harmony with his environment" to be entitled to a record
in the pages of the ALIENIST.
On the 24th of June, 1882, the spiritual adviser of
Guiteau, the Rev. Dr. W. W. Hicks, informed him that
all efforts for a respite had failed; that President Arthur
had declined to interfere with the execution of the
sentence on the 30th of June; that his decision was final,
and that nothing remained but to make ready for the
event. It was thought best for the criminal to disabuse


The Last Chapter in the Life of Gurteau. 551
his mind of false hopes and thus, end the pretense, the
bravado which had kept him up so long, and, by so doing,
give him time to make serious preparation for eternity.
And the whole cominunity experienced a relief at this,
they felt that the farce had gone far enough; and keen
eyes watched for the “weakening,” that, often announced,
never came. But still sleep came to him as it comes to
a child, his digestion was undisturbed, and to all outward
appearance, the sunrise, as it came through the window of his
cell on the morning of his execution, was to him the
same welcome light that it was when he went to enjoy
it in Lafayette Park on the morning of the 2d of July, 1881.
If, as he said to Dr. Hicks and saying maintained it to
the last,“ he had done God's service and had nothing
to repent of,” he could well be calm. One year before,
he had written, “ Life is a fleeting dream, and it matters
little when one goes. A human life is of small value,”
and now he was confronted by his own statement. But
he really meant this when he wrote it, and he accepted
it for himself now. It is too late for me to doubt the
sincerity of this man's belief; in his egotism he posed
before the world, but he was not playing at a farce with
the Almighty. In his religious faith he was as terribly in
earnest as John Brown, of Osawatomie, but without the
intensity of that old man's devotion.
I think he was most fortunate in his spiritual adviser.
Dr. Hicks, having lived a stirring life in both hemi-
spheres, and having been brought in contact with all kinds
of men, knew human nature thoroughly. He found Gui-
teau sincere in his religious belief. He did not claim to
be an expert in mental pathology, but that he was in the
pathology of sin is undoubted, and when this criminal
bared his inmost soul at the confessional, and the Dr.
was convinced that he told him the truth, he did not
make the mistake that so many divines would have made,
of asking him to turn infidel to the religious convictions
on which his life had been staked. With such blind
faith, what chance was there for him to repent as the


552
W. W. Godding.
church sees repentance? The pulpit, from the first, had
been instant in demanding his execution, and now these
Pharisees of “long robes,” hearing his blasphemy, gathered
up their skirts and Aled from him as from one accursed.
This clergyman alone, not attempting to convert, was
content simply to "hold the cross” even to his dying eyes,
inot daring to assume to limit the possibilities of the
Infinite compassion. If this was not bearing worthy
testimony to his Master in the face of a frowning church
I do not know what is. To me this is the one bright
spot in all this sad business.
Winning Guiteau's confidence, Dr. Hicks had great
control over him, and I know was thereby able to
prevent some steps he was disposed to take which were
at least unwise. For example, Guiteau had conceived
a strange fancy to go in robes of white, and determined
that he would be hung in his shirt and drawers alone,
and could not be dissuaded from this by his friends. Dr.
Hicks told him that the doctors would be sure to point
to that absurd costume as conclusive evidence of insanity,
and Guiteau was so averse to giving any countenance to
the idea that he was really insane that he abandoned his
project. He said to Dr. Hicks, “If you say I am insane
I will believe it, but I believe I am sane. I believe I
am God's man, I believe I was commissioned to do this
work, and I am no more insane than you are.” This
was the rock on which he rested, and whatever Dr. Hicks
thought, we may be sure he kindly left the word insane
unspoken.
But while Guiteau was ready to leave a world that
had grown weary of him, he had still something to say
as to the manner of his going. This most egotistic of
men was not likely to omit his valedictory, or make it
less a gala day because he was the chief actor; the
drop scene was merely an unavoidable incident that would
only heighten the effect. Nor did he propose to conduct
the exercises on an empty stomach-he knew the value
of a square meal, though he seldom paid for one. So,


The Last Chapter in the Life of Guiteau. 553
after a substantial breakfast, having taken a bath and his
usual exercise, both hygienic measures, he sat down to
write “Simplicity," a poem! Within the last few weeks
of his life, Guiteau had taken to writing poetry (?). I
here insert two verses from a mystery published in the
Washington Star newspaper of June 17th, 1882, which
sufficiently illustrate his style. It is entitled “God's
Ways.”
“ Thou Jehovah!
All things created
Save the evil one!
He being uncreated
Like Thyself.
(See my book.)
*
*
*
*
*
“The retribution came,
Quick and sharp,
In fire and blood,
In shot and shell,
In endless pain!
Like a jumping tooth,
Lasting forever and ever!
(A jumping tooth
Gives an idea of hell,
And that is what
Those Jews got!)"
The parenthesis in each case lets us down from too
dizzy a flight, but I think the world was no more ready
for his poetry than for his evangel, “The Truth.”
But, to return, there was much to be done that
morning that everything should move off right. Time,
for him rapidly merging into eternity, made moments
precious, but how could the last half hour be more profit-
ably spent than in enjoying a hearty dinner, which he had
ordered earlier than usual, having requested Warden
Crocker to have the procession move at 12 o'clock M.
sharp, he knowing how important it was to be punctual
and not keep the invited guests waiting. But this won-
derful criminal, forgot nothing; at the eleventh hour he
sent out his shoes to be blacked! It will be remembered
that the same office was performed for him at the railroad
station on the morning of the 2d of July, 1881. This was
to be another of his field days, and he went to that plat-


554
W. W. Godding.
form as to a dress parade. At the first step of the
gallows he tripped, and said with a smile to Dr. Hicks,
who caught his arm: “I stubbed my toe going to the
gallows.” And this was the man they expected would
“weaken!” How little they knew him.
On the scaffold he stood erect, master of the ceremonies,
prepared to conduct his last prayer meeting, assisted by
Rev. Dr. Hicks. For twenty years this anomalous: being
had taken a real pleasure in prayer meetings, it was his
privilege to be present at one more. He stood there and
looked down into cold, unsympathetic faces, many of them
present at a prayer meeting for the first time. But he
knew that he was speaking to an audience beyond those
dull ears, and that the echoes of his voice would be heard
outside the limits of those stone walls which formed his
horizon, and past that day's shadows. The clouds of
tobacco smoke rolled up like incense from that sensation-
seeking crowd; it is but charitable to hope that his
prayers rose higher and with a more acceptable savor.
Dr. Hicks, visibly affected, commenced the services
with a brief but fitting supplication “out of the depths;"
he then held 'the Bible for the pinioned man to read, and
Guiteau, “cool as an iceberg,” as the New York Herald
correspondent remarked, said, so distinctly that his voice
filled the corridor and everyone heard him, “I will read
a selection from the tenth chapter of Matthew," naming the
verses. Then he opened on that motley audience with
a Scripture lesson that they well might heed, commencing,
“And fear not them that kill the body but are not able to
kill the soul,” continuing thence for fourteen verses. The
New York Times correspondent says, “As he read the
verses, sometimes looking on the book and sometimes
upon the people before him, he seemed to lose sight of
the gallows and declaimed the words with great earnest-
ness and much dramatic effect.” At that verse which
seemed a most precious promise that he applied to him-
self, “ He that loseth his life for my sake shall find it,”
he was eloquent. Then followed that remarkable prayer


The Last Chapter in the Life of Guiteau. 555
which he had written out and had patterned after the
seventeenth chapter of St. John. It was delivered in the
same firm and, at times, impassioned voice. Then, after
a moment's pause, another paper was unfolded before his
eyes, and this cool, self-possessed man said, “Except ye
become as a little child ye cannot enter into the kingdom
of heaven. I am now going to read some verses which
are intended to indicate my feelings at the moment of
leaving this world. If set to music they may be rendered
very effective. The idea is that of a child babbling to
his inamma and his papa. I wrote it this morning about
ten o'clock.” He had come to the most trying part of
the whole ordeal, the childish treble was to be assumed,
and he was to babble to his father in heaven some of
his fearful verses. He humbled himself, this sane man !
and thus became as a little child that so he might
enter into the kingdom of heaven. This was his new
birth; this was that childhood to which he doubt-
less thought these verses, when set to music, would
hereafter afford an effective entrance for other souls, verses
written by Guiteau the martyr, like those old hymns
which have come down to us from the early church,
hallowed with the blood of the saints, and whose
triumphant strains' have waſted heavenward many a
parting spirit. Here is the hymn that he entitled
“SIMPLICITY.”
“I am going to the Lordy, I am so glad.
I am going to the Lordy, I am so glad.
I am going to the Lordy,
Glory hallelujah! Glory hallelujah !
I am going to the Lordy!
“I love the Lordy with all my soul,
Glory hallelujah!
And that is the reason I am going to the Lord.
Glory ballelujah! Glory hallelujah!
I am going to the Lord.
" I saved my party and my land,
Glory hallelujah!”
But they höve murdered me for it,
And that is the reason I am going to the Lordy.
Glory hallelujah! Glory hallelujah!
I am going to the Lordy!


556
W. W. Godding
“I wonder what I will do when I get to the Lordy,
I guess that I will weep no more
When I get to the Lordy!
Glory hallelujah!
"I wonder what I will see when I get to the Lordy,
I expect to see most splendid things,
Beyond all earthly conception,
When I am with the Lordy!
Glory hallelujah! Glory hallelujah!
I am with the Lord.”
At last he "weakened,” he broke down in his recital,
not from fear but from genuine emotion. So real to
him were his childish pleadings, that the tears came
welling up. For a moment all vindictive feeling was
gone, the pride of “God's man” was bowed down,
even the egotism disappeared, and he was sobbing like
a child as he prattled of the time when he “would weep
no more," and the heaven where he should “see most
splendid things.” Then proudly he remembered he was
master of ceremonies still, and his sobs were hushed and
his voice rose, as he closed exultantly with “Glory
hallelujah! Glory hallelujah! I am with the Lord.”
And so the end came. Dr. Hicks pronounced the bene-
diction. Guiteau stood proudly erect while the functionary
of the law performed his final offices, and as the quickly
drawn cap shut from his eyes the last gleam of our sun-
light, those orbs turned to watch for the first dawn of the
coming brightness, needing no sun to light it, and, master
of ceremonies still, he let fall the paper on which his
prayer was written as the signal agreed upon with the
warden, and saying firmly, “Glory, ready, go,” he went
away.
Realizing how intense must have been the gratification
to his mind from all this pageant, even though a moment-
ary pang followed, and, knowing how little the insane
man considers bodily pain when controlled by his delu-
sions, I was prepared to admit that this had been euthanasia
to him, even though I had been unwilling to avail myself
of my ticket to witness his happiness.
But when, an hour and a-half later, I stood beside
what remained, and saw with what difficulty the dura-


The Last Chapter in the Life of Guiteau. 557
mater was torn away, and was surprised at the ivory
whiteness of the brain substance, and remarked of the
gray matter how thin some portions were anteriorly, and
recognized that familiar, milky opacity of the arachnoid,
extending over all the sulci of the superior convexity of
both hemispheres of the cerebrum and dipping down into
the longitudinal fissure anteriorly, so startingly like what
I had so often seen in the autopsies of chronic mania,
I questioned if it would be sufficient explanation for us
to make to the public that this appearance was common
in drunkards, and had been found in low types of chronic
disease other than of the brain, that, indeed, it was often
the result of cerebral congestion, and was frequently met
with in advanced life; and if none of those conditions
seem to exactly apply to Guiteau, to say further that
Delafield is not inclined to attach any importance to it,
and omit what Foville and Greding and Griesinger, and
in short, all writers on the pathology of insanity, have
said of its frequency in the chronic forms of mental
disease ? And, since in the absence of observed lesions
of the brain substance under the microscope, we certainly
could not claim that mere opacity of the arachnoid proved
the existence of insanity in any given case, would it do to
boldly claim, in the case of Guiteau, that this thickened,
diseased membrane should be accepted as conclusive proof
that insanity did not exist, that by reason of its thickness
it acted as a shield to his brain, even as his winter
coat afforded a better protection than his summer
duster?
These were puzzling questions, then and there; and
the more I pondered the evidences of that autopsy, in
conjunction with the retrospect of the life thus abruptly
closed, the more I felt that it was just possible that
the impartial psychological inquirers of the future, study-
ing this remarkable case, might not be so unanimous as
we had been in pronouncing this a “happy ending.”


Art. IX.-Katatonia.
By JAMES G. KIERNAN, M. D., Chicago. Ills.
FORMERLY OF THE NEW YORK CITY ASYLUM FOR THE INSANE, WARD'S
ISLAND
O NE of the disputed points in the history of insanity is
classification. Single symptoms, causes or modes of
manifestation are taken to signify distinct types of disease.
Some writers, and medical superintendents of asylums in
their reports, go beyond this even, for they give diseases,
apparently evolved from their internal consciousness, which
are neither acute, nor chronic, have no ætiology, pathol-
ogy nor mode of manifestation, but stand alone, sublime
monuments to the scientific use of the imagination.
The principle laid down by Voisin in his “ Clinical
Pictures of Insanity," that classification to be rational must
be founded on the logical association of the clinical symp-
toms, the æetiology, and the pathological anatomy is the
only one, as yet offered that is justifiable on any ground,
than that of mere hypothesis. Such a principle may give
rise, without doubt, to many new divisions of insanity, but
even then they can scarcely be more numerous and more
unwieldy than the divisions of the much lauded system of
Skae. This principle has been independently adopted
by a German observer, who is engaged in the clinical
researches similar to those of the French psychiatrist,
Doctor Kahlbaum,* medical superintendent of the Private
Asylum at Görlitz, Prussia, to whose observations are due
the recognition and clinical demarcation of the subject of
this paper.
The first volume of his recently published work is
devoted to the consideration of the form of disease in
question. He claims that the distinguishing characteristic
is an irregularity, or as he phrases it, an insanity of
*Die Katatonie.


Katatonia.
559
tension, mental and muscular, whence the name Katatonia.
His conclusions (which have been supported by observa-
tions of Meynert, Westphal and Von Kraft-Ebing, La-
fenauer, Donkersloot and Hecker) are, that Katatonia is a
distinct form of insanity, having its own clinical history.
Maudsley under the insanity of pubescence, and Bucknill
and Tuke under choreomania, have noticed some of the
individual symptoms, but have drawn no conclusion there-
from. Foville* in his discussion of Katatonia splits on the
rock of looking only at a single symptom. The first
sympton is like that noticed in the inception of other
forms of insanity, a change in the temper of the indi-
vidual. It presents at times well-marked motions of
rhythmical character, always under the control of the will.
In this respect, while bearing some resemblance to, it is
very distinct from chorea.
Another characteristic, but one which is not noticeable,
unless the case be observed from the inception to the
close, is its cyclical character, maniacal, melancholic and
cataleptoidal conditions alternating with more or less
imperfect convulsive attacks; there are also pathetic delu-
sions of grandeur, and a tendency to act and talk theat-
rically. Erotic manifestations of some kind frequently
occur, and, as is usual under such circumstances, the
patient's ideas have a religious tinge. At any stage, as in
other nervous diseases, remissions, or as is claimed by
Kahlbaum, complete recovery may occur. If the case is
to end unfavorably, periods of excitement and stupidity
recur, with more and more frequency, and the patient
dies, with terminal dementia. The clinical history is best
illustrated by the following cases:
Case 1.–T. R., age 36, policeman, single, common
school education, intemperate, as were also his parents.
The patient had been a masturbator, and had indulged in
sexual excess. He was at first melartcholic, subsequently
maniacal, but recovering therefrom became what his fel-
low-policemen called “stuck up." His temper changed
*Annales Medico-Psychologiques, 1878.


560
James G. Kiernan.
from good humor to irascibility, and asylum treatment was
at length rendered necessary. He was admitted to the
New York City Asylum for the Insane, March 17, 1873.
A week previous he had gone to church, but soon
returned, saying he had been followed by droves of dogs.
He was a tall, powerful, good humored man, and though he
had asserted he would not commit suicide he had cut off
the tip of his ear in an attempt of this kind. He was
somewhat subdued in manner, and had hallucinations of
sight and hearing. The day previous to admission he was
affected with spasm of the muscles of the extremities.
Five days after admission he manifest delusion that he
had committed a great crime, and refused food, but said:
“This is not a penance for the crime.” He require arti-
ficial feeding for three days, took food voluntarily on the
fourth, and again refused it on the fifth day. A period
of excitement then occurred, and he became a subject of
hallucinations, differing from those he had on admission.
After treatment a short time with opium and hyoscyamus
he grew quiet and took food voluntary, but very suspiciously.
In about a week after, a spasm of the muscle of the neck,
followed by slight unconsciousness and slumber, occurred,
the pupils dilating widely, and so remaining for a few
days. Two weeks after, he had very sluggish movements
of the lower extremities, bearing a suspicious resemblance
to functional paraplegia, but this was really an incomplete
cataleptoid condition, involving also the muscles of the
neck and upper extremities. The patient opened his
mouth, and performed other simple actions of that nature;
these, however, were not ideational, but sensori-motor
acts, as his attention to the subject was nil, and he was
in a peculiar emotional state. That all the mental facul-
ties were not in abeyance was shown by the fact that he
involuntarily raised his hands in an attitude of supplica-
tion, or as an acknowledgment of a favor just received.
His pupils responded to light, and the organic functions
were performed as usual. This condition continued for
three days with very little change, except that when asked


Katatonia.
561
to perform a simple action the request would be obeyed,
and the action continued indefinitely in an automatic way.
Five days after the beginning of the condition, just
mentioned, the patient had a rapid, feeble pulse, the beats of
which ran into each other and did not correspond with
the heart's action, which though rapid, was otherwise nor-
mal. His eyelids and lower extremities soon became æde-
matous and the cateleptoid condition disappeared. The
heart's action grew more irregular, the first sound being
alone audible, and accompanied with a loud, blowing
murmur heard at the base. Pulse one hundred and thirty-
two and more rapid in the neck than at the wrist; respir-
ations were increased, the lungs and temperature being
normal. The heart's action soon returned to its normal
condition, and the murmur disappeared. The treatment
was directed to the alimentary canal only. The patient
then became entirely unconscious as to his surroundings,
though taking food and performing other actions, involv-
ing only the organic functions normally, and so continued
for about a week. He then began to have tonic contrac-
tions of the muscular system, followed by lessening of the
ædema which finally disappeared. The cataleptoid con-
dition then returned and was accompanied by consider-
able waxy mobility. Two days after, his muscles were
extremely rigid, and he remained apparently unconscious
for sometime. One morning he suddenly spoke and
being asked his reason for not speaking before said,
“They told me not to,” and when asked who told him
not to, replied “God and others,” and began to weep.
The following day he had a return of the cataleptoid
condition in which he remained for some time. These
alternations continued for three months, when he be-
came suddenly violent, tore off a bar from the window
and tried to make his escape. This excitement con-
tinued three days, the patient then passing again into
the cataleptoid condition, on emerging from which he
was markedly dignified, and very formal in conversa-
tion. This manner of speaking and acting continued


562
James G. Kiernan.
for three months. He then had another cataleptoid
relapse, succeeded by an attack of melancholia attonita.
Then followed a condition during which his pupils at
first contracted and then dilated, his left hand con-
tracted firmly, and from it a quivering motion extended
over the left side, and gradually involved the entire
body. The irregularities of circulation formerly ob-
served once more appeared, and as before went away
without special treatment.
Melancholia attonita became the predominant con-
dition, accompanied, however, by increased suscepti-
bility to external influences. This remained four months,
and was followed by a cataleptoid condition with much
waxy mobility. While in this state he was found to be
developing phthisis. The disease ran a rapid, somewhat
irregular course, terminating life, July 22, 1875, twenty-
six months after his admission to the Institution.
The details of the post-mortem were as follows:
Thoracic cavity ; lungs the seat of tubercles, some under-
going softening, others calcification; remains of old ad-
hesions in the pleuræ. Heart, normal. Abdominal
cavity; the liver was slightly cirrhotic; kidneys, normal;
the mesenteric glands tuberculous, and undergoing same
changes as the lungs; spleen congested and somewhat
enlarged; the intestines somewhat congested and in-
flamed. Head-scalp thick; cranium normal, with the
dura-mater adhering to it in patches. There were firm
coagula in the veins and sinuses. The arachnoid,
especially over the fissure of Sylvius, was very opaque;
the prontico-chiasmal lamina were very dense, and a
pseudo-membrane was formed beneath. There was dull-
ness of the membrane of moderate character between
cerebellum and medulla oblongata. Epithelial granula-
tions present in a rudimentary condition, pia-matter
removable from cortex except over frontal lobe. Cortex
pale, a decided sinking of the surface of certain gyri
below neighboring convolutions. There was a fusion of
the opposite sides of the anterior cornua of the lateral


Katatonia.
563
ventricles. Cysts of choroid plexus were also present.
The first peculiarity noticeable in this case is its cyclical
character. The tendency to act and speak theatrically
is not so prominent. While this peculiarity has per-
chance attracted the attention of many alienists, it has
been regarded as a curious fact, and dismissed to the
limbo of unrecorded observations. It is a peculiarity
likely to attract attention from its occurrence in the
comparatively ignorant, and with other prominent symp-
toms is well illustrated in the following cases :
CASE II.--W. H. G., aged 26; colored, laborer, mar-
ried, intemperate and syphilitic. Mother had been in-
sane, but recovered. The patient one day while at work
fell down suddenly, and his face and arms began to
twitch; from this he soon recovered, but in two months
became much depressed, and was placed in the City .
Lunatic Asylum, where he soon became maniacal and
violent, which condition was followed by a period of
depression with ha!lucinations. He suddenly refused to
eat, and soon after passed into a cataleptoid condition,
from which he emerged one morning; said he “was
equal to any white man,” and spoke very precisely. He
was afterwards taken out of the Asylum by his wife, and
December Ii, 1871, two months after this was read-
mitted, and after having remained two months was dis-
charged improved. He was readmitted during 1874, then
in a condition of melancholia attonita, out of which he
gradually passed. When speaking he always observed
great precision, and if he supposed the expression used
was not correct, he would alter it until he found one
that might with propriety be substituted for it. He
remained in this condition till July of that year, and was
again discharged. He was readmitted March, 1875.
Held his head up in a very consequential way, and
prefaced every reply to a question by the phrase, “I do
not doubt but what.” “What is your name ?” “I do
not doubt but what it is William Henry G.” How old
are you? “I do not doubt but what I was born in the


564
James G. Kiernan.
year 1838, so my mother said.” Where were you born?
“ I do not doubt but what I was born in some part of
the world.” What part? "I do not doubt but what I
do not know what part.” His memory was somewhat
deficient but not materially so, as he remembered that
he was there before, that he went out on a furlough, and
the physician's name. He was well built and compara-
tively strong, and while speaking wrinkled his face very
much; this was somewhat of a sensori-motor act, and
under the stimulus of some emotion, at variance with his
“verbigeration,” disappeared. Patient retained his pecu-
liar manner of speaking and acting, but grew less in-
clined to walk about, would remain for hours in an up-
right position, staring straight ahead at vacancy. He
manifested moderate erotic desires.
CASE III.-P. D.; Irish; aged 28, of intemperate
habits, unmarried, of very ordinary education. The attack
of insanity was preceded by dizziness. He entered the
Asylum in a condition of melancholia approaching cata-
lepsy. He brightened up somewhat in a few days, but
was averse to conversation. About a week after admis-
tion he suddenly became communicative, said he had
wasted time and opportunities, had led a loose life, and
was now suffering the pangs of remorse. Excessive
drinking and the loss of near friends were the causes he
assigned for the present attack, of the nature of which he
was quite conscious. He had then apparently no delu-
sion, and was coherent. This mental condition continued
for two months; there was no delusion present, and the
mental tone was that of depression. Every idea ex-
pressed had that tinge. He said: “I have suffered blank
disappointment in life. Men whom I expected were just
and honest have been found wanting.” He declared at
the same time, with strong emphasis, that he had had no
disappointment of the affections, as his ideas did not run
in that channel. When asked to give the loss of friends
that he had suffered in detail, said, “A host of tender
emotions are thus raised that had better be quieted.”


Katatonia.
565
The abstract sentiments were regarded by him as more
sacred than the affections. The peculiar sensibility of
the brain to depressing influences was undoubtedly
heightened in his case, but not so much as to prevent a
pleasurable feeling when excited by other emotions.
He was very formal in conversation, and though his con-
dition would not in a man of culture necessarily be
morbid, yet in his case it was, because of its spontaneous
origin, and of its being purely subjective. His proud
semi-dignified, semi-melancholic expression, varied by an
irregular play of the muscles concerned, was a fair index
of his mental condition, for he was unable to give the
bond of association between the tender emotions and the
causes exciting them. His treatment consisted in hyos-
cyamus, cannabis indica and whisky. About a month
after the commencement of this treatment, the patient
said he had found food for thought and wisdom, in the
stability of the Christian religion, but dreaded events
would go wrong in the future. When asked “what
events” could give only his probable failure to obtain
work. He remained a week in this state, then refused
food and passed into a cataleptoid condition, with incom-
plete waxy mobility and irregular movements of the
fingers. This lasted a week, he then spoke a few words,
but continued to decline food, refusing to explain his
action. He required artificial feeding for two days, then
took food voluntarily and spoke freely; said, “that he
was the son of a Portuguese noble, who had gone to
discover the source of the Nile, and who was interested
in literary pursuits, having written Virgil.” Symptoms of
phthisis made their appearance, and the patient being
placed under tonic treatment improved somewhat. A
month after cataleptoid conditions alternated with man-
iacal attacks, which were accompanied by hallucinations
of sight. The patient died of phthisis a year after the
first appearance of the symptoms. In this case the
speech-making tendency was well marked, and, from the
imperfect training received by the patient in early life,


566
James G. Kiernan.
was very noticeable. This symptom, with a tendency to
the use of peculiarly formed words, observed in one of
Kahlbaum's cases, is to be found in a greater degree in
the following case:
Case IV.-J. E., aged 26; single, molding-maker, fair
education, intemperate. Admitted to the New York City
Asylum for the Insane, September 23, 1874. Five weeks
previously had been arrested for intemperance, which
caused him to become very much depressed. After his
release went on a spree, and while intoxicated fell down
a cellar, striking on the back of his head. Shortly after this
he said that he heard voices threatening him; that every-
thing was turning round. In obedience to these halluci-
nations, he cut his throat, fortunately avoiding any im-
portant vessel, and causing only a flesh wound. On
admission the patient seemed to have considerable diffi-
culty in talking, opened and shut his mouth as if speaking,
but did not utter a sound. He stared at everything with
a very contemptuous expression. On the following day
he spoke freely, but without any apparent difficulty, and
said that he had attempted suicide because he heard
voices threatening him. This communicativeness lasted
only a short time, and was then replaced by the condi-
tion present on admission. Two days after he appeared to
realize his condition, and said that intemperance and the
injury to the head were the chief causes of his mental
trouble, which he recognized. For a fortnight he remained
much the same. He had a defective reinembrance of
events in the immediate past, and exhibited a tendency
to repeat a question several times, in a confused manner,
before answering it. A week after this he cleared up
markedly; said he had masturbated from the age of fifteen,
and drank as many as thirty glasses of beer a day. The
confused appearance and defective memory returned, and
were accompanied by considerable depression. In a fort-
night the condition of the patient was the same as at the
time of his admission. Five days after he said he saw
blood on everything he looked at. In the course of a


Katatonia.
567
month he became very stupid, took off and put on his
clothes purposelessly, and at length passed into a catelep-
toid condition with waxy mobility, but offered very slight
resistance to any attempt at movement. Artificial feeding
was required for two days. He then took food volun-
tarily, spoke occasionally, but showed much confusion of
ideas. A month after he had improved very much, and
expressed a desire to go out and attend to his affairs,
but had no recollection of his late condition, and the cir-
culation in the extremities was very sluggish. He con-
tinued to improve, but was not considered recovered,
when six months after, his friends, against the advice of
Dr. Macdonald, the medical superintendent, removed him
from the asylum. He was brought back in six days, and
then said “that his father was a witch and his mother
also, she having poisoned his food and bewitched the
house, causing what he is unable otherwise to account
for, the occasional stopping of the house clock on the
mantel-piece.” He had at times returns of the cataleptoid
condition, with maniacal alternations, followed by a ten-
dency to express the contrary of any proposition that
might be made. These statements were intermingled with
diatribes against the other patients, and expressions indi-
cating a belief in his own importance. He made gestures
sometimes indicative of devotion, but more frequently of
contempt. Soon after the appearance of the last men-
tioned symptoms, he spoke in German about religious
matters, but this gradually changed to remarks about a girl
he had seduced. Three days after he became maniacal,
relapsing in two weeks into a cataleptoid condition, fol-
lowed by rhythmic movements of the fingers. He now
began to speak (in English,) and said, “I am Arminius
and have swallowed J. E.” He was very consequential,
resisted any intrusion on a fancied privilege, and once
knocked down a fellow-patient for sitting on the same
bench with him. A period of excitement then appeared,
followed by a relapse into the cataleptoid condition. On
emerging from this, the rhythmic motions once more


568
James G. Kiernan.
appeared, followed by incessant talking in German, imply-
ing that his family descent was noble, and making a
semi-demand, semi-appeal for the regard due him on this
account. A succession of the same phenomenon as before
then occurred, but the increased talking was in no known
language. It was however, articulate, and he made many
attempts at oratorical display. The patient still remained
in this condition when I left the asylum.
In the four cases thus far given there is a family like-
ness, modified it must be confessed, by surrounding cir-
cumstances, but such as to leave no doubt that they
belong to the same clinical type. Forty-six cases have
come under observation having the same irregularity of
mental association and cyclical character. One of the
cases came to the asylum at the time of, and apparently
through the excitement of the Moody-Sankey revival. On
examination of the case, however, it appeared that the
father had died from phthisis; the mother also had the
disease, and the patient himself had had meningitis at
the age of ten, that he became insane therefrom, but
recovered within a year and remained in mental health
for seven years after. The fact of this case occurring
during religious excitement is not peculiar, as that has
been assigned as the exciting cause in many instances.
All the forms of religious belief have furnished cases of
this kind, and they have occurred during a polytheistic
reaction from Christianity. Kahlbaum claims that the dis-
ease is very rare. My own conclusion from the facts
coming under observation is that while the statement is
true, many cases are passed unrecognized. The number
coming under observation at the New York City Asylum
was about two per cent. of the whole number of patients
admitted.
Many cases are discharged from an asylum during a
remission and are lost sight of, but return or enter other
institutions with peculiarities that puzzle the medical
attendant in classification. Such has been the experience
with a few cases discharged at this stage, preceding my


Katatonia.
569
connection with the City Asylum, and which subsequently
returned. The peculiarities of these cases are so fre-
quently described in connection with the insanity of
pubescence and menstruation, that there is little doubt
that the disease, though not so frequent as general paresis,
is entitled to a distinct place as a form of insanity so far
as frequency of occurrence gives any right to the same.
Ætiology is always an obscure, and very frequently a
disputed point in the history of insanity. It is set forth
.at great length in asylum reports, but he who expects
to derive positive information on the subject from the
statements therein contained, will be frequently disap-
pointed. An English asylum report, for example, gives
as a cause “fear of imaginary enemies." Either the
mental or the physical influence is ignored, or both are
so combined as to lead to erroneous deductions. Forbes
Winslow's ten thousand cases of insanity in the United
States caused by spiritualism is a recent example, and
has been much commented upon. The only way to
arrive at any definite conclusion is to take such facts as
are given concerning the patient's ancestry habits, age,
education, civil condition, mental peculiarities, surrounding
circumstances, the presence or absence of physical disease
and of traumatic influences, and then to deduce the logi-
cal relation of cause and effect.
Examination of the cases coming under observation, in
accordance with this principle, shows that in fifteen cases,
one of the parents was phthisical and a paternal uncle
died of hydrocephalus ; in two, the mother died of phthisis
and a maternal uncle died of hydrocephalus; in five, the
father was intemperate; in five, syphilitic; in two a mater-
nal first cousin had been insane; in four cases the mother
had been insane, and in another an aunt was idiotic.
Twenty-five of the cases were intemperate; ten took stim-
ulants moderately, and eleven were abstinent. Thirty-six
of the cases were below the age of thirty ; eighteen had
receive the ordinary common-school education, ten a high-
school education, twelve a liberal, and six the ordinary


570
James G. Kiernan.
education amounting to an ability to read and write.
Thirty were single and sixteen were married. Thirty-four
admitted the practice of masturbation; of these twenty
were in addition addicted to sexual excess, as also were
six of the remaining twelve. Forty were religiously
inclined; three were opposed to religion, not however from
a disbelief in doctrine, though they lived in defiance of
its moral code; the remainder came under the head of
what the religious press call indiffentists.
Thirty were somewhat quiet and reserved, ten were
jovial and pleasure loving, and of the remainder little defi-
nite information could be obtained. Concerning thirty it
was ascertained that they had been what was called by
their parents and relations, very studious, the study con-
sisting in the perusal of works of fiction, sensational and
biographical. The patients in ten cases were in good cir-
cumstances; twenty belonged to the lower middle classes
while the rest were from the lower class; in ten cases the
patient had in early life meningitis; in fifteen there was
some evidence of scrofulous disease; in ten no history of
preceding nervous or other chronic disease could be
obtained. Of the forty-six, but one gave a history of
rheumatism, and that was not articular but muscular. Six
had received injuries to the skull which, however, were said
to be of slight character. Fifteen were Anglo-Saxons,
fourteen being Americans ; ten were Germans, six being
American-German; fourteen were Irish, eleven of these
being Irish-Americans; one was an Italian, one a Bohe-
mian, two were Hebrews and three negroes.
The first deduction following from the facts already
given, is that the inheritance of a scrofulous diathesis acts
as a great predisposing cause, a conclusion borne out by
the pathology of the disease. Age appears also to act as
a predisposing cause. The influence of stimulants either
as an exciting or predisposing cause, seems limited; the
most logical conclusion being that since the proportion of
those abstaining from stimulants is relatively greater in
this than in the other forms of insanity, therefore the


Katatonia.
571
influence of alcoholic stimulant is antagonistic rather than
favorable to the production of the disease; in forming this
conclusion, however, the prevalence of intoxication among
the class from which many of the patients are derived, is
taken into consideration. The influence of education can
best be seen in its effects, rather than its amount, it
being in most cases regarded by the patients, not as an
end, but as a means toward an end; in short a property
entitling the possessor to certain privileges. These effects
of education led to depression on the part of the patient,
because of his not receiving the consideration which he
conceived its possession entailed. The determination of
the influence of masturbation, and whether it is not an
effect, is a question that requires some discrimination to
decide. The practice, however, aided in reducing the
already diminished vitality of the patient, and therefore,
in adding to the existing depression.
Most probably masturbation was to some extent an
outcome of the general morbid condition of the nervous
system, and aided in increasing this. The influence of
sexual excess was of a like nature, as the disease oc-
curred at a period when the sexual passion was in pro-
cess of development. Religious excitement like the
sexual element, with which it is in close alliance, was
both an effect and a cause. In individual cases coming
under observation, there have been two phases, first, the
patient's excessive devotion results in claims to extra-
ordinary religious privileges; secondly, a depression is
produced during semi-lucid periods by the evident con-
tradiction between the duties of religion and the strong
sexual desires, which often control the conduct. The
influence of the literature usually perused by this class
of patients, is very obvious from its effect on normal
minds, leading to a luxurious day-dreaming propensity,
and a disinclination to active exertion whether mental
or physical. On a morbid condition like this, peculiarly
suited for the reception of such impressions, the result
must be much intensified, for what in the normal con-


572
James G. Kiernan,
dition would simply be a day dream, in the disease, is
converted into a delusion.
The influence of surrounding circumstances is perhaps
nowhere stronger than in the United States. On the
one hand examples of self-made men are held up as
incentives to effort for high positions, while on the other
the absence of wealth is regarded as a strong evidence
of incapacity. Traumatic causes appeared in these cases
to have had a slight influence in modifying, rather than
producing the disease, which had existed before the
beginning of their action, One of these cases has already
been cited. The most frequent predisposing cause, as
already stated, seems to have been the inheritance of a
scrofulous diathesis ; the other influences acted often as
exciting causes, though at times they only increased the
predisposition to the disease.
The post-mortems given by Kahlbaum show evidences
of a healed up hydrocephalus and a basilar meningitis,
which, the post-mortenis I have made, confirm. Meynert's
deduction from Kahlbaum's cases, is that the disease has
been preceded by a patho-meningeal process, located at
the base of the brain, and over the fissure of Sylvius.
My own opinion from the cases examined is, that the
disease has been most frequently preceded, during
infancy, by a basilar meningeal process of a tuberculous
character. In a patho-psychological aspect the localiza-
tion of the procees would be over the base of the brain,
in the fourth ventricle, and over the fissure of Sylvius.
According to Dr. O. Schultze, the motor symptoms in
basilar meningitis, are due to an acute spinal affection,
occuring at the same time as the cerebral affection.
Leyden maintains that tubercular, spinal and cerebro-
spinal meningitis, the existence of which has been but
little suspected, is certainly possible, and indeed, highly
probable. Magnon, Lionville, Hayem and Schultze, all
agree that this affection is very frequently present.
Schultze concludes that the stiffness occuring in the
course of so-called basilar meningitis, with the contrac-


Katatonia.
573
tions of the muscles supplied by the spinal nerves, do
not have their origin in the brain, but are due to the
affection attacking the spinal cord; that these symptons
occur on account of the progression of the inflammatory
process from the membranes, by means of the vessels, to
the nerve bundles; and hence, partly from the inflamma-
tory irritation of the nerve bundles themselves, and
partly on account of the irritation of the spinal cord in
which myelitic changes are found. As has already been
hinted at, one point raised by the pathology, is the
question of recovery from tubercular meningeal pro-
cesses.
From the post-mortem already given, and from others
coming under observation, my opinion is that tubercular
meningeal processes are more frequently recovered from
than is generally supposed; that in reality many of the
cases of so-called hydrocephaloid disease are really hy-
drocephalus. This inference is further sustained by a
somewhat limited, though conclusive experience with
children. I have seen four cases recover and two die,
the symptoms in all being in no way distinguishable from
those given as characteristic of hydrocephalus. One case
which died, and one of the recoveries belonged to the
same family, in which there was a strongly marked tuber-
cular taint, as was also the case in another family which
came under observation.
These views regarding recovery from tubercular men-
ingitis have, to a certain extent, the support of Hasse,
one of the best authorities on the subject. Though the
pathology shows that tubercular meningitis may be re-
covered from, still the brain is not restored to its nor-
mal condition, but is so far damaged as to yield when a
strain is applied. The patient, of whose spinal cord and
brain this microscopical examination was made, was
thirty years of age; intemperate, of ordinary education.
He made well marked rhythmical motions, had maniacal
and incomplete cataleptoid alternations, followed by theat-
rical talking. His spinal cord, as will afterwards appear,


574
James G. Kiernan.
showed changes which would seem at first sight to con-
firm the opinions of Lionville, Magnan and Schultze, but
in reality are opposed to the conclusions of these ob-
servers, being, not as might be surmised, a cause, but an
effect of the cataleptoid alternations. The disease had
existed at least two years, and the patient died from
tubercular enteritis.
Post-mortem.—Body emaciated, cadaveric rigidity well
marked ; lungs, seat of tuberculous deposit; heart, normal;
tubercle of the intestines and peritoneum; spleen, con-
gested; kidneys, normal; liver, cirrhotic; head, dolicho-
cephalic; scalp, thin; cranium, thick and not adherent
to the dura-mater, which was normal. Sub-arachnoid
space filled with a number of brownish flakes of a gela-
tinous consistency; most of these drained away with the
cerebro-spinal fluid, but a few were quite firmly adherent
to the underlying pia-mater; minute blackish or dark
brown grains were disseminated through these, probably
exudative products.(?) Arachnoid of base, pontico-chias-
mal lamina, perfectly healthy, clear, and transparent;
cerebello-medullary lamina, opaque, with whitish, dense
bands. Sylvian fissure, slightly opaque. Pia-mater along
the larger, and in some instances along the finer vessels,
minute pale yellowish, whitish, and reddish bodies were
found, supposed to be tuberculous. In the Sylvian fossa
itself, over the island of Reil there was a fusion of the
leptomeninges.
Blood vessels. A whitish spot, measuring one and one-
half inches in every direction, existed on the under sur-
face of the basilar arachnoid ; the large veins were filled
with dark continuous coagula, or with chains of whitish
connected thrombi, such as occur in the ultimate agony,
when prolonged, in exhaustive diseases. The fine net-
work of vessels was injected, and this condition was
especially well marked over the island of Reil. Convulu-
tions, few, simple and typical. The white substance of
the centrum ovale of Vieussens, of the pedunculi, cere-
bellum, ganglia and tegmentum, as well as of the medulla


Katatonia.
575
and pons, showed numerous punctæ vasculosæ, all of a
strikingly venous character; in every direction the veins,
and these alone, were filled with blood. This was also
true of the cortex, and was nowhere better pronounced
than in the gyri-operti of the island of Reil. The claus-
trum which I have never before seen the seat of any
marked injection, was filled with distended venous chan-
nels and puncta venosa. The gray ganglia at the base
of the fourth ventricle, which depend for their color on
the degree and kind of injection, as well as on the pig-
mentation of their cellular elements, appeared semi-trans-
parent and cerulean in tint. Spinal cord; membranes
healthy, no deviation from the normal standard; cord
itself decidedly anæmic. Ventricles; a mucoid substance
covered the parts at the base of these cavities, particu-
larly well marked at the calamus scriptorius of the fourth
ventricle. Over the stria cornua of the left side, the
ground glass appearance was visible ; this passed gradu-
ally into the mucoid substance on either side. Dilatation
of the posterior cornua of the lateral ventricles existed,
this extended backwards, and there was adhesion of the
walls, so extensive on the left side as to cause the com-
plete separation of the apex of the posterior horn from
the body of the ventricle, giving it the appearance of a
cyst in the occipital lobe. There was a beautiful venous
injection of the ventricular lining.
It may be said in passing, that Meynert, two years
before Kahlbaum, described katatonia, called by him a
peculiar form of melancholia attonita, as “characterized
by a series of fluxionary excitations, toned down by co-
existent cerebral pressure, microscopic exudations, ven-
tricular dropsy, and (perhaps) premature ossification of
the sutures. From these would result forced and theat-
rical activities on the part of the patient. The convul-
sive state indicates the control of the irritative factors; the
cataleptoid condition, the triumph of the depressing factors.
The ideas of grandeur, following upon stupor, are the results
of ideas previously caused by tluxionary conditions.”.


576
James G. Kiernan.
As the microscopical examination is perhaps the first
as yet made in this class of cases, it was of importance
that the observations should be under the supervision of
one accustomed, not only to observe, but also to inter-
pret observations, and Dr. Spitzka kindly consented to
make it. The results obtained are certainly of a nature
to throw some light on the clinical manifestations of the
disease.
The mucoid matter on the floor of the fourth ven-
tricle was found to consist of an accumulation of round
cells, not surpassing a red blood corpuscle in diameter,
ome nucleated, others not; all were perfectly colorless.
Interspersed among them were larger elements, identical
in every respect with white blood corpuscles.
Isolated bodies of an oblong shape with a distinct
nucleus and pellucid protoplasm were noticed. All these
were imbedded in a granular mass which showed a for-
mation of imperfect fibrils. The arachnoid exudation
consisted of the same matters together with a fair pro-
portion of red corpuscles, large flakes of pigment and
round spheres of a proteine nature. The pia-mater of the
convexity exhibited numerous small nodules, most of
which were molecular, others calcareous, and a few con-
tained large and small polynucleated cells; these nodules
were periadventitial and hardly visible to the naked eye.
The cortical substance of the island of Reil showed a
marked increase of the nuclei of the neuroglia. The
ganglionic cells, both pyramidal and fusiform, were nor-
mally contoured, processes well developed; protoplasm
healthy, in some cases diffusely pigmented, and nucleus
round and clear. Free lymphoid bodies were accumu-
lated in the pericellular spaces in prodigious numbers, in
one instance, no less than twenty-three of these cells
could be distinguished clustering around one pyramidal
nerve-cell of the third layer. Frequently the nerve-cell
was altogether hidden from view by such cell groups. in
this respect the island of Reil presented marked regional
differences. It was found that areas varying from a line


Katatonia.
577
to an inch in diameter were the seat of this appearance,
while a similar, larger or smaller adjoining area was
either less involved, or perfectly normal in this respect.
The transition from the affected to the healthy areas was
sudden.
The coats of all the vessels were entirely healthy,
presenting no deviations from the appearance of cerebral
vessels in sane subjects. The arteries were empty, the
veins and many capillary districts filled with blood cor-
puscles; these latter were individually distinct, not com-
pressed or fused by crowding as has been described to
be the case in the stasis accompanying general paresis.*
This engorgement was most marked in those areas, in
which the accumulation of lymphoid bodies was farthest
advanced. The periadventitial space was filled with simi-
lar bodies, in the case of the vessels referred to. The
same appearances in a lesser degree were noticed in the
operculum, and the convolutions bordering the anterior
part of the great longitudinal fissure. The remainder of
the cortex cerebri appeared perfectly healthy. The accu-
mulation of lymphoid bodies was still more marked in
the nucleus lenticularis, than in the claustrum and island
of Reil. The cerebellum, olivary bodies, nuclei of the
cranial nerves, corpus striatum, thalamus and corpora
quadrigemina, presented no deviations from the normal
standard.
Spinal Cord ; the nerve-cells of the gray cornua were
perfectly healthy, a delicate granular material filled the
dilated pericellular spaces; central canal open. The white
columns showed everywhere an increase in the number
and thickness of the connective tissue septa, and of
Fronemann's cells. With this the medullary sheaths had
undergone a slight degree of atrophy, while many axis
cylinders were hypertrophic.
These conditions were most marked in the anterolateral
columns of the cervical portion of the cord, although the
posterior were not free from it, here it was limited to the
Spitzka “ Patho-Psychology of Progressive Paresis." Journal of Nervous
and Mental Disease, April, 1877.


578
James G. Kiernan.
peripheral portion, and a small area at the base of the
posterior intermediate sulcus. The anterior pyramids of
the medulla oblongata exhibited the same change as the
spinal cord.
-
-
-
---
-
-
-
-
CONCLUSIONS. *
1. The pia-mater presented signs of an old tubercular
process which had become latent.
2. The encephalon was the seat of a passive venous
engorgement, which had been of long standing. No
mechanical obstruction to the venous outflow could be
found as the cause of this engorgement, and we must
therefore suppose it to have depended on vaso-motor
anomalies.
3. The gelatinous exudation of the arachnoid and
pia-mater can not be considered an inflammatory prod-
uct, but rather as a simple filtration of molecular matter
and blood discs through the walls of the distended
venous channels.
4. The accumulation of lymphoid bodies per diapede-
sis around the ganglionic cells was, in like manner, the
result of the vascular stagnation. The fact that certain
cortical areas were more severely affected than others, is
to be attributed to peculiarities in the distribution of
certain venous channels.
5. This accumulation of lymphoid bodies, of whose
identity with blood corpuscles, both red and white, par-
ticularly the former, I am fully convinced occurs to such
an extent only in one other cerebral condition, namely,
that which accompanies the severer forms of typhus
fever. The similarity between the pathological appear-
ances of the cerebral cortex in katatonia and typhus is
truly striking; the chief difference is that while in the
former, certain parts of the cortex are, chiefly, if not
exclusively, affected, in the latter the whole encephalon
is involved equally. It should not be forgotten that a
few of these bodies, one or two in the pericellular space
*American Journal of Insanity, July, 1877.


Katatonia.
579
of one out of from twelve to a hundred pyramids, occur
in health, but so rarely that they have to be sought for,
and are not, as in this pathological condition, so numer-
ous as to actually conceal the nerve-cells from view. In
a lesser degree such an increase of the lymphoid bodies
takes place in many forms of insanity associated with
atrophy; their origin here is however different, as has
been explained on another occasion.
6. No destruction or degeneration of the essential
nervous elements, the, cells and fibres, was to be found,
for no importance can be attached to the diffuse pigmen-
tation of a few of the pyramidal cells, as many subjects
who have never manifested any symptoms of mental
alienation, show the same condition.
7. The condition of the spinal cord and anterior
pyramids, is to be considered as a mild grade of sclero-
sis, approximating senile sclerosis in character. In a
patient of this age, such a change is unquestionably
pathological. I am inclined to consider it as a degener-
ation due in part to malnutrition, and partly to disuse of
the motor tracts, in consequence of the long continued
and oft repeated cataleptoid conditions. In this it offers
a parallel to Charcot's “sclerose laterale," as found in an
old case of hysteric contracture, where the connective
tissue hyperplasia, was not the cause of the contracture,
but the result of the consequent long continued disuse of
the motor periphery. If future autopsies should reveal
the same appearances, I should have no hesitation in
pronouncing the characteristic pathological conditions to
be an inertia of the vaso-motor centers, whose consecu-
tive injuries effects were concentrated on the parts lying
at the depth of, and around the fissure of Sylvius. Every
other lesion is to be considered as secondary or acci-
dental.
Vaso-motor anomalies, as have been illustrated in
some of the cases, do occur in the course of the disease,
and are quite prominent features in its clinical history.
It is probable, however, that the exudation on the floor


580
James G. Kiernan.
of the fourth ventricle exerted an influence in the pro-
duction of these anomalies.
The symptomatic forms of insanity-mania, melan-
cholia, etc., may be confounded with katatonia, since
they all occur in the course of the disease. A differen-
tial diagnosis is, however, scarcely necessary here, the
result being the same, as regards prognosis, as in the
chronic cases.
Insanity of pubescence bears some resemblance to
katatonia, but does not partake of the cyclical character
of the latter disease, nor is there, unless complicated with
epilepsy or choreá, any convulsive element about it. The
delusions of the form of insanity occurring at pubescence
are very vague, partaking rather of the character of
those found in paresis, more particularly in the mental
enfeeblement, the extremely stupid disregard of all con-
flicting circumstances, and the absence of any explana-
tion; those of katatonia, on the other hand, are rather
intellectual, and do not vary so indefinitely.
The katatoniac is consequential, but his dignity is
not so obtrusively asserted as is the case in insanity of
pubescence; the former likes to be left alone, the latter
pushes himself forward. There is more or less simula-
tion in both, but the victim of pubescent insanity grows
indignant if detected; the katatoniac considers the detec-
tion a good joke.
Hystero-epilepsy* resembles markedly, in some symp-
toms, katatonia, but the general history of the disease is
very different, and on this alone, rather than isolated
symptoms, can a differential diagnosis be founded. De-
spite the apparent diversity, the delusions of grandeur
may raise a suspicion of paresis, but the wide difference
of physical symptoms will soon dissipate any doubt on
the subject. Chorea complicating insanity may cause the
confusion of it and katatonia, but the control of the
motions found in the latter disease, and the cyclical
phenomena will prevent a long continuance of the con-
• Hammond: “Diseases of the Nervous System.''


Katatonia.
581
fusion. Narcolepsy has only one symptom in common
with katatonia, and even this symptom differs from the
cataleptoid condition of katatonia in being a nearly nat-
ural slumber.
The prognosis according to Kahlbaum is good; as
far as my experience goes moderately favorable. Ten
cases out of forty-six having recovered, and of the per-
manence of the recovery of two of these I have my
doubts. These contrasted opinions are not so contradic-
tory as they seem, for though many, perhaps very many,
of Kahlbaum's recoveries were remissions lost sight of,
still his patients were in very different circumstances
from mine, and were not compelled to re-enter the world
during a remission with a damaged brain and endure the
struggle for existence, under much the same adverse
circumstances that led to their being placed under asy.
lum treatment. The presence of a tubercular meningeal
process need not militate against a favorable prognosis.
However, taking everything into consideration, the prog-
nosis should be guarded, not only as regards recovery,
but as regards life, since katatonia per se is a disease
causing death, and in addition the tendency to phthisis
has to be taken into consideration.
The duration of the disease is from two to five years,
depending on the hygienic surroundings and treatment
of somatic affections. The treatment of katatonia is
divisible into medicinal and moral. The medicinal treat-
ment should be, in a great measure regulated by the
symptoms, and should be of a tonic character, as the
katatoniac is always more or less debilitated. The motor
disturbance points to the use of conium. Alcoholic stim-
ulants have had at times what could be nothing less
than a food value, and have aided in sustaining the
diminished vitality of the patient. Stimulant enemata
have been occasionally of service, and frequently pre-
vented the return of a cataleptoid condition. The vaso-
motor anomalies seem to indicate the use of nitrite of
amyl. I have tried this remedy, but not sufficiently long


582
James G. Kiernan.
to speak decidedly of its beneficial effects, although satis-
fied that it is of value. Ten cases have certainly im-
proved under its use, and it has caused a pleasurable
feeling in all cases of katatonia where it has been given.
One of the cases already cited showed an increased
tendency to active exertion and a less theatrical tinge to
his words and actions. The case in which an immediate
effect was best shown is the following:
CASE V.-E. S., age 26; clerk, American, unmarried,
temperate in the use of alcoholic stimulants, no heredi-
tary taint ascertainable, although the father and mother
died young. During the year 1874, an enlargement on
the patient's neck, which seems to have been of the thy-
roid gland, gradually disappeared, after which an altera-
tion was noticed in his temper, which changed from good
humor to moroseness; he then became much depressed,
but soon grew maniacal, passed into a cataleptoid condi-
tion, during which he claimed to have an interview with
the Deity; he was, on emerging from it, very precise and
formal in conversation, and made rhythmical motions with
his fingers. These conditions alternated with semi-lucid
intervals marked by a morbid religious tendency. Three
years after the first appearance of the symptoms, asylum
treatment was rendered necessary by his violence. He
was admitted March 23d, 1877, to the New York City
Asylum for the Insane, was rather blank, but dignified in
expression, and in poor physical health. He had had, just
previous to admission, the delusion that his nerves were all
gone, but when admitted was unable to continue a conver-
sation for three minutes, without passing into a very com-
plete cataleptoid condition. Three days after admission he
was placed under amyl nitrite; in the course of an hour he
became quite vivacious, danced a jig, insisted on indulging
in boxing, talked clearly and connectedly, said that he
had been very lazy and disinclined to do anything for
his own support. He showed no trace of any delusion,
and had no further return of the cataleptoid condition
for two days, when the treatment with amyl was sus-
LS Sus-


Katatonia.
583
of the afterna cataleptored him
pended. In the course of the afternoon subsequent to its
discontinuance, he had a prolonged cataleptoid relapse,
followed by the same phenomena that marked him on
admission. Treatment with amyl, was again resumed on
the following day, since which time he has had no
returns of the cataleptoid condition, although he once
attempted to feign it, to avoid being bathed. He now
has the delusion that he is to live forever, but is clearer
in its expression, although somewhat vague as to details.
He gives as a reason why he is to live forever that he is
“all nerve.” This privilege has been granted by the
Deity to him as a special favor. He at length made a
a good recovery. The other cases did not show as imme-
diate improvement, although one who had been in a cata-
leptoid condition for three months before the administra-
tion of amyl, soon after its administration walked around
and talked freely—and appears to have completely recov-
ered.
Moral treatment, of course, in a great measure, resolves
itself into the consideration of the question of asylum
treatment. This is of advantage, as it affords a means of
isolation from friends, always the most disturbing influence
in treatment. Change of scene and travel, under charge
of a sensible educated man, not a pedant, would benefit
many, as it would enlarge the patient's ideas and stimu-
late him to a healthy tone of mind-in short, stir him up.
If the case be a boy, and he has a doting, foolish mother,
removal from her should be the first step in the treat-
ment, as her sympathy would undo all otherwise bene-
ficial measures; a remark that applies with equal, if not
greater, force in the case of a wife and husband.
Balls and entertainments of a purely sensuous nature
should be avoided, and all things of an intellectually
stimulating nature brought as much as possible in contact
with the patient. Faradization of the muscles of the
chest, as a prophylactic against tubercle, is one means of
treating probable somatic complications, to be recom-
mended. The general treatment by tonics, etc., is of


584
James G. Kiernan.
course indicated in this and all other atonic physical con-
ditions occurring during an attack of insanity. The
preferable method of artificial feeding often required in
cases of katatonia, is by means of a Davidson's syringe,
the use of which is unattended with the danger that
accompanies the use of the elastic but stiff tube of a
stomach pump, or the misadventures that follow the
clumsy funnel method of feeding. From the irregularity
of the symptoms, which set at defiance the dicta of the
forensic psychologist, it would seem as if the disease
could easily be feigned. Apart, however, from the prob-
ability of a criminal being so keen an observer as to
attempt feigning so complicated an affection, one symptom
could scarcely be feigned with even the slightest proba-
bility of success, namely: the cataleptoid condition. The
failure in the simulation of this symptom, with a close
examination of his antecedent history, would soon detect
any attempt of this kind. The crimes that a katatoniac
would be likely to commit are murder, arson and rape.
The murder in obedience to an hallucination, the arson
for a similar cause, while the rape would be an expres-
sion of his excited erotic condition.
If these crimes, however, were committed during a
remission, the patient should be held responsible as he
would for the time being, be capable of acting logically
on any conclusion arrived at in a logical manner. An
instance where a form of disease somewhat similar, and
perhaps, were sufficient history on the point obtainable,
katatonia itself, has been brought under cognizance of
law. This occurred in a fanatical religious organization
in Germany. Two ministers of this organization believed
they had received, during a cataleptoid condition, a com-
mand from God to kill a certain man and raise him from
the dead. The former they succeeded in doing, but in
the latter they failed. In this case which illustrates the
circumstances under which crime might be committed by
a katatoniac, the accused were declared irresponsible.
Any person, however, who has been acquitted on these


Ratatonia.
585
C.
grounds should be immediately sequestrated for the safety
of the public.
Kahlbaum claims that katatonia can occur, and has
occurred in epidemic form in France and Sweden. Influ-
ences ordinarily producing insanity in persons predis-
posed to mental disease, may cause a number of cases
to appear at one time, but never to the extent of, or
with the uniformity in symptoms characteristic of a so-
called epidemic. And this uniformity is the suspicious
point in the hypothesis of patho-mental epidemics, but is
one that admits of a very rational explanation on other
grounds than contagion.
Most probably the greatest number of victims in a
so-called katatonia epidemic were cases of morbid im-
pulse, simulating through a craving for notoriety, a few
instances of katatonia that had occurred. It is a curious
fact, however, that many of these epidemics, so-called,
have occurred in regions subject to scrofulous affections.


Art. X.-Note on Night Terrors,
By Wm. B. ATKINSON, M. D., Philadelphia.
LECTURER ON DISEASES OF CHILDREN, JEFFERSON MEDICAL COLLEGE.
DY this name is known an affection of children in
D which the child suddenly rouses from its slumbers
in great fright, screaming and apparently unable for a
time to recognize those about it. The child appears to
have been dreaming, is flushed, anxious and unwilling to be
left alone.
By many, perhaps the majority of authors, this trouble
is regarded as of no importance, and many of the writers
on children fail to allude to it; yet it is of importance
that all physicians should understand its nature and
place a proper value upon its symptoms.
The disease is not of frequent occurrence or rather
recognition. Many in a large experience do not encoun-
ter it, still, when it does occur, it is extremely annoying;
alarming the entire household; causing in the minds of
the parents an anxious fear lest it may be the fore-runner
of some mental disorder, or be a symptom of latent
disease. For these reasons, if not because of a belief in the
gravity of the affection, we deem it proper that it should
be carefully studied, and its prevention and relief better
understood.
We find it to occur often in child after child of the
same family; generally after some exhausting attack of
disease; without any tendency to assume periodicity,
and in fact apparently without any regularity. In some
instances, the attack appears to have been the direct
result of fright from fear of the dark, or from the silly
and even wicked conduct of the child's attendants.
It is extremely probable that any alimentary trouble,
as the presence of worms, indigestion, constipation, over-
feeding, may and often does cause such attacks. In addi


Note on Night Terrors.
587
tion, we may expect such a result in delicate girls or
boys who are subjected to the forcing system in educa-
tion. When the physician has the opportunity to examine
the patient during or soon after the attack, it is usually
found wearing an excited, frightened look, the heart vio-
lently palpitating, the extremities cold, and the skin
covered with a clammy perspiration.
Usually, the child after being composed by the pres-
ence of an attendant and a light in the room, falls into
a profound slumber from which it awakes in the morning
without headache or other symptoms of cerebal disor-
der. In several instances, either from fear of rising to void
the urine or from concomitant incontinuance, there has
been wetting of the bed.
The treatment must be. directed to the avoidance of
the causes, as fright, silly shines, sleeping without a light,
injudicious feeding; the relief of constipation; the use of
abundance of fresh air and exercise, the latter even to
the point of approaching fatigue, so that the child may
sleep soundly without dreaming, and the employment of
nervines and tonics, preferably those containing phos-
phorus and iron. When there are evidences of the pres-
ence of worms, the appropriate remedies should be
employed.
To prevent a return, especially when, after several
recurrences, the child comes to dread the approach of
the hour for bed, it should be enabled to sleep by the
use of the bromides or chloral, or both combined. The
latter may be exhibited very usefully by the rectum.
In some cases, there is reason to believe that such attacks
often recurring have resulted in imbecility or insanity.
[NOTE.—The above paper is not presented by the
author on account of any special novel observations, but
to call attention anew to a subject which should be kept
before the profession till more generally recognized.
There is reason to believe that the gravity of the sub-
ject of night terrors in children is not sufficiently appre-
ciated by parents on account of lack of instruction on
Poyca,


588
Wm. B. Atkinson.
the subject from the family medical advisor, and conse-
quently many cases are regarded as nothing more than
frightful dreams, for which no medication is needed.
When night terrors are of frequent recurrence in a child
without exceptionally strong exciting causes, the insane
diathesis may be reasonably suspected. We have found
this disorder, through dilligent inquiry, to prevail quite
extensively in children of neuropathic parents, especially
when the insane temperament has been markedly ap-
parent.—Ed.]
Art. XI.--A Psychical Analysis of a
Legally Sane Character,
THE MENTAL STATUS OF GUITEAU AS GLEANED FROM HIS
SPEECH AND CONDUCT.*
By C. H. HUGHES, M. D., St. Louis.
Two opposite kinds of public opinion or rather of
1 public feeling are often prominent where insanity
is pleaded in defence of capital crime. The one display-
ing the pronounced bias of personal sympathy with the
accused, either because the deed has been committed
under the incentive of a great grievance provocative of
the act, or a weak unreasonable sentimentality, on general
principles, for all “poor unfortunates" whose misfortune
it is to become entangled in the meshes of criminal law.
The other kind is one of vengeance and fear for the
safety of society, in which the mad dog simile masters
the judgment and demands the death penalty regardless
of extenuating disease. Under its influence, christians
proposing to hang even the most insane of murderers and
try the question of insanity after their execution. “De-
terrent examples must be made,” “the security of
society must be assured,” cry the Press, the Pulpit, the
Forum and the crowds that throng the court; and other-
wise humane men insist that the man who is “sane enough
* Being the editorial article omitted from last number.


Psychical Analysis of Guiteau.
589
to murder is sane enough to hang," as if any degree of
sanity was essential to the commission of homicide.
Medical men, being no more than human, are often
influenced by the popular feeling and sometimes, unfor-
tunately for science, reflect it from the witness stand when
acting in the capacity of experts.
One of the most painful sights that true psychiatric
science is sometimes thus obliged to witness, is that of a
psychological expert surrendering the convictions of
observation to popular clamor and uttering as truths of
science, expressions, which, though they agree with
public sentiment, are without warrant and disproved in
the real phenomena of disease. Sometimes this is done
somewhat unconsciously under the powerful surrounding
pressure of public sentiment, as men yield to the orator's
spell, or as a trance subject obeys the behests of the
operator. At other times, no such extenuating plea can
be admitted. The standards of true psychiatric science
are simply shamelessly trailed in the dust and soiled to
please the populace. Sometimes, too, power and influ-
ence shape and preponderate testimony, so that the
expert's opinion upon that must be different from what
it would be if he were presented with all of the real
psychical facts undistorted and not discolored, and had
resources to procure and the public willingness were at
hand to furnish, what, but for the adverse sentiment, would
willingly come forward—the requisite testimony to estab-
lish the whole truth.
But, whatever the difficulties in the way of correctly
determining questions of insanity before courts growing
out of present inefficient, and to the victim of insanity,
often unfair methods of procedure, the true medical
expert must endeavor to reach the whole truth even
though legal methods sometimes allow him but a glimpse
of it. He should make his psychological analysis of the
sane man or lunatic, whose blood the crowd are clamor-
ing for, as coolly and dispassionately as though their
vengeful demands were not heard and as deliberately as


590
C. H. Hughes.
when, duty calling to the unpleasant service, he cuts the
lifeless cadaver which can neither be helped nor harmed
by his knife, in the hope of benefiting science.
In this spirit, we propose to briefly conduct the psy-
chical analysis of the late assassin of the lamented
President. As the pathologist may exhume and examine
the cadaver in the seclusion of the dead-house without
disturbing the repose of the dead or equanimity of the
living, so may and ought science to make its calm
unbiased dissection, uninfluenced by the world without
and for the sake of truth only, of the morbid mental
character who, in an hour of delusion, plunged a nation
into consternation and sorrow and convulsed it with horror
and vengeance in which it could see only its great wrong
and the criminal who did it, and feel nothing but grief
at its great loss and hatred towards the cause of it.
In the case before us good men, irreproachable men,
observant men of experience found no evidence of insan-
ity adequate to convince their judgments, while the
psychical phenomenon was on trial for his life; but
the suggestion of feigning explained to their observant
and experienced minds what was otherwise inconsistent
with sanity, and this, with the fact that gave doubts of
the man's simulation and sanity, filled the minds of other
equally observant, irreproachable, experienced and credible
experts, who saw and heard him, adds interest to the
subject and will continue to invest it with that peculiar
charm to the faithful student of mental pathology which
always attaches to complex and unsolved problems in
psychiatry, until they are finally definitely settled. It
has been so in the past. The true mental status of the
Arnold's, the Howison's, the Bellingham's and McNaugh-
ton's having been thus established at variance with the
hasty conclusions at the time they were tried and con-
demned. It will be so in the future in regard to Guiteau.
The question why did Guiteau kill the President,
already so often asked and unanswered, will again and
again recur, and as often as it is asked will the suspicion


Psychical Analysis of Guiteau.
591
of his sanity obtrude as it came to the mind of his
victim shortly after the tragedy, as the only solution of
the crime compatable with all the light thrown upon it
and the life history of the murderer.
In a time of peace, in broad day light, in one of the
most public places in Washington, in presence of many
witnesses, after deliberate and prayerful preparation,
assurance that his pistol is true, careful attention to his
personal appearance, getting his. boots blacked, in marked
contrast with his indifference to appearance when, un-
couth and half-dressed, with rubber sandals on feet and head
bare, he sought of Senator Logan, the Paris consulship, pre-
arrangement for his conveyance to the place above all
other places where, safe from the fury of the mob, he is
to be the protected hero of the day, the observed of all
observers and “savior of his country,” this man shoots
down without hesitancy or precipitancy, or purturbation
or malice, deliberately and in cool blood, the Chief Magis-
trate of the nation as he walks arm in arm with the one
who alone had offended him and who ought instead to
have been his victim, if vengeance had been his motive.
Two shots are fired low enough to be sure of fatally
hitting their distinguished mark. If mere notoriety had
been his purpose, the assassin might have gained all of
that and better by missing his aim, or slightly wounding
the President. If reward had been his object, he would
have struck his distinguished victim in the dark, covered
up all trace of the crime, and been sure that it was
known to those who were to pay him, but he had
neither stipulation nor hope of reward; instead of this,
he exultingly proclaims the deed and its motive
and the absence of accomplices. “The President's
nomination was an act of God, his removal was an
act of God”—“I conceived the idea myself and kept
it to myself”—“No one but the Deity and I are
responsible ”—God alone was his accomplice. “I am a
stalwart of stalwarts,” he proclaims, “a lawyer, theologian
and politician,” “ I was with Grant and the rest of our


592
C. H. Hughes.
men in the canvass "_" Garfield has wrecked the grand
old Republican Party and for this he dies." And this
snubbed unrecognized Lazarus, feeding precariously off
the crumbs that might fall from the political table, is its
self-appointed, heaven-commissioned savior. To this
universally recognized “crank,” the republican party is
the country and the dissentions in the party were disrupt-
ing the nation. He has averted in the insane act a civil
war, which was not impending and brought peace by
making greater confusion. For this he insanely claims
the stricken and enraged nation's plaudits and protection
and the approval of God. Let us further describe him in
the minds of that Master of mind painters, the great
Esquirol, whose delineations, though the Master is dead,
are living portraitures of insanity that cannot be mis-
taken: “He seeks no escape in flight, delivers himself up
to justice, acknowledges the crime laid to his charge,
describes the state of mind which led to its perpetration.”
(Esquirol Mal. Ment.) “Even his premeditation is pecu-
liar”—(Ibid.)
He has written a book entitled “The Truth," which
is "designed to save souls.” This “removal of the peo-
ple's idol whom his hand has smitten unto death” will
promote its sale.” He holds up his head and his hand
that he may be seen and known of the country for his
great deed!
A year of trial for his life as the deliberate slayer of one
of whom he "thought as much as he did of his friend
General Burnsides” passes, and he stands a convicted
assassin on the gallows; his claim of divine pressure and
inspiration has been dispised and rejected, yet undis-
mayed and confident in his mission, he still proclaims
himself God's man and the savior of a country that
has not yet appeared to any other mind to be in peril,
who is about to receive his reward in “paradise and
glory.”
As the hangman's noose tightens it is not an utter-


Psychical Analysis of Guiteau.
593
ance of regret or remorse that escapes him, as would
have been natural in a sane man, but an unnatural and
insane song of glory! and his last dying word is a halle-
lujah, absolutely unwarranted by anything in his normal
life history and completely out of harmony with his ante-
cedents and environments.
Never did martyr at the stake seal his convictions in
blood more surely than has this deluded victim of a
morbidly unstable and wrongly wrought organism con-
firmed his insane faith in his fatal folly by dying speech
and conduct, yet he did it without either the cause, the
incentive, the justification or the sustaining following or
fraternity of martyrdom. All suspicion of his having
played a part is now surely settled. The question of
simulation is dissipitated in the manner of his death.
Those experts were right who said he was acting out his
true character in jail and at the trial. But the testimony
that slew the slayer of the President was based on the
assumption of the now disproved simulation.
Forty years of a singularly erratic life mingled with
good resolves and good and evil deeds, but without
previous capital or other great crime save the strange
one of open and confessed adultery for the avowed pur-
pose of securing a divorce from his wife at a time when
he seeks and needs public confidence in his professions
as theologian and lawyer, ends in unprovoked, causeless,
remorseless, unvengeful, unnaturally justified murder of
the nation's President, in a time of peace which the
murderer imagines to be a time of impending revolution.
and ruin; a murder which brings upon hiin the maledic-
tions of mankind, yet gloried in by the murderer as a
great salvation sent of God and approved of the Ameri-
can people, and he the heaven commissioned and earth
applauded savior who has averted the impending crisis
and will be cleared by God's aid of the awful crime, to
become the possible future president of the grateful
republic he has so signally served! Cleared of the
insane crime through the plea of insanity, not because he


594
C. H. Hughes.
is insane; he vigorously denies insanity, but because
legally, his inspiration will be so regarded by the jury and
so ruled to be by the court through providential guidance
even though he plead the cause of his insanity himself.
A lawyer boldly facing judge and jury and, not by
mimicry of madness as a sane man would, but by vehe-
ment and ingenious speech as coherent as he is capable
of making, seeking to establish his insanity by proof and
precedent! Yet, though knowing by experience the neces-
sity for proof and what constitutes evidence in law,
omitting all evidence of every form of insanity known to the
law of which he is by profession an exponent
and endeavoring to establish his case upon his own testi-
mony alone, in his own behalf, unable to discern what, in
his best mental estate was quite familiar to him through
experience at the bar, that such testimony was of no value.
The delusional thralldom of this morbid mind is here
most apparent. Was there ever a more insane act and
action than Guiteau and his insane plea of “spiritology
and Abrahamic insanity, not craniology,” in the late serio-
comic performance at the Capitol ? How the insane incon-
gruity of the man and his act, and his morbid disharmony
with his surroundings could escape expert detection and
fail to make its impress on the Government medical
witnesses, as it did not fail to do upon others, seems
most strange.
How natural that such a man should sleep soundly and
fatten and show no remorse for the first (and causeless)
murder of his life, and claim to the last as in the begin-
ning that God inspired the act, and see the providence
in his behalf in the lingering agony and final death of
the President and in every other event and movement
about him, where every body else saw only vengeance,
reproof and the approach of his doom !
It was “God's act and God will take care of His
own," was not only the consolatory utterance with which
he justified the bloody deed from the scaffold, but it is
the key that unlocks the masked interpretation of his


Psychical Analysis of Guiteau.
595
conduct in the court, at the time of the killing and dur-
ing his life in prison. This is the correct and only
solution that comports with all of the facts.
Doubts may yet linger in minds reluctant to concede
cerebral disease in explanation of the anomalous conduct
of this insane character, but the sincerity of his con-
victions must be conceded, and as time passes his insanity
will be admitted also. No explanation but insanity
adequately explains.
To deny that he was deluded on the ground that his
insane feelings and beliefs were“derived from the teachings
of others and not the result of disease” is rather sophist-
ical than logical. He had acquired peculiar beliefs at the
Oneida Community, but there was neither murder nor any
excessive amount of self-sacrificing patriotism in the creed
of that Community of Perfectionists, nor was assassination
a plank in the platform of that party to which Guiteau
professed allegiance and in whose behalf he was suffered,
in the canvass to make, but not to repeat, a "cranky''
speech to a negro audience.
This logic is far-fetched and of the kind that necessi-
tates the unsustained and unsustainable theory of feign-
ing to confirm it. The antecedent experience of all insane
persons, more or less, shapes their delusive conceptions.
The believer in ghosts and withcraft actually sees ghosts
and witches when his brain is morbidly touched. Spells,
charms and incantations, electrical injuries, spiritual visi-
tations and inspirations become real to those lunatics who,
when sane, believed in their existence. The difference now
is only a changed and special and intense relationship
of these supernatural and mysterious agencies to themselves.
Lunatics literally lose their heads in times of revolution
when the heads of other ones are being shot off, and carry
them under their arms; stories of snakes and lizards being
swallowed in the dark, coupled with abnormal intestinal
sensations are often the insufficient, but none the less real
rational data from which spring the not unfamiliar insane
delusion that the belly is peopled with reptiles and living


596
C. H. Hughes.
things innumerable. Suppose this lunatic did not name the
delusion of the resistless pressure of God being upon him
to do the unnatural act, in strict conformity with psycho-
logical parlance when he called it an "inspiration,” the
delusive feeling was there all the same and because he
designated his delusion in phraseology familiar to him,
does not disprove its existence. It was the most natural
thing, when we consider Guiteau's antecedents, that he
should have done to mistake the insane feeling for an
inspiration. His fanatical training at Oneida made insanity
a ready possibility to him.
It has been said that Guiteau's delusion was an
after-thought, a defensive suggestion, because, in describ-
ing the insane pressure of God upon him, he did not use
the word inspiration to all to whom he spoke, and he
spoke always with the disingenuous candor of insanity.
But he always spoke of the pressure as coming from
God; and though he did not characterize it as an inspir-
ation when first speaking to Dr. Gray, he did so to Dr.
Stearns. It is absurd to suppose that a sane man after
planning a deliberate murder from which he was to
escape on the plea of insanity, would have neglected so
important a matter as that of impressing the asserted
àssumed delusion upon all who came about him. The
word inspiration was a familiar one to Guiteau, expres-
sive of preceding morbid experiences at the recurrences
of his delusional exaltation, when schemes gigantic pos-
sessed his mind, like the conception of the great theo-
cratic daily which he and Jesus Christ were to conduct
in partnership, in which only the genius of Charles Julius
Guiteau was required to make the Almighty strong enough
to evangelize the world and bring about the long delayed
millenium.
Guiteau's simple candor of manner regarding every-
thing appertaining to his delusion in these interviews
and confidence in his cause must now convince the can-
did, after time for thoughtful reflection, that it was the
verity of disease and not the subtile design of the simu-


Psychical Analysis of Guiteau.
597
lator that formulated his speech. He even admitted to Dr.
Gray, that, had he received the Paris Commission at any
time prior to the time when the pressure to kill the
President came upon him, he would have taken it and
gone. And this is the simple truth, but would the feigner
of insanity have said so? Never! Simulation concedes
nothing that plainly thwarts its purpose. He was never dis-
concerted at anything he said though it appeared to others
as showing too much sanity; nor did it disturb him that he
"gave himself away so often,” to use a criminal phrase-
ology, in needlessly disclosing a depravity of character to
his prejudice and strangely inconsistent in those in whom
we expect consistency-with his pious professions and
labors. No feigning criminal would ever have acted like
Guiteau. He must either be categoried with the latter
or classed with the insane cranks, and in the popular
opinion a crank is a lunatic who is sane enough to hang
if he kills a President, but insane enough for the asylum
if he shoots at and misses a Queen, an actor or hits
and fails to kill an asylum Superintendent.
Guiteau's life, inconsistent and inharmonious as it was
in everything else, ended on the gallows in consistently
insane accord with his acts and utterances during
his trial and incarceration. He was there the same
and publicly conceded “crank" when about to give
the signal for the fatal drop as when he stood up to
receive his death sentence in the court room, and hurled
the defiant anathemas of God “his ally and inspirer"
upon “all who had taken part in the unrighteous verdict
against God's man.” “May God have mercy on your
soul,” he responded to the Judge's commendation to
Heaven's mercy on that last eventful day of his trial and
sentence, “I shall have a glorious flight to glory;” and
this word “glory” is the last to escape his lips as he
swings off into eternity, yet nothing about him during the
last year of his life would have inspired any sane man
with the faintest hope of glory.
Whether remembering on this last day to pay the last


598
C. H. Hughes.
dime due his washerwoman, the payment of which had
been deferred from the day before, or giving direction on
his last day on earth about the posthumous publication
of his insane book on “The Truth and Removal; or, the
Life and Works of Charles J. Guiteau," or giving directions
about the monument to his infamous memory, which his
insane imagination sees erected by a grateful posterity,
he is always and ever the same, insanely self-absorbed,
egotistical, deluded hero of a tragedy, which to his morbid
mind is approved and justified of Heaven.
The bad education theory, the simulation theory and
the total depravity dodge have played their parts well in
bringing Guiteau to the gallows, but Guiteau about to die,
dead, dissipates them all. “To this complexion must it
come at last,” Guiteau died insane.
Dispassionate sanity seeks its victim in seclusion or
surrounds itself with safeguards for escape based upon
rational appreciation of environments and regard for its
reward and usually has accomplices. It does not constitute
itself a thankless, unapproved, unrewardable, unvengeful un-
commissioned murderer. It does not openly kill in cold blood
when other methods are possible and safer with no way of
escape from arrest or adverse testimony and without other
justification than the delusive one of divine pressure or
inspiration, and the delusion that a nineteenth century
jury could be brought to believe a self-asserted delusion
would be taken as proof of its existence. The same
delusion that nerved the arm of this natural coward to do
the basely bold deed of blood so vastly at variance with
his native cowardice of character and which, but for his
delusion, he would have discerned was in defiance of
public sentiment and the law of God and man, lead him
confidently to rest his vindication before a jury of his enraged
countrymen who, but for the formal restraint and pro-
tection of the law would have put him to the rack and
torn his limbs asunder.
To this delusive, insanely unwarranted confidence in
God, born of Guiteau's undoubtedly morbid and insane


Psychical Analysis of Guiteau.
599
egoism is to be justly attributed the singular and incon-
gruous spectacle of a prisoner arraigned for a recent,
unjustifiable and atrocious homicide of which he vaun-
tingly proclaims himself the insane author, acting as his
own lawyer, protesting against or approving proceedings,
accepting or rejecting jurors, balking and embarrassing
his own counsel, complimenting the opposing to the dis-
paragement of his own attorneys before the jury, citing
precedents of law, interrupting and supplementing the
words of the court to his own harm, spoiling the effects
of the best speeches in his behalf on the part of his
counsel, and giving them no aid whatever in the conduct
of his trial; fulminating proclamations to the people and
appeals to the legal profession for aid, demanding the best
legal talent in the land as his right, promising large fees,
which he expected to come indirectly from the horrified
and outraged people! and directly from the sale of his book
and all of the familiar and insane incidents, the untimely
and shocking levity, the damaging voluntary statements
of the prisoner and his insane actions and justifications at
the trial. To insanity and nothing else can be reason-
ably attributed all the delusive conceptions, the claim of
the pressure and approval of God and inspiration, the
absurd convictions, mal à propos utterances, vehement
impulsions and morbid violence of speech and action,
so often manifested to his detriment during the trial.
The character he claims is one which rational human-
ity only concedes to the saints. A sane man would have
known the value of consistent purity of character, but he
makes no effort to even assume it. The prosecution
prove upon him practises at times in his life far from
those of angels, making the most of every faux pas and
piccadillo, while the defence blindly omit to record his
aspirations after good, his good deeds, and better impulses
and virtues, spasmodic often, it is true, but far better
than they were shown to be, and to the credit of one so
inherently unstable in his mental organism. But he can
discern nothing so adverse that it will not be dissipated


600
C. H. Hughes.
when his time comes to “get at the jury” with his trium-
phant vindication, “the true theory," as he calls it, and
when the speech is finished it proves to be of a piece with the
other “babbling," characterized as senseless, by the court
and which along with Guiteau's opening plea would have
procured for any other lawyer, at any other time and place,
a commissio de lunatico inquirendo.
That commission is holding its session now and the
higher court of impartial history will soon record its final
irrevocable decision, removed from the disturbing incidents
that embarrassed and fettered impartial opinion during
the trial of this lunatic.
Leaving the tribunal that has established the sanity of
this man, let us go again to the scaffold. Here the
prisoner is standing in the presence of the highest
court of last appeal, before whose Omniscient Judge all
minds are open and simulation avails nothing. Here he
dies as before the other court he lived maintaining his
convictions, his inspiration and his sanity to the last ;
predicting that the nation will go down in blood and
denouncing his wrath upon his murderers from the exec-
utive to the executioner. He reads in a clear, strong,
confident voice, the fourteen verses from the tenth chap-
ter of Matthew, which conclude with the warning that
“Whosoever. receiveth a prophet in the name of a prophet
shall receive a prophet's reward, and he that receiveth a
righteous man in the name of a righteous man shall
receive a righteous man's reward,” and invokes the coun-
try to make no mistake. “It is not Guiteau who is in
trouble. It is the people of the United States who are
on the brink of crime. Guiteau, the inspired, is all right,
but those who hang him will wish they had never been
born," and warns Crocker and his men to have nothing
to do with hanging him for the wrath of the Deity will
be searching and terrible to behold.
Before his executien he makes the most careful prep-
arations that he may go decently and everything be done
in order. He directs a “clean, close shave" and prescribes


Psychical Analysis of Guiteau.
601
the order of procession to the scaffold ; directs that he
may be clothed for the final scene in robes of befitting
white, emblematic of his purity and destiny, denied this,
he will go to the gallows en dishabille, in white shirt and
drawers; he omits not the slightest minutæ, takes his regular
bath and exercise; his meals and sleep, ordering his dinner
.an hour earlier than usual-eleven o'clock—and asks the
warden "to hang him sharply at twelve o'clock and go
ahead with his murder.” The scaffold is carefully examined
by his direction that there may be no bungling and that he
may go off gracefully at the right time, when he has said
his insane say to the world. He is as punctilious about his
time of taking off being assured at the moment best fitted
for tragic effect, when his devotions are just completed
and song of glory ended, as he displays about the neg-
lected ice on his raspberries on the morning of his exe-
cution and about the disposal of his patriotic body, being
extremely particular that it should not be exhibited for
gain.
Nothing is too insignificant for“ God's man's” attention
on this last day in the world that is to enshrine his
memory among its great patriots and statesmen! He
kisses his niece through the bars that “it may go that
way on the record” of his martyrdom; brushes away the
involuntary tear which comes at the reception of his
sister's bouquet with the remark as though he were
about to die a great death, "God's man must not weaken,"
but sheds not a tear, nor heaves a sigh of regret for his
illustrious victim. Once let the people be educated up to
his theory, he thinks, and “they will hail him a second
Nazarene.” The epitaph on his tombstone shall be "patriot
and christian.” “He cares nothing for his body but he
does care for this nation.”
A poem on “Simplicity, or Religious Baby Talk," written
at ten o'clock on the morning of his execution he reads
with emotion; attempting to sing it, he is overwhelmed
and breaks down.
To the President he addresses, the day before his


602
C. H. Hughes.
execution, his conception of the chronology of biblical
inspirations and retributions from the creation of Adam
to the coming and crucifixion of Christ, and His second
advent, which he places at the year 70 when Jerusalem was
destroyed, and demands of the President his liberty, saying:
“I am God's man and do not forget it, Americans, and ye
men of power, lest ye get into hell as did the Jews. Better
let me out. I am an inspired patriot. I saved my land
and party. The men that keep me here shall rue it-
God keeps the account.” Finally, and in a loud tone and
with the distinct and deliberate emphasis of conviction,
he prays: "Father I go to Thee and the Savior. I have
finished the work Thou gavest me to do and am only
too happy to go to Thee. The world does not yet appre-
ciate my mission, but Thou knowest it. . Thou knowest
Thou didst inspire Garfield's removal and only good has
come from it.” * * “ Thou, Father, didst inspire the
act for which I am murdered. This Government and
nation by this act, I know, will incur Thy eternal enmity
as did the Jews by killing Thy Man, my Savior. The
retribution in that case came quick and sharp, and I know
Thy divine law will strike this nation and my murderers
in the same way. The diabolical spirit of the nation, its
government and newspapers towards me will justify Thee
in cursing them, and I know that Thy divine law is inex-
orable. * * * And now my blood be on them (the
Press), this nation and its officials. Arthur, the President,
is a coward and an ingrate, * * his ingratitude has no
parallel in history! But Thou, righteous Father, will judge
him. Thou knowest me, but the world hath not known
me, and now I go to Thee and the Savior without the
slightest ill will towards a human being. Farewell, ye
men of earth.” This paraphrase of the prayer of the
Crucified is said to have been commingled with maledic-
tions, which more clearly revealed Guiteau's insane incon-
sistency, but his colored spiritual advisor, by threats of
deserting him, succeeded in eliminating some of its more
insane features.


Psychical Analysis of Guiteau.
603
If the dying words of a sane man are valid testimony,
we cannot refuse to give to this deluded wretch's insane
utterances their just weight. With his life history thus
completed, it can no longer be believed “that he was
simply an eccentric criminal, who has been playing a part
in court that might at least (if not humbug the experts),
affect the jury and gain for him disagreement.”
At several points, it is reported, he paused and
endeavored to impart increased emphasis to his words by
the peculiar facial impressions so often observed during
the trial when he was angered at something said or done.
This was particularly noticeable when he alluded to
President Arthur, and when he declared that this nation
would go down in blood. At the conclusion of this
prayer, he reads the silly verses beginning : “I am going to
the Lordy," to which we have referred and which he said
"represented a child babbling to its mamma and papa," and
"might be effective if set to music.”
Is it not a little too much to ask of psychiatry, now
that this lunatic's career is ended, to pronounce hini a
sane man? Had this unprovoked, motiveless, remorseless,
insanely vindicated murder had for its victim any other
than an exalted government official, a most justly beloved
Chief Executive, or had Guiteau's insanity displayed itself in
harmless proclamation or threat, he would not have been
pronounced insane. But the horrible deed, done by a
mind so insane that it regarded itself as an exception to
the general rule of law with which he was familiar, that
the penalty of unjustifiable murder is death, that believed
the act would receive universal approbation, and that
he was bound by resistless pressure to do it regardless of
consequences to himself, which in its very nature bears
the impress of a madman's hand, is so horrible that the
universal cry for vengeance which it excited, so drowned
the voice of humanity, that the plea for a stay of execu-
tion ever so brief could not be heard.
It is greatly to be regretted that the Government did


604
C. H. Hughes.
not institute and carry out to a satisfactory conclusion, a
dignified, critical and impartial inquiry into the mental
status of Guiteau even after his conviction. His conduct
and speech towards the close, if they were not before,
were more than sufficient to justify the suspicion that
a grave mistake had been made in pronouncing Guiteau
sane. Had it done so, a great blunder would not now
have blotted a page in our judicial history. It was due
to this victim of cerebro-mental disease that the govern-
ment should have ascertained, beyond doubt, that the
assertion of feigning was founded in fact instead of a
theoretical conception, which arose in the mind of Dr.
Gray and others to explain away, otherwise inexplicable
facts incompatable with the idea of sanity.
But the sacrifice is made and vengeance is complete.
The angry god of public opinion is appeased and the
public rejoices in its work. It cannot be charged that we
seek by scientific refinement to thwart justice or rob the
fair Goddess of her due if we now inquire :
What description of insanity will exclude this lunatic ?
And are compelled to answer, not one, unless it be specially
framed for the purpose of exclusion.
Not one, unless it be so exclusively somatic and physical
as to exclude all evidences beyond the dissecting table, and
will not find them there unless they are such as indicate
the results of the disease in its extremest stages of dementia
or mania. None whatever, if “ that which makes insanity
a subject of study is manifestly the symptoms which indi-
cate its presence.”—BUCKNILL and TUKE.
None, whatever, if “insanity is a condition in which
the intellectual faculties or the moral sentiments or the
animal propensities—any one or all of them have their
free action destroyed by disease—whether congenital or
acquired;" if “ bodily disease including defect are to be
regarded, if it be a disease of the brain, idiopathic or
sympathetic, affecting the integrity of the mind."-Ibid.
Or, if even we “add to the foregoing definition for
forensic purposes,” that “the cerebro-mental disorder


Psychical Analysis of Guiteau.
605
must be such as to suspend or impair the action of the
healthy will” (ibid.), it is doubtful if Guiteau could be
excluded.
None, whatever, if insanity is, as it has been defined
with approval of the best of writers on psychiatry to be
“a departure without adequate external cause from the
states of feeling or modes of thinking, usual to the individ-
ual who is in health.”—GOOCHE, COOMBE and Ray.
It will hardly be contended that there was even a
shadow of an adequate external cause for the murder
of the President, or that assassinations under divine pres-
sure or inspiration was the natural mode of thought or
feeling of Guiteau, though his delusive life began far back
in his insanely singular career.
It was not necessary that Guiteau's insanity should
have come upon him through auditory or visual halluci-
nation like the sane change of character of Saul of Tarsus,
or the "voice, as of a trumpet from behind” that moved
the Apostle John, in order that Guiteau should be recognized
as the victim of a delusion. Delusions may come through
pure psychical hallucination and a resistless mental
pressure may be to some morbid minds as much an in-
spiration as the visible face or the audible voice of God,
is to others. No true student of morbid psychology who
has observed insanity in all of its phases needs to be told
this.
Dead-house definitions have given as the sequent pa-
thology of the most marked and advanced forms of in-
sanity, but the post-mortem revelations of the scalpel
have not yet taught us half so much as the ante-mortem
disclosures of the psychical symptomatology of this affection
and not more, practically, than the test tube, the micro-
scope, the sphygmograph and other aids to correct inter-
pretation have done. We do not diagnose insanity by
these means, though we employ them as confirmatory
aids, as we likewise use the scalpel.
We do not diagnose insanity on the dead but on the
living subject, as we determine yellow fever, chorea or


606
C. H. Hughes.
tetanus, though we may with profit, on the cadaver, study
its somatic causes, sequences and accompaniments. Dead-
house experts may be used to dust the eyes of the populace
when it is desirable to hang a dangerous lunatic, and may
serve, as doubting Thomas, in great crises when the public
and not the patient needs the benefit of the doubt, and sub-
serve a useful purpose in inspiring the inexpert with awe.
But living lunatics have their signs as well as dead ones
-the morbidly acting brain is often more of a revelation
than the brain stilled by death. It is in the actual ob-
servation of the insane (while they are living and insane)
that the true characteristics of the disorder are com-
prehended. “Remove the mental and retain the physical
signs” (when the latter are prominent which, in chronic in-
sanity especially, is not the case), “and the patient would
be esteemed sane, alike by the ordinary observer and
the medical man.”—BUCKNILL and TUKE.
We do not even discharge lunatics from our asylums
as recovered when the physical evidences of physical
disease only disappear in them. Mark Gray is still
retained at Elgin without other evidence of disease,
sufficient at least to establish his insanity, than the per-
sistent delusion that he is still the “Melancholy Dane,"
mimicked by Edwin Booth, and justifying the shot which
imperilled the great tragedian's life; Freeman is still (if
living) at Danvers, with no other reason for his detention
there than his abiding delusion that he was called of
God for the unnatural ungodly purpose of killing his
child. Brown, who shot at Queen Victoria and
who shot at Dr. Gray, were insane, regardless of physical
signs.
It would take many a page to name the insane re-
tained in, as well as committed to asylums, on the psychi-
cal evidences of cerebral disease alone. They are in
Utica and Oshkosh, in Hartford and Nashville, at College
Hill and New York as well as at St. Elizabeth and Boston.
They are everywhere, and if they are, the physical
symptoms cannot be placed equal with the psychical,


Psychical Analysis of Guiteau.
607
for the psychical are characteristic and never absent;
while the former often are, and when present, are at best
generally only confirmatory signs, when we are in doubt
as to simulation in chronic cases especially. “The devia-
tions from the normal standard of physical health are
valueless for the purpose of diagnosis of insanity in gen-
eral or for any one form of mental disease,” (Lockhart
Robertson's Greisinger, p. 161.) notwithstanding their great
importance as regards etiology and treatment.
"But he twice previously sought to take the President's
life and was rescued from his purpose. He knew what he
was about. He was able to resist the propensity then.
Why could he not resist finally ?” This is the history of
nearly all destructive insanity. First, the unbidden morbid
impulse resisted, then recurring again and again, and, finally,
resistless; then the culminating suicide or homicide, or the
miscarried attempt and the arrest and commitment to the
asylum. Lunatic asylums are the cemeteries of unexe-
cuted morbid impulses.
“But he reasoned on the subject.” It would make his
friend, Arthur, President, (who never gave him a friendly
recognition). “This is not murder; it is a political neces-
sity.” “It has to be done as a matter of duty”—as a
matter of duty. Here the insanity of his motive is
revealed again. What rational human duty was on him
to murder the President? But is it anywhere on record
that the insane do not reason? They reason very
shrewdly sometimes, though often disastrously. “They do
not so much reason wrongly as rightly from wrong pre-
mises”, as Locke observed, premises formed' in delusion.
The literature of insanity contains many examples of the
worst of lunatics who could reason sensibly in their trained
capacity of clergymen in the pulpit, judges on the bench
and lawyers at the bar. The case of Col. M. and the
Rev. Simon Brown, cited by Ray, and the judge and
devine referred to by Rush, are old and familiar
examples.
“ The mental disability of the insane may be evinced,


608
C. H. Hughes.
not in failing to recognize the illegality of their acts, but
in considering themselves as absolved from the obliga-
tions of the law. They move in a sphere beyond the
reach of the ordinary motives of human conduct, and
are a law unto themselves.”—Ray, Prelim. Views, p. 45.
It is thus they reason. Thus, reasoned Guiteau : “Gar-
field has wrecked the grand old Republican party. The
Deity and I avenge this crime against the country.""
“But he prayed over it.” So has many another lunatic
before his morbid feeling has taken shape in resistless
delusion. Asylum records and psychiatric literature are
full of confirmatory examples.
The following illustration taken from among a number
of similar import, reported by Marc, and familiar to all
alienists, having been greatly added to by subsequent
writers, will suffice to illustrate :
M. R. - , a distinguished chemist and poet, of a
disposition naturally mild and sociable, committed himself
a prisoner in one of the asylums of the Fauxbourg St.
Antoine. Tormented by the desire of killing, he often pros-
trated himself at the foot of the altar, and implored the de-
vine assistance, to deliver him from such an atrocious
propensity and of the origin of which he could never render
an account.
A riband ligature lightly tied about his thumb, at his
request, "was sufficient to calm him, but he finally finished
his career by trying to kill one of his friends, and perished
in a violent fit of maniacal fury.—Prich. on Insan., Bell's
Library, p. 275.
“But,” says another advocate of Guiteau's insanity :
“Guiteau's egotism was so intense and inordinate that he saw
nothing like other people exactly." Exactly, his egotism
was a delusion of itself. In confirmation we quote one of the
most experienced of American alienists: “Instances have
been referred to where the motive seemed to be a desire to
excite public interest and curiosity and to obtain notoriety.
I am disposed, however, to regard such cases as examples
of real insanity. I do not think that any sane person


Psychical Analysis of Guiteau.
609
would sacrifice his social position, and otherwise injure his
prospects in life under the influence of such a motive, and
that for a purpose yielding no advantage whatever. A
deliberate sacrifice of substantial interests, for a position
generally considered as damaging, if not odious, and
one which can by no possibility minister to the welfare
of the subject, is of itself an evidence of unsoundness of
mind.”—Chipley on. Feigned Insanity (Amer. Jour. of Insan.,
1865, p. 6). “But,” says Dr. Stearns, “the love of notoriety
has little, if any, influence with the insane."-Arch. Med.,
june '82, p. 301.
Yet Prichard and all other authors, besides Chipley, have
noted an intense and inordinate egoism as the chief char-
acteristic in some of their cases of insanity. Egoism may
be morbid as well as a propensity to steal or to destroy,
and when it allies itself with God in flagrant crime plainly
denounced in the decalogue, and claims the instigation
and vindication of Heaven in what God only forgives in a
lunatic, it is the offspring of insanity.
A century ago Dr. Arnold, one of the best of English
observers, described the mania of vanity or self-importance;
and later in the first quarter of the present century came
the clinically well founded descriptions of Bayle, Calmiel
and Delaye, of general paralysis, founded as it is in a
specially intense morbid egoism. It is this morbid egoism
which makes Calmiel's Sovereigns of Les petite maisons a
possibility.
Dr. Chipley was the peer of any American Insane
Hospital Supt. in his day, as an observer of the charac-
teristics of insanity, and his opportunities for clinical ob-
servation extended over a-third of a century.
Again let us ca!l up the voice of the dead. This time
it shall be the distinguished physician-in-chief of the Mc-
Lean Asylum, Mass., Dr. John E. Tyler: “We all know
that with the insane self becomes the central point of
interest—the important consideration and the authority.”
* * * * “We all know how soon it is that his
relations to everything and person are more or less


610
C. H. Hughes.
changed by the different estimation to which he has un-
consciously grown to hold himself. Upon any subject within
the circle of his disease, fact and external circumstances
show little or no influence with him. His convictions come
from his own personal laboratory. They are original, some-
times they are strictly intellectual results, often they grow
from morbid emotion. But they are coined by him and not
received from another. And they are ultimate authority to
him. No sane man is ever half so sure of any most pal-
pable truth as an insane person is of the infallibility of
his own convictions. 'I know it is so,' and upon this he
rests without a shadow of doubt. “I know it is so,' and
this is more to him than all the facts and logic of the uni-
verse. Because his own opinions are not received or are
even scouted, never leads him to distrust or examine them
or even for a moment disturbs the ineffable complacency of
his belief.”— Tyler's Tests of Insanity, (Amer. Jour. Insan.,
Oct., 1865.)
Does not this fittingly paint Guiteau ? Ray and every
writer of merit may be searched in vain for contradic-
tions. It is of such morbid mental material as this that
religious lunacy is fabricated, as we often see it in the
hospitals and not infrequently out of them. Like the
perfectionist woman who sends her babe to glory with
morphine, or the faith-lunatic Freeman, who transcends
the faith of Abraham and kills his child.
It is a fitting portraiture of that not unfamiliar phase
of morbid, unnatural egoism, which reveals itself in
bringing obscurity into unnatural, abnormal notoriety so
strangely maladjusted to its natural environments, that
when seen, all the world notes it as unnatural and singu-
lar; which makes timidity audacious and mediocrity bold
as the murderer of Kings and Presidents in the name
of God and the people and the heaven appointed,
but, otherwise unauthorized avenger of peoples oppressed;
which feeds on the froth of unfounded expectations,
as mankind in general on a full diet of solid food;
which takes courtecies for compliments and civilities for


Psychical Analysis of Guiteau.
611
merited praises, and seeks consulships and other govern-
ment positions without capacity or warrant or claim of
real political service, and couples its applications with
disclosures of delusional matrimonial expectations which,
if they were founded in fact, the discretion of ordinary
sanity would prompt to withhold as not fitted for state
secrets, which allies pigmy intellect with the Deity in
schemes titanic and impracticable and disapproved of
heaven; and claims, without thought of irreverence or
blasphemy, partnership with God and the pure Christ,
in things which defile body and soul and which are con-
demned in the decalogue and by every recorded word
and deed of the Immaculate.
“But he was immoral, did not pay his board bills
or railroad fare, sold an oroide watch for a gold one,
collected his clients money sometimes, and kept it
etc., while writing and talking of his devotion to the
cause of Christ, etc. He was inconsistent." Exactly, if
he had been a normally converted christian, he would
have conformed outwardly at least to the requirements
of the character he professed. But when did morality
become a test of insanity? If that time ever comes,
lunatics may go out and the people go into the
asylums.
“Another sign of mental disorder," continues the author-
ity from whom we quote above, which has been too little
estimated and often estimated wrongly, “is the inconsis-
tency of the insane. One of the notable and distinc-
tive characteristics of insanity is its inconsistency with
itself.”—Ibid. “But his delusion was an after-thought,”
says Dr. Gray; but this is contradicted by Dr. Stearns.
But suppose it did not possess him in full force from the
beginning, “almost the entire pathogeny of mental disor-
ders,” says Greisinger (Mental Ap. on Health and Disease),
“consists in psychical perversions produced by internal
organic causes, and these perversions finally give rise to
delusions."
Delusions do not come upon the insane from the first


612
C. H. Hughes.
and overwhelm like a tornado, as it was insisted they
should have come upon Guiteau.
“But there was no change of character” says another
advocate of Guiteau's sanity.
The change of character in the insane shows itself
either in the intensification or reversal of the natural
manner of thought, feeling or action.
They must be blind indeed who can see no change
of character in this homicide and in the conduct of the
murderer in court, or his morbid antipathies to brother
and counsel and natural friends and in his altered attitude
and demeanor towards the world. How long had he
been proclaiming himself the savior of the country and
killing people who stood in the way of its glory, etc.?
When before had he regarded himself as the avenging
Nemesis of the Republican party and the nation ? Strange
natural character this! So strange that all others like him
during his trial were promptly sent off to the most con-
venient asylum, and always will again whenever and
wherever found, if public policy does not demand a sacri-
fice regardless of mental condition. He was disappointed
at a preceding presidential election. Did he then imagine
the country wrecked and the duty on him to save it by
assassination ? He never in all his life, under delusional
or other impulse, fired a shot at mortal before!
If the defense, in his trial, had appreciated the impor-
tance of showing insanity, in the medical sense, as thor-
oughly as the prosecution appreciated that they had a
medical question to deal with, there is no doubt but the
time of the beginning change in this man's career had
been more plainly set forth and the incubation of his in-
sanity made clear. It began in sexual exhaustion (and
secret vice probably) and emotional excitement at Oneida.
How do these acts and all the immoralities attributed
to him comport with the “pledging of the energies of
his life to God to do all that within him lies to extend
the sovereignty of Jesus Christ, by placing at His disposal
a powerful daily paper” to “be an illuminator," to point


Psychical Analysis of Guiteau.
613
out “the devices of satan's emmissaries and let in the
light of God's truth upon men's souls,” to “battle the
corrupting influences of Anti-Christ,” and “reconcile the
conficting interests of the world and combat its errors,”
as he declared his faith and purpose in 1865.*
Guiteau's father was a consistent religious fanatic, at-
testing his faith largely by his daily walk and conversa-
tion. The son was an inconsistent lunatic, as the relig-
iously insane usually are, claiming public confidence as a
man of God, and inspired, without compliance with the
scriptural and publicly appreciated requisites, to establish
the public confidence he sought. His was a dead faith
without works and culminating in a deed which only
devils could affirm and claiming for it the favor of Heaven.
There was nothing in the teachings of the Oneida com-
munity that approved of murder; nothing in the nature
or natural habits of thought, feeling or action of Guiteau
in his sane though fanatical estate that made the crime
natural to him any more than there was in his father,
and but for the further instability of mental organism ac-
quired through the circumstances of his birth and sub-
sequent health-depraving influence of his residence at
Oneida and precarious manner of living since, impover-
ishing his blood and starving his already illy nourished
and irregularly acting and congenitally unstable brain, the
morbid delusive impulse so foreign to his nature had not
arisen and denominated him till the death of President
Garfield was accomplished, bringing sweet peace to the
assassin's morbid mind only, while a tumult of consternation
"took possession of the country.”
But he had no physical disease? Let us see:
“He was badly nourished and anaemic and with a pulse
of 88 on two occasions,” testifies Dr. Hamilton; “pallid
and rather delicate looking,” says Dr. Folsom ; “suffering
from malarial fever," testifies Dr. Young at the time of
the tragedy, "and had latent syphilis, if his own state-
A chapter from Dr. Workman's pen on “Insanity of the Religious Emotional
Type,” Amer Journ. of Ins., vol xxvi., July, 1869, would be interesting reading, but
would too greatly prolong this paper,


- - -
- -
614
C. ·H. Hughes.
ments are to be credited.” Surely here is enough
physical disease for a basis even for the most somatic.
" Yet it constantly happens that associated with trifling
changes there is great mental disturbance and but little
with more serious lesions.”—GRAY.
Dr. Gray also in a paper on “The Dependence of
Insanity on Physical Disease ” (Amer. Jour. Insanity, April,
1881), gives some good examples of insanity dependent
upon anæmia, and they well illustrate his fourth pro-
position which he classes among the “fundamental
starting points,” viz : "that insanity more frequently has
its primary origin in pathological states outside of the
brain, than in primary disease of the brain.”
All observers confirm the fact that anæmia and deprave
ity of blood are potent causes of insanity, and Guiteau's
manner of living before the tragedy was well calculated
to starve and deprave his blood and exhaust and render
still more unstable, his hereditarily neuropathic and
unstable mental organism, as it did.
But good and experienced men saw naught but feign-
ing in Guiteau till the final scene, I was about to say
upon the cross, for the lunatic evidently died in the be-
lief that he was being unjustly sacrified. And this brings
us to Dr. Chipley again, and his experience-founded ob-
servations: “We must not then be too confident, or de-
mand to much from the present state of our knowledge
of the workings of the human mind and its obnormal
manifestations. Unreasonable demands are too often made
on the psychological expert. Peremptory decision is fre-
quently required, when we can do no more than balance
probabilities.”
The Government demanded a peremptory decision, and
the probabilities were balanced against Guiteau while he
lived. Now that he is removed from the arena of his de-
lusive conceptions, they are balanced in favor of his in-
sanity.
At least for ourself we so balance them. With the addi-
tional light reflected from the scaffold we see more clearly


Psychical Analysis of Guiteau.
615
and the true psychological meaning of the strange tragedy
with its attendant details—the willing surrender, the letter
"To the White House,” proclaiming the “sad necessity of the
President's removal ;" Guiteau's freedom from ill will, etc;
his stalwart pronunciamento and demand on General Sher-
man to order out his troops and take immediate posses-
sion of the jail, whither Guiteau had predetermined to go ;
his authorative bestowal of the prospective chiefship of
police on the police officer who arrested him; his state-
ment that "Sherman would come and take charge of
matters ;” that "Arthur and those men were his friends ;"
that he was "with Grant and the rest of our men in the
canvass ;" his singular satisfaction with and frank confession
of and candid confidence in everybody, as to how he is to
be vindicated on the plea of insanity, the whole affair-de-
nial of accomplices and no subsequent attempt to impli-
cate others; his groundless expectation of public gratitude,
reward and applause for a crime which, from the moment
of its commission connected his name (as a sane man),
with eternal infamy and ignominy—are proofs so plain,
that we need not the illumination of a cadaveric examin-
ation to confirm our conviction of insanity.
Post-mortem examination can neither cast light nor
shadow on the diagnosis. Had Guiteau been permitted
to live, as he ought to have been, secluded within the
walls of a criminal insane asylum until his disease had run
its course and had he died of his insanity, and not of some
intercurrent disease, we might have expected to find more
marked cerebral lesion in this undoubted victim of cerebro-
mental disease than the autopsy has thus far given, though
they are as great as has been found in other grave cases
of insanity.
Whatever may be the further microscopic revelations,
whether sufficient to satisfy the most somatic alienist or
not, Guiteau died insane and he was as insane while living
and disclosing without reason to Dr. Gray under the dom-
inion of his delusion that God and the American people
were with him, and how and when the pressure to remove


616
C. H. Hughes.
the President came upon him, and what his defence would
be, not as a remorseful confession, but as his providential
vindication before the law, as when on the last day of his
life, and all through his trial, and on the scaffold, despite
opposition and disappointment of every kind such as must
have made its impress upon a sane mind, not hardened
by life-long indulgence in crime, he vehemently, vociferously
and strenuously, in season and out of season re-affirms
his inspiration and dies repeating it.
Guiteau's mental disease is shown in its symptomato-
logy, just as epilepsy, tetanus, athetosic-spasm, myxce-
dema and many states of insanity, like the insanity of drugs
and anæsthetics, regardless of post-mortem examination,
especially when death takes place before the disease runs
its course and not in consequence of it.
"It will scarcely be contended, at the present day at
least, that the structural changes found after death from
any disease are the primary cause of the disturbance man-
ifasted by symptoms during life. “Cerebral irritation suffi-
cient to produce insanity may endure for years, and death
occur at last from other causes, without one being able to
discover any morbid appearances.”—Ray, Jurisprudence of
Insanity, p. 139.
This was said by a recognized Coryphæus in psychiatry
in his palmiest days, and the psychiatric world repeats it.
The student of psychiatry need not be reminded, in ad-
dition, that the underlying pathology of that vast terra
incognito of vaso motordis order and ganglionic disturbance
(reflected and intra-cranial), with their vast capacity for
mischief yet unexplored, and the significance of cerebral
anæmia, hyperæmia and local meningeal adhesions in the
productions of insanity and delirium, and the potency of
the imperceptible virus of specific fever, must be denied,
and the unsettled groupings of the layers and cells of the
cerebral cortex and their multiform shapes and sizes
squared to a normal standard yet to be fixed by future
science, before the sole counter proof of suspected mental
aberration may be found in such post-mortem evidences


Psychical Analysis of Guiteau. 617
as pathologists shall agree to call morbid. Especially must
the part played by reflected disease and the relation of
morbid states of the sympathetic system be better known
than now, though already conceded to be important, to
enable us to unsettle in the dead-house the conclusions of
psychiatry, clearly and cautiously made from the symp-
toms during the life of the patient. The dead insane
often tell us no tales of their erratic lives even on the
dissecting table, though, while they lived they may have
made history.
ADDENDUM.—Everything that has come to light since Guiteau's death,
only confirms the view of insanity, from the letter of the condemned 10
detective McElfresh promising retribution to whoever shielded McGill
who assaulted him in his cell, to the microscopic examination which has
been made since this paper was written.
The latter is what might reasonably bave been suspected as associated
with Guiteau's singular and varying mental states during life. It sustains
the reasonable, and to our mind certain conclusion, that the cortical layers
of Guiteau's brain at the time of the tragedy were in a state of what Grie.
singer has named, atrophic irritation, due not only to that poverty of blood
so abundantly attested, and which, as Maudsley affirms, undoubtedly
"plays the same weighty part in the production of insanity as it does
in the production of other nervous diseases," but proven to have existed
Ly the post-mortem sequello ; the hyper trophied spleen; “tbe almost abso-
lutely anæmic white substance of the brain;" the thinned first layer of the
cortex to almost nothing in spots at the convexity of the convolutions; the
degenerative changes in the subjacent layers and in the corpus striatum;
the granular degeneration in the capillary blood vessels and the alterations
in the neuroglia and ganglionic corpuscles of gray matter; in short, in the
"unquestionable evidence of decided chronic disease of the minute blood
vessel of the brain in numerous minute diffused areas accompanied by
alterations in the cellular elements, and other equally significant structural
sequences.


THIRTY-SIXTH ANNUAL SESSION
OF THE
Asociation of fertical Superintendents of American Institutions
FOR THE INSANE,
HELD AT
Cincinnati, Ohio, May 30th, 1882.
The Association was called to order at 10 A. M. by
Dr. John H. Callender, Vice President, in the absence of
the President, Dr. Clement A. Walker.
The reading of the minutes of the last meeting was
commenced and continued for a short time; when, on
motion of Dr. Gundry, the further reading was dispensed
with.
The following members were present during the ses-
sions :
J. B. Andrews, M. D.................State Asylum for the Insane, Buffalo, N. Y.
Wm. J. Bland, M. D.................... Hospital for the Insane, Weston, W. Vs.
Richard M. Bucke, M. D.............. Asylum for the Insane, London, Ontario.
D. R. Burrell, M. D..............................Brigham Hall, Canandaigua, N. Y.
John H. Callender, M. D............. Hospital for the Insane, Nashville, Tenn.
John B. Chapin, M. D...............................Willard Asylum, Willard, N. Y.
Edward Cowles, M. D..........................McLean Asylum, Somerville, Mass.
John Curwen, M. D..................State Hospital for the Insane, Warren, Pa.
R. S. Dewey, M. D............ Eastern Hospital for the Insane, Kankakee, Ills.
Orpbeus Everts, M. D............... Cincinnati Sanitarium, College Hill, Ohio.
Theodore W. Fisher, M. D ..................... .Lunatic Hospital, Boston, Mags.
R. H. Gale, M. D.........Central Kentucky Lunatic Asylum, Anchorage, Ky.
Wm. B. Goldsmith, M. D..........................Lunatic Asylum, Danvers, Mass.
Leonidas J. Graham, M. D................ State Lunatic Asylum, Austin, Tex.
John P. Gray, M. D.............................State Lunatic Asylum, Utica, N. Y.
Eugene Grissom, M. D................. .........Insane Asylum, Raleigh, N. C.
Richard Gundry, M. D.................. .. Maryland Hospital, Catonsville, Md.
John C. Hall, M. D............ Friends' Asylum, Frankford, Philadelphia, Pa.


Association of Medical Superintendents, &c.
619
F. W. Hatch, Jr., M. D., Assist. Physician Asylum for Insane, Napa, Cal.
Charles H. Hughes, M. D).........
......... ........ St. Louis, Mo.
Henry W. Hurd, M. D....... ....... Eastern Michigan Asylum, Pontiac, Mich
E. A. Kilbourne, M. D.......... Northern Hospital for the Insane, Elgin, Ills.
Andrew McFarland, M. D.................Oak Lawn Retreat, Jacksonville, Ille.
H. P. Mathewson, M. D................. Hospital for the Insane, Lincoln, Neb.
C. A. Miller, M. D............................... Longview Asylum, Carthage. Ohio.
L. J. Mitchell, M. D................................ Lunatic Asylum, Jackson, Miss.
A. R. Moulton, M. D.... Aso't Physician, Lunatic Hospital, Worcester, Mass.
Charles H Nichols, M. D.............. Bloomingdale Asylum, New York City.
Geo C. Palmer, M. D................. Asylum for the Insane, Kalamazoo, Mich.
Joseph A. Reed, M. D........, Western Pa. Hospital for Insane, Dixmont, Pa.
A. B. Richardson, M. D.....................Asylum for the Insane, Athens, Ohio.
Joseph Rogers, M. D................. Hospital for the Insane, Indianapolis, Ind.
Jobn W. Sawyer, M. D......... .................Butler Hospital, Providence, R. I.
S. S. Sehultz............................. State Hospital for the Insane, Danville, Pa.
Henry P. Stearns, M. D...... ........... Retreat for the Insane, Hartford, Conn.
Charles W. Stevens, M. D.................................................... St. Louis, Mo.
J. Strong, M. D............................ Asylum for the Insane, Cleveland, Ohio.
H. A. Tobey, M. D.......................... Asylum for the Insane, Dayton, Ohio.
J. M. Wallace, M. D................... Asylum for the Insane, Hamilton, Ontario.
II. Wardner, M. D........... ............ Hospital for the Insane, Anna, llls.
James M. Whitaker, Assist. Physician, Lunatic Asylum, Milledgeville, Ga.
Letters were read by the Secretary from Dr. C. Lock-
hart Robertson and Dr. T. S. Clouston, in acknowledge-
ment of their election as Honorary Members of the
Association.
ROYAL COURTS OF JUSTICE, X
London, November 18, 1881.7
MY DEAR SIR:I have the honor to acknowledge the receipt of your
letter of the 14th October, intimating to me that I had been elected Honor-
ary Member of the Association of Medical Superintendents of American
Institutions for the Insane. I am greatly flattered by this act of courtesy
on the part of my American brethren. Ever since my short visit to the
United States in 1877, your country has been to me like another England
across the seas, and I am glad to have this tie more to bind me to this land
of our race in the far west.
Believe me, sincerely yours,
To DR. JOHN CURWEN.
C. LOCKHÅRT ROBERTSON.
ROYAL ASYLUM, MORNINGSIDE, I
Edinburg, 4th Nov., 1881.
DEAR SIR:-( beg leave to thank you and through you the Associa-
tion of Medical Superintendants of American Institutions for the Insane
for your letter of the 14th, and for the high honor conferred upon me by
that Association, in making me one of its Honorary Members. No mark
of distinction and friendship could have been more grateful to me than
this from my American brethren.
lam, yours, very respectfully,
To DR, J. CURWEN.
T. S. CLOUSTON.


620
Thirty-Sixth Annual Session
The following letter was received from Dr. Motet a:
few days after the adjournment:
Paris, le 7, Mai, 1882.
161 RUE DE CHARONSE S
MONSIEUR ET TRES HONORE CONFRÉRE:-Fai reen, apres beaucoup de
retard la lettre que vous m'avez addressé et daus laquelle vous m'annoneez-
que l'association des medicines en Chef des asiles d'alienes d'amerique
m'a fait C'honneur de me nommer membre honor aire.
Je suis tres touché de ce témoiquage de sympathie qui ne s'addresse
pas seulement a mois, mais a la Societé Medico-Psychologique de Paris.
Je vous prie, Monsieur et tres honoré Collégue de remercier en mon nom
les Members de la Societé savante qui vend bien m'accueilles avee une si
grande courtoisee, et d'etre l'interprete de mes sentiments de respectenense
reconnaisance.
Recevez Monsieur et tres honore Collégue, l'assurance de ma consider-
ation tres distingué.
A. MOTET,
Vice-President de la Societé Medico-Psychologique.
Letters were also read from Dr. Knapp regretting his
inability to attend this meeting; from Dr. Draper, enclos-
ing a letter from Dr. Peeters, of Gheel; from Dr. Bryce,
introducing Dr. Moore, of Mississippi; from Dr. Park,
introducing Dr. Moulton, and from Dr. C. A. Walker,
resigning the office of President.
On motion, the President was requested to appoint the
usual standing Committees.
On motion of Dr. Gray, a recess of thirty minutes was
taken to enable the Business Committee to prepare their
report, and also to give the members an opportunity to
register.
On reassembling Dr. Miller offered the following reso-
lution, which was adopted:
Resolved, That members of the regular medical profession of Cincinnati
and vicinity, and visiting brethren, and also trustees of any hospital for the
insane who may be in the city, are hereby respectfully invited to attend the
sessions of the Association.
Dr. Everts, from the Business Committee, made the
following report, which was unanimously adopted :
On Tuesday, May 30th, hold sessions from 10 A. M. to 1 P. M., and
from 3 P. M. to 6 P. M. Reception in the evening, from 81 to 12 o'clock,
at the Burnet House, given by the medical profession of Cincinnati.
On Wednesday, May 31st, reception at Longview Asylum; leave hotel
at 9 A. M., dinner and session until 3 P. M Reception at Sanitarium, from
4 to 6 P. M., reaching the city at 7 P. M.
On Thursday, June 1st, reception and dinner at the Dayton Asylum ;
leave city at 8.15 A. M. Excursion to the Soldiers' Home at 2 P. M. Re-
turn from Dayton at 6 P. M.
On Friday, June 2d, meeting at 10 A. M. for business.
Dr. C. W. Wallin, of North Carolina, was introduced
to the Association by Dr. Grissom.


Association of Medical Superintendents, &c.
621
On motion of Dr. Gray, the communication of Dr.
Peeters, of Gheel, was referred to the Committee on
Business.
On motion of Dr. Everts a committee of three was
appointed to nominate a successor to Dr. C. A. Walker,
President, resigned.
The President appointed on this Committee, Drs.
Nichols, Reed and Gale.
Dr. J. B. Chapin offered the following resolution, which
was referred to the Committee to nominate a President.
Resolved, That the usage of the Association in respect to the tenure of
the office of President and Vice President of this body be so far changed
that hereafter there shall be elected a President and Vice President to hold
their respective offices for a period of one year, and that the President
present an annual address which shall be deemed exempt from critical
discussion unless the Association shall direct otherwise.
The President then announced the Standing Com-
mittees as follows:
To Audit the Treasurer's Accounts. Dr. Schultz, of Pennsylvania;
Dr. Mitchell, of Mississippi; and Dr. Stevens, of Missouri.
On Time and Place of Next Meeting: Dr. Stearns, of Connecticut;
Dr. Bucke, of Ontario; and Dr. Bland, of West Virginia.
On Resolutions : Dr. Gundry, of Maryland; Dr. Grissom, North Caro-
lina, and Dr. Hurd of Michigan.
Dr. Chapin offered the following resolution, which was
unanimously adopted by a rising vote :
Resolved, That this Association in extending a welcome to Dr. John P.
Gray, offer their congratulations at his preservation from the peril of sud-
den death, and their sympathy for him and his family during his painful
convalescence.
The President introduced to the Association Dr.
Muscroft, Chairman of the Committee of Arrangements of
the medical profession of the city of Cincinnati, who
extended an invitation to meet the profession that evening,
which was, on motion, accepted.
Dr. Charles H. Hughes, of St. Louis, said :
MR. PRESIDENT AND GENTLEMEY OF THE AssociaTION:-I present a
record of a form of mental aberration quite familiar to us all, but about
the proper designation of which alienists have for a long time differed ;
differed ever since Prichard, following in the footsteps of Pinel and
Esquirol, ventured to class a certain kind of niental aberration as moral
insanity, a difference which has widened in some directions and narrowed
in others, since Mayo made his ineffectual assault (in my opinion on the
doctrine of moral insanity. I have purposely taken the description of this
case from a non-professional person, the one of all others supposably
most familiar with changes in the mental character of the individual
described; and in whose description I think we shall see insanity, the


622
Thirty-Sixth Annual Session
individual's own mother. I hope you will give me your views with regard
to the case as to whether it is one of total depravity or mental aberration.
[Notes introducing the case published in the October number of the
ALIENJST and NEUROLOGIST.]
I have purposely given this record from a non-professional person, in
order to show how clearly a mother might describe that change which
takes place in her child manifesting itself in insanity of emotion and feeling,
impulse, action and passion. This record will be recognized by at least
one of the physicians present, as a faithful description. From my own
observation I have verified most of the facts as stated by the mother. The
usual records of this kind of cases are the records which physicians make
and which possibly they might be supposed to make for the purpose of
elucidating a medical theory; but here is a picture drawn by a non-profes-
sional-by a persou well qualified to discern the change in the moral
faculties which has taken place in her own child. In our histories of
mental aberration, we have no better records than those made by intimate
friends. The husband or wife, or father or sun, or mother, can often
describe departures from the normal habits of thought, feeling or action,
brought about by disease, when the medical man who visits the patient
only occasionally and professionally may fail to detect the characteristic
changes for lack of this knowledge. Now men may cavil about the impli-
cation of the intellectual faculties in changes like these. In the vast
majority of changes in the moral character, the intellect either becomes
abeyant-and in such a sense may be considered to have undergone a
change-to have become subservient and acquiescent, and evidences a
predominance of the aberrant moral over the intellectual character; or,
the intellect becomes also specially implicated and delusions accompany
the affective change which we call moral insanity.
When Prichard described his cases, some of them were open to the
objection which Blandford has made, and the latier's searching analysis
enabled him to detect what does not really seem, however, to have escaped
the perception of Prichard-subtle changes in the natural intellectual char-
acteristics of the individual; but the picture which l’richard made was none
the less complete, because it described a form of mental aberration, which,
if not characteristic of an exclusive change of the moral faculties to the
independent of the mental change, was nevertheless a description of the
departure mainly in the natural habits of feeling and action of the individ-
ual, so markedly characteristic of such change of the affective life as to
entitle it to be called moral insanity. We cannot give it any better descrip-
tion, and I'richard himself never undertook to define moral insanity as
a change exclusively in the affective life. He spoke of the change in the
affective life as being so predominant that the intellectual change is not
appreciable, and this is a fact which we all recognize in some of these cases.
Whether we dispute about the propriety of the term or not, we recognize
the fact that there is a form of insanity which displays itself especially in
disordered impulse, feeling. propensity or passion. All insanity in fact
displays itself, niore or less, in that way, and that oftentimes is the only
evidence, as it most ofien is the first evidence that alienists have of that
cbange which ultimates in the most recognized forms of insanity. This


Association of Medical Superintendents, &c.
623
case is not described to elucidate a theory that the mind is a community of
interest in which to disorder the moral faculties without disturbing the
intellectual would be impossible-a non-professional paints the picture,
and I apprehend that it will be recognized as a picture of something more
than mere Satanic possession. With whatever of intellectual implication
may be apparent, I call it moral insanity as the most descriptive term.
DR. GOLDSMITH:-Mr. President and Gentlemen of the Association-
I have little to say with regard to Dr. Hughes' paper. It is difficult to
discuss because the description is incomplete, which, undoubtedly, would
not have been the case if it had been given by himself instead of by the
mother of the patient. As given, it hardly seems to me to describe ingan-
ity without decided intellectual disorder or defect. As I understand, there
is stated the belief on the part of the patient that her sister and others
engaged in licentious intercourse with men, without reason for that belief.
I think that would natur:illy, without further explanation, be considered
an insane delusion. The mother also asserts that she has believed that all
sorts of abuses bad been practiced upon her by her relatives. Well, that
belief may or may not be founded on an insane delusion, but the fact is
8:uid to have been just the reverse. Under the term “moral insanity,” only
those rare cases should be classed in which there is no decided intellectual
defect or disorder. I believe they are exceedingly rare, and this case does
not appear to me to be one of them. Certainly it does not appear that
there was no intellectual disorder. The mother states she was brilliant
intellectually, but we all know that such testimony is not very reliable,
The fact that she was observed in a hospital for a period of several weeks,
and no marked dementia was detected has much weight, but I think it
altogether probable that the girl would show, if she was watched a long
time, some intellectual disorder. Of course, imbecility might be expected
in a girl, who showed such marked mental disease thus early in life.
The case is an interesting one, and of a kind very trying to physicians
and others who bave its care; but I should not call it moral insanity if the
description given is correct and complete. Certainly if such cases are so
classified, those considered morally insane will constitute a larger propor-
tion of the insane than at present.
DR. STEVENS :- I had occasion to observe and study the case so lucidly
narrated by Dr. Hughes, and it is hardly necessary for me to say anything:
I rather prefer to hear the opinions or arguments of others. I will just
say, however, in regard to the existence of delusions, as conjectured by the
gentleman who has just spoken, that this girl, at all times, was capable of
correcting what seemed in periods of excitement to be delusions. In
truth they were not delusions. In her calm moments she candidly admitted
that she made those charges against her sister and others in a spirit of
malice or revenge.
Dr. HUGHES :- They were only spoken in passion; we allege they were
not delusions.
Dr. MCFARLAND:- I have but a word to say ; perhaps nothing to add
to the interest of Dr. Hughes' paper. I have seen some parallel instances
of the same form of disease, one or two of which I briefly relate


624
Thirty-Sixth Annual Session
Some of them I did not see, as they came to my notice through
correspondence. A very marked case was the daughter of a physi-
cian, then residing at Memphis, Tenn. She could not then have been
more than ten or twelve years old; but, from the description of an
aunt who wrote me, showed a precocity in evil that would hardly
be believed. Almost every form of vice seemed as familiar to her
as to any practiced-adept; giving herself up, with unblushing openness,
to libidijous relations with whites and blacks alike. Many years after-
wards I learned from the same informant that the girl, a little later,
changed in character entirely, married respectably, and her parents having
removed to a distant part of the country, was living a life in every
way exemplary,
Another case occurred in the town where I live. This was a clergy-
man's daughter, who displayed much the same traits as found in Dr.
Hughes' case. The father, in despair of other remedy, made an attempt to
place her under Dr. Carriel's care, in our State Hospital. The jury, SUD-
moned as our Illinois juries are, from the chance hangers-on about a court-
bouse, could see nothing like insanity in the case, and refused the necessary
verdict. The father then came to me for advice, which was, that he make
another effort before the court, and I would appear as an expert. But I
had the mortification of seeing my own opinion beld as valueless, by the
bucolics in the jury-box, as any other, and a verdict again refused; one
juror remarking, as I afterwards learned, " The girl knows most things as
well as she ever did.” The ending of tbis case was most unbappy. After
a wild and disgraceful career at home, slie ran away, disguised in boy's
clothes, with a college student, whom she married. The young gentle-
man's friends, being of the bighest respectability and willing to make the
most of a bad matter, settled the pair on a farm, which, of course, was not
to the taste of the girl, whose instincts to evil were strong as ever. In the
briefest of time a divorce followed, and she went to the bad with all speed.
It all ended by her throwing herself from a steamboat near Long Branch.
I have taken notes of other cases, in both sexes, where such precocious
bent to evil is shown, that mental abnormali:y can alone account for them.
In some of these cases-not especially those I have related-there seemed
a certain complexion of mind-disease, that made the case to appear like an
arrested epilepsy, which, I suspect, often has more to do with certain
abnormalities found in early life than we take into account.
Dr. Nichols:-Most of the members of the Association are aware that
I have always assented to the doctrine of the existence of what is called
moral insanity, and I should not offer any remarks upon the paper read by
Dr. Hughes, did it not appear to me that it may be no more than fair on
my part for me to support that side of this question, just now more or less
unpopular in this country, which he has espoused, though I may not agree
to all of his views touching the case he has narrated with such minute
pains-taking detail, and, without doubt, accuracy. Neither experience nor
opposing arguments have shaken the convictions on this question which
formed at the outset of my career as an alienist. My views upon this
subject have formulated themselves in my mind in this way: Every intel-
ligent person recognizes the fact that there is, in individuals, every grade


Association of Medical Superintendents, &c.
625
of difference in their intellectual and moral or affective faculties—that
there is no uniformity in their relative strength and activity in individuals,
as manifested in the bent and activities of their lives. In the most marked
instances, living and historical, which every intelligent man can call to
mind, one is intellectually great and his opinions and conduct are the
simple logic of the facts within bis knowledge and the circumstances that
surround him, while he naturally gives little thought to questions of good
or evil, to duty or ambition. On the other hand, all of us have both known
and read of individuals who either, as Pollock writes of one such, “never
had a dozeu thoughts in all his life," but who loved and served his God”
-who not only had a quick conscience, but a quick sense of duty and of
the moral merits of human conduct-or who from inherent mental quali-
ties, make their ambitions and interests the guides of their lives and actions.
That the distinction I have briefly described is universally recognized is
a strong evidence of its reality; but I believe it exists, not alone por princi-
pally because it is universally recognized, but because I see it in nature. One
man has a superior intellect and a deficient moral sense. Another has a
weak intellect—with all advantages of education and experience he could
not do anything in life that required much thought and reason-but has a
quick, correct moral sense. He could guide stronger minds in the line of
their duty. Now having observed these marked differences in the intellect-
ual and affective manifestations of individual minds in health, I think I
should infer, a priori, that there would in all probability be the same differ-
ences in their manifestations when deranged; and I entertain not the
sligetest doubt that I have, in fact, witnessed cases in which only intellect-
ual derangement appeared to exist, and others in which the deranged
manifestations appeared to be confined to the affective faculties; and nu-
merous cases of the kind are reported on as good authority as any man
has for any thing he does not personally witness.
As has been remarked by another, the cases in which the affective
faculties of the mind are deranged, to the exclusion of apparent intellect-
ual disturbance, are quite rare in my own experience, but purely intellect-
ual insanity is also rare, though it does appear to exist. It is quite true
in fact, that if one function or power of the mind is affected, every other
power is likely to become affected if the first affection is not soon re-
covered from.
Perhaps I have reached the peace-loving age of life, when I am more
disposed to compromise with expediency when it does not sacrifice princi-
ple than I formerly was. At any rate I have come to regard the qualify-
ing or descriptive word moral to designate a form of insanity, as unfortunate,
for this reason only; that the terms mural insanity imply to the popular
or lay mind, the idea of an insanity of the moral agency or responsibility
which it does not regard as subject to disease, but only to the influence or
possession of a good or an evil extrinsic spirit. While an over-sensitive
conscience, if it arises from disease, is as true a moral insanity as is a
tendency to evil doing if it comes from the same cause, the popular idea is
that those who believe in a moral or aflective insanity apply those terms
only to the latter condition, and that the moral condition to which they
are applied is one of wickedness, and that the effect of their use is a


626
Thirty-Sixth Annual Session
compromise with sin by giving it a soft name. If then the use of the
adjective affective should be substituted for the adjective moral, I think it
would be less objectionable in the direction just stated. There is, indeed,
equal need of an appropriate substitute for the use of the word moral, to
designate every treatment of insanity except its medical treatment, inas-
much as the uninitiated suppose that what is called the moral treatment of
the insane refers to the religious exercises they engage in while under
treatment.
I do not at all sympathize with the popular fear-partaken of too much
by our specialty—that the recognition of a derangement of the affective
faculties of the mind is calculated to screen wicked doers from deserved
punishment. Such a recognition does not appear to me to at all increase
the acknowledged difficulty in a limited number of cases, of distinguishing
between the irresponsibility of disease and the responsibility of wicked-
ness in health. Indeed it appears to me that a recognition of an insanity
in wbich there is no apparent lesion of the purely intellectual powers, is
the only key to a philosophical, not to say correct and just, elucidation of
a limited number of cases of disordered mind that we are called upon to
consider and pronounce an opinion upon.
The remarkable phenomena of the case of the girl presented by Dr.
Hughes are very intelligently and without doubt truthfully described by
her mother, but the opinion of the mother in respect to the natural intel-
lectual capacity of her child, is, as usual, to be taken with some grains of
allowance. It may be that the girl's mind suffered from poison or disease,
but I am inclined to regard the case as one of imbecility, both intellectual
and moral-of what Ray terms imbecility of the first degree. I think it a
question whether it be a case of disease or original defect.
DR. STRONG:-I have no special remarks to submit to the Association.
I would like to inquire of Dr. Hughes what the age of the individual is at
present?
DR. HUGHES :—Twenty-seven.
DR. STRONG:—What is her present mental status ?
DR. HUGHES :—She is a bright girl, and at times when she is actuated
by strong external incentives acts very pleasantly, especially in the presence
of strangers to whom she is unaccustomed.
DR. STEVENS:-She is well educated.
DR. STRONG:—She is not an imbecile it seems to me.
DR. HUGHES:—No, sir. She is at times quite attractive in her manner.
She is well formed and her personal appearance wins for her great sympa-
thy on first acquaintance.
DR. STRONG.-Was her conduct a few years ago as bas been described?
DR. HUGHES:-Yes, sir, pretty much as I have described. I observed
her personally and others observed her. I did not rely on the mother's
statement as to her daughter's mental aberration. But I had a desire to
see how the mother would describe the moral and mental characteristics
of the girl, to see a picture painted, and not by a professional artist, &
picture drawn from nature by one of Nature's own artists, and I think the
painting a truthful one of that form of mental disease.


Association of Medical Superintendents, &c.
627
A more elaborate description might have been made by an expert
observer, but the picture is complete enough whether you call it moral
imbecility—if you choose a term which Mayo proposed to substitute for
moral insanity when he saw his dilemma afier denying the existence of
the form of mental aberration described by Prichard- or you may call it
“ reasoning mania," as has been offered by Pinel and others. But with or
without a special designation the fact of the existence of a morbid mental
condition is plain enough, and the other fact is equally plain of the
pronounced disturbance of the affective life, the moral faculties. The
characteristic or psychical symptoms are in the affective rather than in the
reflective life. I make no contest with gentlemen who wish not to call it
moral insanity. I have no objection if you choose to concede theoretical,
hypothetical, congenital defect. It matters little whether there was
congenital or acquired defect so that we recognize the moral derange-
ment. It matters not what you call those who are affected, the disease
exists in the asylums and out of the asylums, and as alienists we must
recognize it. It matters not to us that the people identify with total
depravity that change which comes over an individual by reason of
disease, making him different from what he was or ought to be in his
natural moral or affective character. Because the public misconceive and
misconstrue our views on moral aberration, believing that we mean thus
to shield immorality, there is no re:son why we should withdraw our
acquiescence in the existence of that aggregation of psychical phenomena
wbich is so characteristic that the moral perversion predominates when,
we know it exists. I beg Dr. Strong's pardon for taking up so much of
his time.
DR. STRONG:-1 think I have no further remarks to submit with
regard to the views expressed. I ask whether Dr Hughes sympathizes
with the views hinted at by Dr. McFarland, that there may be an epileptic
feature in cases of this class? If so, could that be associated with intel-
lectual lesion ?
DR. KILBOURNE:-I desire to ask still further the question whether, it
the symptoms are truthfully and fully delineated by the mother; this
child does not fairly represent what our German friends denominate
“psychical epilepsy with the convulsive seizure?
DR. STRONG:-And, if so, could it be associated with intellectual
lesion ?
Dr. HUGHES:-[ think I will answer all the questions in a lump.
Perhaps there are some other gentlemen who wish to speak on the
subject.
DR. EVERTS :-It seems to me that we are getting into the deepest
kind of water when we undertake the discussion of such questions as are
raised by Dr. Hughes' paper. We have arrived at a stage of scientific
acquisition where we know that metaphysical psychology is of no use to
us—where we have just begun to find out that physiological psychology
may become useful, and that the present state of Psychological Science is
more remarkable for what is not known than for what has been revealed
and established by it. What do we now know about the genesis of mind?


628
Thirty-Sixth Annual Session
-or about those delicate, perhaps complicated changes of integration and
disintegration of brain structures which can not be seen nor felt nor other-
wise apprehended wbile taking place, but which we know must precede
and influence or characterize all psychical manifestations? Who knows
now to what specific structure or locality to ascribe changes affecting
mental manifestations, 80 as to say, this particular activity constitutes
“ will,” this “ judgment,” and this “imagination ?” Or that the activities
of this region or layer of brain matter are manifested as “moral," while
the activities of this other locality or substance are purely intellectual? It
is necessary that we know more in order to satisfactorily answer the
questions raised by the paper. For my own part, I confess a great amount
of ignorance on these subjects. I think we know nearly as much as is
known by any one at the present time, but until we know more we are
simply speculating. Our wings are in the air but we do not know where
we shall alight. To diagnose an obscure case and give it a name, may be
the province of the practitioner; it is not the work of a philosopher.
Dr. BUCKE:—I would like to ask Dr. Hughes whether there was any
hereditary taint in this case ?
DR. HUGHES:—There was no admission of such to me.
DR. BUCKE:-Did you make inquiry on the point?
DR. HUGHES: I asked about it; yes, sir. I think Dr. Stevens would
know more about that than I.
Dr. BUCKE:—Did you make inqiry as regards the conception of this
child, particularly as to whether the parents' minds were in any peculiar
condition at that time? I am asking a serious question. I know posi-
tively of two cases of mental and one of moral imbecility which have
been traced by me to a condition of great mental depression on the part of
the parents at the time of conception of the persons so afflicted. I beliere
that this is a prolific cause of mental defect and disease. The question
is, did it exist in this case ?
DR. HUGHES:-No, sir; I made no such inquiry. I was told the cir-
cumstances of the family at that time were very good, they were in
prosperous circumstances pecuniarily and socially, and not only prosper-
ous but the parents were in good health and lived congenially together.
DR. BUCKE: I thought that Dr. Nichol's analysis of this case was
most admirable. I would like in just a few words to carry it a little
further. There is no doubt in my mind that the intellectual and moral
natures are fundamentally distinct. So that with a good intellect there
may be associated (in the same person) a high, medium, or low moral
nature; and with a high moral nature, a good, medium, or poor intellect.
So moral idiocy may exist along with a fair intellect and intellectual idiocy
with an average moral nature. I have seen several examples of each class
referred to. Dr. Hughes' case seems to me one in which the intellect
being fairly developed, the moral nature is defective—a case in short, of
moral idiocy or imbecility. But it seems impossible for the intellect to
remain intact. without a certain guidance and support from the moral
Dature, and it is my experience that these cases of moral imbecillty develop


Association of Medical Superintendents, &c.
629
intellectual insanity, almost without exception, about the period of pu-
berty, if not earlier. I believe the case described by Dr. Hughes to be
such a one, and that if the girl is not now insane, that she will in all
likelihood become so before the lapse of many years.
But beside these cases of congenital defect, I could never understand
why disease.might not as well be manifested by perversion of the moral
as of the intellectual nature and I am sure that I have seen, over and over
again, cases in which there was what may be called moral, without in-
tellectual insanity; but in such cases I have found (as in the cases of con-
genital moral defect) that intellectual insanity followe, sooner or later,
upon moral insanity, as if (as I believe to be the case) the intellect could
not maintain its equilibrium without the support of a healthy moral nature.
I have at the present time in my Asylum a woman who became many
years ago the subject of moral without intellectual insanity, and this con-
tinued until very lately, but she has now become subject to delusions and
at times refuses both food and medicine on the ground that they are
poisoned. This is an extreme case, but is it not a fact that, in a large
proportion of cases, the onset of insanity is shown by moral aberration
for a longer or shorter time before the intellect is disturbed? And, if so,
what is to binder this moral disturbance existing even for many years
before the intellect manifests disease ?
Dr. Hughes' case, as I have said, seems to me simply one of con-
genital moral detect, and I have no doubt that if the girl lives a few more
years, she will become intellectually insane.
DR. NICHOLS:-Did not Dr. Hugbes remark at the close, that this
person became feeble-minded ? I think there was a statement of that kind.
Dr. HUGHES :-No, sir; there was a statement made in the description
that she had manifested an extravagent fondness for new dresses, an in-
ordinate fondness for dress.
DR. EVERTS:-A new dress would make her like a child.
DR. HUGHES :—She has also an inordinate fondness for money and
when she has a new dress she acts like a child, happy for the time.
DR. ANDREWS:-Dr. Hugbes has presented this case of a young lady
as a typical one of moral insanity. It is written by the mother and claimed
to be all the more valuable because presented by a non-professional
observer. The history is an interesting one, but lacks the qualities which
such a history should have and which would without doubt have been
noted had it been reported by a physician There is little reference to the
state of the health ; the only fact of a strictly medical character being the
poisoning in early life and the increased excitement manifest at the
catamenial periods.
The presence of definite and positive delusions would seem to remove
it from the field of moral insanity, if such a division exists. Delusions
are stated by the mother to have been present during the early years of
life and to have been prominent in the periods of excitement, subsequent
to her arriving at womanhood. The most marked were, that she was
repeatedly assaulted, that her property was taken away by her father and


630
Thirty-Sixth Annual Session
a conspiracy was formed against her by her family. These were ac-
companied by violent conduct, obscene talk and accusations regarding
her sister of immoral acts. The history shows her threats and open
violence led to her commitment to an asylum. The fact that she was able
to control herself, and to deny the delusions previously, openly and vigor-
ously asserted, is common enough in the life of many lunatics.
Another feature of the case is the marked hysterical element
evinced by the increase at menstrual periods and the disturbance of the
sexual feelings shown by the vile talk about her sister and others. There
are evidences of more or less marked dementia, the natural sequence of
prolonged mental excitement. This is given in the love for dress and
finery, the "childlike" regard for these things, her mother says, has been
lately developed. It thus appears that in this, as in other instances, the
existence of moral insanity is disproved by an analysis of the symptoms.
There are peculiarities in the care which might lead to honest differ-
ences of opinion as to the diagnosis, but without attempting to make any
finely drawn distinction, the features presented are sufficient to enable us
to classify it as one of mania, with a tendency to mental enfeeblement.
DR. HURD :—There is one additional feature which perhaps has not
been sufficiently dwelt upon-the lack of self-control shown by these
patients. I think all will concede that when a lack of self-control is dis-
played by the insane, we bave one of two conditious, either overwhelming
emotions, the effect of delusions concealed or otherwise, wbich entirely
sweep away the reason and will of the individual; or, an intellectual
impairment which renders it impossible for him to exercise a proper
amount of self-control under disturbing circumstances. Looking at the
case under discussion from this stand-point, it would seem that we have
either mental aberration with actual delusions, or an intellectual impair-
ment resulting in loss of self-control to deal with, and not a simple case
of moral insanity.
The hour of adjournment having arrived, the Chair
announced the Committee on Nomination of Officers for
the ensuing year to be Drs. Nichols of New York, Reed
of Pennsylvania and Gale of Kentucky.
On motion, adjourned to 3 P. M.
The Association was called to order at 3 P. M. by
Dr. Callender.
The Secretary read a letter from Dr. Godding express-
ing his regret at being unable to attend this meeting.
Dr. Schultz, from the Committee to Audit the Accounts
of the Treasurer, reported that they had examined the
accounts, compared them with the vouchers and found
them correct, and $13.13 in the Treasury, and they
recommend that an assessment of five dollars be made
on each member for the payment of the expenses of


Association of Medical Superintendents, &c. 631
the Association, and on motion the report was received
and adopted.
DR. CALLENDER:—WIU Dr. Hughes please proceed with the discus-
sion ?
DR. HUGHES :-Mr. President, I shall be very brief, as the questions
were few, and in my opinion, not difficult to answer.
In regard to the existence of epilepsy, there certainly was none so far
as I could discover. In regard to the existence of epileptoid or epilepti-
form manifestations, or psychical epilepsy, I was not able to discover any
evidence of these either. It is true that psychical epilepsy is sometimes so
obscure that even a failure to discover it does not prove that it does not
exist. But the suggestion of psychical, epileptoid, masked or larvated
epilepsy, never arose in my mind from any manifestation of the patient
disclosed to me by conversation or observation, nor did that occur to any
of the other gentlemen who saw the patient, and all the men are recog-
nized as capable men in the profession and men of standing. I do not
wish to mention the names except privately, because I do not wish the
case to be located. As to imbecility there was certainly no evidence to
my mind, or to that of any other of the alienists so far as I could ascertain,
or of any form of congenital mental defect of sufficient magnitude, at
least, to be appreciable to ordinary perception. It certainly would not fall
under any recognized degree of imbecility given by Hoff bauer, and in my
opinion there was no evidence of imbecility of any higher grade.
Medical men of course differ as to the designation they would give to
the form of mental aberration described in this narrative, but it is clear
enough that, notwithstanding men might differ as to a specific designa-
tion, there seems to be but one opinion as to the fact that a forin of mental
aberration certainly is portrayed in that description.
Now, having less objection myself than some other gentlemen to the
term “moral insanity," preferring to describe under that designation not
only those forms of mental derangement manifested in marked departure
from the natural habits of thought and action of the individual, without
an appreciable intellectual lesion, but also those forms of mental aberra-
tion in which the affective life is chiefly and paramountly affected, 80
much so as to give to the disease its chief characteristics, regardless of a
minor degree of intellectual involvement, I should of course have no
hesitancy in classifying it as a form of moral insanity, while making no
quarrel, however, with any gentleman who might think differently, by
reason of any theoretical opinions he might entertain concerning the
impossibility of affective aberration existing in the mind without concomi-
tant intellectual derangement, and I should have no quarrel with him as to
wbat he migbt choose to term it; but in my own opinion, Prichard's own
views of moral insanity arc somewhat misconceived in some quarters.
Possibly this may be owing to my own obtuseness, but that is my impres-
sion. Now the cases which Prichard describes, embrace in my opinion,
some intellectual aberration co-existent with the change in the affective
life. But it is clear that he did not intend, under the designation of “moral
insanity," to exclude forms of aberration in which the intellect was second-
arily and remotely affected. “Moral insanity or madness consists,” he


632
Thirty-Sixth Annual Session
says, “in a morbid perversion of the natural feelings, affections, inclina-
tions, temper, habits, moral dispositions and natural impulses, without
any remarkable disorder or defect of the intellect or reasoning faculties,
and particularly without any insane delusion. This form of mental
derangement,” he goes on to explain," has been described as consisting in
a morbid perversion of the feelings, the affections and active powers, with-
out any illusion or erroneous convictions of the understanding, and is
sometimes co-existent with an apparently unimpaired state of the intel-
lectual faculties.” Further on he says, indeed, that the "intellectual
faculties may be termed unsound, that they act under strongly excited
feelings, as a person would if sane and in a passion. Under such circum-
stances they are liable to err both in judgment and conduct.”
It is not contended that a person affected with derangement in his
affective life, in order to be designated as morally insane, should be
more free from errors of judgment and of the understanding, than
an average number of sane people are liable to be under excitement,
Understandings are not all alike. Errors of judgment are common to the
rational mind. To err, is a human attribute of mentality, and it is
obviously illogical and irrational to expect that before we should permit
or acquiesce in the use of the term "moral insanity” or “affective insanity,"
describing that form of mental aberration, with which we are all familiar,
that we should demand of the individual so affected, that he should be
sounder in his reasoning powers than the average rational mind. Miscon-
ceptions of judgment, and misconceptions of fact are common to sane
people. Mistaken conceptions are not uncommon to rational minds, and
it is not to be expected that there should be nothing of that kind before we
should recognize the existence of a state of disease call it “moral insanity"
or "affective insanity," "reasoning mania" or whatever term we may
choose to invent-it is not to be expected that with such a form of
aberration, we should guage the mind of the affected individual by a more
rigid standard than tbat by which we would measure the average rational
mind. That is what I should argue in a case of that kind. Of course I
know that 'there are gentlemen who would differ as to the propriety
of the term and knowing the theoretical basis upon which those differences
are made, I should make no quarrel with them or enter any objection to
their designating it by some other appellation. Nevertheless, the fact of
mental disease still remains, in my humble opinion.
Dr. Nichols, from the Committee to Nominate Officers of
the Association, made the following report, which was
unanimously adopted:
The Committee on Nominations, to which was referred the resignation
of the office of President, Dr. Clement A. Walker, and the resolution
offered by Dr. Chapin relating to the terms of office of the President and
Vice President and the presentation of an annual address by the President,
respectfully offer the following report:
The Committee recommend the acceptance of Dr. Walker's resignation
and the passage of the following resolutions :
Resolved, That in accepting the resignation of the office of President
of the Association, Dr. Clement A. Walker, the Association desires to


Association of Medical Superintendents, &c.
633
assure him of its high sense of the able and impartial and acceptable manner
in wbich he has discharged the duties of that position.
Resolved, That the Association has learned with great regret and very
earnest sympathy of the sickness th:t led to Dr. Walker's resignation of
the Superintendency of the Boston Lunatic Hospital which he conducted
for many years with great ability, usefulness and credit to the Institution
and to hims "If, and that the reported improvement of his health is highly
gratifying to this body which sincerely hopes that such improvement will
continue until his health is fully restored, and that he will yet enjoy many
years of health, happiness, and congenial professional labor
Resolved, That the secretary of the Association be directed to commu-
nicate a copy of these resolutions to Dr. Walker. The committee nominate
Dr. John H. Callender for the position of President of the Association, and
Dr. John P. Gray for the position of Vice-President of the Association,
which will becoine vacant by the elevation of Dr. Callender from the posi-
tion of Vice-President to that of President. The committee further recom-
mend that Dr. Chapin's resolution be adopted, and that the terms of the
resolution apply to the election at this time, and that the president shall
deliver his address immediately after the reading of the minutes of the pro-
ceding annual meeting, and the appointment of i he usual committees, the
first of which shall be a committee on the nomination of officers. The com-
mittee so nominated shall report at the opening of the afcernoon session of
that day, and the consideration of its report shall be the first business in
order at that session, and immediately after the election of the President
for the ensuing year, tbe retiring President shall introduce the President
elect to the chair and the latter shall preside until the election of his suc-
cessor in like manner at the next annual meeting of the Association.
CHARLES H. NICHOLS,
JOSEPH A. REED,
MMITTEE.
R H. GALE
.
DR. CALLENDER:-Gentlemen of the Association: For the high honor
conferred in calling me to the Presidency of this body, I offer you my pro-
found thanks. I must ascribe the preferment, however, to considerations
of personal regard and faithful service in attendance rather than to any
peculiar merit or qualifications I possess. It may well be esteemed a
distinction to preside over your deliberations and I assure you it is sincerely
appreciated.
This organization is the oldest national medical association on this con-
tinent, and is indeed not bounded by national limits comprising as it does,
the Dominion of Canada. Quietly and without vaunting itself, for thirty-
six years it has been steadily accomplishing a work which is not the least
among the evidences of the lofty civilization of which North Americans
justly boast-the amelioration of the condition and the conservation of the
interest of the insane. Upon these important subjects, while tolerating and
promoting the utmost freedom of opinion among its members, it has sought
for and uttered the highest scientific results as its teachings, and adapted
them in the most practicable form. On questions medico-legal and juridi-
cal in character, it has held the scales of scientific truth justly over human
infirmity, and the rights and interests of society. It has wholesomely im-
pressed public thought and wisely directed governmental action, and the
land is to-day dotted with noble monuments to its efficient labore in the
numerous and well-ordered institutions for the insane which grace every
State. Its record on all its field of work is clear and high, and challenges
criticism.


634
Thirty-Sixth Annual Session
While occupying this position, I shall be careful to say nothing and do
notbing to iropair the high character of the body or to inar in the least its
usefulness or integrity, and in such a coai se. I shall beet show that your
generous partiality is deeply felt. Again, gentlemen, I thank you.
Dr. Rogers offered the following resolution which was
accepted and referred to a committee to report at a
subsequent session of this meeting of the Association:
Whereas, It is almost axiomatic that a definite assignment and division
of labor will always produce the be-t attainable results in all co-operative
organizations, and whereas this principle has been applied with evident
advantage in nearly all prominent scientific bodies; therefore, in order to
secure a more certain and thorough collation of the results of individual
experience and research for the benefit of this society as a whole, be it
Resolved, That on the last day of rach annual meeting of the Associa-
tion of Medical Superintendents of American Institutions for the insane,
the President shall appoint committees whose duty it shall be to report at
the next annual meeting upon the state and progress of the various impor-
tant divisions of special science and art relating to the insane as assigned
to and accepted by them, and whose chairmen shall be ethically respon-
ible for the proper production and prompt presentation of such reports.
The President appointed on said Committee, Drs. Rogers,
Strong and Kilbourne.
The President then said the next business in order
would be a paper to be read to the Association by Dr. R.
M. Bucke, of Ontario, Canada.
Dr. BUCKE:-Mr. President, I propose to read a short paper on the
** Growth of the Intellect." You will find it defective in many respects, and
I wish to say by way of preface to it, that I would like you to regard it
rather as pointing toward truth, as indicating broadly the direction in
which it must be sought, than us an attempt to define any specific truth.
Dr. Bucke then read his paper which was published
in the July number, 1882, of the American Journal of
Insanity.
The President:—The Association has heard the paper of Dr. Bucke
upon the Developments of the Intellect, and the members have listened
to the Doctor with very close attention. Any gentleman who desires to
speak upon the paper is invited to do so, without calling specially on each
one.
DR. NICHOLS :- I listened to Dr. Bucke's paper with a great deal of
interest. I do not rise to discuss it. Indeed I consider myself quite
incompetent to discuss it, but it embraces a curious and learned specula-
tion that is certainly very interesting. Its bold, far-reaching generaliza-
tions remind me of an incident whose relation may, without impropriety
momentarily relieve the natural gravity of these proceedings. When he
was in this country, a few years ago, I took our distinguished honorary
member, Dr. John Charles Bucknill, to a meeting of the Washington
Philosophical Society. The paper of the erening gave rise to some


Association of Medical Superintendents, &c.
635
discussion concerning the difference in time between the first and second
glacial periods, and the gentlemen who took part in the discussion were
certainly quite free in giving a hundred thousand years here, and taking a
hundred thousand there, with the amiable purpose of reconciling their
somewhat conflicting views. As we issued from the hall of meeting the
Doctor exclaimed, “ You are indeed a generous people. The liberality
with which hundreds of thousands of years were given and taken in the
discussion to-night, could only be witnessed in a great and free country.”
DR. EVERTS:- I do not wish to appear too often before this Associa-
ciation, but I cannot permit Dr. Bucke's paper to pass without some
expression of appreciation, for whatever may be said of the particulars, as
presented, of this paper, the work of Dr. Bucke in preparing it has
certainly been in the right direction.
I think the time has come when we are compelled to recognize the
generalizations of Science, known familiarly as “Evolution," elaborated,
if not discovered, by DARWIN and HAECKEL as the world not so very long
since was compelled to recognize the generalizations of their predecessors,
KEPLER and NEWTON, about which only here or there a parson Jasper is
found to raise a question.
It may be true that the theory of Evolution, which occupies if possible
a more comprehensive relation to animated Nature than does the theory of
gravitation, attraction and repulsion to the inorgantic world, is not yet
proved by demonstrable facts answering every possible question. Yet the
facts upon which the theory is based, already observed and harmonized.
are overwhelmingly numerous and important-and are supplemented by
inferences so logical, consistent and unavoidable, as to partake of the
truthfulness and force of facts observed, that it must be difficult for a
thoughtful and comprehensive mind not to accept it as beyond, peradven-
ture, true.
I think also that this method of studying any subject, well illustrated
by Dr. Bucke's paper, by beginning with the first or simplest ascertainable
fact pertaining to it, and tracing its growth to whatever limit the subject
may have attained, or to which we may be able to reach, is the truly scien-
tific, rational and profitable method.
I think this is the way to get at the whole matter of insanity in which
we are all so much interested, but about which we know indeed so little be-
cause we know so little about the genesis and growth of mind itself. Men
are not born men—they are born babies. Mrs. Stowe stumbled on a scien-
tific truth when she made Topsy say in reply to her question “ Who made
you?” “Spect I nebber was made. Spect I grow'd.” The human mind
is a thing of growth-integrations of activities-incrementations of exper-
iences-limited and moulded by mechanism. As such must it be studied,
not only in general, but in all the particulars of its manifestations. Dr.
Bucke's paper represents to my appreciation an admirable example of the
proper method of studying mer, tal phenomena, and is worthy of the great-
est commendation on that account if no other.
DR. HUGHES :-Mr. President: In every attempt to trace words from
their roots, a great many absurd terms are coined. It does not follow
that because objection can be made in regard to such terms, that there is


636
Thirty-Sixth Annual Session
not pretty satisfactory evidence existing ofthe evolution of language from the
simple to the compound. I think the paper inculcates a good theory of the
evolution of words from the simple to the complex, arising pari passu with
the evolution of mind. Thus far I am in accord with the assayist. But
that it is a tenable theory of the growth of mind being dependent upon
word “concepts," I do not believe. Though that word "concepts" facilitate
mental advancement by the easy communicability of mind with mind, this
cannot be denied. I would sustain the paper only in part as a good theory
of the evolution of language from the simple to the complex. Words I
would regard rather as the outgrowth of the necessities of mind, to com-
municate the growth and needs of ideas, and the concepts formed in the
mind of objects.
The author's view was the same that prevailed in the days of
Condillac and Warburton, when they promulgated the theory that the
mind could only think in words, and which stood in the way of pathologi-
cal progress in psychiatry, as we know to be the fact-it stood as a barrier
before the mind of the great Trousseau and caused him to hesitate to
accept the doctrine of apbasia promulgated by Broca, Bouillaud, the
Daxes, and their confreres and predecessors. Yet, to-day, the fact that
apbasia is not incompatible with ratiocination is established beyond all
cavil, Aphasia stands as an immovable barrier to the doctrine that the
mind can only think in words, and in my opinion has overthrown the old
metaphysical obstacles that stood so long in the way of progress. This
pathological fact, therefore, stands in the way of the acceptance of the
conclusions of the paper. The inferior animals do not think in words, yet
they do certainly have concepts which are responsive in a measure to our
own concepts which we express in words, and which enable them to
become in a manner companions for man. There is a degree of mind in
animals though they cannot formulate concepts into speech,
DR. BUCKE:—I do not wish to occupy the time of the Association, of
which I have already had my share. I will only say in reply to Dr.
Hughes' strictures, that we are constantly thinking without speaking
aloud, but it does not follow that that thought exists without words.
Silent thought takes the form of words, though these are not spoken. As
regards animals, there is no doubt that many of these have concepts,
thoughts, and it is equally certain that many of them have language
though, no doubt, a very small vocabularly. It does not follow that their
language should be vocal; it is thought by some tbat, for instance, ants
have a system of tactile signs, which with them takes the place of speech.
DR. HUGHES :-Does the gentlemen recollect the confession «f Profes.
sor Lordat made to Trousseau and others, in regard to the very fact as to
the concepts of words, after he had recovered from the aphasia by wbich
he had been stricken ?
Dr. BUCKE –I do not recollect.
DR. HUGHES.—He said he could compose, but, that he could not shape
words and did not think of words.
DR. BUCKE:-I am simply unable to conceive of the formulation of


Association of Medical Superintendents, &c.
637
thought without language. If not formulated in words what form would
it have?
The Secretary read an invitation from Dr. E. W.
Walker, Secretary of the Staff of the Cincinnati Hospital,
to visit that hospital; and, on motion of Dr. Gray, the
invitation was accepted with thanks and referred to the
Business Committee.
Dr. Stevens offered the following resolution :
Resolved, That the Secretary be instructed to furnish certified copies of
the proceedings of the Association to the ALIENIST AND NEUROLOGIST.
On motion of Dr. Nichols the resolution was referred
to a committee of three; on motion of Dr. Gale, increased
to five, to be appointed by the President. The President
appointed as committee, Drs. Stevens, Nichols, Reed, Gale
and Sawyer. On motion of Dr. Hughes it was
Resolved, That the medical press of Cincinnati be invited to be present
at the sessions of the Association and take notes of its proceedings.
On motion, the Association adjourned to 9 A. M.
of the instiew Asylum iter passing
WEDNESDAY, May 31st, 1882.
The Association, after passing through the wards of
the Longview Asylum and examining them and the grounds
of the institutions, was called to order at 1:30 P. M. by
the President.
The Secretary read letters from Dr. A. E. Shew and
Dr. A. E. Macdonald, regretting their inability to attend
this meeting
Dr. H. P. Mathewson of the Hospital for the Insane,
Lincoln, Nebraska, and Dr. James M. Whitaker, Asst.
Physician of the State Lunatic Asylum, Milledgeville,
Georgia, appeared and took their seats.
Dr. Stearns, from the Committee on time and place of
next meeting, reported that the Committee had agreed to
report in favor of holding the next meeting at Atlantic
City, New Jersey, at some time during the latter part of
the month of May, the day to be fixed at a future time,
which was, on motion, laid on the table for the present.
Dr. Hurd read a paper on “Periodic Insanity.”
DR. Nichols:-I agree in general with the doctrines of the paper.
The specialty of mental medicine has not produced since their day, more
critical observers of morbid mental phenomena, tban were Pinel and
Esquirol, and no subsequent classification of mental derangement has


638
Thirty-Sixth Annual Session
appeared to me to be a material improvement over that made by those
pioneers, and I have substantially adhered to it. I appreciate the difficulties
the Doctor meets with in making a satisfactory classification of individual
cases that either exhibit symptoms of several recognized forms of derange-
ment or change from one form to another. No multiplication of classes
could possibly keep pace with the infinite gradations with which the sim-
ple or primary forms of manifestation run into each other. The best that
can be done in these intercurrent cases is to make the primary form most
nearly simulated, the basis of a description of the case, in more or less de
tail, according to circumstances. In recurrent cases, the manifestations
often not only differ in different attacks but are particularly confused in
the same attack.
In circular insanity, particularly in anaemic conditions, I have found
quinine administered in large doses and followed by iron, to break the al-
ternations of excitement and depression. Any remedy that makes a pro-
found impression upon the system-as opium in anaemic and tarter ametic
and digitalis in hyperaemic cases-will sometimes do it, but this class of
remedies should be used with much caution.
The use of conium and hyosciamus in the treatment of insanity has
been revived with much benefit; but these are remedies that should never
be prescribed in effective doses in a routine way, as susceptibility to their
medicinal and toxic action differs very greatly in different cases. They
should at first be administered tentatively in moderate doses and the dose
increased or the medicine withdrawn according to the susceptibility of the
patient.
It seems to me that no very definite rule can be laid down in regard to
the proportion or condition of the cases that may, with more or less bene-
fit and safety, go home on furlough or trial. It ought to be left to the dis-
cretion of superintendents and the friends of patients, or in the case of the
depend ºnt insane, of the proper authority. Periodical cases are so seldom
wholly cured, and have so little of liberty and social life to look forward
to, that I think the point of allowing them to go home whenever circum-
stances permit should be continually strained. A patient may be sent to a
comfortable home when it would be inadmissible to send him to a home of
poverty and want. In the latter case he would be better off to remain in
the asylum. I have found that sending periodical cases to discreet friends
in happy homes is, as a rule, not likely to hasten the occurrence of exacer-
bations.
DR. Schultz:–Mr. President: The circumstances into which a patient
is likely to be placed after leaving the hospital constitute a very important
item in the decision of the question whether it is prudent to discharge him
or not. I believe that many patients who have been fully restored relapse
after being discharged simply because they have no home to go to, at least
not what could properly be called a home. What these circumstances are
we often have no means of deciding, and we discharge patients who ought
to get along but do not, simply because they are subjected to bad influ-
ences which in their condition they can escape only while in hospital.
My opinion is, therefore, that before sending a patient, who is doing well in
a hospital, adrift into the world with a view to his entire and perhaps more


Association of Medical Superintendents, &c.
639
speedy restoration there it is all-important, indeed essential, to know what
influences he is likely to encounter.
DR. GOLDSMITA:—Mr. President and Gentlemea: No general rule can
be given as to the management of these recurrent cases any more than
other cases of insanity, and this, is particularly true during their quiet
intervals when the success of a visit at home often depends full as much
on the temperament and circumstances of their relatives as on their own
condition. I am inclined to be very liberal in granting these people per-
mission to visit their relations, and have thus far experienced no ill results
from the practice. If the patient is liable to resume drinking habits or is a
woman and liable to become pregnant, I do not favor a discharge from the
hospital. When the recurrent attacks take the form of maniacal excite-
ment and the patient is plethoric and the symptoms are what we usually
regard as evidence of cerebral congestion, I have several times seen appar-
ent benefit from the administration of iodide of potassium in pretty large
doses, as one hundred and twenty grains daily. I am sure th:ut the drug
has an action in some of these cases entirely separate from any anti-syphil.
itic virtue it may possess and believe that it consists in the general sedative
effect which it has on the circulatory system.
DR. DEWEY:-I have but one remark to make and that is, I have been
a good many times agreeably disappoint:d with the result of allowing
such patients to be returned home, in allowing them to be removed some-
times by their friends or family when they assumed the responsibility
entirely, not feeling able to recommend it at all. The result has been such
that I have got a good deal into the habit of permitting this where the
patients have no dangerous tendencies, suicidal or homicidal, especially
where the patients have been partly restored and where they will be
respectably kept. With reasonably good environments I allow them to go
much oftener than I formerly believed to be advisable and practicable.
DR. FISHER:-I was about to make a similar remark to Dr. Dewey's,
that some of my patients have derived benefit from making an experimen-
tal visit at home after having long been hospital residents. I have had
specially striking evidence of patients being restored on returning home
after one or two years treatment in the hospital. When they had appar
ently got into the ruts spoken of, the going home acted as a stimulus to
recovery. In one case in particular in which I did not dare to recommend
a discharge on account of active symptoms, the patient was taken home
and not to a very good home and recovered entirely and immediately and
is well at present. I had several other cases of that sort—where I did
not venture on the discharge of the patient but allowed the patient to be
taken home on trial-which were attended with such good results that I
feel it now to be a duty in all such cases to try the patient at home. I do
not tbink that hospitals will ever be any less needed than they are to-day,
but I think it is an important question that demands our attention. I
have no doubt that we superintendents are apt to get into the habit of
believing that patients are better off with us than away ; we are apt to
think that because we have been accustomed to certain methods that no
other course is feasible, and for that reason I think we should take the


640
Thirty-Sixth Annual Session
risk of home treatment. But in many cases of long hospital residence, I
think we all know the prospect of going home is one of the most powerful
motives we can present to patients to induce them to put themselves more
under self-control, I have thought much about it since commencing the
practice of sending patients home, and fully believe in its efficacy. I have
sent them home for short visits, first say for an hour and then for a day or
a night, or a week on trial, until the patient finally has been discharged.
In experimenting in this way it is very soon found what patients are likely
to be benefited. I find this practice stimulates other patients to hope
that they finally may be subjected to a similar experiment. I do not see
any possible harm likely to result from this course. I believe also that
much liberty should be allowed in the matter of revisiting. Even with
patients in the acute stage of insanity I have almost invariably allowed
them to see friends from the outside. There is very seldom in our hospital
a single patient who cannot receive friends in any stage of his disease. On
some visiting days there are as many visitors as there are patients, and I
can see little harm from this source. I used to think, and I suppose most
superintendents thought, that it was necessary to seclude patients from
the visitation of friends for quite a long period, for months, in some cases
six months or a year. I think that is a great mistake. So far as my
experience goes, no harm has resulted from an opposite course and until
I am convinced to the contrary I shall continue that practice.
DR. HUGHES :-Mr. President: In these cases of folie-circulaire the
social condition of the patient must be taken into consideration when the
question comes up as to the patients going home in the interval. If the
patient, who is afflicted with a pronounced form of recurrent insanity
be married and young, and the intervals of recurrence are short, it
would be obviously unwise to counsel the return of that patient
home with the likelihood of the wife or the husband becoming a parent.
So much for the social condition of these patients. In the case of young
girls and boys and very old people it certainly would be most desirable to
encourage the desire to return home in the intervals of the exacerbations.
that is supposing we have determined that the case is incurable, or if not
incurable that it can be treated as intelligently by the home physician in
the interim of the return of the patient to the asylum which in this case is
usually inevitable. We are speaking now of recurrent mania, not of con-
valescence from ordinary forms of insanity. The period of quiet in
these patients is often the best period for observation and study of the cases ;
it is in the absence of the maniacal excitement in the absence of the intense
depression during which we can elicit the most satisfactory information
from our patients-information on which we can best treat them,
Folie-Circulaire is generally accompanied with a disordered state of the
vaso-motor system. The sympathetic system is often more or less impli.
cated in this form of mental aberration, and if we study our cases carefully
in the interval of ihe maniacal seizures-the markedly maniacal seizures-
we may discover an increased arterial tension, an accelerated pulse, and
other prisisting physical conditions, worthy of our consideration and which
are amenable, especially at that time, to our remedial measures. Then the
question is to be considered whether it is not better for us to retain the


Association of Medical Superintendents, &c.
641
patient in charge in order to attempt in this interval to affect a change in
the pathological condition upon which the morbid physical manifestations
depend. Where the paroxysm has assumed a state of physical depression,
where the patient is intensely maniacal and before having come out of that
you have discovered that the condition of the patient's circulation is differ-
ent from what it was during the paroxysm, it is better to keep that patient
under observation and do what you can as a physician to affect a restoration.
Probably the medical staff of the hospital is better qualified to attend the case
the two or three months or shorter period which may elapse before he may
again return into the morbid psychical state. So it is not a subject which
can be disposed of in any one manner. The social status of the patiert is
to be considered, and we have to consider in the interim who is to have
charge of him, and whether we ourselves can best study the patient in the
hospital and study his morbid condition, or whether it can be done fully as
well at ho.ne.
In regard to the question of returning patients home, the usual argu-
ment is of course that home is the place at which the insanity received its
inception, that often the predisposing causes, at least the exciting and
determining causes, are there, that it became necessary to remove the
patient from home to the asylum, as an essential part of the remedial treat-
ment. We have then to consider the patient's condition having undegone
a change towards apparent convalescence-which is only an apparent con-
valescence in these cases of folie-circulaire as we all know-we have
to consider whether the exciting cause still remains ot home, whether there
exists that domestic infelicity or cause there which may have over-balanced
the patient's mind and caused the necessity for removal to the asylum;
whether his pecuniary circumstances wil be the same again at home as
those which precipitated bis mental overthrow. A hundred other ques-
tions will come up in the mind of the alienist having charge of a patient of
this kind which he can only satis factorily answer after a reference to his
case book and a careful study of the antecedents and home surroundings
of his patient.
DR. Strong:-I will submit a few remarks on the medical treatment of
recurrent mania, especially when accompanied with great motor disturb-
ance. My own experience in the use of the amorphous hyoscyamin of
Merck in this form of mental disorder has been satisfactory. I am fully
in accord with Dr. Hurd in relation to its efficiency as a controlling agent
in recurrent mania. In several instances I have observed that where the
hyoscyamin was administered during the premonitory stage of the recur-
rent seizure, it would greatly modify the symptoms, and in some cases cut
short the attack. Of course the longer the duration of the attack the more
thoroughly and seriously the nervous centers become involved, and hence
the advantages gained by modifying, if possible, the severity of the attacks
I have never found any remedy that will accomplish so much and so
speedily, as the hyoscyamin in this special condition-recurrent mania
accompanied by extreme motor disturbance. Its dose is from the one
tenth to the one-fourth of a grain, and when administered hypodermically.
it seems more efficient than when given by the stomach.
It is sometimes intimated that medicine is of little use in the treatment


642
Thirty-Sixth Annual Session
of insanity, but I do not belong to the class that adopts that view. Medi-
cine in my view has its place in the treatment of insanity as well as in other
pathological conditions. Take for example the disease under discussion:
If the motor excitement be permitted to go on unchecked, the waste of
Lissue reaches a stage wherein nutritive repair may become impossible,
whereas, if motor excitement be arrested this waste is prevented, nervous
energy is conserved, and consequently you have a better foundation for
the patient's nutrition.
THE PRESIDENT:—The hour for adjournment has arrived; in order to
reach the trains the discussion will be suspended until the next session
of the Association.
DR. MILLER:- Mr. President: Allow me to say we have been very
highly honored by your presence here to-day. It has been a source of
pleasure and profit, and I shall be pleased to meet you here again at any
time in the future.
THE PRESIDENT :-Without further motion the Association will stand
adjourned to meet at 8 P. M.
The Association, after adjournment, visited the Cincin-
nati Sanitarium under the charge of Dr. Everts, and
spent the afternoon at that institution, returning to the
city at 7:30 P. M.
The Association was called to order at 8 P. M. by
the President.
The business in order, the report of the Committee on
time and place of next meeting, was taken up, and it was,
on motion,
Resolved, That Newport, R. 1., be substituted for Atlantic City, N.J., and
that the Business Committee be requested to arrange the time of the
meeting.
The President appointed as the Business Committee,
Drs. Sawyer, Stearns, Fischer, Shew and Curwen.
On motion of Dr. Gundry, it was resolved that the
Business Committee entertain no invitations outside of
Newport.
On motion the Association adjourned to 7:45 A. M.,
Thursday, June 1st, to proceed to Dayton.
THURSDAY, June 1st, 1882.
The Association spent the day in an excursion to
Dayton under the direction of Dr. H. A. Tobey, to visit
the Asylum and also the Soldier's Home, and returned to
the city at 7 P. M.


Association of Medical Superintendents, &c. 643
Friday, June 2nd, 1882.
The Association was called to order at 9:30 A. M. by
the President.
The minutes of the sessions of the two previous days
were read and approved.
The Secretary read a letter from Dr. Wilkins expres-
sing his regret that he could not attend this meeting and
stating that the Institution would be represented by F.
W. Hatch, Jr., Assistant Physician.
The Committee, to which was referred the resolution
of Dr. Stevens, made the following report which was, on
motion, adopted :
The Committee to whom the resolution offered by Dr. Stevens was re-
ferred, which was to the effect that the Secretary be instructed to furnish a
copy of the proceedings of the Association to the ALIENIST AND NEUROLOGIST
published in St. Louis, Missouri, respectfully report by the recommendation
that the Secretary be instructed to permit the condictor or conductors of
any respectable American Medical Journal, who may desire it for publica-
tion in such journal, to take a copy of his (the Secretary's ) revised manu-
script of the proceedings of the Association immediately after such revision
has been completed.
CHAKLES W. STEVENS,
J. A. REED,
C. H. NICHOLS,
R. H. GALE,
JOAN W. GALE.
COMMITTEE.
Dr. Rogers, from the committee on the resolution offered
by him, made the following report which was, on motion,
received and adopted:
Your Committee instructed to consider a resolution to appoint at each
annual meeting of this Association, special committees to report at each
next following meeting upon the state and progress of some of the impor-
tant subdivisions of science and art relating to the care of the insane, begs
leave to report its hearty approval of the same and suggests that the
President appoict Committees of three on 1st, The Annual Necrology of
the Association; 2d, Cerebro-Spinal Physiology; 3d, Cerebro-Spinal Path-
ology; 4th, Therapeutics of Insanity and new remedies; 6th, Bibliography
of Insanity; 6th, Relation of eccentric diseases to Insanity; 7th, Asylum
location, construction and sanitation; 8th, Criminal responsibility of the
insane.
JSTRONG, UPNE
JOS. G. ROGERS,
J. STRONG,
E. A. KILBOURNE.
COM-
MITTEE.


644
Thirty-Sixth Annual Session
Dr. Dewey read a paper on the “Differentiation and
Segregation of certain classes of the Insane."
DR. GUNDRY :- I agree with most of the sentiments of the paper, and
should have read a report covering pretty much the same ground, except
as to advocating the removal of epileptics, of criminals and inebriates from
institutions. The paper that I read last year on the same subject will give
my view's pretty generally. Dr. Dewey bas so freely gone over the ground,
that it is unnecessary to say very much about it in a formal way. I think
he said we shall have to adjust our means to the end to be arrived at. I
know of no better way of enlarging our institutions, or the taking out of
them of patients not proper to be there. What I want to get at is that
epileptics should be cared for. I know it is everywhere the case that
wben an epileptic can be got rid of, he is to be taken from the institution.
I know an epileptic is not a pleasure to any one inside of an institution and
I know they have to be very carefully protected, or separated from the
rest in the ward. I think it does not necessarily follow as to the position
in which they are placed, that the proper provision made for them should
be away from the institution although I personally prefer it. In this state,
I understand, a movement was made a number of years ago for the treat-
ment and care of epileptics, and that that movement is going on. As a
gentleman of this state who represents an opposite view of the matter has,
what we would call elsewhere, “ a conclusion," I do not feel that I have
much more to say than what I have said. I think a separate building
would be instrumental for good, that they might be taken care of without
reference to the other insane, that it would be better if they were taken out
and classified according to their respective qualities, and not be classified,
as now, in connection with the qualities of the insane they are among. I
wish they could be bronght together in sufficent numbers to be properly
cared for at night. All these things suggest separate buildings or separate
parts of buildings for their care. Further than that I do not wish to
enlarge.
I could add a remark of my own experience that while epileptics and
insane people do uot get along well together, personally, I have observed
that epileptics have a way of helping each other, and are kind to one
another, and that they do not resent insane people, so to speak, after the
fit ceases. It is not the mere noise or the shriek that people talk about,
it is the appalling falling of a person apparently struck down dead. An
epileptic bas sympathy and care for another and they put up with each
other better than with any other class we have. That is one of the reasons
which induces me to argue for their isolation. The special subject I had
intended to speak about I will defer.
I had the pleasure last year of going over Dr. Bucke's institution, and
saw those separate cottages that he spoke of, and which I must say gave
as wide and as much liberty as could be granted separately to insane per-
sons, and the system is carried out with remarkable fidelity also, and with
remarkable results in my opinion. The cottages, which are very plain
and almost meagerly furnished, with a fullness of occupants, and members
going in and out as they pleased, presented to my mind a very contented


Association of Medical Superintendents, &c.
645
family of insane persons, carrying on for themselves. They went about
their work by being simply directed by one or two minds instead of being
governed more than necessary.
DR. HUGHES:—Do they have any accidents ?.
DR. GUNDRY:—We have accidents everywhere; I am not speaking of
the asylum at all, I am speaking of his small cottages. I do not wish to
stand, or to be understood to be in a position I do not occupy, and as I
made a remark last year, which might be intended to reflect upon that very
matter, I wish now to say that what I saw changed my ideas in regard to
the comfort and wants of these classes. I will be honest and candid with
all men. This is merely a statement of the fact, because I left another
impression by having made a contrary statement.
Dr. HUGHES :- I was interested in knowing or ascertaining the possible
number of casualties that might have occurred in those immense dining-
rooms and how many patients are aggregated in them, and I asked the
Doctor that question. There were two or three hundred patients. I
think it was the largest aggregation of patients at one table at any
institution in the United States or Canada either, or anywhere else so far as
I know.
In regard to the paper of Dr Dewey, I concur in most of the purposes
of the paper and its views and aims. I consider that segregation is as
essential a matter to be taken into consideration in the treatment of the
insane as aggregation. The grouping of patients is a psychical problem
which the superintendent has often to solve with a view of favorably
impressing the patient's mental condition, and so also the separation of
patients one from another and the taking of patients from the hospital
itself is often a psychical problem which demands considerable attention,
and upon the proper consideration of which sometimes depends the mental
welfare of the patient. My idea about an establishment for the manage-
ment and care of the insane is, that every such institution ought to have
not less than a section of ground, and that in selecting a site, a locality
ought to be chosen where the surroundings are ample, not restricted to
the ordinary fifty or one hundred acres, and that buildings should be
located on the ground for the care and treatment of patients who are not
requiring constant personal observation, that as many annexes should be
constructed on that section of ground as might suggest themselves as
necessary to answer the requirements of each particular institution. I
shall not undertake to prescribe the number of separate buildings there
onght to be on that section of ground or within the vicinity of the main
hospital. I would provide for those patients who become restless and
dissatisfied in the main building. There are times in the lives of insane as
well as sane people when change is salutary to mental health, and it is a
source of great relief to the superintendent of the asylum if he has, contig-
uous to the main building and under his entire control, a few well located
hospital annexes placed at a sufficient distance from the main building to
give the patients sent to them a sense of removal from the asylum, a sense
of change. I do not think it would be unwise to have these annexes even
more remote than a mile or two. The wisdom of more remote distance


646
Thirty-Sixth Annual Session
however, should be left to the views of superintendents specially inter-
ested.
But for the treatment of the insane in general, for the vast majority of
insane which come under our observation, [ apprehend that no better plan
can be adopted than the present structures. There the patients are easily
accessible by the superintendent at all seasons and hours, and the patients
are accessible to the place of amusement and chapel in the most inclement
weather. The most serious objection I have seen or heard urged by gen-
tlemen who have these cottages connected with their buildings, was the
lonesomeness of the detached structures; that the patients who would ask
to go there would change their minds when the winter season came on,
and when they could not attend the amusements and winter gatherings in
the main building regularly.
But I think there is a field for the detached hospital structure, and I
think it is much wiser to provide for a certain number of patients out of
the main population of a large hospital in this way, than to advocate the
construction of entirely distinct hospitals, under distinct management, for
certain classes of the insane. Now the epileptic insane are insane. There
is no reason why distinct and exclusive hospitals for the epileptic insane
should be made, but I believe distinct buildings should be made for them
and constructed in such a manner as to be adapted to their peculiar
malady. The subject of seizures alone will suggest that-an epileptic
being seized with a fit and falling on the hard floor, is not guarded in his
rights of protection, if we provide him with a hard floor to fall on like
other patients. There are other considerations than patients falling on
hard floors, or falling against projections and bruising their faces. I do
not believe in the building of separate hospitals especially designed for
the separation of demented patients, I have no objection, however, if
more buildings can be got in that way and in no other, to ask for them.
But for the chronic insane, I would not name such buildings hospitals for
the incurable.
DR. KILBOURNE:- I had not the pleasure of listening to the whole of
Dr. Dewey's very interesting paper, bence cannot speak at length upon it,
however, I heard a goodly portion of it; sufficient, perbaps, to give me a
tolerably clear understanding of its drift and I take pleasure in saying
that in the main, the views presented by the doctor, and especially as to
separate provision for the epileptic and criminal insane, are in hearty
accord with my own. As to differentiation in bospital buildings, I desire
to say that it has been a growing conviction with me for years, that some
provision different from wbat we now have, ought to be made by each
state for the accommodation of that ever increasing, chronic but demented
class of the insane; that we are called upon from sheer necessity to dismiss
and return to the county infirmaries from time to time, to make room for
more recent and deserving cases-buildings embodying the best views of
the profession upon this subject, but arcbitecturally simpler and more
inexpensive than usually afforded-not in any sense fire traps, but neat,
well built, unpretentious dwellings that would afford reasonable protec-
tion against loss of life and at the same time confer all the benefits that an
enlightened philantrophy ought properly to exact.


Association of Medical Superintendents, &c.
647
In saying this, I do not wish to be understood as in any way reflecting
upon hospital construction in the past, for it could not be better-much
less as favoring those erude immature projects, the outgrowths of minds
who believe it “not necessary to understand things to talk confidently
about them,” but I believe the time has come when the present system of
caring for the insane must be supplemented by means and methods that
will admit of large numbers being cared for under one management, and
at a less per capita cost in the original outlay, than has heretofore been
thought necessary. Where the conditions favor it, this could be accom-
plished to some extent, by grouping together about existing structures a
few cottages for each sex; but at best, this would prove only a temporary
make-shift, and in the end, a more comprehensive plan would necessarily
force itself upon the attention of every community.
We have upon the grounds of the State Hospital at Elgin, two very
tasty, brick and wood cottages, one for men, and one for women, costing
less than $300 per capita, the former accommodating fifteen and the latter
ten patients. The one occupied by the men I have no trouble whatever in
keeping filled, and generally to the satisfaction and apparent comfort of
the inmates. The ore for women is pleasantly located, carpeted' and
warmed throughout, and withal, furnished with a piano and every con-
venience and luxury of a well organized home, yet, it is with the greatest
difficulty that I can persuade sufficient numbers to leave their comfortable
quarters in the main building and take up their abode here. During the
summer months, perhaps, not so much difficulty is experienced, but in the
winter season, our perplexities are many.
The principle and it seems to me, the insuperable objection raised by
the ladies of refinement and culture, a goodly number of whom we have
under our roof at all times, is, that they are compelled to share their sleep-
ing apartments with others—the cottage being so arranged that two, three
or more, must be associated together in dormitories, on the second floor-
this enforced association they find exceedingly repugnant and wounding
to their pride and prefer for their own comfort, the single, but cheerful
rooms off from the corridors of our general wards. Another reason
assigned by them is that they are more isolated, that they see nothing of
the bustle and activity of hospital proper—and the relief from the
“monotony of asylum lite” is, after all, not so real as it has been pictured !
In view of these facts, the question naturally arises, whether structures
of this kind can be made available for the custody of any considerable
number of the insane other than those whose feelings and susceptibilities
bave become blunted to the finer instincts that usually govern their 8880-
ciation with each other. After an experience of four years it has been
demonstrated to me that their usefulness is quite limited.
Touching separate provision for the criminal insane, I think little need
be said, as it is a subject that has engrossed the attention of this Associa-
tion on numerous occasions, and if I mistake not, it is a settled belief with
all its members, that no community has any moral right to inflict upon
the ordinary insane, the enforced association of the criminal classes, as is
now practiced in nearly every state in the Union.
DR. GRAY.—I do not rise to discuss the paper of Dr. Dewey's, while I


648
Thirty-Sixth Annual Session..
think it is a very important one for our consideration. It is to be hoped
that the valuable hints thrown out by Dr. Dewey, in regard to the several
classes of insane of which he has treated, would be tiken up by the section
of the Association created under the resolution and report of Dr. Rogers,
and that each class may be clearly designated, and especially those that he
has suggested should be treated, perhaps, in other institutions than our
ordinary insane asylums, and that we may have their full report next
year.
Many of the propositions that Dr. Dewey has presented are, in fact
pregnant with the most difficult problems that we have to deal with; the
care of criminals and the care of epileptics, among the ordinary insane, and
also a certain class addicted to alcoholic excess. The latter, we all recognize,
are exceedingly troublesome in hospitals, whether they are sane or insane.
If they are really insane as the result of dissipation and long alcoholic
saturation, there is no difficulty in the law in the various States, in
holding them under treatment; but if they are merely persons given to
alcoholic excess, whether they come to institutions more or less voluntarily,
or whether under compulsory control, the great majority are likely to
give trouble, and the court, as far as the State of New York is concerned,
would release them upon their own application of that or their friends.
Indeed, as to the inebriate asylum of the State of New York-whatever
elements entered into making it unsuccessful, and finally induced the
State to abandon it or convert it into an asylum for the insane-the courts
held that drunkards could not be kept under such restraint for any indefinite
time. Although committed under State law as inebriates, such as made
application were released.
Still, we must all admit that they are a class of people who ought to be
looked after. From my own observation and experience, I frankly say,
that during the period in the history of the Asylum at Utica, when more
or less were received for treatment, generally speaking, they gave a good
deal of trouble to the ordinary patients, and often a great deal to their
friends, by reason of their confinement in the insane hospitals; except in
cases where they came absolutely voluntarily and were anxious to be rid of
their habit.
One problem suggested by Dr. Dewey, which is in itself very important
on all the points he has thrown out, 18, how far special provision might be
made in any ordinary hospital for the insane, for those recognized as not
insane, but simply as persons given up to excessive drinking; whether &
ward or an entire building, in proximity to the hospital should be used
for that class, being under the care and medical treatment of the medical
staff of the general institution. Again, how far such people could be made
useful aiding in their support. I take it these are some of the points
which would grow out of the suggestions of Dr. Dewey. Am I right in
80 understanding?
DR. DEWEY:-Yes, sir.
DR. GRAY.-Upon the brief time for reflection here, since the reading
of the paper, I should hardly be willing to give a positive opinion upon the
proposition just referred to, but I can see no possible objection to its full


Association of Medical Superintendents, &c.
649
discussion, and I repeat that I hope the committee having charge of tha
section will take the problems into full consideration along with any others
that may suggest themselves.
In regard to the epileptic insane, it has always seemed to me that we
should advocate hospitals for epileptics, to include all epileptics who cannot
remain at their homes, either from difficulties arising from extreme irrita-
bility of temper associated with more or less dementia, or owing to the
poverty of their families, or by reason of maniacal attacks, which we know
are quite common in epilepsy of some standing. We all know that the
poor generally have to give up their epileptic children to the care of the
ordinary poor-houses and al.ms-bouses We also know of epilectic men
and women without means. As far as I have been able to ascertain, they
are a very troublesome class to deal with among the ordinary non-insane
paupers, and are often abused by those with whom they are associated,
while they, themselves, are often as dangerous as the vicious class of the
poor. As to epileptics who are placed in asylums, my experience is, and
I think it must be the experience of every superintendent, that, as bas been
heretofore suggested, they give great anxiety and great trouble. They are
often violent towards others, or the ordinary insane are violent towards
them. As Dr. Gundry has suggested, among the great evils of attempting
to treat epileptics among the ordinary insane, is the terror that is inspired
in persons unfamiliar with epilepsy, whether sane or insane, by seeing one
fall suddenly, as though he were dead. I have witnessed this fact very
often, indeed. There is probably no State in which there is not a sufficient
number of epileptics who need hospital care, to constitute a hospital espe-
cially for that purpose, and the same might certainly be said of Canada
and I am very glad that Dr. Dewey has, in his paper, laid so good a found-
ation for the further discussion and development of this important matter
In reference to the question of buildings for these classes and for the
insane, I think we should all be glad to have the subject fully discussed
I do not recall that anybody connected with this Association has ever as-
sailed the general hospital system and its absolute nec-ssity. The questions
that have arisen from time to time are mainly how proper provision shall
be made for each class. How the best care of the insane embracing all
classes shall be best accomplished. Dr. Dewey has thrown out many
valuable hints and it is for us to see how they can be properly applied.
In regard to the institution which he has more clearly outlined than has
been done heretofore, I notice that he speaks of a number of persons having
escaped and that some of those who escaped drifted back again into the
alms-houses of the state. I suppose we have to take into consideration
this fact: that the alms-honses are, more or less, a part of the general system
of taking care of the insane, both in America and Europe. The question
is, what particular class of cases could be taken care of properly with the
ordinary poor and sick and how they shall be designated. The local
authorities are charged with the general care of the poor who are sick or
infirm everywhere, and undoubtedly there are quite a number of chronic
pauper insane who might be associated and taken care of with the ordinary
poor; at least such is the fact that they are so taken care of. The paper
of Dr. Dewey while exhaustive in so many respects is of equal value from


650
Thirty-Sixth Annual Session
being so largely suggestive, touching problems which we all have before
us constantly and upon which we are called upon from time to time in
connection with legislation for the proper care of the insane.
Dr. Rogers then read a paper on certain effects of
the alkaloid Cinchonia, particularly as to its effects as a
paretic to the powers of accommodation of the eye.
DR. GRAY:-I do not wish to break the general stillness and silence
upon this paper; at the same time I cannot refrain from expressing grati-
fication that Dr. Rogers bas taken the pains to make the careful clinical
observations he has bere detailed, associated with the administration of
the remedy and its value. I do not intend to discuss the matter as I should
not feel justified in entering upon such discussion, unless I had made
similar investigations in regard to the same remedy. Dr. Rogers deserves
the thanks of the Association for what he bas done in this direction, and it
is a hint to others to do likewise touching various medicines used. By
such observations and investigations we shall be able to enlarge or limit
the remedies, and understand more fully the application of medicines for
the relief of those under our care. We cannot do too much in the way of
clinical observation in asylums, in the treatment of insanity and other
diseases with which it is constantly associated.
Dr. Kilbourne offered the following resolution which
was adopted:
This Association, having learned with profound regret of the recent
death of one of its oldest members and most earnest collaborators, Dr.
Mark Ranney, Superintendent of the Iowa Hospital for the Insane at Mt.
Pleasant, lowa, a man estimable in every quality of head and heart, profes-
sional as well as social, it is hereby
Resolved, That a Committee be appointed to express in fitting terms its
appreciation of the life, character and services of the deceased, said memo-
rial to be incorporated in the proceedings of the present session of this
body.
The President appointed Dr. Kilbourne the commit-
tee, who reported as follows:
MEMORIAL OF DR. M. RANNEY.-Dr. Mark Ranney, late Superintend-
ent of the Iowa Hospital for the Insane at Mt. Pleasant, died after an illness
of only one week, from an attack of acute pneumonia, January 31st., 1882.
Dr. Ranney was born in Westminister, Vermont, July 7th, 1827.
His early education was such as could be obtained in the schools of
his native state. Determined to pursue the study of medicine, he received
instruction under eminent physicians in Providence and Boston, and
graduated from the Vermont Medical College, at Woodstock, in 1849.
Soon after graduation he received the appointment of Assistant
Physician to the Butler Hospital for the Insane, at Providence, R. I., then
under charge of that distinguished physician and alienist, Dr. Isaac Ray.
During the five years he remained at the Butler Hospital, he so far
profited by the opportunities for acquiring experience under that able
eacher, as to secure what was regarded as an advancement in position-


Association of Medical Superintendents, &c.
651
an appointment upon the staff of the McLean Asylum at Somerville, Mass.,
then under charge of the scarcely less distinguished Dr Luther V. Bell.
In 1865, after a thorough training of more than fifteen years as assistant
physician, he was called to the superintendency of the Iowa Hospital for
the Insane at Mt. Pleasant, and the published reports of the Board of Trus-
tees of that Hospital thereafter, abound in expressions of intelligent appre-
ciation of the character of the services he rendered.
In 1872, some legislation in the state of Iowa affecting the management
of the hospital having been enacted, which was regarded by the Doctor
as likely to seriously interfere with his successful administration of its
affairs, he resigned the charge of the institution, intending for a time to
retire from the specialty, but the Trustees of the Hospital at Madison.
Wis., being then in search of a person for superintendent, invited him to
that place, whither he went in 1872.
He remained at Madison less than two years, and a vacancy again
occurring in the management of the Iowa Hospital, he was by unanimous
vote of the Trustees invited to return and assume its management in July,
1874, and thereafter was its able executive head until the time of his
death.
Dr. Ranney was well read in all that pertained to hospital organiza-
tion, management, and the care and treatment of the insane.
He had gathered together a library, ample in volume and scope, for
the study of psychological medicine from the earliest to the present time,
and all the limited leisure he could spare from ordinary duties was indus-
triously used in the acquirement of some thing that might inure in a
practical way to the benefit of the insane.
In the daily work of hospital life nothing was too small to merit his
consideration, and his ability to grasp and carry in mind all the details of
hos pital work was more than usual.
His executive ability was also supplemented by a rare good judgment
outside of strictly professional matters; and it has fallen to the lot of few
superintendents to originate and carry to completion so many improve-
ments as were made in the hospital where he labored. Nothing was ever
done as a make-sbift but everything was planned and executed for the
lasting future.
For several years he had filled the chair of “Lecturer on Insanity” in
the Medical Department of the Iowa State University, to the complete
satisfaction of the faculty and students. He gave much attention to the
jurisprudence of insanity and his services as an expert witness were
frequently in demand in the Courts of Iowa.
He died with the “harness on ” after having worn it nearly a third of
a century, leaving for emulation a life crowned with yood acts springing
from generous impulses.
The President then announced the committees under
the resolution of Dr. Rogers and the report of the com-
mittee under that resolution. [The said Committees are
here omitted having been published in the last number
of the ALIENIST AND NEUROLOGIST.]


652
Thirty-Sixth Annual Session
DR. FISHER:-I wish to say in explanation of this paper upon that
extremely difficult and complicated question of the mental status of Guiteau
that it was prepared, not as a scientific and comprehensive study of the
subject, but merely to give my views of the case, and some criticisms upon
the manner of trial. It was prepared and read before a small society in
Boston, and thinking that the question might be introduced at this meeting,
I brought the paper as an easy manner of expressing my opinion and have
been requested to read it. Therefore, if there should be any inappropriate
ness for this Society in any minor particulars, this is my explanation:
“ Was Guiteau sane and responsible for the assassination?"
Dr. Fisher then read his paper on the “Mental Status
of Guiteau.”
DR. HUGHES :-Mr. President: It is evident at this late stage of our
proceedings the opening of so vast a subject as a psychical analysis of the
character of Guiteau and the many questions that would arise in connection
with his case, the question of civil responsibility of the insane as well as
the sane, the civil responsibility of persons whose character is modified by
the neurophatic diathesis, the possible character of insanity, the question
of mental unsoundness as distinguished from insanity, the legal test of civil
responsibility, “the knowledge of right and wrong," test of insanity;
the degree of disease that may be co-existent with the capacity to resist
the tendency to insane acts and a hundred other questions would be in-
volved, and we would at this session reach no end to the discussion. For
these reasons while I should like to engage in the psychological analysis
of the character of Guiteau, it is obvious we would get but a hasty and
imperfect expression of opinion, were we now to attempt to discuss the
very interesting paper of Dr. Fisher.
After some conversation relative to the presentation
of papers at the regular meeting next year, the
Association, on motion, adjourned to 2:30 P. M.
The Association was called to order at 2:30 P. M. by
the President.
Dr. Gundry from the Committee on Resolutions, made
the following report, which was unanimously adopted :
The Association of Medical Superintendents of American Institutions
for the Insane, before separating for another year, desire to record their
grateful appreciation of the generous hospitality received from the citizens
of Cincinnati, and their hearty thanks for the numerous invitations to visit
their celebrated Hospital aud other institutions which want of time at their
disposal alone prevented them from accepting.
To the medical profession we are greatly indebted for their cordial
welcome and elegant entertainment where, as brethren engaged in differ-
ent departments of the same great work of healing the sick, we learned to
know each other, or to renew those old-time friendships which diverging


Association of Medical Superintendents, &c.
653
paths in life bad seemed to efface. We rejoice at every opportunity thus
afforded to strengthen the ties that bind us to our common profession, for
we remember that to the general profession is largely due the origin
development and progress of the institutions we represent, and to their
fidelity and watchfulness must we look that the standard of qualifications
of their medical officers is maintained, and the honor and general interests
of the profession therein protected.
To the Directors of Longview Asylum and Dr. Miller, its excellent
Superintendent, we owe our thanks for the opportunity afforded of visit-
ing and inspecting that institution, whose admirable arrangements and
beautiful surroundings attest the wise liberality of the County which has
provided so excellent a refuge for its sorely afflicted wards, while the
present appearance of everything in and about the institutiou shows that
no relaxation has been permitted in the labor and care required for the
development of the plans 80 wisely initiated.
To the Trustees of the Cincinnati Sanitarium and Dr. Everts, the
Superintendent, we are also under many obligations for their attention in
showing us the cheerful and elegant institution they bave charge of. We
shall not soon forget the kind hospitality we met with, nor the pleasant
and tasteful home so well adapted to the class of patients for whom it is
designed.
To the Board of Trustees and Dr. Tobey, the Superintendent of the
Dayton Asylum for the Insane, we tender our acknowledgments for their
considerate attention in providing an excursion to Dayton for our benefit,
wbich enabled us to view many points of interest, the Soldier's Home
near that city and the asylum under their care, and to partake of their
generous hospitality.
The short time we could devote to visiting the Asylum we deeply
regretted, but it was sufficient to impress us all with the good taste dis-
played in all the appointments in the building and grounds, the admirable
condition of every department, of the “homelike" character of the wards
and the care and attention to the individual comfort of the patients con-
fided to their care. Everything we saw gave evidence of the liberal and
wise public spirit of the State of Ohio in the foundation, equipment and
support of her benevolent institutions of which this asylum is but one of a
- large and noble group.
The pleasure of our visit to the Soldiers' Home or National Asylum
for Disabled Volunteer Soldiers was greatly enhanced by the courtesy ex-
tended to us by Gen. Patrick the gallant Governor of the Home, whose
attentions enabled us to see many of the interesting features of the beau-
tiful institution, and by Chaplain Earnshaw whose genial attentions con-
tributed to the same end. The unwearied attentions of Assistant Surgeon
Dunlap in pointing out all matters which bad a special interest, demands
our most cordial acknowledgement. Words are inadequate to express the
delight we experienced in wandering over those beautiful and capacious
grounds, whose capabilties have been improved by the highest art of the
landscape gardener; or the feeling of national pride at the magnificent
scale on which comfortable accommodations have been provided for the
declining years of those brave veterans whose disabilities have been con-


654
Thirty-Sixth Annual Session
racted in fighting the battles of their country. In this connection we refer
to one matter with regret. The retention of several insane persons and
many afflicted with epilepsy in the institution can only be justified by
necessity, and it is to be hoped that steps may be taken for their admission
into the Government Hospital for the insane where they can be suitably
cared for.
Messrs. Gilmour & Sons, the proprietors of the Grand Union Hotel,
have placed us under obligations for the numerous courtesies which have
contributed to the pleasure of our visit and for the use of the commodious
parlors in wbich we have held our meetings.
Last, but not least, the reporters of the Commercial, Gazette, Enquirer
and Star-Times have won our kindly rememembrances by the faithful re-
ports of our proceedings and their many acts of courtesy to eacı of us.
RICHARD GUNDRY, 1.
EUGENE GRISSOM, Ž
HENRY M. HURD. j.
COM
MITTER.
On motion, the Association adjourned to meet in New-
port, R. I., in June, 1883.
John CURWEN, Secretary.
ASSOCIATION OF MEDICAL OFFICERS OF AMER-
ICAN INSTITUTIONS FOR IDIOTIC AND
FEEBLE-MINDED PERSONS.
The seventh annual session was held at the Penn-
sylvania Institution for Feeble-minded Children, Elwyn,
Penn., commencing Tuesday, October 3rd, 1882, at 8 P. M.,
and continued for three days.
· The following papers were presented and discussed :-
1. The “Mathematical Idiot,” by Dr. Geo. Brown,
Barre, Mass.
2. “Cerebral Localization, Chiefly with Reference to
Idiocy,” by Dr. C. K. Mills, Philadelphia, Penn.
3. “The Practicability of Instructing Feeble-minded
Children in the Various Industries,” by Dr. John Q. A.
Stewart, Frankfort, Ky.
4. “The Relation of the State to its Charities," by
Dr. H. M. Greene, Lawrence, Kas.
5. "Account of a Visit to Four English Asylums-
Earlswood' Darenth, Normans-fels, Lancaster," by Mrs. C.
W. Brown, Barre, Mass.


Seventh Annual Session.
655
6. “The Organization and Methods of Institutions for
Idiots,” etc., by Dr. H. B. Wilbur, Syracuse, N. Y.
7. “The Medical Treatment of Idiots and Imbeciles,” ·
by Dr. Wm. B. Fish, Elwyn, Penn.
8. “A Few Points in Embryology," with photo-micro-
graph illustrations, by Prof. W. Hailes, Jr., Albany. N. Y.
The following reports were also made :-
“The Protection of Institutions against Accidental Fire,”
by Dr. C. S. Wilbur.
"On Bibliography of Idiocy," etc., Dr. H. B. Wilbur,
chairman.
"On Statistical Records,” Dr. G. A. Doran, chairman.
"On Causation of Idiocy, etc.” Superintendent report-
ing illustrations from cases received into institution for
past year.
"Clinical or Historical Reports of Special Cases.”
The meeting passed off with great satisfaction to the
members present. On the opening evening a reception
was tendered the Association, by the Board of Directors
of the Pennsylvania Institution, which was largely attended,
and the guests were hospitably entertained by the super-
intendent, Dr. Isaac N. Kerlin. An inspection of the
Institution impressed all present with its admirable manage-
ment and the excellent results obtained by the system of
education there employed.
AMERICAN ACADEMY OF MEDICINE.—The annual meet-
ing of the American Academy of Medicine will take
place at Philadelphia, Thursday, October 26th, at the
time of the great Bi-centennial Celebration of the landing
of William Penn.
HEREDITARY ALCOHOLIC INSANITY-D:. Lewis D. Mason's
Analysis of six hundred cases of alcoholic inebriety
reveals the history of immediate or ancestral inebriety in
two hundred and nine cases.
A HINT TO THE WISE IS SUFFICIENT_One of our sub-
scribers in a late letter incidentally makes the following
remarks:
If the superintendents of our great asylums, who have on such a vast
scale, what Charcot calls un musee pathologique vivant, would give us their
careful studies, clinical and pathological, of the commonly recognized
phases of insanity, its value would be incalculable when presented in our
journal. Why should we be dependent on the hospital of the West
Riding in Yorkshire for the most interesting contributions of our day on
alienism and neuropathy? Can't you stir up a change?


SELECTIONS
NEURO-THERAPY.
HYOSCIAMIN IN INSANITY FOLLOWING THE PUERPERAL
STATE.-A clinical brief of two cases. By C. H. Hughes,
M. D., of St. Louis. Before the St. Louis Medical
Society in January, 1881, the writer called the attention
of the profession to the value of this valuable hypoder-
mic agent in delirium and mania. Subsequently in the
Alienist and Neurologist for April, 1882, a somewhat
extended paper was presented discussing its “special
therapeutic value in psychiatry” and referring to the
experience of others to which the reader is referred for
details here omitted, this paper, in fact, being a continu-
ation of that as promised at its conclusion. (Vide A. &
N. for Apl. p. 260).
The purpose of this note is to briefly record the bed-
side value of this excellent and prompt hypnotic, in cases
of insanity following the puerperal state, even where a
cure of the insanity does not result. * * *
The two facts concerning the therapeutic value of hyos-
ciamin, which, as yet, are not definitely settled in clinical
psychiatry, are as to its possession or lack of specified ther-
apeutic properties in the cure . of the psychoses and its
superiority over chloral and the bromides, the circumstances
favoring the administration of the lalter being equal. That
it is preferable to either under certain obvious circum-
stances in mental alienation cannot be questioned, but
the true test of its value is yet to be furnished in its
uncombined employment in cases which by their nature
admit of recovery. Chronic cases of maniacal excitement
and insomnia merely tranquilized but not subsequently
recovered through its administration do not fully prove
its therapeutic value. We are apt to use hyosciamine
when we can not use chloral, bromides, etc. Whereas,
the only way to satisfactorily establish the comparative
value of the former is to give it to recent cases where
other agents might as well be employed, and note com-
parative effects and results.
The following case will illustrate its value in acute


Selections.
657
puerperal mania, with the usual delusional excitement
and motor activity. The delusions in this case were
varied and rapidly shifting from one subject to another.
The patient's insanity was first displayed about the ist
of March, shortly after the birth of a child, in the delu-
sion that she was commissioned to save the world from
sin ; but that delusion is now abandoned. She has been
inclined to violence, having fought at those about her
sometimes, and on one occasion having attempted to
injure her pet dog. She pays no attention to her babe,
and requires constant watching to keep her in bed.
In this case morphia and hyoscyamin were at first
alternately given on account of her debilitated condition;
as she improved in strength the hyoscyamin was exclu-
sively relied on. When it was attempted to give her
chloral in a glass of milk she refused it. No medicines
could be given her per orem. The notes below are fur-
nished by her attending physician.
AFFTON, Mo., Friday, March 17.
Dear DOCTOR: The patient has been more active up
to 2 P. M., throwing off the bed-clothes and stripping
herself naked. Refused all nourishment till about 7:30
P. M., when she eat an egg and drank six ozs. of milk.
Since three P. M. she has been much more quiet. Visited
her at three P. M. Pulse 84. Gave hypodermically 3 m.
of the new solution, hyoscyamin, crystallized.—[Previously
the non-crystallized was used, but having no reliable
amorphous salt on hand, I sent out the crystallized.-C.
H. H.]—but think some of it was lost by leakage, having
neglected to sufficiently tighten the needle. In half an
hour tendency to doze and in an hour she was asleep.
Pulse 120.
Saturday, March 18.—The patient slept last night from
nine to eleven, then turned about in bed and slept till
one A. M. Though she did not sleep during the rest of
the night she remained very quiet, at times absolutely so.
She took no nourishment, except an egg, up to noon,
imagining that it was poisoned, when she drank six ozs.
of milk. In the evening she took another egg and the
same quantity of milk. During the entire day less activ-
ity, both physical and mental. Pulse 78. Gave 3 m.
hyoscyamin at 8:50 P. M., and at 9:20 P. M. she was
quietly sleeping. Pulse 108.
Sunday, March 19.—The attendants report that she
slept five and a-half hours last night. Visited her at
She took she remained did not ste in bed"


658
Selections.
noon and found her about as yesterday. Pulse 76. She
had taken no nourishment up to this time, saying, as
before, that they had poisoned it. Asking her why they
did so she replied: "For money.” She was willing to
take food from me, however, and did so, eating an egg.
a small piece of bread, and drinking 16 ozs. milk. Eight
P. M. She has taken in all to-day three eggs and 38
ozs. milk. Injected 3 m. hyoscyamine at 8:40, and in
half an hour she was asleep. Pulse, before injection, 74;
half an hour afterwards, 108.
Monday, March 20.—The patient slept five and a-half
hours last night. Has taken three eggs and 42 ozs. of
milk to-day. Her physical condition is evidently improv-
ing.
I suggested to the husband on Friday that it would
be best for you to see her again, but he said that he
could not afford' the expense, and would be obliged to
send her to the asylum. He is now taking measures to
that end.
Yours, truly,
FREDERICK KIDDER.
On the 23d of January, 1881, a lady living nine miles
distant from St Louis raving and delirious, with a form
of mania, induced by frequent child-bearing-(one child
every year for the first four years), and exhaustion conse-
quent upon prolonged lactation and other causes, had
not slept for one hundred hours nor been mentally or
physically quiet in that time. She would take no medi-
cine by the mouth and no hypodermic hypnotic impres-
sion had been made by any effort of her physicians.
Her bowels had not moved in this time. Her pulse was
ninety per minute and full, and her temperature 999 F.
The character of her delirium was inconstant, chang-
ing from one subject to another every few hours, and
alternately pleasing and self-satisfied and angry and
destructive, beatific visions and mundane fancies alterna-
ting. Her pupils were natural and skin was apparently
normal.
A hypodermic injection of one-twelfth of a grain of
Mercks' amorphous hyosciamin given at ten P. M., a few
minutes after our arrival, sufficed to put this patient into
a prompt and pleasant sleep from which she only
awakened late the next morning refreshed, and she was
for a brief space of perhaps half an hour, tranquil.
The repetition of this method of procedure nightly
with appropriate daily medication was always followed


Selections.
659
by a like result as to tranquil sleep, with lengthened
periods of mental and physical tranquility following. At
the expiration of about ten days, complete mental clear-
ness became manifest, displayed in the desire to see
children and husband and friends, questions as to what
had been the matter with her, pleasant, connected and
rational conversations, etc.
But relapses followed the interviews with her husband
and some of her family, notwithstanding the invariably
satisfactory effect of the hyosciamin in inducing sleep
(until the patient became sufficiently manageable to take
chloral), and at the expiration of fifty days from the
beginning of treatment she was committed to a private
asylum for the insane in a distant State, where she now
is. Since this paper was written the physician under
whose care she was placed, reports her convalescent and
advises her removal from the asylum.
It should have been remarked that the patient was
removed from her home to the city at our suggestion on
the morning after we first visited her. The organization
of this patient was delicate and nervous. Her tempera-
ment was poetic and emotional and her tastes were
æsthetic. Her education, which had been very liberal,
rather overstrained her emotional and poetic nature and
she was mated to a matter-of-fact, strongly physical hus-
band. Her father committed suicide while her mother
was enceinte with the present patient.–St. Louis Med. and
Surg. Jour., Oct., 1882.
A Year's RECORD OF NERVE STRETCHING–Dr. Bastian,
of University College Hospital, reports two cases of loco-
motor ataxia. The operation was done by Mr. Marshall,
who cut down on the sciatic at the middle of the thigh,
and hooking his finger under it, thoroughly stretched it.
In the first case, operated on February 5th, 1881, the
result was improvement in the sensation and motion of
the limb, which was accompanied by considerable eleva-
tion of temperature in the part.
In the second the improvement was very slight, and
the rise of temperature small,
Brown-Sequard first called attention to this rise of
temperature, which is explained by the partial vaso-motor
paralysis. The improvement of nutrition caused by the
increased vascularity of the part probably explains the
benefit to motion and sensation which often follows the
operation.


660
Selections.
tel ave fatade the causilongata aus jour, Feinal para
Dr. G. M. Hammond reports a case of athetosis,
relieved by nerve stretching. (Trans. of Am. Neurological
Ass'n, 1881.) The median nerve was slightly stretched
near the middle of the arm. On coming from under the
anæsthetic, the patient could hold his fingers in any posi-
tion he wished, and has had no return of the disease
since. The patient had been suffering from pain in the
foot and epileptic attacks. The first was entirely relieved
and the latter much lessened.
Dr. Julius Althaus (Brit. Med. Journal, Jan. 7th, 1881.)
cites five fatal cases of nerve stretching in tabes dorsalis.
He thinks that the cause of death in most of these was
shock to the medulla oblongata caused by undue violence.
Mr. R. M. Simon (Brit. Med. Jour., Feb., 23rd) has
done this operation in a case of infantile spinal paralysis.
The nutrition and motion of the limb were both much im-
proved.
Mr. F. A. Southam (Lancet, Aug. 27. 1881) reports two
cases of clonic spasms of the sterno-mastoid and trape-
zius muscles, in which the spinal accessory nerve was
stretched. In both cases there was slight temporary relief.
Dr. W. J. Morton (Med. Record, March 4th, 1882) has,
1. Stretched both sciatics in a case of lateral sclerosis
with marked relief.
2. A case of paralysis agitans, the left sciatic stretched
with slight improvement.
3. A case of athetosis, ulnar and median nerve stretched
with great improvement, only slight numbness of hand
and occasional twitching of the thumb remaining.
4. A case of chronic transverse sclerosis, both sciatics
stretched ; temporary, but no permanent benefit.
5. Sciatic neuralgia cured by stretching the nerve.
6. Reflex epilepsy. Touching the right side of wound
caused an attack; the brachial plexus was stretched and
the number of seizures diminished.
Thiersch is reported by Dr. G. S. Walton (Boston Med.
and Surg. Jaurnal) to have stretched both sciatics in a
case of spastic spinal paralysis, one of spinal paraplegia
and two of tabes dorsalis, all without benefit, even the
shooting pains in the last remaining as before. M. Berger
(Le Prog. Med., No. II, 1882) has had great success in a
case of paralysis agitans from stretching the sciatics.
Fieber (Allg. Wien. Med. Zeitung, 1881, No. 50) describes
a new method of stretching the sciatic. The ankle is sup-
erflexed, the knee extended, and the thigh is then forcibly
chronics of the slight


Selections.
661
flexed on the abdomen. By this method the benefits of
the operation can be obtained without many of its
dangers and it can be repeated when necessary.
Dr. J. W. Chambers has done subcutaneous nerve
stretching in three cases of sciatica with marked success.
Dr. G. H. Branham in Medical Chronicle.
ater on him bromiar: the urine.
GLYCOSURIA AND POTASSIUM BROMIDE.-Dr. Felizeh
having occasion to administer potassium bromide to
a diabetic affected with a well marked nervous dis-
order, found that, together with the subsidence of
the nervous phenomena, the quantity of sugar in the urine
also diminished considerably. He at once, following Claude
Bernard's classical experiment, punctured the floor of the
fourth ventricle in several animals, thus producing glyso-
suria. Later on he injected into their venous system a
solution of potassium bromide, which caused the prompt
disappearance of the sugar in the urine. Acting on these
results he administered this drug more regulary to fifteen
patients, who, having been carefully observed for six years,
enabled him to testify to the great value of potassium
bromide in diabetes mellitus and glycosuria. He also
concludes that it is important in this disease to check the
disorder of the organism producing sugar in excess, and
to that end he particulary recommends persevering and
regular muscular exercise.—Paris Medical.
in hate it is importroducing sugas per
INFLUENCE OF MEDICINES ON CEREBRAL IRRITABILITY.-
P. Albertoni, of Genoa (Archiv. f. Experiment. Pathol,
and Therap. Bd. xv, Heft. 3 and 4, 1882), has proven.
that in dogs the electrization of the so-called irritable
zone of the cortical substance of the brain produces an
epileptic seizure. It is further known that of all forms of
epilepsy the most common is that which is caused by a
discharge beginning at the cortex of the cerebrum and
spreading over the whole nervous system.
Albertoni's experiments were made on dogs and
monkeys, with bromide of potassium, atropia and cinchon-
idia. The results were as follows:
1. The continued administration of bromide of potas-
sium diminishes in dogs, decidedly, the irritability of the
cerebrum. If a brain, under the influence of the bromide,
is irritated by an electrical current the effect is nil or
hardly observable. One single large dose of the bromide
will also reduce this irritability in a high degree.
If the administration of the bromide is continued for


662
Selections.
a long time in dogs, irritation of the irritable zone of the
cortex of the cerebrum (especially of the irritable zones
for the facialis and the extremities) with even a far
stronger current than that which, in a normal condition,
will cause severe epileptic seizures, proves itself ineffect-
ual, causing no response.
The conclusion may be considered correct, that a
continued use of the bromide obtunds the irritability of
of the irritating point of the cortex of the cerebrum, as
well as it prevents the spreading of the irritation.
2. Atropia, in not too large, but still poisonous doses,
increases the irritability of the cerebrum, as proven by
the greater irritability of the irritable zone of the cortex
to an electrical current.
The differences in the irritability and in the develop-
ment of the cerebrum explain satisfactorily the following
interesting facts; (a) the diminished effect of atropia in
children and young dogs; (b) the fact that the brain
symptoms caused by atropia are far more intense in dogs
than in sheep, the brain of which is more developed, but
much less irritable; (c) the total want of effect of this
drug in pigeons, the cerebrum of which is unirritable.
The possibility of inducing epileptic seizures in the
larger mammalia by irritating with an electric current
certain parts of the cortex of the cerebrum, is, by atro-
pia, neither diminished nor removed.
3. Cinchonidia, in therapeutical doses, increases in
epileptics the number of the seizures. As well as all
other alkaloids of the Peruvian bark, cinchonidia is
contra-indicated in epileptics.
If the cerebrum or the psycho-motor centers is
removed, cinchonidia will still cause epileptic attacks.
This drug has an irritating effect on the central motor-
ganglia.
The epileptic seizures which take place in dogs when
under the iefluence of large and fatal doses of cinchon-
idia are prevented in animals which have been kept for
a long time under the continuous influence of bromide of
potassium. At the same time, even the largest doses of
cinchonidia lose, under such circumstances, their fatal
effect. This proves that the bromides are indicated
whenever epilepsy is caused by a condition of tension of
the nervous centers.
The long-continued use of atropia prevents neither the
epileptogenic nor the fatal effects of cinchonidia.


Selections.
663
In epilepsy due to a condition of tension in the ner-
vous centres, atropia is not only useless but hurtful. It
may be administered, however, in fresh cases of epilepsy,
caused by fright. In such cases, atropia should be given,
up to poisonous doses.
In cases in whom the epilepsy is caused by conges-
tion or obstruction of the blood-vessels of the brain,
atropia may be of benefit by producing contraction of
the vessels, and preventing, in such a way, that hyper-
æmic state which induced the seizures. In cases of
peripheral origin it may also be useful by obtunding the
irritability of the peripheral ends of sensory and motor
nerves.-Philadelphia Med. and Surg. Reporter.
could give and first complaint for the last three had atta
NEURO-PATHOLOGY.
CEREBRAL TUMOR; AUTOPSY; ENDOTHELIOMA.—(Under
the care of Dr. Philipson. Reported by Mr. James Limont,
M. B., Senior House-Surgeon.)-J, M., aged thirty-six,
machinist, admitted May ii, 1882, in a state of stupor,
and complaining of pain at front and back of head. Patient
could give very little account of himself. His friends stated
that he had first complained of pain in the head four
months previously, and that for the last three months he
had been unable to work; also, that he had had attacks
of vomiting and giddiness from time to time. No history
nor any signs of syphilis; nor, at this time, could any
signs of cranial injury be got, but after his death his friends
admitted that he had had some injury to the head.
When admitted, patient was in a state of stupor. Mem-
ory appeared much affected. There was double internal
strabismus, with unequal pupils; double optic neuritis.
Hearing unaffected; sense of smell lost. Lies on back;
stumbles on trying to walk. Is with difficulty got to answer
questions; speech slow and hesitating. Pain in head ap-
parently increased by percussion in right frontal region.
From the sickness, headache, double optic neuritis, etc.,
Dr. Philipson diagnosed the presence of a cerebral tumor,
probably situated in the frontal region.
May 20.—Patient still more torpid. Bowels obstinately
confined. Can scarcely be got to take any food. Pupils
insensible to light.
27.-Death.
Post-mortem Examination.-When the calvarium was


664
Selections.
removed the membranes appeared normal. The right fron-
tal bone had on its internal surface a much greater con-
cavity than the left, and at its upper and outer part was
rough, deeper in color and thinned. The dura-mater was
very adherent towards the front of the longitudinal fissure,
and over the right frontal lobe. The right frontal lobe was
very hard to the touch, and was gray and mottled, and in
all its diameters it was larger than was the left lobe. On
section a new growth was discovered, which presented an
almost fibrous resistance to the knife, and was found to
occupy the whole of the right frontal lobe. It was grayish,
with a ragged outline, and measured three inches in each
diameter. It was surrounded by soft diffluent cerebral
tissue; but all the rest of the brain was healthy. On mi-
croscopical examination the tumor was found to present
all the characters of an endothelioma.-Med. Times and
Gazette. Sep. 16th.
THE LOCALIZATION OF HÆMIANOPSIA AND THE MUSCULAR
SENSE IN MAN.-Westphal, (Charité-Annalen, 1882), reports
a case which throws some light on this subject. The pa-
tient was a man aged thirty-eight, who in July 1879, suf-
fered from delirium tremens. From this he recovered, but
on August 7, he became aphasic without losing conscious-
ness. On August 14 and again on August 10 he was
convulsed on the right side and had symptoms of the so-
called atactic and sensory aphasia, but did not lose con-
sciousness. And lastly, on November 13, he was uncon-
scious for a short time, and was temporarily paralyzed in
the right arm. In all of these attacks the motility of the
right extremities seemed deeply impaired, but it is diffi-
cult to say how far it is, owing to the inability to orig-
inate a suitable nervous impulse to a defect of volition.
There was undoubtedly some motor weakness, but it was
not permanent, and in a short time the patient always
recovered his muscalar strength.
But in addition to these motor symptoms there were sen-
sory symptoms, and these were permanent. They were
observed with great minuteness from October, 1879 to
December, 1881 (when the patient died somewhat suddenly),
and were never found to exhibit much variation. There
was a marked impairment of the muscular sense of the
right upper extremity. The right hand was used very
clumsily, and the patient seemed unconscious of the po-
sition of the upper extremity and the movements it made.
In the right lower extremity there was scarcely any af-
called sed numestie man aphasis on this hie July 1879,


Selections.
665
DR. DEW 20th, shows en plantar lled "ter
fection of the muscular sense. Sensibility was diminished
in the right side of the body and in parts of the face.
There was bilateral right hemianopsia.
The post-mortem revealed a lesion implicating the whole
of the parietal lobe (including the ascending parietal con-
volution), the greater part of the occipital lobe, and a
small portion of the temporo-sphenoidal lobe. Here the
pia was adherent to the cortex, the gray matter was soft-
ened, and of a yellow color, and the convolutions were
atrophied. The atrophy was less noticeable in the posterior
part of angular gyrus than elsewhere. The cortex only
was involved. The rest of the brain was normal. This
condition of the brain reminds us of general paralysis,
but Westphal is of the opinion that the two processes are
essentially different.
Westphal attributes the hemianopsia to the lesion of
the occipital convolutions. He is unable to say whether
the loss of muscular sensation is dependent on the lesion
of the ascending parietal convolutions or on that of the re-
maining parietal convolutions.—Cin. Lan. and Clinic.
Dr. DeWattville's TracinGS:-In British Medical
Journal, May 20th, shows that:-
1. The latency of the plantar reflex is about three
times as long as that of the so called “tendon-reflex.”
The latter, in his tracings, has the usual duration ascribed
to it by most authors, viz., about .03 of a second.
2. The muscular contraction following cutaneous stim-
ulation tends to run a more protracted course than that
following percussion of the tendon.
3. In certain cases, percussion of the tendon is followed
by a contraction, of which the latency and protraction
correspond exactly to those characteristic of the reflex
contraction excited by excitation of the skin.
4. In certain cases, the galvanic stimulation of the
muscles also gives rise to a contraction occuring later, and
running a more protracted course than that due to the
electric stimulus.
5. In comparing the latencies of contraction of the
extensor femoris, and of the gastrocnemius, following ex-
citations at the sole of the foot, it must be borne in mind
that the difference will be comparatively small, owing to
the fact that the two muscles receive their nervous sup-
ply near the knee. The difference, likewise, between the
latencies of the knee-jerks following cutaneous excitations
at the sole of the foot, and at the pateller tendon respect-


666
Selections.
ively, will be equal to the time taken by the transmission
of the stimulus from the sole to the knee.
6. The possibility of true reflex contractions following
a galvanic shock and a tap on the tendon is one of great
importance in diagnosis, and deserves further consideration
and elucidation.
He has investigated miographically the question of
"cross tendon-reflex.” The tracings show that the latency
of contraction in the opposite leg is absolutely identical
with that in the leg percussed-a fact in itself sufficient
to disprove the reflex nature of the phenomenon. Further, it
is easily shown that a blow, given over the tibia or patella
of one leg with the fleshy part of the hand, or still better
on the heel of the fully extended leg, produces little or
no contraction in that leg, whilst the opposite is adducted
vigorously; a blow given on the heel of the right bent leg
causes no contraction in the opposite limb. It is plain,
therefore, that the shock conveyed along the femur to the
pelvis, and acting mechanically on the most favorably
placed tendons, is quite sufficient to explain the facts—a
view obviously forced upon us by the results of Prevost
and Wallers's experiments on rabbits.
REPORT OF THE MICROSCOPICAL EXAMINATION of the body
of Charles J. Guiteau, who died by hanging June 30, 1882,
at the United States Jail, Washington, D. C., in execution
of judicial sentence.
D. S. LAMB, M. D.—Sir: The Committee of three
whom you, with the assent of Rev. Dr. W. W. Hicks,
requested to make a careful microscopical examination of
sections from the brain, dura-mater and lung of the late
Charles J. Guiteau, and to report the conditions found to
be present, have completed their investigation and have
agreed upon the following report:
Thin sections, prepared by Dr. J. C. McConnel of the
Army Medical Museum, from the lung, dura-mater and
brain, were submitted to your committee for their in-
spection.
The Committee regret that the preparations presented
did not more completely represent the whole brain and
its membranes.
The Lung.-The sections of lung were from the leit
upper lobe. Their appearances were common tolert
miliary tubercle. Some of the minute nodules consisted
of aggregations of recently formed miliary tubercles in
which giant-cells were quite distinct. Others containe


Selections.
667
3. were cut on, whilst +
tal, the
older foci of similar aggregations which had undergone
corneous degeneration.
Considerable pigmentation of the pulmonary parenchyma
very like that of anthracosis, was also to be seen.
Dura-Mater.—The sections of dura-mater were from
the region of the middle meningeal artery. They showed
but few, if any, signs of inflammatory action, and there
was not much thickening evident.
Brain.—The brain sections comprised the following
series, viz., sections from two portions of the corpus striatum
marked respectively, corpus striatum i, corpus striatum 2;
and sections from four portions of the gray inatter of the
convexity or cortex of the cerebrum, labelled respectively
frontal region convexity I, convexity 2, convexity 3.
Those from the frontal region were probably from the
superior frontal convolution, whilst those marked convex-
ity I, 2 and 3, were cut respectively from the ascending
frontal, the ascending parietal; and the superior parietal
convolutions bordering upon the median longitudinal fis-
sure, but the committee were not informed from which
hemisphere.
A close examinination of these sections, under a high
power of the microscope, revealed the lesions noted below:
Corpus Striatum 1.—Not a few of the blood-vessels, par-
ticularly capillaries and venules, were decidedly abnormal.
Their perivascular lymph spaces were often more or less
completely filled with masses of yellowish-brown pigment
granules, which appeared to be the degenerated remains
of old blood extravasions.
In areas very numerous but mainly limited to the gray
or ganglionic substance, the capillary blood-vessels presen-
ted their walls in a state of granular degeneration.
Sometimes these granules were liniited within the endo-
thelial cells, constituting the wall of the capillary, but
often they were found for a considerable distance com-
pletely encircling the vessel
The lumen of the blood-vessels was usually void of
blood corpuscles, and was patulous. A small number of
very minute recent hemorrhages were to be seen.
In the gray or ganglionic matter of these sections
were quite numerous areas, in which alterations of the
neuroglia and of the ganglionic nerve corpuscles were
very plainly visible. In them the pericellular lymph
spaces were much crowded with lymphoid elements. In
some such areas, the whole space seemed to be occupied
very in the numerous


668
Selections.
by collections of such cells, no trace of the neuroglia cell
or nerve corpuscle remaining. Most frequently, however,
neither the encompassed nerve corpuscle nor the neurog-
lia cell was destroyed. On the contrary, their nuclei and
branched processes were generally distinct. Yet in many
cases the body of the cells was extensively tinged with
a yellowish-brown pigment, and, in a smaller number of
cells, the presence of well-defined, dark granules in the
cell body was sufficient to mask entirely the nucleus, if
any existed. Moreover, in the last case, the cell processes
were sometimes much less numerous than normal, and the
body of the cell was not so angular.
Corpus Striatum 2.-In these sections, the neuroglia
and nerve corpuscles were found to be in much the same
condition as above noted.
In a general way it may be stated that the cellular
hyperplasia or cell multiplication was more marked than
in No. 1.
With respect to the lesions of the blood-vessels, two
departures from health were noteworthy. Instead of those
lesions consisting of the remains, in the perivascular lymph
spaces of blood extravasations, as in the first sections
examined, these spaces at points along the course of the
vessel were often found crowded with lymphoid elements.
In some instances, these white cells were clustered closely
around and adherent to the wall of the vessel upon its
exterior, and often most abundently aggregated in the
immediate vicinity of a bifurcation. In others the cells
were closely packed together upon the external wall of
the perivascular lymph space and slightly infiltrated the
adjaceut neuroglia.
In the white fibrous nerve substance there were iso-
lated bundles of nerve fibres and collections of such bun-
dles, easily distinguished from the others by the presence,
in the greatly increased numbers, of cell elements upon
and between them. Under a high power of the micro-
scope, these elements were found to be outside the cap-
illary bloodvessels, and to occupy the same relation to
the nerve bundles and to the vessels, and to present the
same general microscopic picture as that seen in long!
tudinal sections of the optic nerve in a descending optic
neuritis.
The areas of diseased structures above mentioned were
more or less diffusedly scattered among tissues in wh
nothing distinctly abnormal could be made out.


Selections.
669
erned, althod, nucleusthe nucleusemented the body of quite
Cerebral Cortex. Frontal region.—The first layer seemed
to be thinned almost to nothing in spots at the convexity
of the convolution. The depths corresponding to these
spots were, perhaps, a little more hypercellular than other
portions. In the second, fourth and fifth layers, especially
in the two latter, the blood-vessels presented, in a marked
degree, degenerations similar to those remarked in the
corpus striatum.
In the second, fourth and fifth layers, the pericellular
spaces, both of the neuroglia cells and of the ganglionic
corpuscles, were more or less filled with lymphoid cells.
In these layers, some ganglionic nerve cells were also quite
freely pigmented. Sometimes one-half the body of the
cell was densely packed with pigmented granules to such
an extent as to veil the nucleus, but the latter as well as
the enclosed nucleus even then could be genearlly dis-
cerned, although with difficulty.
This cellular hyperplasia was much more marked in
the fourth and fifth layers than elsewhere, and it was
pretty uniform throughout them, yet even here there was
an obvious tendency to distribution en plaques.
In the subjacent white nerve fibrous substance, the ves-
sels were also sometimes slightly altered, and a few ex-
amples of cellular hyperplasia along the nerve bundles,
much as was described for the corpus striatum, were rarely
seen.
But few recent hemorrhages were visible in the sections
examined.
Convexity Nos. 1, 2, 3.—The same abnormal appear-
ances were remarked in all the sections, varying only in
degree. It is sufficient to state that they were usually
identical with those noted in sections from the frontal re-
gion, the only difference worth mentioning being the fact
that the areas in which the vessels offered a granular de-
generation were much less numerous and extensive than
in the frontal region.
In the foregoing report it is to be assumed that the
structures not specially mentioned were found in a condi-
tion so nearly normal as to call for no remark.
It should be stated, however, that in these various
brain sections numerous so-called minute vacuoles were
found. Whether these forms were real cavities or were
transparent, highly refracting bodies of a definite consti-
tution which was not revealed by the method of prepara-


670
Selections.
tion, the committee do not undertake to say. Neither do
they, in view of the widespread difference of opinion
among observers, feel warranted in expressing a positive
opinion as to whether or not these so-called vacuoles are
to be regarded as post-mortem changes.
As bearing somewhat against the assumption of a
post-mortem origin for such appearances in general, the
following facts, besides many other considerations, may be
referred to:
Ist. They are not constantly found in brains which
have been obtained thirty-six and forty-eight hours after
death, long after decomposition has set in.
2nd. They have not infrequently been found in brains
of animals killed for the purpose of experiment, when
the nervous tissue has been instantly subjected to the
action of the most perfect preservative fluids.
3rd. They have been met with when the brain sub-
stance has been examined perfectly fresh.
4th. If they are the result of post-mortem change,
they should not be met with immediately after death,
but should appear and increase in number as decompo-
sition advances. Yet no such relation to the time of
death and state of decomposition has been observed for
them.
In estimating the significance of these vacuoles in Gui:
teau's brain, it should be remembered that the specimens
were obtained and submitted to the action of the preser-
vative agents not more than five or six hours after death,
an early period rarely possible with human subjects; that
the microscope showed the elements of the brain well pre-
served in other respects; that in some brains examined
forty-eight hours after death these appearances are absent
and in others they are often less numerous than they
were found to be in this particular brain; finally, that
they were associated with the abnormal conditions of the
blood-vessels and of the cellular elements of the brain.
In conclusion, your Committee have no hesitation
whatever in affirming the existence of unquestionable
evidence of decided chronic disease of the minute blood.
vessels in numerous minute diffused areas, accompanied
by alterations of the cellular elements in the specimens
of brain submitted for their examination. Whilst the
lesions found were most marked in the corpus striatum
and in the frontal region of the cerebral cortex, yet they


Selections.
671
has nothich mighto-called valled upon upon the opini
very diffusely pervaded all portions of the brain which
the sections represented.
They are of the opinion that all the lesions to be rec-
ognized in the sections placed in their hands have been
pointed out in the foregoing report. They regret that it
has not been possible to subject the tissues to all the
tests which might determine the nature beyond a per-
adventure of the so-called vacuoles referred to.
They have not been called upon to pass upon the
bearing the lesions found might have upon the state of
the subject's mind, and, therefore, do not offer an opinion.
Respectfully submitted,
J. W. S. ARNOLD,
E, O. SHAKESPEARE,
J. C. McCONNELL.
bearThey have he so-callesmine the the tissuetegret that in
TUMOR OF THE CORTEX: SYMPTOMS.—The Phil. Med. &
Surg. Rep.-Abstracts from Pesth. Med. Chi., Press No.
46. —A case presented in Prof. Wagner's clinic, in which
an apparently tubercular tumor the size of a walnut
occupied the left upper temporal lobule, causing soften-
ing which extended to the posterior central convolution,
with the following symptoms: Awkwardness and debility
of the right hand movements and two attacks of convul-
sions, the spasms beginning in the same hand; the patient
died in the second paroxysm.
to the emporal to size" inic, in white
CLINICAL PSYCHIATRY.
TRANSITORY MANIA.—Dr. Edward N. Brush, assistant
physician of the New York State Lunatic Asylum at
Utica, reports in the July No. of the American Journal of
Insanity another Clinical Confirmation of this disputed
form of Mania, in the person of “Charles B- ,” a
strong healthy butcher who was brought to the Utica
Asylum, February 2d, violently insane.
After a light breakfast, he went to the slaughter-
house and engaged in cutting up and packing meat.
From this occupation and while warm, he drove thinly


672
Selections.
OH.
estate put whisky pussium
clad, two miles, on business and returned, in a tempera-
ture, 20° F. below zero. On re-entering the house he
felt chilly and stiff, headache and vertigo and soon
became incoherent, noisy and violent, requiring three
persons to hold him. The physician kept him etherized
three hours ineffectually, the violence returning on the
withdrawal of the ether. There was also muscular spasm
and tendency to opisthotonos.
At the asylum, four men controlled him with difficulty.
His struggles being violent but objectless, and he groaned
at times as if in pain. His pupils were contracted and
impressible to light, face flushed and hot and temporal
veins were distended. Pulse 142, full and bounding.
Extremities cold and pale. After ten minutes in a warm
bath with cold to the head, he broke out in a copious
perspiration over face and head; his pupils began to
dilate and pulse fell to 128°. In twenty minutes more,
the latter fell to 120°; the pupils were responsive to
light; his struggles were less and he tried to talk. He
was in this semi-conscious state put to bed, muffed in a
warm dry blanket and given a hot whisky punch. One
hour after admission, 40 grs. bromide of potassium were
given. His pulse soon fell to 112°; the whole body
became warm and perspiring, though his face was still
fushed and pupils were small. Five hours after admission
the pulse was 104° and pupils were normal, and he had
sufficient consciousness to understand and answer ques-
tions, though still confused and complaining of intense
head-ache. An ice-bag was applied to head and thirty
grains of bromide of potassium were given.
After thirty minims of fluid extract of ergot, given
about midnight he went to sleep. At times he was still
restless and talked in his sleep."
By 9 A. M. next day, he was fully conscious with
a pulse of 88° and a normal temperature. In three days
convalescence was complete and the patient discharged
cured.
The writer refers also to the cases mentioned by
Otto Swatzer (Die Transitorische Tobsucht, p. 23), quoting
the VIII. one, Samuel W— , entire. He notes also, the
four children reported by Reich in (Berlin Klin. Woch.,
No. 8, 1881), and the two cases recorded in Krafft
Ebing's Monograph, Lehrbuch für Psychiatric, Bd. III. p.
42, as caused by “caloric influences.'
The cases recorded by Jarvis are not referred to.


Selections.
673
ofith drealage ind sincer women me
PERVERTED SEXUAL FEELING, by Kraft-Ebing.–This
phenomenon, which has also been observed in roaches,
was first recognized as a disease by Casper, in 1852. In
a publication of the date of 1877, the writer claimed that
the congenital perverted sexual feeling is to be regarded
clinically as a symptom of a neuro-psychotic condition,
generally hereditary, denoting functional degeneration.
During the past year, he has had the opportunity of
observing three cases, all belonging to the higher walks
of life.
I. Count Z, æt. 37, single-father insane, mother died
of apoplexy, admitted into the asylum for Verfolgungs-
wahn from masturbation indulged in since his iith year.
As a child, he sought the society and delighted in the
amusement of girls. In his IIth year, he fell in love
with a man whom he saw in church. The sight of hand-
some men, or even of statues, produced in him feelings
of sensual desire. He suffered from nocturnal pollutions,
with dreams, in which men were the objects of his desire.
At the age of 20, he had intercourse with a female,
unwillingly, and since that time he disliked more than
ever the company of women. For the first time in his
life the patient confessed to me the secret of his sexual
life, although he could not see in it anything wrong. He
considered himself a kind of hermaphrodite, and thinks
that his feelings towards men are the same as those of
women towards men-embracing a man is sufficient to
produce an ejaculation.
Patient is a large well-formed man with no trace
of anything feminine in his voice, his character, his feel-
ings, etc. Not one of his relations had ever suspected
his secret.
II. Dr. G. was brought to the asylum in Grætz by
the police, who had arrested him for sodomy. He is 50
years old, large and powerful, normally developed in every
respect. Father was insane, mother peculiar, and an
aunt on his mother's side insane. He related with evi-
dent satisfaction that he was the subject of a perverted
sexual feeling. At the age of 5 years, his greatest de-
light was to get sight of a penis. He took pleasure in
dressing in girls clothes. Before the age of puberty he
began to masturbate—at the age of 26, he began to
practise intercourse with men. He regards his 'sexual
feelings as abnormal, but in no sense diseased. His.
erotic dreams were always of men, never of women. His
t of a port the ages, he began xual


674
Selections.
desire to have intercourse with men is strong about once
a week. He considered the ordinary mode of coition,
disgusting in the extreme. He had never had the least
curiosity to become informed about the female genital
organs. On the whole, he makes the impression of an
insane man. His mind has a very cynical turn—his self-
esteem is unbounded.
In his passion for men he sees nothing debasing-on
the contrary, he feels himself morally elevated by the
gratification of this love. Expresses contempt for sodom-
ists, with whom he does not class himself.
Herr V. H, æt. 30. Family history good. From
childhood indisposed to engage in boys' pursuits-effemin-
ate in all his tastes. In his 17th year, began to suffer
from nocturnal and diurnal pollutions, and as a conse-
quence developed various symptoms of disturbances of
the nervous system, without sufficient strength of char-
acter or purpose to devote himself to any pursuit in life;
unable to take care of money or to spend it to any ad-
vantage; he had led a worthless, idle life. His time is
spent in making his toilette—in painting, etc. His feelings
towards men are those of the opposite sex, whilst towards
women he feels entire indifference. Denies sexual inter-
course with men, though it is known to be a fact that
he has attempted it. Has had sexual intercourse with
women, though without any pleasurable excitation. His
whole appearance is decidedly effeminate, thorax and
pelvis like those of a woman. Voice high-pitched and
without masculine tone. His time he spends chiefly in
his boudoir, his conversation is of fashion, household
employments, cooking, etc.; symptoms of Neurasthenia,
induced by his effeminate mode of life. Patient is decid-
edly abnormal in his mental constitution from his birth.
His perverted sexual feeling is incurable, but not being
strongly developed, it is not likely to bring him into
trouble with society or with the laws. He is responsible
for his acts in the eyes of the law, and is not a proper
subject for an asylum. In case of his coming in conflict
with the law, his perverted sexual impulse must be
declared to be the consequence of organic disease.
Masturbation must be held to have been the original
cause of the affection, and the existence of a sperma-
torrhæa may constitute an important element of the
case.


Selections.
675
followrds their the opposition difference are
sh Waust bosite si
In summing up the evidence furnished by a study of the
seventeen hitherto reported cases of perverted sexual im-
pulse, we find the following facts established : The suffer-
ers invariably feel towards their own sex as a normally
constituted person feels towards the opposite sex, whilst,
towards the opposite sex they feel either indifference or
else a positive aversion. Their tastes, pursuits, &c., are
those of the opposite sex to that to which they belong
anatomically. Amongst them hermaphrodites have not
been found, although in some cases the whole type ap-
proaches that of the opposite sex. Hence we conclude
that the source must be sought in cerebral organic
defect, although Westphal contends that the conscious-
ness of their congenitably perverted sense belongs to the
history of these cases. I have found in four cases that this
was wanting. These subjects had no sense of debase-
ment, but rather a sense of exaltation from the gratifica-
tion of their sexual desires. In the majority of the cases
the sexual feelings became developed abnormally early in
childhood, and were also of abnormal intensity. The
neuropathic constitution, with great irritability and weak-
ness of the genital system, are features of these cases.
All congenital anomalies of the sexua! impulse are
the effect of functional degeneration in persons of a
heriditary predisposition.
In 13 of the 17 cases, progressive insanity existed.
The subjects were all with one exception neuro-psycho-
pathic.
In the present state of our knowledge, we must char-
acterize perverted sexual feeling as a symptom of func-
tional degeneration.
In regard to the frequency of this affection, Ulrichs
reckons one subject to 200 adult males, and amongst the
Magyars and Sclavs he claims even a greater percentage.
These figures are undoubtedly too high.
In regard to the method of gratifying the sexual
impulse, we find that they practise masturbation, kissing,
embracing, with or without coming in contact with the
sexual organs of the other party. In some cases the act
consists in masturbation by the opposite party. As a
rule they abhor sodomy as much as normally constituted
persons. * * * [Remarks on Legislation are
omitted.] Ulrichs makes the mistake of considering per-
verted sexual feeling a physiological phenomenon, and
hence his requirement allowing marriage amongst “Ur-
"
8".


676
Selections.
ningen," etc., need not be discussed. [The author sug-
gests legal assent to restrictive qualification of this
perverted instinct which we hope will never be counten-
ancede byola de Dr Dat in medico-
He concludes that in medico-legal cases, we should
take the ground: 1. Perverted sexual feeling is a patho-
logical symptom-a neuro-psychic affection. 2. Its deter-
mination requires the service of an alienist. 3. Its
occurrence, independently of other psychical anomalies, is
doubtful. 4. The question of accountability in each case
will depend upon the character, degree and extent of
the psycho-pathological symptoms.—Translated from All-
gemeine Zeitschrift, etc., by Dr. E. W. Saunders, St. Louis.
irns but after a tinflex exciteous and under his
CLINICAL NEUROLOGY.
TENDON-REFLEX IN SECONDARY Syphilis.—Dr. Finger
(Vierteljahrschrift fuer Dermatologie und Syphilis), claims
that in every case of secondary syphilis coming under his
observation a decided increase in cutaneous and tendon-
reflex excitability exists. Reflex excitability falls very
much below normal after a time. The normal condition
of things returns but slowly. Relapses of the eruption are
followed by changes in the tendon-reflex excitability.-
Chicago Medical Review. July 1.
INTRA-CRANIAL DISEASE AND CHOKED Disc.—Dr. Edward
G. Loring's conclusions in the N. Y. Med. Jour. and Obs.
Rev., of June: 1. The vaso-motor theory, as advanced by
Benedikt, is not sufficient to explain either the mode of
transmission of the morbid irritation within the head, or
the resulting neuritis optica. 2. The irritation is conveyed,
not by the isolated fibers of the sympathetic system, as.
stated by Benedikt, but through the agency of the trige-
minus. 3. Choked disc or papillitis, in connection with
brain disease, is the expression of an irritation or compres-
sion of certain intra-cranial fibers of the fifth pair, which
preside over the blood supply of the disc and neighboring
parts, and also maintain the healthy processes of waste
and repair of the tissues themselves.
A FAMILY OF PSUEDO-HYPERTROPHIC PARALYTICS.-Dr.
Donald Macphail in the Glasgow Medical Journal, re-
ports the cases of four boys each of whom became
affected at about the age of six years. Their mother
was always well; the father is fifty-five and paralyzed in


Selections.
677
the lower extremities, attributed by him to an injury to
his back twelve and a half years previously, but by his
wife, thought to have begun in halting gait and easily
tripping before they were married. Incipient symptoms
have appeared in the other living boy of the family, who
is now sixteen years old. Another brother died at nine
years of a bowel affection; one sister died at four years
of scarlet fever and the other was drowned at night.
Only one of this family remains well and she is a girl of
aged, twenty-one years.
SEMIOLOGY.
IodoforM INSANITY.–Schede has noticed that the use
of iodoform has been attended with marked psychical
symptoms. One type which is very noticeable among
children is marked by dullness of the special senses, vom-
iting, and spasms of single groups of muscles. In adults
Schede has on two occasions seen great mental confu-
sion, loss of personal identity, loud singing and violence.
He has had under observation cases of melancholia attonita,
also two cases of melancholia with frenzy, and three
cases of simple neancholia ; all arising from the use of
iodoform.—Chicago Med. Jour, and Examiner, July.
'
of the cit were
and a great
The ANCIENT Scotch METHOD OF PREVENTING EPILEPSY
on the authority of Dr. Donald Campbell, was to castrate
in youth, all who took fits.
This was getting very near the root of the evil going within
"an ace of spayeds," as it were, towards its eradication.
A revival of the custom would, under due restrictions,
be a great salvation of the race from brain degeneracy
and ought seriously to engage the attention of the pro-
fession in view of the great certainty of hereditary trans-
mission, as known to all clinical observation and confirmed
by the experiments and observation of Luciani on dogs and
bitches and their descendents after cerebral traumatism.
Either restraint and surveillance, for example for virile
epileptics, or liberty and castration. This would be a rad-
ical remedy for the individual but it would be just to the
race. Sentiment may revolt at it but reason justifies it.
The only obstacle in the way would be the determination
of the precisely proper cases, so that for the present, we
should probably have to be content with restraint against
cohabitation.
by the exped their
and su


EDITORIAL.
ne shouldor wer eine mai
PROF. TAMMASSIA ON THE RELATION OF CADAVERIC
RIGIDITY TO THE NERVOUS SYSTEM.—(Revista Sperimentale
di Freniatria e di Medicina Legale.)-The last issue, now
before us, of the above able and most respectable periodical,
among other highly instructive articles, presents one of great
merit from the pen of the distinguished Professor Arrigo
Tamassia, on the subject of“ Cadaveric Rigidity,” (Rigor mor-
tis), whichwe should have pleasure in reproducing in full, did
our space permit, or were we sure that its perusal would
prove as interesting to the majority of our readers as we
have ourselves found it. After a succinct review of the
published literature of his subject, Prof. Tamassia pro-
ceeds to give details of thirty-five vivisectional experi-
ments, made by him on dogs, rabbits and pullets, with
the view of clearly ascertaining whether cadaveric rigidi-
ty is, or is not, in any way or degree a phenomenon
under the control or influence of the nervous system.
His operations were all skillfully and carefully executed,
and they afford convincing proof of his earnest desire to
present facts in their true light, and to educe from them
rational and just conclusions. We here present, in the
words of the author, the resumé of his conclusions:
Ist. Cutting through of the nerves before death, pro-
vided it provokes not convulsive phenomena, does not
manifest any influence on the progression, the intensity,
or the duration of muscular rigidity.
2nd. Neither has the cutting through of the medulla
spinalis before death, when it does not provoke convul-
sive phenomena, any influence on cadaveric rigidity.
3rd. The cutting through of the nerves, and of the
medulla spinalis, or the maltreatment of these parts after
death, has no influence on the rigidity.
4th. The dependence, which according to some writers
(STANNIUS, MUNK, BLEWER and EISELBERG) has been sus-
pected, between the nervous system and cadaveric
rigidity, is to be explained by the local lesions inflicted
on the muscles, and the action of the surrounding atmos-
phere.
5th. The law of Nysten may be explained rather by


Editorial.
679
oreater-fre more than scular sp the fatal he frequenble
It osthodox pening-strokanted to dete is now
well knut that sund long pro Tamassią, eeding sud
prompt rabbits, operataulla spinalis byetc. etc.,
the greater-fractioning and isolation of the various mus-
cles, and the more intimate penetration into them of
atmospheric agents, than by the direct influence of the
nervous system on the muscular groups...
oth. Cadaveric spasm is one of the most frequent of
the phenomena consequent on rapidly fatal hemorrhage.
7th. Cases of instantaneous death, are very frequently
followed by a cadaveric rigidity of more than double
or treble the duration of that consequent on ordinary
cases.
8th. The precedence of sound health and the instan-
taneousness of death, should be regarded as the principal
agencies in inducing cadaveric spasm and rigidity.
Remarks: It is not very long, we believe, since it
was held as an orthodox physiological tenet, that death
from hemorrhage, from lightning-stroke, or froin extreme
muscular exhaustion, as in animals hunted to death, was.
characterized by failure of cadaveric rigidity. It is now
well known, not only that this belief is unfounded on
fact, but that such cases of death are followed by
prompt, intense and long protracted muscular rigidity.
In the rabbits, operated on by Tamassia, by severance of
nerves and of the medulla spinalis, by bleeding suddenly
to death, crushing of the brain, etc. etc., muscular
rigidity occurred, on the average, within one hour and
twenty minutes, and lasted on the average four days, with
a maximum of seven days. In dogs the average time of
commencement was fifty-six minutes, and of duration
six days, with a maximum of eight days. The nerve
trunks—as the brachial plexus, and the ischiatic, were
cut, sometimes both on one side, sometimes on opposite
sides, and the spinal cord between various vertebræ.
Unless, when the muscles were casually, or intentionally,
maltreated in the operations, no difference in the time of
commencement of the muscular-rigidity was observed in
the parts cut off from connection with the nerve-centers,
and those remaining in connection.
Tamassia very properly suggests that medical experts
when called on to specify the probable time of the occur-
rence of death, from violence, should be on their guard
against over-positive or rash decision. Alluding to the
time of occurrence of rigidity in the animals experi-
mented on by him, and the duration of the phenomenon,
he uses the following cautionary words:
“From a rational analogy we might infer—that in man


680
Editorial.
avity of pro he woulo Worki
suddenly struck by death, in a state of prior good
health, cadaveric rigidity should be protracted beyond
the generally fixed average of forty to forty-eight hours;
and this exceptionality of progression should not be
overlooked by the expert when he would solve the very
delicate question of the date of death.”— Workman.
Two CONCEPTIONS OF INSANITY exist in the minds of
alienist physicians; the one broad and comprehensive
based upon objective perception of all of its phen-
omena, as it revealed itself to such men as Pinel, Es-
quirol and Prichard, and later, to such as Griesinger,
Ray and Maudsley, the other a narrow and theoretically
circumscribed conception, evolved rather from the inner
consciousness of the sane mind, hampered by the theo-
retical misconception that, the healthy mind-perceptive,
affective and reflective faculties-acting harmoniously, dis-
ease cannot disturb this harmonious activity, but all must
be sound or unsound together, whereas, the very essence
of insanity is a disturbance or incordination of the normal
relationship of the reasoning, perceptive, emotional and
reflective faculties.
The one conception expresses itself as follows: "I
look upon man in his mental condition as being a simple
unit; that his mental being consists of his intellectual
and moral faculties so united that everything he does,
must spring out of them jointly. No physical sickness
could reflect itself through a man's moral nature only.".
Having thus platted out its theoretical area and
marked its imaginary boundaries of disease, it proceeds
to define all beyond its unnatural and unreal limits as
health.
“No physical sickness could reflect itself through a
man's moral nature only,” yet it does so despite this
theory, as every observant physician daily sees in the
morbid aversions attendant upon fevers, in which the
reason takes no part, but condemns. But why should
not physical sickness reflect itself through the moral as
well as through the intellectual faculties? We seek for
light. We hope the theorists will answer.
This circumscribed misconception of the invariable
unity of the mental operations in disease, "cannot possibly
dissever this mental unity," therefore it sees only thiev.
ing in kleptomania, though its victim should die demented
within a twelvemonth, only drunkenness in dipsomania,
though the victim's interests and reason alike, resist the
misconcel answer Wesmoral as
ntal unitations in dison of the in


Editorial.
681
:self-destructive morbid craving, only depravity in the per-
verse displays of the moral or affective madman, though
the latter may have been most exemplary till a blow on
the head, a sunstroke or a fever changed his character. It
can see no such thing as emotional insanity, though emo-
tional disturbance is as much an accompaniment of insanity
.as intellectual disorder and often precedes the latter.
Like those who are color blind, these theory-blinded
.alienists who cannot see what others plainly discern,
imagine the true colors of inorbid mental action so plainly
discernable by others, to be non-existent. They reason
in their false theory like the lunatic from subjective sen-
sation, and mistake this for objective impression.
The other conception being unfettered by theoretical
preconception, takes its lessons from morbid nature just
as she teaches, without seeking to abridge her teach-
ing or circumscribe her possibilities by artificial bound-
.aries. It expresses itself thus: “It has always been
observed that insanity affects the moral as well as it
does the intellectual perceptions. In many cases there
are evinced some moral obliquity quite unnatural to the
individual, a loss of his ordinary interest in the relations
of father, son, husband or brother, long before a single
word escapes his lips sounding to folly." —Ray.
“Common sense and professional experience teach us
that there is a distinction-obvious enough for all practi-
cal purposes-between the depravity which belongs to
the character of the man, and that which is the result of
disease or congenital deficiency."-RAY.
The true psychological expert will recognize the clinical
features of mental disease, whether they accord with his
preconceptions of the nature of mind or popular notions
respecting the unity of the mental movements in disease
or not.
It was only after medical men threw off the thralldom
of the metaphysicians and recognized mind morbid, that
they discovered what mind normal actually was.
A Hair BREADTH DIAGNOSIS of Sterility and the
.conundrum of a medical student:
The Peoria Medical Monthly tells us of a Chicago
professor who, while teaching that a straight growth of
hair on the mons-veneris is a sign of sterility, was
promptly asked by a listening student if curling would
not secure fecundity. Strange things happen in Chicago.
acter of theen the depous enough for teach us


682
Editorial.
SCIAMIN, 10f surgery: "not the dagent that cure Sla
in has is likely te, againsto-spina
HYOSCIAMIN IN PSYCHIATRY—Potent hypnotics, like the
keen bistuories of surgery, need to be used with skill and
experienced caution. It is not the dagger of the assassin
that kills nor the scalpel of the surgeon that cures, but
the hand that wields and the brain that directs the blade.
With hyosciamin, efficacy or futility of results depends
on dosage and time of administration and these are deter-
mined by the prescribing physician. The resistence of
a state of mental tranquility to the overpowering influence
of such a hypnotic is less than that of a state of high
maniacal excitement and the resistence of a partly spent
paroxysm of excitement and state of muscular exhaust-
ion from previous over-excitation, is less than it would be
during the caluminating stage of either. The resistence in
the recumbent attitude especially, if voluntarily assumed
by the patient, ought to be less than in the upright, and
after a relaxing warm bath, than before, and in certain cases,
in the middle of the night than in the middle of the day,
etc. Hyosciamin has its uses and like all powerful and
valuable hypnotics it is likely to be abused. The protest
of the German alienist Schule, against hyosciamin as
endangering depression of the cerebro-spinal system,
aphonia, ataxia etc., would never have been uttered
against English and American alienists but for the injudi-
cious use of the drug, through neglect of precautionary
considerations elsewhere indicated (Vide A. and N.
Apr. p. 249.) A very legitimate and instructive personal
experiment made by a medical gentleman of character,
and undertaken on the testimony of Dr. G. M. Bacon as
to the proper dose of this drug, is recorded in this issue
of the Alienist, which may be contrasted with the two
cases reported among the selections illustrating the good
effects of the satisfactory and safe dose of from three to
five minims, (of a grain to a drachm solution of the
alkaloid). Dr. Bacon's doses-from one-third of a grain,
to a grain and a quarter-are too large for general use,
even in asylums for the insane and misleading and unsafe.
Only an alienist of the largest experience, like Dr. B.
could determine the advisability and safety of the max-
imum doses he uses, and even his minium dose is far too
great for ordinary indications.
How The Rights of the Insane are guarded in Crim-
inal Trials—Different experts variously define a disease,
undefinable in some of its phases, a case of moral insan-
ity or certain monomanias are declared non-existent by
to a id); Dr. Bara grain and sales illustrat
ases, a cas define a in Crim-


Editorial.
683
Part lack of insane, result beca
on
experts who deny the existence of moral insanity and
these monomanias, a jury of the lunatic's peers listen to the
symptomatology of an unfamiliar disease, presented by a
lawyer, who out of the necessity of his calling, must be
more or less ignorant of insanity, especially in its excep-
tional or obscure phases, and endeavor to convince them-
selves according to the direction of their prejudices that
the prisoner's thus imperfectly given symptomatology con-
forms with or varies from the definition and render their
verdict accordingly. Under such procedure, disease is
more likely to be made to appear when it does not really
exist, than to be brought to light when it actually is,
and this suits the legal fraternity, becanse talent and
legal ingenuity determine the result more than the facts,
but it wrongs the real insane, whose insanity may fail of
proof because of lack of knowledge, of proof of its essen-
tials on the part of their counsel. The Society for the
Protection of the Insane should look into this matter.
The insane have rights before the courts not fully con-
ceded them, and chief among them is to free them from
the jeopardy of failure of discovery of their disease
through legal rather than medical methods of inquiry.
Lawyers having really insane clients, should demand for
them, in every instance, full and complete medical inqui-
ries and not risk their client's cause by waiting till the
day of the trial to establish the existence of mental
disease upon an hypothetical array of symptoms.
The EDITORIAL Corps of the Annales Medico-Psycholo-
giques, M. M. Baillarger, Lunier and Foville, present the
paper of Dr. Charles Folsom, of Boston, maintaining the
insanity of Guiteau to the readers of the Annales with the
following preface:
"It is probable that no criminal trial has ever had as
much importance, in a medico-legal point of view, as that
following, in which Charles Guiteau, the assassin of President
Garfield, was condemned to be hung.
"The most celebrated alienists of the United States were
called to testify, to the number of twenty-two we believe,
some called for the defence, others for the prosecution.
"All the organs of the political and medical press have
published the most contradictory articles respecting the
insanity or presumed sanity of Guiteau; this stream of
matter has not been stopped, and in a very recent number
of a journal, devoted to the specialty, we found no less
than three original articles, in which the mental state of


684
Editorial.
Guiteau is regarded and expressed in terms differing widely
the one from the other; however, the opinion which seems
to predominate among physicians is that he was alienated.
"At the time we felt ourselves greatly embarrassed
in forming an opinion, being at such a distance and in
the midst of so many opposing elements, we were fortu-
nate in finding in the Boston Medical and Surgical Journal,
of Feb. 16, 1882, a very interesting and moderate article
on Guiteau, due to the pen of Dr. Charles Folsom, whose
opinions have the weight of authority in America, in
questions relating to mental diseases. In default of formal
conclusions, which the author declares he cannot give,
there is found in this article an absolutely impartial ex-
position of the facts of the case, and very fine personal
appreciation in certain respects.”
Then follows an entire translation of Dr. Folsom's ar-
ticle, only omitting such passages as have only a local
importance.-A. Ħ. Ohmann-Dumesnil.
MORAL INSANITY.–Our pages contain the record of a
case of moral insanity portrayed by the non-professional
but observant pen of the patient's mother. We do not
care to split hairs with those who refuse the appellation
of moral insanity to the form of mental aberration
described, because intellectual derangement may be dis-
cernible at times in the character portrayed. It is suffi-
cient that the predominent aberration is in the moral or
affective faculties, so-called, as distinguished from the
strictly intellectual, in order to justify the distinctive des-
ignation. So long as the distinction between the affec-
tive and reflective mental life is recognized in descriptions
of mind rational, so long will the differentiation between
moral and intellectual insanity according to the predom-
inance of the one or the other morbid phenomena, be
justifiable.
The fact of moral insanity everyone recognizes, yet it
is astonishing with what opposition on mere theoretical
grounds this term of Prichard's (for which Pinel, Esquirol
and Georget, had prepared the way), meets. Each year
witnesses the battle of the giants fought o'er and o'er.
Two years ago, the learned Bonfigli gave the world a
summary review of the literature of the so-called moral
insanity and yet the views of his distinguished adversary
Tammassia are no nearer annihilation in Italy, than those
of our own Ray are, through the antagonism of Dr. Gray.
Theoretical conceptions of the nature of mind and its


Editorial.
685
operations may be misconceptions, but the phenomena
constituting moral insanity are observable facts.
TO THE FRIENDS OF THE ALIENIST AND NEUROLOGIST :-
The present number completes the third volume. The
A. and N. has visited you regularly each quarter for
three years. The evidences you have given us of your
appreciation is gratifying and gratefully appreciated. We
are thankful for the pecuniary and literary support you
have given us. The Journal was not started as a pecun-
iary enterprise but it has proven a financial success.
There were certain features in psychiatry which we did
not think were, up to the advent of the ALIENIST AND
NEUROLOGIST properly presented by any American journal
before the profession. A professional pride and an interest
in the spread of sound psychiatry prompted us to under-
take the work, and with the cordial aid we have received
from an appreciative profession, at home and abroad, we
are assured the mission of the ALIENIST and NEUROLO-
GIST has not been and will not be in vain. Notwithstanding
the many neurological journals extant, we are assured
that the special features of the ALIENIST AND NEUROLOGIST
are sufficiently distinct to continue to secure for it the place
it covets in your confidence, among the most valuable
and prized of your Medical Journals. We shall some
day name our collaborators and then you will know why
the A. and N. has been and is what it is.
THE CARDIAC AND LARYNGEAL CRISES OF ATAXIA are
the most formidable and trying to patient and practi-
tioner of all the distressing crises of this intractable
malady. Their therapeutic management vainly taxes our
utmost skill. Heroic measures imperil life, for if by
chloral or chloroform and hypodermic morphine the
patient be suddenly sent off to sleep, he may never
waken, while a less potent influence leaves the patient in
the painful distress of dyspnea.
It is the root of the vagus that is mainly implicated-
the outgoing channel of the nervous influence, that refuses
to conduct the normal nerve currents. Strychnia in
minimum doses, often does not stimulate, and in larger
doses, it aggravates the symptoms; anti-spasmodics do not
tranquilize the laryngeal spasm, or modify, for the better
the jerking respiratory movements. Galvanism to the
neck is of some service, but it often disappoints; ap-
plied to the feet, though it prolongs life and mitigates the


Editorial.
687
of our appearance or recollection of our services at the
time he was under our care. The sequel has fully con-
firmed our diagnosis as well as prognosis, in which the
lamented Hogden concurred.
In The DiscuSSION OF THE Lamson Case, Dr. H. H.
Kane, in the last number of the ALIENIST AND NEUROLO-
Gist, did not take sufficient account of the tendency of
opium eating to obtund the moral sense, as a factor
presumptive of guilt. The vicious habit impairs the sensi-
tiveness to conscientious conviction without destroying
either knowledge or the capacity to resist evil. Crime
may be committed without compunction by opium eaters,
but not always without criminality.
Ralph WALSH AND His RETROSPECT--Ralph Walsh
having undertaken to vaccinate the nation, announces from
the office of the National Vaccine Establishment No.332,
C Street, Wasnington, Aug. ioth, that The Retrospect will
be suspended till Jan. 1883, after which small-pox and the
dissemination of the ideas of the Retrospect may be expected
to become epidemic. We hope the editor of the Retrospect
may be well protected, or at least not to be pitt'd in his
new departure.
The Chicago MEDICAL Review has taken a new
departure, a sort of retrogressive progeess, we judge, from
the lack of neurological medicine in its pages of late.
We had come to look upon that journal as one of the
few medical periodicals that was properly appreciative of
the present practical progress being made in the neuro-
logical aspect of medicine. It will hereafter reveal more
of the field of the speculum than of the æsthesiometer.
To The London Medical Times and Gazette :--We
heartily thank this excellent medical periodical for the
commendatory phrase in which it has referred to the
Alienist and Neurologist and hope we may long retain its
good opinion. We also for ourselves and brethren in the
profession wish to thank it for the high compliments it
pays our well-deserving citizen, Dr. Oliver Wendell Holmes.
PAPERS READ BEFORE THE Association of Superinten-
dents of American Hospitals for the Insane, and papers
of any other body of alienists, are welcome to our pages.
The Association of Superintendents has no official organ,
and the material presented before that body is sufficient
to supply several quarterly Journals.
cort of retrogresslicine in its pag one of the
nion. Welogist and which it has periodicale


688
Editorial.
THE QUESTION OF Mrs. Frances Scoville's insanity-
sister of the assassin Guiteau—was adjudicated at Chicago,
Octber 29th, the jury declaring her to be insane. Her
husband alleged that:
In 1770, when the lady's ancestors settled at Ulica N. Y., the family
consisted of ten children. Five of them became insane or were afflicted
with diseases akin to insanity. This lady's grandmother, he said, the wife
of Dr Guiteau of Utica, was a strong-tempered, peculiar woman, possibly
not insane, but probably so. One of this lady's uncles died in an inspne
asylum in New Ỳork. Another died at a moderate age, weak-ininded and
unfitted for business by erysipelas. The evidence would show that the
lady's father died a lunatic after having been insane on the subject of
religion for twenty years. Two of her sisters were insane. A niece was a
lunatic, and a nephew had died in the asylum at Elgin. Whether the man
who was executed at Washington was insane or not, the jury would not
be called upon 10 decide. If he was, that made another insane member of
the family. The mother of the defendant suffered from a blood disease,
salt rheum, whish had been transmitted to her children, and which had
severely atflicted the defendent and her two brothers.
It would be shown that she was iparried tbirty years ago at the age
of 16. During most of her married life she had suffered from epileptic fits.
Dr. McFarland testified to her insanity and to the
insanity of her father and sister.
THE STATE OF THE CEREBRAL VESSELS IN EPILEPSY—
The pallor of the face does by no means imply anæmia
of the brain as certain authors think; it is merely the
effect of the excitation of the vaso-motor nerves of the
face; the cerebral capillaries, far from being contracted,
are violently dilated, as an examination of the fundus of
the eye with the ophthalmoscope abundantly proves.-
Magnan, Le Progress Med., Feb. 1882.
THE SPONTANEOUS FALLING OUT OF THE TEETH in Loco-
MOTER ATAXIA without caries and without pain has been
observed by Emile Demange of Nancy (reported in Review
Menseulle.) He connects this falling out of the teeth with
trophic trouble in the trigeminal nerve, manifested in the
fulgurent pains of the face and a certain incoördination and
paresis of the muscles innervated by the nerve. “This trophic
trouble is perhaps an advance phenomenon of tabes.”
DR. KNAPP ON CHOKED Disc AND INTRA-CRANIAL Dis-
EASES—The reading of Dr. E. G. Janeway's paper on “Diag-
nosis and Localization of Cerebral Diseases" before the N. Y.
Acad. of Med., Oct., 5th, elicited from Dr. Knapp the remark
that "choked disc could not be much utilized in the local-
ization of cerebral disease.”
THE PROPOSED Journal of the American Medical Asso-
ciation, it gives us gratification to state, promises soon to
become an accomplished fact. We shall welcome its
coming and aid it on its way.


REVIEWS.
MENTAL PATHOLOGY AND THERAPEUTICS.-Griesinger's work has
long been an accepted authority, but neither psychiatry nor any other
science can remain quiescent and an authority of the past ceases to be an
authority of the present unless very thoroughly modified The second
edition of Griesinger was thoroughly up to the time at which it was
written, nay in some respects, was in advance. The present work opens
with a discussion of the seat of mental disease in which the, even then
scientifically extinct. views of the metaphysical school are slaughtered
once more. Strange to say, however, these views still survive among
medical men to such an extent that, in Canada an alienist has recently
gravely refuted them.
The term mental diseases is somewhat objectionable. The chapter on
preliminary anatomical considerations is antiquated. Dr. Robertson would
have improved the volume by supplementing it with a concise reference
to the views of Meynert, which do not conflict with those of Griesinger,
but give them a wider scope. The chapter on “ Preliminary Physio-patho-
logical Observations" is open to the same objections. The discussion of
elementary disorders in mental disease is as a rule sound, but is biased by
Griesinger's attempts at formulating general laws. In contrast with the
statement made during the Guiteau trial, that moral insanity was unknown
to science, is the following: “ Mental disease does not necessarily imply
the existence of delirious perceptions. Marked changes in the character
and in the sentiments, morbid dispositions and emotions, blunting of the
sentiments, total or partial relaxation of the mental powers can exist with-
out truly insane ideas, as acute and morbid states. A number of such cases
may be comprehended under the class of moral insanity”-He, however,
does not agree with the too absolute position erroneously attributed to
Pritchard, that in the morally insane intellectual symptoms are never
present, for he says: “But experience teaches that in the great majority
of these cases the mental derangement does not cease here .... what
at the commencement was only an insanity of the feeling and emotions.
be comes an ins:inity of the intellect."
l'he classification adopted by Griesinger is as follows: “ Conditions
of mental depression, conditions of mental exaltation and conditions of
mental weakness." But there are states of mental depression which have
no possible relation to each other. Thus many of the cases of hypochon-
dria which are cited as allied to melancholia are widely different. They
belong rather to the states of mental weakness as Griesinger understands
them. The depression in hypochondriasis is objective in origin and
dependent on the supposed existence of certain disease. The delusions
produce the sadness. In true melancholia, the depression is barely sub-
jective; it hypochondriacal delusions exist in it, they are secondary to
the depressions and not its cause. The types of melancholia cited are


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Reviews.
intermingled with cases of hebephrenia and morbid impulse, which
should certainly be demarcated. Griesinger places the pyromaniacs his
“ melancholiacs with destructive tendencies." Yet, says about them that
“these are for the most part young, childish, or balf childish, often mor-
ally and intellectually weak, silly and capricious individuals.” Such being
the case, Griesinger should have, to be consistent, placed these among the
pyromaniacs patients classified under "states of mental weakness." The
same remark applies to the only case cited of "melancholia with persis.
tent excitement of the will."
Griesinger makes the statement that mania succeeds melancholia in
the majority of cases. This is an evidence of lack of demarcation between
mania properly so called and the various excited states, really varieties of
the raptus melancholicus. Mendel (Die Manie) says, that when melancholia
precedes true mania, folie circulaire (the cyclothyuria of Kuhlbaum), is to
be suspected. It is a curious circumstance that Griesinger cites cases of
typical raptus melancholicus as evidence that the statement about the pre-
melancholia stage of melancholia should not be taken too absolutely. The
class of cases considered under monomania comprise cases of progressive
paresis of hypomania (the sub-acute mania of asylum reports) and of
primære Verruecktheit (the monomania of Spitzka). Griesinger demarcates
this last form but not too well, and appropriately places it under states of
mental weakness," citing also the French synonym " folie systematisée," but
he inconsistently says about certain cases of monomania " that they make
attempts at explaining their delusions.” Some of the cases cited under
monomania are cases of typical progressive paresis, some typical cases of
hypomania and other cases of decided “folie systematisée." Under states
of mental weakness, Griesinger, as already stated, very properly places
what he calls primære Verruecktheit, the monomania of Spitzka, the imbecil-
ity of the first grade of Hoffbauer and Ray.
In recognizing this relation of what would seem to be a typical intel-
lectual psychosis, Griesinger took a more scientific position than Krafft
Ebing. In this position he was long preceded by Ray, Nichols, Brigham
and other superintendenis co-existent with them. They recognized a
psychosis d. pendent on teratological defect which they therefore classed as
imbecility of the first group. This was the type of insanity now known as
primære Verruecktheit or original insanity." Concerning the relations of
this type of insanity to idiocy and imbecility, Spitzka (Somatic Ætiology
of Insanity p. 18). says: “No greater contrast could be exbibiteil within
the walls of an asylum than by placing side by side an idiot and a lunatic
with systematized projects and delusions." On further inquiry there is
found an uninterrupted single line of gradation running from idiocy to
original insanity, with systematized delusions."
The chapter on the causes of insanity” is fairly complete, but per-
vaded by the error that removing the cause produces a cessation of the
effects. The primary cause in many cases sets up a series of secondary
results wbich acts and interact in a vicious circle, long after the immedi-
ate effect of the primary cause has passed away. The book is somewhat
of an advance on ordinary text books. It is, however, behind the times in
many respects. It does not recognize the existence of progressive paresis


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691
.
and all attempts at clinical demarcation are, as may be seen from what
has already been said, biased Ly the formula of a doctrinaire. As an addi-
tion to the library of the alienist it is of value. As a guide to the general
practitioner, it is of less use than the manuals of Sankey and Blandford.
The translation has been well done. The work is well issued. " Wood's
Library of Standard Medical Authors, New York, Wm. Wood and Co.,"
-[Kiernan,
AMERICAN NERVOUSNESS.-Its causes and consequences, is the subject
of another interesting book by Dr. Geo. M. Beard, which he has prepared
as a supplement to his work on nervous exhaustion.
Dr. Beard writes observantly, philosophically and pleasantly. We
always like to see what Dr. Beard has to say on any subject he may choose
to write upon, though we do not always subscribe to all of his conclusions
as we do not in all of those in the book before us; nevertheless, we have
scanned it with profit and shall read it again with pleasure. It is a book
that will prove of interest to the intelligent layman who likes to learn a
little of the literature of medicine. Published by Putnam & Son, 27 & 29
W. 230 St., New York.
'THE Spinal NERVES. By A. H. P. Leuf, M. D.-In this small work of
less than sixty pages is given a condensed but detailed description of the
anatomy of all the spinal nerves. It is accompanied by a diagram of the
spinal nerves (36x18 inches) representing every muscular filament and
other smaller branches worth remembering. Six anatomographical charts
of the spinal nerves also accompany the text. The diagrams are similar to
the plates of Flower, except that the latter are printed in colors and
Flower includes the sympathetic system and cranial nerves. Lenf's plates
are much cheaper than Flower's. Price: text, charts and diagram together,
One Dollar, net. F. B. O'Connor, Jr., 68 and 70 Court Street, Brooklyn,
N.Y.
THE TRANSACTIONS OF THE MEDICAL ASSOCIATION of the State of Mis-
souri, 25th annual session held at Hannibal, Mo., May 16, 17 and 18, 1882,
are gotten up in good style and the papers and discussions are likewise
creditable. They are mostly practical in character, well written and
instructive. Some of them, however, might have been a little more scien-
tific.
The paper in these transactions whicil would most interest the readers
of this Journal is that of Dr. J. L. Matthews of Carthage, on Hydrophobia,
detailing the history and fatal termination of a case in a little girl of five
years. There is no other literature coming legitimately within the proy-
ince of Neurology, except Dr. Hughes' paper on Neurotrophia. Dr. Steel's
paper on “ The treatment of Pott's disease” is a good one.
NITRO-GLYCERINE IN ANGINA PECTORIS-Is the title of a small volume
edited by Wm. Murrell, M.D., F. R. C. P., London and published by Geo.
S. Davis, Medical Publisher, Detroit, Michigan. It attests the therapeutic
efficacy of Nitro-Glycerine in Angina Pectoris given in solution and Parke,
Davis & Co.'s pills. I'he directions for the administration of this remedy
in this affection are explicit and satisfactory. The book will repay
perusal.


Reviews.
693
Tbe book is written in an unobjectionable, scholarly style, betraying
evidences of observation and research on the part of the author and is there-
fore pleasant and profitable to read. What is said, is said succinctly. It
is too good a book to be lost to the profession, and we suggest that the
author, if he be still living, amend it by needful additions without emen-
dation of the present context so far as it goes and give it to the profession
in a new edition, supplying the present deficiency of an index,
The author does not discuss the bacillus malaria and the asserted
power of quinine to destroy it. Perhaps he has not heard of Crudelli
and Salisbury. To be a modern author and make no reference to either
Crudelli, Kleb, Klein, Koch, Pasteur, Forman or Wood, is to be out of med-
ical fashion, as much so as, a few years ago it was, to know nothing of the
“blasted” cancer cell or later of listerism, and so it will continue to be out
of fashion till some Bastian comes again to the front and harmonizes the
spontaneous generation of the whole tribe of bacilli with disease-products
as their favorite propagating soil.
THE PHYSICIAN HIMSELF.—Is certainly entitled to some share of the
physician's atiention, a greater share in fact, than the subject generally
receives, and this is the aim of Dr. Cathell's new book, the second edition
of which, revised and greatly improved by important additions, is before us.
This excellent book will elevate the profession by enlarging the use-
fulness and exalting the moral character and personal worth of its members,
as well as by promoting their pecuniary welfare. The highest attainable
success to the physician lies in the line of its precepts. Medical men as a
class, need just such a book. Its precepts are not only ethical, but they
constitute, in addition, a code promotive of pecuniary and social success. It
keeps before the average physician, proverbial as he is for neglect of his
business interests, the essentials for maintaining his professional standing
with his patients and the community, and for establishing and securing
that just public appreciation and financial reward of his arduous labore
which is his due. Dr. D. W. Cathell, author, No. 2 N. Broadway, Baltimore.
REPORT OF THE TRANSACTIONs of the Medical and Chirurgical Faculty
of the State of Maryland, eighty-fourth Annual Session held at Baltimore,
Md., April 1882, contains some excellent matter of especial interest to the
readers of this journal.
The paper of Dr.J. S. Conrad on “Associated Physiological and Patho-
logical Mentality” is a very clear presentation of those interesting mixed
cases of alternating preponderance of the pathological and physiological
mental movements which every observant alienist has witnessed.
Dr. A. M. Fauntleroy's address on the “ Reciprocal Action of Morbid
Bodily and Mental Movement” will be read with interest and profit. In
fact none of the contributions are profitless or uninteresting. The volume
as a whole is creditable to the profession of that State.
The memoir on Dr. E. Lloyd Howard, by Dr. Thos. 0. Latimer, is a
well merited and well written tribute to the memory of an ardent, enthu-
siastic and effective worker in the ranks of the profession, who died too
soon.
The surgical contributions are by McLane Tiffany and Geo. Balsted
Boyland; those on Practice, Gynecology and Sanitary Science, by Drs.


694
Reviews.
Evans, Apie, Morris, Kemp and Van Bibber; on Anatomy, Physiology and
Pathology, by Randolph Winslow; on Ophthalmology, by Chisholm. The
Miscellaneous, Physiological, Pathological and Therapeutical papers are
by Newell Martin, Wm. H. Howell, Henry Sewell, Frank Donaldson, Jr.
H. H. Donaldson, Mactier Warfield and John N. MacKenzie.
ESSENTIALS OF VACCINATION.–Our dermatological friend, Doctor
William A. Hardaway, has lately gone into the subject of vaccination
more than skin deep, and presented “a compilation of facts relating to vac-
cine inoculation and its influence on the prevention of small-pox," under
the title of “ Essentials of Vaccination," in the form of a neat one hundred,
and fifty page duodecimo volume, in such a manner as to invest this old
subject with a new interest.
In this book the history of vaccination, the nature of vaccinia and
variola and the abnormal modifications and complications of the former
are well portrayed. Re-vaccination and the merits of the different kinds of
vaccine virus and the methods of obtaining and storing it, and the objec-
tions to vaccination are clearly discussed. The book is well worth a place
in the practicing physician's library. Jansen, McClurg & Co., Chicago, are
the publishers.
THE TRANSACTIONS OF THE RHODE ISLAND MEDICAL SOCIETY are
before us, evincing the usual ability, scientific and literary, in the addresses
and papers. The annual address of Dr. Chas. O'Leary “On the L'se and
Abuse of Hospitals and Medical Charities," is timely and convincing.
Medicine undoubtedly ministers too much to mendicancy. Its mistaken
charity has helped to swell the ignoble army of paupers that disgraces
our civilzation. The sentiments of Lycurgus might sometimes safely sup-
plant the feelings of the Samaritan in our dealings with the pauper class as
distinguished from the unfortunate and worthy affiicted. To help the
former whenever they demand it, as the author truly says, “corrodes the
vigor of mankind in a nation by sapping the foundations of manhood-
self-reliance." Dr. Simeon Hunt's paper on “ Abscess of the Liver," is a
careful and instructive analysis of this interesting subject with valuable
clinical illustration and autopsy. Dr. F. P. Capron's paper on “ Purulent
Middle Ear Catarrh," sounds the proper precautionary note of warning
and enjoins timely preventive procedures at a time when dire mischief may
be averted, which once established, is not easily arrested. Dr. O. V.
Chapin discusses - Malaria in Providence." There is undoubtedly a good
deal of malaria attributable to Providence both there as elsewhere. But
the kind of malaria Dr. Chapin discusses, is the kind that J, K. Mitchell,
Salisury and Klebs have seen in fungi, spores and bacilli. The author does
not think the bacillus theory yet proved. The author has written a mysty
paper on a mysterious subject and has told in good phrasiology what we all
know,-nothing, but it took a great philosopher all of his life to learn even
that, so history repeat itself in medicine as in philosophy. Malarial
Keratitis, by H. S. Miller, M. D., is briefly treated. The author relies on
quinine, but such sequelæ after malaria of the elimination of the poison,
are better treated by iodides, arsenic and galvanism, besides the local
measures.
Puerperal convulsions occupies the attention briefly of Dr. Edward T.


Reviews.
695
Casswell, accompanied by a detail of a case. The author favors prompt
delivery of the child and heroic doses of morphia, subcutaneously, three-
quarters of a grain. He would find that rectal injections of chloral and
bromide of potassium in drachm doses more certainly efficacious. The
Uremic theory and pathology he does not discuss.
The transaction contains also obituary notices of Dr. Samuel Wiswell
· Butler, Dr. James P. White and the now imuiortal Dr. Isaac Ray. The
correctness of diction and accuracy of typography manifest in these pro-
ceedings is as gratifying as the subject matter of the papers is generally
interesting.
THE CHANGE OF LIFE IN HEALTH AND DISEASE.—A Clinical Treatise
on Diseases of the Ganglionic Nervous System Incident to Women at the
Change of Life. By Edward John Tilt, M. D. Octavo, pp. 184. P.
Blakiston, Son & Co. Price, cloth $1 25; paper 75 cents.
The change of life in women with its attendant pathological disturb-
ances and distinguishing physiological features is a subject of great interest
to the physician and Dr. Tilt, who is the only English author who has
written a work exclusively on this interesting subject has invested it in
many parts of his book, with a peculiar charm for the observant physician.
He paints with vividness and force the clinical aspects of the most signifi-
cant crisis in the physical life of woman with which wide medical expe-
rience is familiar, and bas added much of inestimable value from his own
original store-house of observations. The neurologist and the alienist are
peculiarly qualified from their special experience to appreciate the prom-
inence given by this author to the diseases of the ganglionic nervous
system, but particularly to the former, in his treatment of the special
pathology of his subject. No one else has given such prominence to the
ganglionic nervous system in disease, and our author has not overesti-
mated the influence of ganglionic disease in women, though we cannot
endorse in toto his theory of insanity. His view that mental disease in
women at the change of life, depends more upon anæmia than plethora of
the brain is in a great measure we think correct, and that the ganglionic
nervous centers may produce morbid reflex phenomena in the brain
according to the variable cerebral pre-disposition cannot well be disputed.
Dr. Tilt takes a broad view of insanity which he has permitted to expand,
with his experience and not sought to contract this vast and ever widening
subject to any narrow pre-conceptions of the unity of mind in its morbid
operations, however undissevered these operations may appear in perfect
sanity, accordingly he has observed and recorded as Brierre de Boismont,
Esquirol and Royer-Collard have done, cases of dipsomania coming and
going with the ganglionic disturbance and subsequent tranquility of the
change of life and thinks “it is easy to understand how such impulses
should be rife at all periods when the ganglionic nervous system is in a
state of purturbation," and so do we. Kleptomania, erotomainia, demono-
mania, suicidal and homicidal impulses and those strange deceptive impul-
sions, uncontrolable temper, peevishness, and melancholia are discussed in
the same spirit, and examples are given from the author's experience and
the observation of others. In short, the subject of climacteric insanity and
the kindred diseases, paralysis, epilepsia, chorea and aphasia are practi-


696
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cally presented in a manner that must prove profitable and instructive to
the practitioner. The various neuralgies are presented in a separate
chapter. The book is not a new one. It is the fourth edition that is before
us. We have long been familiar with it and have often commended it for
its real practical utility which we now most cordially do again. It is the
most intelligible and practical presentation of the subject upon which it
treats, for the space it occupies, within our knowledge and bears evidence
in itself that it is the product of cautious clinical observation and enlight-
ened and thoughtful medical experience. The book ought to be in every
library. The author criticises Dr. Emmet's views of uterine inflammation
and discountenances the too frequent and needless operative interference
of American gynecological surgery. Part I treats of the physiology of the
change, the range of ovarian power, the probable and comparative dates of
cessation, late parturition, diagnosis and kindred points. Part II of the
pathology and treatment at the change of life, with a chapter on the rules
of hygiene to be observed at this time, in discussing the important subject
of marriage late in life, and mental and moral hygiene. Part III, (special
pathology) embraces chapters, devoteil respectively to the Diseases of the
Ganglionic Nervous System, Diseases of the Brain, Neuralgic Affections,
Diseases of the Reproductive Organs, including Diseases of the Kidneys
and Bladder, Diseases of the Gastro-intestinal Organs, Vomiting, Jaundice,
Hemorrhoids, etc., Diseases of the Skin, and the last, to other common
diseases, such as Gout, Rheumatism, Cancer, Tumor, Consumption, etc.
HYGIENIC AND SANATIVE MEASURES for Chronic Catarrhal Indian mation
of the Nose, Throat and Ears are subjects of especial interest to the deni-
zens of the Mississippi Valley—physician no less than layman, since catarrh
in its sub-acute form is almost as prevalent as the omnipresent malaria of
this river region, and far more of an approbrium medicorum. This is a prac-
tical book of sanatary precepts, prefaced by the following note:
“To M— You are expected to read this book through completely
and to follow such instructions as are suited to your care. The subjects
most important to you are in pages , etc., which the patient is enjoined
to read several times and to bear constantly in mind, that his permanent recor-
ery will depend largely upon his living in obedience to the hygienic and
sanative measures mentioned in this work,” by which the purport of the
book can be seen.
The author congratulates himself upon a due appreciation of his efforts
and the rapid sale of his works, the present being the second edition, the
first edition having been exhausted in less than one year. The present
edition has been entirely re-written," the author informs us, and "new
matter on every subject added." The author is pleased with the very
favorable and unexpected comments made by his reviewers, as he has
* occupied new ground and occupied and advocated new theories very
diverse from those written upon the subject," and notes the steady and
rapidly increasing interest beiny taken in his subject, but thinks * its
importance still underrated,” as one must naturally, who believes that
* chief among the diseases originating in chronic inflammation of the nasal pas-
sages is disease of the mind, there being few severely affected catarrhal
patients whose minds are not, to some degree, atfected." The author


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would criticise most, is the absence of the scientific spirit in the gentlemen
who are the authors. To run an asylum on an economic basis is something,
but it is not all. There is a science known as psycbiatry. We have in.
this country three hundred gentlemen who have almost exclusive opportu-
nities for studying it upon their forty thousand patients. But they, as a
rule, contribute nothing of real scientific value to our literature. Such a
thing as this is unparalleled in any other civilized country or in any other
medical specialty.
“This absence of scientific work is not always and entirely the superin.
tendent's fault. Asylums are poorly equipped; in some States it is worth
his position for an officer to ask the Legislature for a microscope or a
laboratory. It seems but fair to expect that the reports should show that
their authors are not only good superintendents but earnest and studious
physicians. And such evidence he has not always found.”
This is certainly the most temperate and sensible paper that has been
presented before this body and it will be read with interest by all interested
in the insane, and must do much more good than many of the other papers
hitherto presented to this society, which have usually begun and ended by
assailing the natural friends and guardians of the insane-the asylum medical
officers--a8 ignorant of their needs and obstructive of progress and reform.
There is certainly a broad field and much work to do for any organiza-
tion that wishes earnestly and honestly to befriend the insane, and such can
find enough to keep it busy if it will but listen to the suggestions of those
who live with the insane and know their necessities and co-operate with
them in bringing about that salutory legislation and public sentiment which
is yet so backward concerning these unfortunates. Suggestions too of value
may come from without as well as from within the asylums, but to be
effective this Association must seek to co-operate with and not to antagonize
“the asylum circle." The remediable evils for which asylum medical
officers are responsible, are exceptional, slight and trivial, compared with
the wrongs done these helpless unfortunates by apathetic localities and
indifferent legislators that build palaces for the abodes of the few, to please
the public. vanity, while the many languish and die neglected in alushouses
and jails; that construct costly domes and lay out handsome grounds
while placing such constitutional limits on expenditures for medical skill,
as, but for the humanity of our profession, would never secure anything
but incompetent medical service, and which often does get indifferent
skill for a malady requiring the widest experience; that rotates the physi-
cians of these afflicted ones out of office for political considerations, while
acute and curable insanity passes into incurable and hopeless dementia for
lack of that medical aid; that higgles at the price paid medical attendants,
so that hod-carriers and scullions only, in some States, find the service
pecuniarily congenial; that investigates every escape, censures the mortality
of bad sewerage and ventilation and blames every casualty on the superin-
tendent, while grumbling at every expensive outlay demanded to make
the asylum what it ought to be save in grand appearance.. A little expe-
rience with the true inwardness of getting proper appropriations for
asylums would mollify opinion greatly towards asylum superintendents
in some quarters.


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701
THE EVIDENCES OF INSANITY DISCOVERABLE IN THE BRAINS OF CRIMI-
NALS AND OTHERS WHOSE MENTAL STATE HAS BEEN QUESTIONED; WITH
SOME REMARKS ON EXPERT TESTIMONY AND THE GRAPOTTE CASE-By
Edward C. Spitka, M, D., President of the New York Neurological
Society. (Read before the New York Medico-Legal Society, May 3rd, 1882.)
“Thirty years ago, I would willingly have written on the pathological
cause of insanity; to-day I should not attempt as difficult a task, so much
uncertainty and contradiction is there in the results of post-mortems made
on the insane to this very day.” Thus wrote the great Esquirol half a
century ago : one of the cotemporary French alienists, after citing this
passage, adds, " What Esquirol said at the time he wrote, that might he
have adhered to, to this day, notwithstanding the incontestable progress
which has been made more recently in the pathology of mental diseases."
“ In turning to pathological anatomy for enlightenment, it cannot be
suppressed that in a certain number of post-mortems of the in-ane, palpa-
ble morbid appearances of the brain are absent. Experience teaches that
it is almost exclusively the primary forms, the first stages of insanity, in
which we find nothing palpable in the autopsy, and must content our-
selves with assuming anomalies of innervation, blood-distribution and
chemical composition.”
* When we recollect that only from two to five per cent of maniacs die
aud that, consequently, chiefly those subjects reach the post-mortem table
in whom, either through complications or an intensification of the manical
excitement to the degree of maniacal exhaustion, the brain disturbance
must be assumed to have reached a far higher pitch than in the ninety-five
per cent, recovering; when we bear in mind that Esquirol, Greisinger and
otbers consider the possibility of (and there are cases to prove) the causa-
tion of maniacal symptoms by processes associated with anæmia, instead of
hyperæmia of the brain, it must be clear that the evidence concerning the
tangible signs of a form of insanity comprising about fifteen per cent of all
asylum admissions is fragmentary and inconclusive, where it is not entirely
negative.
** Summarizing the teachings of the master minds in pathology, of
reliable observers generally, and his own experience, he considered himself
justified in saying that positive and indisputable evidence of disease can
not be found in more than thirty per cent. of the insane, that in another
thirty per cent. slight changes are found, not differing in character, though
perhaps in extent, from what we observe in some sane subjects, while in
the remainder, there is no visible deviation from the normal standard of
any kind.”
*The cases, here briefly cited, show that post-mortems have been
made on the brains of the insane, sometimes to complete the chain of
evidence, sometimes merely to test the truth of an opinion in the abstract,
while the negative findings in the cases of deceased criminals and suicides
have been erroneously thought to support the view that they had been
sane, and the positive evidences in others demonstrated the correctness of
the opinion of those pronouncing such persons insane."
This paper opens with some animadversions upon the inconsistencies
and inaccuracies of medical experis, referring especially to the Wallace


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Will contest, the Gosling case and the Guiteau trial, and asserting that
medical testimony on questions of insanity has come to be regarded in
American courts of law with doubt, explains the assertion partly on
account of the enunciation of such perversions and parodoxies of truth,
and partly on account of the unpalatable nature of some of the established
dogmas of mental medicine.
The author might have gone further and found a more complete expla-
nation of the fact which is only in part a fact in regard to the disfavor
with which courts regard medical expert testimony, in tbe inferior quality
of expert evidence and its sham and pretentious character which the
courts make possible by allowing men to testify as experts on their own
assertion, simply tbat they know all about a subject upon which they often
know nothing and in the improper interference by courts often with the
character of the medical evidence submitted to the expert, and with the
manner of the expert's replies. If five "experts” in psychiatry testify in
a case, two on one side and three on another, the conclusion of the three
counts the stronger in inany trials, though they may be ignorami and only
the two have the skilled discernment to decide aright.
The evil working of our expert system is pointed out, the European
plan is referred to hut not recommended for imitation, the salutary and
expurgatory influence of cross-examination is lauded, and the best remedy
is in assisting members of the bar in the elucidation of the qualification of
those assuming the position of experts by instruction in some of the
accessible provinces of science. The paper before us is contributed as an
humble mite to that end.
With reference to the opening animadversions upon the medical testi-
mony that denied the existence of moral insanity and the hereditary
transmission of disease, while conceding the correctness of the author's
criticism, it may be also said that the author himself is not so faultless in
his utterances on the witness stand as to be par excellence the one who
should be selected to cast the first stone.
There is no attitude in which a medical man can be placed, in which
circumspect and prudent utterance of exact truth should be so studiously
aimed at, as in that of the psychological expert on the witness stand, and
no position in which the physician is so liable to be provoked into saying
more, and sometimes intimidated into saying less, than the facts of science
warrant.
The author's attitude on the subject of the somatic ætiology of in-
sanity is fortified by clinical illustrations.
A RATIONAL MATERIALISTIC DEFINITION OF INSANITY AND IMBECILITY
with the jurisprudence of legal criminality founded upon physiological,
psycholugical and clinical observations is the title of a new book, by Dr.
Henry Howard, M. R. C. S., Eng., Ex-Pres, of the Montreuil Medico Chirur-
gical society. For the last twenty years connected with asylums for the
treatment of the insane, in which the author expresses his belief that he is
the first person who has advanced the theory that insauity is the symptom
of a physical disease (?) in fact that abnormal mind, which insanity is, is the
outcome of abnormal matter-teratological matter in the imbecile, as in the
case of Hayvern, pathological in the insane—from either mechanical lesion


704
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tained the exclusively psychic. And while not a few have held to the
exclusively somatic, the majority yet adhere to the psycho-gomatic, giving.
however, to the somatic its full causative influence.
The author makes the mistake, quite common to many recent writers
of regarding views which are novel to himself as new to the world, and
wbile reflecting light in psychiatry, imagines he is omitting it. Dr. Howard
in his recapitulariou defines insanity to be a physical disease caused by a
pathological change in the sensory nerves and organ of consciousness, or
either, consequently loss of consciousness, increased reflex action, confusion
of intellect, loss of intellect, necessarily loss of normal reason, insanity.
Froin the same state of these organs we have low temperature and insow-
nia."
Two HARD CASES.Sketches from a 1 hysicians Port-folio.- By W.
W. Godding, M. D., Washington, D. C. Published by Houghton, Miftlin
& Co., Riverside Press, Cambridge, 1882.
The title of this little book is rather puzzling and suggests at first sigut
the possible history of two persons of hard character, or two celebrated
criminals, perhaps. When we see that the author, however, is Dr. God-
ding, our curiosity is stimulated and we proceed at once to dive into the
inner depths, and there we find that we have two hard psychological cases
to read about, one of whom was a former patient of Dr. Godding's when
he was superintendent of the State Insane Hospital at Taunton, Mass, and
the other Charles J. Guiteau, the assassin of President Garfield.
As is well-known, Dr. Godding has made mental diseases a specialty
for more than 20 years, and at the Government Hospital for the Insane in
Washington, of which he has been the superintendent for some years, be
now has nearly 1000 insane persons under his charge. The opinion of an
ordinary man with this vast experience would have considerable weight.
How doubly valuable then becomes the opinion of such a man as Dr. God-
ding, wlio with large experience combines rare abilities, strong common
sense, good temper and thorough honesty! From this point of view, it
will be seen, that the judgment on Guiteau expressed in this book, becomes
one of the most important which has been given to the world, and we
sincerely hope that our well-meaning and scientific, but sometimes narrow-
minded English brethren, will duly reflect thereon.
We are glad that Dr. Godding saw fit to clothe his “Two Hard Cases"
in semi-popular form, as thereby many persons may get some healthy,
unprejudiced ideas on the subject of Guiteau which they would not have
got otherwise. But way we not hope that sometime in the near future,
we may have Guiteau's case bound separately by itself, in order that it
may reach all the medical readers tbat might otherwise not see it; and
also, that, as the opinion of a well-known expert, it may be properly
handed down to posterity with other Guiteau literature?
Hard ( ‘ase No. 1, was a psychological sphinx who seemed to combine
a high degree of conscientiousness with an entire lack of conscientious
scruples; as the Irish say, “sometimes he could be trusted and more
t imes he could not.” He was an inveterate escaper from the hospital,
often keeping his promises not to escape for many months, and often


Reviews.
705
returning in the most repentant manner. Bad impulses and good impulses
seemed to come over him in rapid succession, and almost before he was
off witb the old one, he was on with the new. Finally the miserable map
ended his life by suicide. The whole case is extremely interesting, though
sad, and shows an amount of kindness of heart and patient endurance on
the part of Dr. Godding, which to say the least is very unusual.
Turping from this brief consideration of the first case, we come to the
second, that of Guiteau, which is the special object of this review.
In stating what his opportunities have been for the observation of
Guiteau, Dr. Godding says that he saw him in the jail late in September
and early in October and again during the trial, and passed eight weeks in
the court-room as an expert in insanity. Beside this, he examined a large
number of letters not produced at the trial, which threw some light on
Guiteau's early career. He has taken scenes from the trial as the basis of
the outlines he presents. The whole paper, therefore, is founded on the
evidence as Dr. Godding heard it given, as well as upon the conduct of
Guiteau in court and the various incidents and accidents attendant on the
trial. He begins with a vivid sketch of Garfield, then weaves together
the various detailə in the history of Guiteau, at the same time keeping up
a running commentary on the various actors on the scene as they appear
from time to time.
“From a medical stand-point, the trouble in the Guiteau family begins
three generations back-of eleven children born in the second of the
three generations, ten grew up to adult life. Of these, five, and perhaps six
died or pulmonary disease. We class consumption among the constitu-
tional diseases predisposing to insanity and two of the five all said to have
been insane, on sufficient authority. Another of the eleven died intemper-
ate and broken down in body. Another died of cancer. Two had insane
children. Luther W. Guiteau, the father of the assassin, was the youngest
of this ill-starred family. Dr. Godding publishes a letter of Dr. Andrew
McFarland, the well-known alienist, in which the latter says of his
personal acquaintance with Luther W. — “He devoted all his time in
following me up with a strain of discourse which I perceived to be delu-
sional. . . . . . His talk was that of a man who had long brooded in
secret over disordered fancies...... Now, while the delusions of
the father and the son prove the opposite of each other in their tendencies,
and especially their results, the fundamental nature of the two is the same
-a belief in the power to act by supernatural agency." Dr. Godding there-
fore concludes from this letter of Dr. McFarland, and the evidence, that
Luther W. Guiteau was at times on the border-land and at times over-
stepped the bounds of sanity, though not continuously insane.” This
opinion is important as contrary to that of many or most of the experts.
Guiteau was born with a crooked mind. Dr. Godding thinks he was
mentally wrong, or wicked, probably both in carly life. The Oneida
Community made him only worse (he was strange enough then to be
called insane by Noyes and others), and when he left there his egotism
had become enormous and bis insane inspiration did not litt him out of
his evil courses. “ If, as seems most probable, Guiteau's religious experi-
ences at Ann Harbor and Oneida were an outgrowth of insanity. ....


Reviews.
707
they resembled the writings sometimes found on crazy tramps. It cannot
successfully be claimed that he manufactured his defense and these papers
were a part of it, for he was not an imitator and had had no opportunity to
study the insane.
Guiteau's inspiration to remove the President was the same that was
taught him in childhood and at the Oneida Community. It was the inspir-
ation that Noyes believed in and not an insane delusion, but a matter of
education. “ Strictly speaking, there is no such thing as an insane delusion.
Insanity is in the man and not in the idea."
“But consider, wbat a terrible power inspiration becomes, when as an
honest belief, a matter of life-long education, like the demon of old, it enters
into an insane man's mind to dwell there."
"Insane delusions—they are only in the alphabet of their knowledge
of the insane, who do not understand that genuir.e religious truths may, in
the minds of those bereft of reason, become clothed with all the power of
the most fearful delusions. It was by this road that Guiteau traveled,
and when his mind was once made up to that, which his insane reasoning
convinced him the political situation demanded, I believe there was no
escape (for the President.) He would have shot him, sooner or later, no
matter how often the design might have been frustrated. He did not need
the audible voice, the vision at night; bis inspiration was a familiar one
that he had tested before and he knew whereof he affirmed; yet strange
contradiction, worthy of an insane mind, each time his inspiration had
ended in perfect failure, while his faith in its latest manifestation was
blinder and stronger than ever. ”
In these extracts which have been given, Dr. Godding shows the keen
insight and penetration of the trained psychiatrist and points out clearly
and beyond dispute, the marked features of Guiteau's insanity.
It is in the weighing of the expert testimony that Dr. Godding shows
a power of analysis wbich is clear, discriminating, convincing, impartial
and not lacking in humor and as we have not had such an analysis before,
it is of particular interest.
The case was probably lost for Guiteau before the expert testimony
began. It was unfortunate that Mr. Scoville did not pay more attention
to the experts for the defense, for that would have been of great service to
him. The gentlemen summoned for the defence acted without concert
of action, and though they held conferences were of little use to the defense.
“ The prosecution, bowever, did not thus cast their net into the sea.
They wisely selected Dr. Gray, of Utica, to act as medical adviser and advo-
cate.” They also had the advantage of popular favor.
The first medical witness, Dr. Kiernan, called for the defense, finished
his testimony for the jury by stating that five persons out of twenty-fiye
that one would meet on the street, were on the road to an insane asylum.
Dr. Spitzka, the only other medical witness examined at length, made some
excellent points, but his cross-examination seemed to go more for Spitzka
than for Guiteau, and had but little weight with the jury. Unfortunately,
Dr. Nichols and the other defense expert bad no opportunity to testify.
The trouble seemed to be that these men had not made up their minds on
the question of responsibility. They only had the opportunity to answer


708
Reviews.
the hypothecal questions of the defense, which was a self-evident proposi-
tion, though some of the experts were staggered by it; "and the distin-
guished leader of the government experts after bringing all bis erudition
to bear on it, did not feel equal to answering the question, though the
objection be urged to its answer, might impress an unbiased listener as
hypocritical.”
Several of the government experts had parts given to them; among the
most remarkable was the aasigament to Dr. Fordyce Barker, the well
known Professor ot of Obstetrics, “ to whom was assignee the delivery of
the defination and limitation of the disease known as insanity." Why, it
might be asked, was Dr. Barker called on at all? Is he an expert in insan-
ity, or, is there anything in obstetrics which gives a special insight into
insanity? We are inclined to wonder why some one has not pointed out
the incongruity of asking a specialist in one branch to testify as a specialist
in another,
Dr. Gray “gave in effect a very lawyer-like summing up of the gov-
ernment medical testimony.” He spoke as fully realizing the importance
of making' no mistake in the verdict. He said he did not believe that
insanity was inherited as a disease. He had changed his former opinion
about moral insanity," and did not now believe in it; as for kleptomania,
dipsomania, pyromania, they were simply “make-shifts to secure from
punishment for crime.” “Emotional insanity" also, he did not believe in.
Concerning this method of classification, Dr. Gray might say if he
were to come to life: "You cannot get rid of a fact by denying its exist-
ence.” “That is the difficulty” as Dr. Gooding says, “ I believe with Dr.
Gray's insanity; he simplifies our psychological studies wonderfully ; but
what are we to do with those 'minus diseased,' which bis cl ssification
leaves out, to shift for themselves? We must still keep the bounds of
insanity essentially where they were, or if we narrow them with Dr. Gray,
we must set up another kingdom in disease and call that unsoundness of
mind."
“I dislike to bear drunkenness called dipsomania, as I so often do,
but I do not therefore say that dipsomania is only drunkenness. It might
improve my standing with the legal fraternity if I should pronounce klep-
tomania'only another name for stealing; but iny personal observation
convinces me that the insane have sometimes a disposition to steal, which
is a direct result of their disease and for which they are no more account-
able than tbe puerpural maniac is for her oaths." As for "moral insanity"
Dr. Godding does not believe it is a form of disease unattended with
intellectual disturbance and probably few of the experts on either side at
the trial so believed, though undoubtedly many cases which have been
most carefully observed bave shown no symptoms of such disturbance.
While we cannot believe that the older authors were right in establishing
such a form of insanity, we cannot but believe that they made an honest and
correct record of what they did see.
Concerning hereditary insanity Dr. Godding says, “almost in accents of
despair:"-just when the medical profession has come to believe, if one
fact in medical science is better established than another, it is that insanity
is hereditary and we undertake, in the present case, to look up the beredi-


Reviews.
709
tary predisposition and the family disposition likewise, we are met with
the withering conundrum, “can a man inherit insanity from his uncle?
and we are told that there is no such thing as hereditary insanity. A
tendency to the disease may be inherited! .... That little thing
which you call a tendencs,' so minute that it will elude your most care-
ful scrutiny with scalpel and microscope, is a fixed fact, and will prove
more potent than all your theories. Not born there; develope. Ah, how
is it that science shows us that syphilis and small-pox and tubercle are
born in the offspring; that the infant comes into the world with spina
bifida; idiotic, hydrocephalic, acephalic; that the child is blind and mute
and misshapen in its mother's womb, but is never insane. . . . . .
Heterodox I know it is, but observed facts compel me to be heterodox
with Prichard, Esquirol and Ray, with Morel, Griesinger and Maudsley,
and I know not how many others, in recognizing in some cases a condi-
tion inherent, born in the individual and not a result of education—a condi-
tion which writers have recognized under various names, as hereditary
mental disorder, insane diathesis, insane temperament. But the difficulty
is not in the nomenclature but in getting scientific observers, our leaders
in psychiatry, to recognize the fact as it exists.”.
Dr. Godding says that though he is inclined to claim a congenital
origin for Guiteau's insanity, he thinks that this element could be thrown
aside and there would be still enough left behind to make up a plain case
of insanity. There are many cases in the experience of every expert,
especially where hereditary predisposition exists, where delusion, mania
and violence even, may be developed, without indications of bodily sick-
ness, that even near friends remark. There are many such cases in insane
hospitals which have become chronic, who are constantly employed about
the premises and have never taken a dose of medicine in their lives.
It was legitimate for Dr. Gray, appearing as the medical advocate and
expert for the government, to controvert Mr. Scoville's theory of an inspi-
ration in the form of a direct command from God. Mr Scoville “could not
complain that the Doctor, as an advocate, met him on a field of his own
selection.” But if Dr Gray had appe-ired in the character of “amicus
curiæ," “it would have been his duty to point out to the court and the jury
wherein the so-called inspiration of Guiteau, a mere matter of life-long
education of a mind which sane or insane, was controlled directly by the
political situation, and if insane, the insanity was chronic in type-was
necessarily very different from the inspiration which came as the control-
ing delusion in these acute types of insanity to which this has been com-
pared.”
At this point we must resolutely bring these quotations to a close, as
we have already far exceeded our intended limits. We made no excuse
however for our lengthy article, as the importance of the subject demands
every ray of light wo can get. Dr. Godding bas ably pointed out many of
the inconsistent points in the government expert testimony and clearly
shown wherein the straight and narrow path of scientific accuracy, has
been departed from. We hope that the other side will endeavor to meet
his arguments, and we further hope that still more extended discussion
will help to clear up the misconceptions that still remain. W. C.


Hospital Notes.
711
of household furniture in the hospital is, at a low estimate,
at least ten thousand dollars greater than it was on the
30th of April, 1865, at the same rate or standard of appraisal.
To be certain, however, of no exaggeration, let it be called
eight thousand dollars. Collecting these several sums, the
account of debit of the Commonwealth to the hospital
appears to be as follows:
Excess of cost of land over direct bonus, - $ 20,590 00
Repairs and improvements, - - - 191,722 38
Excess of present cash assets, - - - 30,668 17
Increase of provisions and supplies, - - 12,956 20
Increase of furniture, - - - - - 8,000 60
The necessary current repairs of the building may be
estimated at three thousand dollars annually. Deducting
this sum for each of the sixteen years since September 30th,
1865, a total of $48,000, there is a remainder of $215,936.75.
To this amount, then, has the hospital assisted itself to
things, for most of which it is generally expected that such
institutions will rely upon direct appropriations from the
Commonwealth.”
Dr. Earle takes occasion, rather apologetically, to treat
of a subject which we all know is near to his heart:
Statistics relative to the Curability of the Insane. Apologies
on the part of the doctor are quite unneccessary, for no
man in the specialty has done more to correct the fallacies
of the statistics relative to insanity, and to bring about the
reforms which enable him to say: “The curable three-
fourths of a former faith dwindles very nearly to one-fourth
in absolute practice.”
WILLARD, NEW YORK-Admitted during the year, 256;
Males 116, females, 140; total number under treatment,
1884; males, 895; females, 989; discharged 149; males, 81,
females, 68; as follows: recovered, 7; improved, 25;
unimproved, 22; died, 94; not insane, 1; remaining under
treatment September 30th, 1881, 1695; males, 814:
females, 921.
The average cost of maintainance per week for the
year was $2.67, and the average weekly cost of main-
tainance for the past five years was $2.72.
It is gratifying to those who have made a study of the
economical, yet proper, care of the indigent insane of the
United States, and particularly to those who are acquainted
with the history, and have watched the progress of Willard
Asylum, to read from the report of the trustees the follow-


712
Hospital Notes.
vork of faith and and in front st But, to-dayet to a
ing: “When projected, the result was an unsolved problem.
It was a work of faith and hope, back of which stood charity
as the motive of action, and in front stood opposition, long
standing prejudices and uncertainty. But, to-day, it is a
problem solved. Faith and hope have given place to a
blessed reality, affording relief and comfort to suffering
humanity, giving in the name of the great State of New
York, an asylum in perpetuity to the most helpless of her
people.”
This institution has grown in dimensions and increased
in population to such an extent, that its operations equal
those of many small towns.
The medical staff comprises a superintendent and six
assistant physicians, who have charge of designated depart-
ments under direction of the superintendent; they are
obliged to be conversant with everything that relates to
their respective dspartments, and to visit them at least once
daily, to the end that the medical service may be as good
as is maintained in the best organized hospital in the
country.
The Institution is conducted upon the non-restraint,
open-door system as much as possible, and Dr. Chapin
says: "mechanical restraint will be reduced to the least
quantity admissible, and be supplanted by increased per-
sonal attendance and attention.”
The occupation of patients is here turned to profitable
account. We read that for the purpose of completing the
railway communication between the various departments,
it was necessary to bridge over or fill up a ravine; the
former was expensive, the latter difficult to do, but with
the daily aid of 150 to 200 patients, they were in about six
months able to pull down the hill tops and raise up the
valley to the extent of moving about 35,000 cubic yards
of earth, and constructing therewith a road bed three hun-
nred feet long, seventy-five feet high, two hundred feet
wide at the base and sixteen feet wide at the top. The
same energy is manifest in other methods of employment.
Dr. Chapin writes briefly, too briefly, of his experience
and observation while visiting England, Scotland and the
Continent. He expresses great admiration, among other
things, for the comprehensive and uniform provision for all
the dependent insane of Great Britain, in contrast with our
defective and expensive State provision, which provides for
a few, and relegates the mass of helpless insane to alms-
houses,


Books, Monographs, Etc., Received.
The Mental Status of Guiteau. The Assassin of President Garfield.
By Walter Channing, M. D., Boston. Reprinted from the 'Boston Medical
and Surgical Journal of March 30, 1882.
Letters and Facts, not heretofore published, touching the mental condi-
tion of Charles J. Guiteau since 1865. By G. M. Beard, M. D.
The Treatment of Pott's Disease existing in the Upper Dorsal and Cer-
vical Regions. By Dr. A J. Steele, St. Louis. Read before the Missouri
State Medical Association, May 17th, 1882.
Nervous Control or Equilibration, By James T. Searcy, M. D., of
Tuscaloosa, Ala.
On Restraint and Seclusion in American Institutions for the Insane.
By H. M. Bannister and H. N. Moyer. Reprinted from the Journal of Ner-
vous and Mental Disease, Vol. ix., No. 3, July, 1882.
The Guiteau Autopsy. Reprint of Editorial from the American Jour-
nal of Neurology and Psychiatry, August, 1882.
Higher Medical Education in New York, Parts 2 and 3. By Dr. E.
C. Seguin, M. D. Reprinted from the Archives of Medicine, August, 1882.
The Efficient Dosage of Certuin Remedies used in the treatment of Ner-
vous Diseases. By E. C. Seguin, M. D.
A Case of Abscess of the Left Frontal Lobe of the Cerebrum, with
special reference to localization. By E. O. Seguin, M. D.
Quacks and Quackery in Missouri. By Dr. Willis P. King, Sedalia. ·
The Insanity of Masturbation. By C. B. Burr, M. D., Pontiac, Mich,
Reprinted from the Physician and Surgeon, Ann Arbor, Mich.
On Cortical Sensory Discharging Lesions (Sensory Epilepsy). By
Allen McLane Hamilton, M. D. Reprint from The New York Medical Jour.
nal and Obstetrical Review, June, 1882.
Stricture of the Rectum, Treated by Electrolysis. By Robert Newman,
M. D., New York. Reprint from New England Medical Monthly, September,
1882.
Delle Nuove Ricerche Sull' Ipnotismo. Rassegna del Dott Giuseppe
Seppilli.
Meningeal Tuberculosis of the Cerebral Convexity. By William
Julius Mickle, M. D., M. R. O. P. London, Medical Superintendent, Grove
Hall Asylum, London.
Report of the Post-Mortem Examination of the Body of Charles J.
Guittau. Reprinted from The Medical News, July 8, and September 9, 1882.


Books, Monographs, Etc., Received.
715
· The Mineral Water Controversy. Artificial or Natural! Conflicting
official opinions. By Carl H. Schultz,
The Disease of the Scythians, and Certain Analogous Conditions. By
William A. Hammond, M. D. Read before the American Neurological
Association, June 38, 1882.
Ten Years’ Experience in the Treatment of Stricture of the Urethra by
Electrolysis. By Robert Newman, M, D. Reprinted from The Medical
Record, August 12 and 19, 1882.
Del Mixoedema 0 Cachessia Pachidermica. Rivista Crítica del Dott.
Giuseppe Seppilli.
11.• Contribuzione Allo Studio Sperimentale Dell'Ipnotismo Nelle
Isteriche. Comunicazione Preventiva fatta al R. Istituto, Lombardo,
nella seduta 22 Giugno, 1882. dai dott." A. Tamburini - G. Seppilli.
Contribuzione Allo Studio Sperimentale, dell Ipnotismo Nelle Isteriche.
Seconda Comunicazione Preventiva dei dott. A. Tamburini e G. Sepilli
fatta al R. Istituto Lombardo, nelle seduta del 22 Giugno, 1882.
Proceodings of the Seventh Annual Session of the Southern Ill. Medical
Association, held at Carbondale, May 17 and 18, 1882.
Fourteenth Annual Announcement of the Kansas City Medical College
Session of 1882-'88.
New York Medical Times. A Monthly Journal of Medicine, Surgery
and the Collateral Sciences.
Annual Announcement of the Memphis Hospital Medical College and
Medical Department of Southwestern Baptist University.
Announcement of Michigan College of Medicine for 1882-'83.
Annual Announcement of the Toronto School of Medicine, Session
1882-'83
The Asylum Index and Review, Published in the Interests of Feeble-
Minded Children.
Circular of the Oxford Retreat, Oxford, Ohio. An Institution for the
Treatment of Nervous and Mental Diseses. D. A. Morse, Superintendent.
Twenty-Seventh Annual Report of the Board of Trustees and Officers
of the Dayton Asylum for the Insane, for the fiscal year 1881.
Eleventh Biennial Report of the Iowa Hospital for the Insane, at Mt.
Pleasant. For the fiscal years of 1880 and 1881.
Fifty-Eight Annual Report of the officers of the Retreat for the Insane
at Hartford, Conn. April, 1882.
Annual Reports of the New Hampshire Asylum for the Insane. June
1882.
Thirty-Ninth Annual Report of the State Lunatic Asylum, at Utica,
N. Y., for the year 1881.
Twenty Second Annual Report of the State Asylum for Insane Crim.
inals, Auburn, N. Y. For the year ending September 30, 1881.


216
Books, Monographs, Etc., Received.'.
• Forty-Ninth Annual Report of the Boston Lunatic Asylum. For the
year ending April 30, 1882.
• Twenty-Seventh Annual Report of the Cleveland Asylum for the In-
sane. For the fiscal year 1881. . . .
First Biennial Report of the Michigan Free Eye and Ear Inbrmary,
Detroit. For the two years ending September 31, 1882
Eleventh Annual Report of the State Homeopathic Asylum for the
Insane, at Middletown, N. Y.
• Report of the American Hospital for Skin Diseases, Philadelpbia
From its foundation to the end of the second year, September 1, 1882


th
"Quantam ego quidem video motus morbost fere omnes a moubu, ia systemate. Dervorum Ita
pendeat, ut morbi fere omnes quodammodo Nervosi dioi queant."-OULIE'S NOSOLOGY: Book II.
|' P. 181 - Robot Ep. 178.
ST HEE
Alienist and Neurologist

A QUARTERLY JOURNAL
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SCIENTIFIC, CLINICAL AND FORENSIC
PSYCHIATRY AND NEUROLOGY.
INTENDED ESPECIALLY TO SUBSERVE THE WANTS
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VOL. III.
-
OCTOBER, 1882.
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various styles of Table and Office Batteries, Bath Apparatus, &c., &c. Our manufacturing
ities are the largest of the kind in America, and we employ none but skilled mechanics and men
ientific experience. .
Our Illustrated catalogue, a handsome book giving full description of all our goods, and other
able information, sent free on application.
MCINTOSH GALVANIC AND FARADIC BATTERY CO.,
192 & 194 JACKSON STREET, CHICAGO, ILL.
- 3-


BRIGHAM HALL,
A HOSPITAL FOR THE INSANE OF THE PRIVATE CLASS,
CANANDAIGUA, N. Y.
ORGANIZED IN 1855.
INCORPORATED IN 1859.
Accommodates 70 Patients.
Number of atients admitted, about 1300. .
Receives cases of Mental and Nervous Disease, for medical treatment and care
Inquiries may be addressed to
Dr. D. R. BURRELL.
SUNNYSIDE.
WWW
A PRIVATE MEDICAL HOME FOR NERVOUS INVALIDS.
NEW YORK CITY,
THIS HOME, unsurpassed by its beauty of location and surroundings, and
with handsomely furnished apartments, receives a limited number of cases, of
either sex, of MENTAL AND NERVOUS DISEASES, DIPSOMANIA AND OPIUM HABIT,
and ofters to such patients all the attentions. C
all the attentions. comforts and attractiveness of a
home, together with medical treatment. Application may be made either by
mail or personally at 28 West 30th Street Opium habit and Dipsomania
receive especial attention, and patients enjoy the strictest privacy.
• EDWARD C. MANN, M. D.,
Consultation Hours: 10 to 12 daily.
Medical Superintendent.
GULATH'S RHINE WINES.
CHAS. GULATH,
DIRECT IMPORTER OF PURE OLD
RHINE WINES,
FOR HOSPITAL AND PHYSICIAN'S USE.
NO. 2613 CARONDELET AVENUE, NEAR SIDNEY STREET,
Or, MEYER BROTHERS, Wholesale Druggists.
ST. LOUIS, MO.
----
SPECIAL TERMS TO HOSPITALS..



DR. RALPH L. PARSONS
Continues to receive a limited number of cases of
MENTAL AND NERVOUS DISEASE,
For care and treatment, at his residence at
GREENMONT,
ON-THE-HUDSON,
(Near the Village of Sing Sing.)
Selected cases of JNEBRIETY AND OF THE Ppium HABIT
ARE ALSO RECEIVED.
REFERENCE: Dr. C. IL. Hughes, Editor of this Journal.
For further references, particulars and terms, address Box 234, Sing Sing P. O., or call at
45 E. Twenty-Third Street, N. Y. City. Mondays and Fridays, from 4 to 5 o'clock r. M.
BUAN-BRAE,
A Private Hospital for Nervous and Mental Diseases,
CLIFTON HEIGHTS, Delaware County, Pa.
BURN-BRAK, located a few miles west of the City of Philadelphia, has been in operation
nearly twenty years, and now numbers its friends in all-sections of the Union.No better
proof of the confiden'ce reposed in its management by the profession and the community at
large could be given; than the expensive improvements and additions that have been made
during the last few years--not for the purpose of adding to the number of patients already pro-
vided for, but in order to increase the size of the old dormitories and of erecting conservatories
in the ladies' apartments. The number of patients designed to be accommodated is about
forty-twenty of each sex.
Psychological Physicians 'now fully recognize the advantages, for a considerable number
of the insane, of small establishments where the arrangements are more home-like and famil-
iar than in the large hospitals.
The location of BURN-BRAL is brantifut and salubrions; the house, though possessing all
The safe-guards and appliances of a public hospital, in external and internal arrangements,
presents nothing to unfavorably impress the inmates. The Patients, the Physicians and their
families take their meals at the same table, which is liberally supplied, and differing in its!
appointments in no respect from the tables of the educated classes elsewhere. The agreeable
and soothing influence of music is provided for, and games of chess, billiards and backgam-
mon are daily resorteil to by the patients. A lady, well educated and of unexceptional man-
ners and deportment, resides in the same apartments, and devotes her time to the lady
patients, thus securing them on all occasions a pleasant companion and a watch ful friend
Unless when at meals or social gatherings, an entire separationof the sexes is secured in the
distinct wings of the establishment.
Access from Philadelphia by Baltimore Turnpike, or West Chester and Philarielphia B.
R, ; nearest station, Oak Lane,
"Consulting Physician: Isaac RAY, M.D.; Ass't Phys.: J. WILLOUGHEY PHILLIPS, M.D.
R. A. GIVEN, M. D. Sup't
REFERENCES :-Professors Stille, Da Costa, Agnew, Penrose, Wallace. H. C. Wood. Drs.
J. L. Ludlow, Lawrence Turnbull, Edward Hartshorne. Israel H. Jónnson, Edwin M.
Lewis, B. B. Comegys, Wm. V. McKean, Esq's. Rev. Wm. P. Breed, D.D., Dr.
Joseph Parrish, Burlington, N.J.
-
-
6


WE SUPPLIED ALL THE CITY INSTITUTIONS WITH DRY GOODS LAST YEAR
WM. BARR GORES CO.
Keep the Largest Stock of Goods suitable for
1HOSPITAL PURPOSES I
TO BE FOUND IN ST. LOUIS,
And Special Terms will be made with all institutions ordering from them.
BEDDING MATERIALS OF. ALL KINDS,
UNDERCLOTHING, IN SILK, WOOL AND COTTON,
LADIES' AND CHILDRENS' READY-MADE CLOTHING, ,
*FLANNELS AND UPHOLSTERY,
TABLE AND BED ROOM LINENS,
SOAPS, NOTIONS AND PERFUMERIES,
ARE ALL SPECIALTIES AT THE
WM. BARR BRIS CO'S
NEW BUILDING,
SIXTH, OLIVE AND LOCUST, .. .
P.S. Write and find out our special terms to Hospitals.
·
ST. LOUIS.
:: Ev. E. CARRERAS,
Printer, Publister anil . Binler,
COND AND
CUST
S. E. FOR. SECOND AND Locust Sts.
ST. LOUIS, MO.
Hospital and Physicians' Medical Records, Post Mortem and
Case Books, Laundry Blanks, Bill Heads, Letter Heads,
Receipt Blanks, Clothing Lists, Professional
Cards, Treasurers' and Stewart's
Day Books, Cash Books,
Ledgers, Check
Books, Etc. .
Furnished Promptly and at the Lowest Rates,
semmo mangiaren
Estimates Cheerfully Given.
Correspondence Solicitra



(ESTABLISHED IN THE UNITED STATES IN 1840.)
Have been Awarded 3 Silver Medals, 4 Bronze Medals and 6 Diplomas.
E. WHITELEY,
Steam and Sanitary Engineer and Machinist,
57, 59, 61 and 63, Charlestown Street,
BOSTON, MASS.
Patentee and Manufacturer of the most improved Apparatus for Warming and
Cooking purposes, for Public Institutions, consisting of Ranges, for Coal or
Wood, of extra strength, with Flues of extra size, and means of cleaning the
same. Also,
Patent Cast-Iron Steamers, Plain or Jacketed,
Round or Square,
with removable baskets for vegetables, &c., with Copper or Galvanized Iron
Covers, having Ventilating tubes, which convey the steam and odors from the
kitchen. E. Whiteley's Celebrated Seamless
Patent Cast-Iron Jacket Kettles,
in one piece, no bolts or packing used. Best in the World.
Copper Jacket Kettles,
for Tea and Coffee, thickly tinned inside, with Cylinders for the Tea and coffee
Strong and durable, wil bear 75 pounds of steam ; 80 gallons can be made and
drawn off clear in 20 minutes. See Dr. P. Earle's report for Oct. 1874.
Portable Ovens, Steam Ovens or Brick Ovens.
New Hospital Range, that is quite portable and can be set up without
Brick-work, is made in sections to ship and put up easily.
All my work is made in my own shops, under my personal superintendence,
and of the best material, and thoroughly tested and warranted.
I refer by permission to the following gentlemen :
Dr. Nichols, of Washington, D. C. Dr. P. Earle, of Northampton, Mass.
Dr. J. P. Gray, M.D., Utica, N. Y.
Michigan Insane Asylum, Kalamazoo, Mich.
Taunton Insane Asylum; Taunton, Mass. Tewksbury, Alms House, Tewksbury, Mass.
Eastern Lunatic Asylum, Williamsburg, Va. Dr. Calvin May, Danvers Insane Hos. Mass.
Dr. C, A. Walker, South Boston, Mass, Hospital for Insane, Worcester, Mass.
Dr. B. D. Eastman, Asylum for Insane, Topeka, Kas.
And many others.
Father and Sons have been engaged in this business for seventy-nine years,
forty in Europe, thirty-nine in the United States.
Two Silver Medals were awarded for improvements in Cooking Apparatus,
at the Mechanics' Fair in October, 1874 and 1878.
Improved Ranges are now in use at the National Soldiers' Home, Tampton,
Va.; National Soldiers' Home, (Togas), near Augusta. Me.: State Insane Hos-
pital, Northampton, Mass.; State Insane Hospital, Middleton, Conn.; Young's
Hotel, Boston, Mass.; New City Hospital, Boston, Mass.; New City Homco-
pathic Hospital, Boston, Mass., New Hospital for Insane, Worcester, Mass.;
New England Hospital for Women.


B. J. PATTEZSON, M. D., Sup't.
JOAN. PATTERSON, 1. D., Aks't Phy.
Mrs. MARY A. BUGGLEB, Hatoon
قیمے ے
| BELLEVUE PLACE
cao
Q H IS Institution for the Insane of the private class, is located in the beautiful town
of Batavia, Illinois, near the bank of the Fox River, thirty-five 'miles west from
PD Chicago. It is accessible by the Dixon Branch of the Northwestern Railroad, via
* Geneva; and by the Chicago, Burlington & Quincy Railroad, via Aurora.
BELLEVUE PLACE is under the medical care of R. J. PATTERSON, M, D., formerly
Medical Superintendent of the Indiana State Hospital for the Insane, late Medical Superin-
Tendent of the Iowa State Hospital for the Insane, and formerly Prolessor of Medical
Jurisprudence in the Chicago Medical College.
The main building of this Institution is a massive, permanently built stone structure.
It contains three splendid corridors or halls, each seventy feet long by twelve feet wide,
with spacious rooms on either side for the liberal accommodation of twenty patients.
The views from the building are pleasant and extended, ranging up and down the valley
of the Fox River, to Geneva and St. Charles, north, and Aurora, south. The grounds, which
embrace twenty ncres, are private, quiet and pleasant.
Connected with Bellevue Place are green-houses, covering 16,000 square feet, with
wide walks and ample sitting spaces, where our whole household may spend the gloomy
days of winter, under glass, in a semi-tropical climate and amid flowers.
During the twelve years since the opening of Bellevue place, no serious accident has
occurred to any patient; and it is believed the best results have been realized.
"Nervous Invalids” who are not insane, and those who occupy a borderland between
undoubted insanity and doubtful sanity, are admitted for treatment. Also, those addicted
to Alcoholism and the “opium habit.”
Incurable patients who, for want of rooin, cannot gain admission to State Hospitals, or
those whose friends may prefer a less. public place for them, may here find a pleasant home,
with every essential comfort and all needed care.
Bellevue Place is arranged and fitted with special reference to the best care and treat-
mont of patients who possess means to defray expenses, and whose friends prefer an
institution of the private class which is derigned to combine the comforts of a rural, quiet
home, with such treatment as ample experience and able counsel can suggest,
· Bellevue Place is, by law, subject to official visitation and inspection by the State Board
of Public Charities.
Department for females only, now ready.
REFERENCES BY PERMISSION.
MARK RANNEY, M. D., Medical Supt. lowa Hospital for Insane, Mt. Pleasant.
0. EVERTS, M. D., Late Medical Supt. Indiana Hospital for Insane, Indianapolis
A. REYNOLDS, M. D,, Med. Supt. Northern lowa Hospital for Insane, Independence, la.
E. A. KILBOURNE, M D., Medical Superintendent Northern Illinois Hospital for Ingane,
Elgin, bls.
CHAS, W. STEVENS, M. D., Late Medical Superintendent St. Louis Hospital for Insane,
St. Louis, Mo.
C. H. HUGHES, M. D., Late Superintendent and Physician Missouri State Lunatic Asylum,
Consulting Physician to Misericordia Asylum and Female Hospital, St. Louis, Mo.
PROF. J. S. JEWELL, M. D., Editor Journal of Mental and Nervous Diseaso, Chicago, Iller
PROF. N. S. DAVIS, M.D.,
W. H. BYFORD, M.D.,
" DELASKIE MILLER, M, D., Chicago, Ille
" EPHRAIM INGALS, M.D.,
. 'D. R. BROWER, M. D... Address : R. J. PATTERSON, M. D.
BATAVIA, PLS.
. - 9-



WL
TU
WINCHENDEN HIGHLANDS I
FAMILY HOME.
PIE
DR. IRA Russell, assisted by his son, Dr. F. W. RUSSELL, will
receive a few patients into his family, suffering from
MENTAL and NERVOUS DISEASES.
By means of inteligent and educated attendents, the greatest freedom is allowod
and everything is made as home-like as possible.
REFERENCES :D
C. A. WALKER, M. D., Boston, Mass President of the Ass. of Med. Sup'ts of American
Hospitals for the Insane. ELISA IL ARRIS, M. D., Sec'y N. Y. State Board of Health.
· W. W. Gopping, M.D., Supt of Gov. Insane Asylum, Washington, D. C. S.J.
WEBBER, M. D., Hotel Pelham, Boston, Mass. C. H. HUGHES, M. D., 1126 St. Ange
Avenue, St. Louis, Mo.
– 11 –



TO PHYSICIANS
BROMIDIA IODIA
FORMULA.-Every fluid drachm contains 15 grs.
EACH of pure Brom.-Potas, and purified Chloral, and
% gr. EACH of gen. imp. ext. Cannabis-Ind. and Hy-
oscyam.
FORMULA-Iodia is a combination of Aed
DOSE.-One-half to one fluid drachm in WATER or
Principles obtained from the Green Roots
SYRUP every hour until sleep is produced.
BROMIDIA is the Hypnotic par excellence. It pro STILLINGIA, HELONIAS, SAXIFRAGA. Meni
duces refreshing sleep, and is exceedingly valuable in
mum and Aromatics. Each fluid drachm
Sleeplessness, Nervousness, Neuralgia, Headache, Con-
vulsions, Colic, etc., and will relieve when opiates fail. contains five grains IOD-POTAS. and a
Unlike preparations of opium, it does not lock up the
grains PHOS.-IRON..
secretions. In the Restlessness and Delirium of Fevers
it is absolutely invaluable.
DOSE-One or two fluid drachms (more or
as indicated) three times a day before meals
IODLA is the Ideal Alterative. It has
EUGENE GRISSOM, A.M., M.D., LLD., Raleigh,
N. C., Superintendent North Carolina h.sane Asylum.
LARGELY PRESCRIBED in Syphilitie sa
FH. DAVENPORT, M.D., Boston, Mass., Ass't in ulous, Cutaneous and Female Diseases, and
Gynecology, Harvard University Medical Depar ment.
an Established Reputation as being the
J. K. BAUDUY, A.M., LL.D., St. Louis, Mo. Prof.
Nervous and Mental Diseases, Missouri Medical Col-
Alterative ever introduced to the profession.
lege.
L, CH. BOISLINIERE, M.D., LL.D., ST. LOUIS, MO,
Prof. of Obstetrics and Diseases of Women, St. Louis
Medical College.
WM. B. HAZARD, M.D., ST. LOUIS, Mo. Prof. of
General Pathology and Mental and Nervous Diseases,
EUGENE GRISSOM, A.M. M.D. LL.D., Ilale
St. Louis College of Physicians and Surgeons.
N. , Superintendent North Carolina Insane As
J.S. JEWELL, A.M., M.D., CHICAGO, ILLS., Ed.
W. H. BYFORD, A.M., M.D., CHICAGO, ILLS., PE
Journal Mental and Nervous Diseases, and Prof. Ner-
vous and Mental Diseases, Chicago Medical College.
dent and Prof. Obstetrics, Woman's Hospital Me
H.M. LYMAN, A. M., M.D., CHICAGO, ILLS., Prof.
College; Piof. Gynecology, Rush Medieal Collegt.
Physiology and Diseases of the Nervous System, Rush
RICHARD MCSHERRY, M.D. BALTIMORE, MD., :
Medical College.
of Principles and Practice of Medicine, University
D. R. BROWER, M. D., CHICAGO, ILLS., Ed: Chicago
Maryland Medical Department.
Medical Journal and Examiner, and Prof. Nervous
C.F. BEVAN, M.D, BALTIMORE, MD., Prof. or
and Mental Diseases, etc., Woman's Medical College.
tomy, Genito-Urinary, and Orthopedic Surgery, 9
IN DANFORTH. M.D., CHICAGO, ILLS.. Prof. Patho-
lege Physicians and Suageons.
logy and Diseases of the Kidneys, Woman's Hospital
R. M. KING, A.M., M. D)., ST. LOUIS, MO, PA
Medical College; President and Lecturer on Pathology,
Physiology and Clinical Medicine, St. Louis Call
Spring Faculty, Rush Med, Col.
of Physicians and Surgeons.
D. D BRAMBLE, M.D., CINCINNATI, 0., Dean; Prof.
A.'S. BARNES, M.D., St. Louis, Mo., Prof. of Ote
Principles and Practice of Surgery and Clinical Sur-
trics and Diseases of Women, St. Louis College
gery, Cincinnati College of Medicine and Surgery.
Physicians and Surgeons.
WM. CLENDENIN, M. D., CINCINNATI, O., Prof. C.D. PALMER, M.D., CINCINNATI, O., Prof. Med
Descriptive and Surgical Anatomy. Miami Medical and Surgical Diseases of Women and clinical G
College. .
"logy, Medical College of Ohio.
J. B MARVIN, M, D., LOUISVILLE, KY.; Prof. Chem- J. A. LARRABEE, M, D., LOUISVILLE, KY, PR
istry etc., and Clinical Lecturer on Nervous Diseases.
Materia Medica and Therapeutics, and Clinical La
Hospital College of Medicine.
turer on Diseases of Children, Hospital College
W. B. FLETCHER, M.D., INDIANAPOLIS, IND., Prof.
Medicine.
Physiology, Hygiene and Clinical Medicine, Medical M. F. COOMES, M.D., LOUISVILLE, KY., Prof Php
College of Indiana.
ology and Ophthalmology, in the Kentucky School
Medicine.
W. J. SCOTT, M.D., CLEVELAND, 0., Prof. Princi-
ples and Practice of Medicine, Medical Department
D. OVERLY CRIST, M. D., INDIANAPOLIS, IND., PR
Wooster University.
Materia Medica and Therapeutics, Central Col
H. H. POWELL, M.D., CLEVELAND, O., Prof. of
Physicians and Surgeons.
Obstetrics and Diseases of Children, Cleveland Medi- NW. WEBBER, M.D., DETROIT, Mich., Prof. Ne
cal College.
çal and Surgical Diseases of Women and Clinie
Gynecology, Detroit Medical College
TOBY:
J. A. McCORKLE, M.D., BROOKLYN, N. Y., Pre
Complaints have been made to us by physicians Materia Medica and Therapeutics, Long Island
that some dishonest druggists substitute an inferior prep- lege Hospital.
aration made by themselves, when BROMIDIA is pre- J.M. BIGELOW, M.D., ALBANY, NY, Prof. Mater
scribed. Physicians are cautioned to look out for these
Medica and Therapeutics, Albany Medical College
substitutions, because the lives of their patients may be
endangered, and their own reputation injured as well as
J. L. WHITE, M. D., BLOOMINGTON, ILL.S., Ex-Pre
ours. We have employed detectives, and shall protect
dent Illinois State Medical Society.
our rights to the fullest extent of the law.
CARL SEILER, M.D., PHILADELPHIA, PA, late Dime
tor of the Microscopical and Biological Section of
Acadamy of Natural Science, of Philadelphia, etc
NO DOSE OR DIRECTIONS ON OUR
Lecturer on Diseases of the Throat, University
BOTTLES.
Philadelphia.
BATTLE & CO., Chemists,
116 OLIVE STREET,
[12]
ST. LOUIS, MO.


The Medical and Surgical Reporter.
.
A WEEKLY JOURNAL.
Edited by D, G.. PRINTON, M. D. .
ISSUED EVERY SATURDAY:
Large Octavo, Doublé Column, 26 to 28 Pages of Reading
Matter in each Volume.
The REPORTER was established in 1818, and now has attained as large, if not the
largest, circulation of any medical weekly in this country. It has achieved this
through its independence of all cliques, it steady devotion to the highest interests
of the regular profession, its energy in obtaining the most important scientific
news, the value of its original articles, its broad national character, and its atten-
tion to the practical and clinical aspects of professional study.
FOR 1882.
Some important improvements will be added to the REPORTER in 1882, and we
have arranged with several of the most distinguished American medical writers
to contribute to its pages. We suggest to our subscribers to send in their renewals
at an early date, and should be glad to have them bring the REPORTER to the
notice of their friends. We can guarantee them a satisfactory periodical the
coming year. .
PRICES:
The regular price for the COMPENDIUM for one year (two numbers, 300 pages
cach, bound in paper) is $2.50.
A discount is allowed on the REPORTER and COMPENDIUM when taken together,
as follows:
The Weekly Medical and Surgical Reporter, - $5.00
The Half-Yearly Compendium of Medical Science, 2.50
The Reporter and Compendium taken together, - 7.00
tar Payable in advance, direct to the publisher,
A Table of Contents of a number of Half-Yearly Compendium will be sent ou
application to the publisher. A single copy will be sent for examination for $1.00.
Specimen copy of the Reporter free, on application.
NEW BOOKS AND NEW EDITIONS
Published by D. G. BRINTON, M. D., 115 S. Seventh St., Philadelphia.
The Physician's Daily Pocket Record Lessons in Gynecology. By William.
and Visiting List. By S. W. Butler, Goodell, A.M., M.D. One vol. 8vo.
M. D. Sixteenth year.
Price, cloth, $1.00; sheep, - 4.50.
The Physician's Clinical Record and Differential Diagnosis. By F. De Hav.
Case Book. For 100.patients. Neat- illand Hall, M.D. One vol. 8vo.
ly bound in cloth, with pocket and 205 pp. Price, $2.00.
stencil plate. Price, $1.00. - A Manual of Ophthalmic Practice. By
The “Modern Therapeutics" Series. Henry S. Schell, M.D. With 53
I, Modern Medical Therapeutics. II, illustrations, test types, etc. Price,
Modern Surgical Therapeutics. III, cloth, $2.00.
Therapeutics of Gynecology and Ob- Compendium of Microscopical Tech-
stetrics. Edited by William B. Atkin- nology. By Carl Seiler, M.D. One
son, M.D., etc. Second edition, greatly volume. 8vo. Cloth. 111 pp. Price,
enlarged (1881). One volume. Price, $1.00.
cloth, $4.00; sheep, $5.00.
The Care and Culture of Children. By
The Principles and Methods of Thera-
Thomas S. Sozinskey, A.M., M.D.,
peutics. By Adolphe Gubler, M. D.
Ph.D., etc. One volume. Cloth. 8vo
1 vol. 8vo. 545 pp. Price, $4.00.'
Illustrated. 500 pp. Price, $2.50.
-
13 -



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cars at New York, with fine Piano Cover, Stool and Book, only
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sent with order will be refunded and freight charges paid by us both waysif Piano is not just as represen
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MENDELSSOHN PIANO CO., P. O. Box 2058, New York City,
The Cost of Advertising.
For any responsible advertiser, making application in good faith, we prepare and
furnish a written estimate, showing the cost of any proposed advertising in the leading
Newspapers of the United States and Dominion of Canada.
We prepare and exhibit printed proofs of any proposed advertisements.
For the preparing of estimates no charge is made, and the applicant is placed under
no obligation to transact his advertising business through us unless it appears to him
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A copy of the advertisement, a list of the papers, the space the advertisement is to
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When an advertiser does not know what he wants, or what he ought to do, he can
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Newspaper Advertising Bureau. (Printing House Square, Opposite Tribune Building.)
10 SPRUCE STREET, NEW YORK.
PINUS CANADENSIS.
The concentrated extract of Pinus Canadensis has established for itself the most un-
qualified commendation as an astringent, and it scarcely requires any further affirmation
on my part.
LOUIS BAUER, M. D., M. R. C. S. Engl.
Professor of Surgery in and Dean of College of Physicians and Surgeons, St. Louis.
- 14 -



THE ALIENIST AND NEUROLOGIST.
OPINIONS OF THE MEDICAL PRESS.-Continued.
“This excellent quarterly journal has a wide circulation in the United States,
and is well known also in Europe.--Il Pisani Gazette Sicula, etc.
"Highly creditable to its editor, and we have pleasure in commending it to the
readers of our Journal. Likely, judging from the numbers before us, to combine
practical experience with editorial ability." - Journal of Mental Science, London.
“One of the best quarterlies a medical man can read. Not alone to the specialist
are its pages invaluable, but the general practitioner will always find it instructive
and especially adapted to his wants." - Miss. Valley Med. Monthly.
"One of our most valuable exchanges, and we desire to recommend it to the
profession as a valuable Journal, that should be read by every physician who
attempts to treat any class of nervous diseases. -"'Fort Wayne Journal of the
Medical Sciences.
"It avows itself to be not so much a journal for specialists as a special
journal for general practitioners and advanced students of medicine, but in the
scope, detail, and thoroughness of its articles it is as well fitted for the former
rôle as for the latter, if not better - London Medical Times and Gazette. 5.
"This valuable quarterly publication has entered on its third year, and as an
exponent of advances made in our knowledge of nervous and mental diseases, Dr.
Hughes has made his jourual a success Not only is the journal a necessity to
specialists, but it is exceedingly useful to general practitioners of medicine.”
-Cin. Lancet and Clinic
“In no department of medicine has so much rapid progress been made in the
last few years as in the one relating to the diseases of the nervous system. .
The general practitioner should be conversant with the symptomatology of these
affections. We can readily see a field of usefulness for the Journal. It prešents a
handsome appearance, and contains excellent articles.''-Kansas Med. Index.
"One of our largest and best American quarterlies, devoted to the cultiva-
tion of a field in pathology and its necessary therapeutics, which is asstuning a
grave importance in American' medicine. The wide-spread and rapidly growing
nervous and mental disturbances of our people cannot escape the notice of the most
casual medical.observer, and, to be competent to grapple with them, the physician
must possess all the light accessible: this light is recent-not commonly found in
books, but mostly in periodical literature, and of this the ALIENIST AND NEUROL-
OGIST, we think, is superior "-St. Joseph Med. and Surg. Reporter.
"In the four numbers already printed, which we have received in exchange for
our Revista. we have found a most abundant amount of original memoirs and reviews
which are more especially occupied in discussions of mental pathology, neurology,
legal medicine, the organization of asylums, and the treatment and care of the insane.
We feel assured that the work of our new confrere will be crowned with the highest
success, and that, by continuance in the path entered on, it will prove of grea
benefit to journalism and to practical medicine.''- Reviste Sperimentale di
Freniatria e Medicina Legale.
716


Dup. 616057
COUNT RUMFO
UMFORD
HORSFORD'S
Ta 398
are no 201003 Ees
FORMULA.
EACII FLUID DRACUM CONTAINS
54 grains free Phosphoric Acid (P05).
3 grains Phosphate of Lime (3CaO PO:).
gruin Phosphate of Magnes. (3MgO POS).
grain.Phospháte of Iron (Fe, 03 PO3).
i grain Phosphate of Potash (3KO, POs).
Total amount of Phosphoric Acid in one'iuid.
drachm, free and combined, 7 grains..
It contains no pyrophosphate ur metaphosphate
of any bose whatever. i
(LIQUID.)
3 DYSPEPSIA, MENTAL AND PHYSICAL EXHAUSTION, NERVOUS-
NESS, DIMINISHED VITALITY, URINARY DIFFICULTIES, Etc.
CID PHOSPHATE
HORSFORD'S
ACID PHOSPHATE.
Prepared according to the directions of Prof. E. N. Horsford, of Cambridge, Mass..
There seems to be no difference of opinton, in high melical authority, of the value of phosphoric
1, anil no preparation has ever been offerul to the public which seems to so happily meet the
veral want as this.
is not nauseous, but agreeable to the taste.
No danger can attend its use.
s action will harmonize with such stimulants as are necessary to take. .
It makes a delicious drink with water and sugar only.
.
Dr. REUBEN A VANE, of New York: 'The
prepartion on which I place the most reliance
is lorsford's Acid l'hosphate."
W. A. IIAMMOND, M. D., late Surgeon-
eneral U.S. Army, said that under the nse of
senio and Horsford's Acid Phosphate, a
yung lady, rescued her reason, who had been
ndered insane by a dream.
Dr. R. M. TENRY, of New York, says:
Ilorsford's Acid Phosphate possesses claims
a bererage beyond anothing I know of in the
rm of Medicine, and in nervous diseases I
Dow of no preparation to equal it."
The late WINSLOW LEWIS, MD, of Roston,
Sail: "llaving in my own person experienced
those ills for which the Acid l'hosphate is pre-
scriled, I have found great relief and alleviation
Tv its 18e: most cheerfully attest my apprecia-
tion of its excellence.'
'rices Reasonable. Pamphlet giving further particulars mailed free on
application to manufacturers.
"hysicians desiring to test it will be furnisheil a bottle free of expense, except express charges, if
they mention ALIENIST AND SEUROLOGIST, St. Louis.
MANUFACTURED BY THE
RUMFORD CHEMICAL WORKS, - Providence, R. I.
I=SEND FOR DESCRIPTIVE CIRCULARS.











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